San Gabriel Valley Surgical Center LP

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

930000450 Issued in CA

Legal business name

SAN GABRIEL VALLEY SURGICAL CENTER LP

Practice address

1250 S Sunset Ave
Ste 100
West Covina, CA 91790-3912

Phone

(626) 960-6623

Fax

(626) 962-4341

NPI assigned

Feb 8, 2007

Last updated

Oct 11, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Eric Boon

Title

Officer / Authorized Official

Phone

(480) 567-0269

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

San Gabriel Valley Surgical Center LPCCN 05C0001006

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Baylor University Medical Center

  • Durable Medical Equipment & Medical Supplies
  • Dallas, TX
  • NPI 1518967231

  Member Of

  NPD member
• VHS San Antonio Partners LLC

  dba Baptist Health System

  • Psychiatric Hospital Unit
  • San Antonio, TX
  • NPI 1487633509

  Member Of

  NPD member

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Humberto A Galleno, M.D.

  • Orthopaedic Surgery Physician
  • Covina, CA
  • NPI 1760410757
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728604800000",
    "number": "1558401299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 S SUNSET AVE",
            "address_2": "STE 100",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903912",
            "telephone_number": "626-960-6623",
            "fax_number": "626-962-4341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 S SUNSET AVE",
            "address_2": "STE 100",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903912",
            "telephone_number": "626-960-6623",
            "fax_number": "626-962-4341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN GABRIEL VALLEY SURGICAL CENTER LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2024-10-11",
        "certification_date": "2024-10-11",
        "status": "A",
        "authorized_official_last_name": "BOON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OFFICER / AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "480-567-0269"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "930000450",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• San Gabriel Valley Neurological Medical Group
• San Gabriel Valley Oral & Facial Surgery
• San Gabriel Valley Oral and Facial Surgery
• San Gabriel Valley Perinatal Medical Group, Inc
• San Gabriel Valley Sleep Lab, LLC
• San Gabriel Vip a California Limited Partnership (Valley Imaging Partnership)
• San Gabriel Vip, a California Limited Partnership (Valley Imaging Partnership)
• San Gabriel Vip, a California Limited Partnership (Valley Imaging Partnership)
• San Jose Charter Academy
• Diana Brisa Sanchez Gomez, MD

• Ambulatory Surgical Clinic/Center in West Covina, CA
• Providers in West Covina, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.