Provider Demographics
NPI:1952451049
Name:MARK GALBRAITH, M.D., INC.
Entity Type:Organization
Organization Name:MARK GALBRAITH, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:GALBRAITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-360-6009
Mailing Address - Street 1:26691 PLAZA
Mailing Address - Street 2:110
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6329
Mailing Address - Country:US
Mailing Address - Phone:949-360-6009
Mailing Address - Fax:949-360-6162
Practice Address - Street 1:26691 PLAZA
Practice Address - Street 2:110
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6329
Practice Address - Country:US
Practice Address - Phone:949-360-6009
Practice Address - Fax:949-360-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1780619916OtherINDIVIDUAL