Individual
MARK ANTHONY SORIANO GALLAGHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
390200000X
Contact information
Practice address
1660 HOTEL CIR N STE 101, SAN DIEGO, CA 92108-2801
(619) 961-2120
Mailing address
6915 PARKSIDE AVE, SAN DIEGO, CA 92139-3891
(619) 764-3925
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
175T00000X
Peer Specialist
Primary
MPSS-HMORYS
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2023
Last updated
12/22/2025
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