Provider Demographics
NPI:1780619916
Name:GALBRAITH, JON MARK (MD)
Entity type:Individual
Prefix:
First Name:JON MARK
Middle Name:
Last Name:GALBRAITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:GALBRAITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:26732 CROWN VALLEY PKWY STE 511
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-8525
Mailing Address - Country:US
Mailing Address - Phone:949-360-6009
Mailing Address - Fax:949-360-6162
Practice Address - Street 1:26732 CROWN VALLEY PKWY STE 511
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-8525
Practice Address - Country:US
Practice Address - Phone:949-360-6009
Practice Address - Fax:949-360-6162
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66070207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1952451049OtherNPI
CAG13549Medicare UPIN