San Gabriel Valley Surgical Medical GRP, Inc

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

G6999 Issued in CA

Legal business name

SAN GABRIEL VALLEY SURGICAL MEDICAL GRP, INC

Practice address

1330 W Covina Blvd
Suite 101
San Dimas, CA 91773-3200

Phone

(909) 599-6784

Fax

(909) 599-7073

NPI assigned

Jul 21, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Mark Frederick Anapoell, M.D.

Title

President

Phone

(909) 599-6784

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318896000000",
    "number": "1629078589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 W COVINA BLVD",
            "address_2": "SUITE 101",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733200",
            "telephone_number": "909-599-6784",
            "fax_number": "909-599-7073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 W COVINA BLVD",
            "address_2": "SUITE 101",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733200",
            "telephone_number": "909-599-6784",
            "fax_number": "909-599-7073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN GABRIEL VALLEY SURGICAL MEDICAL GRP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-21",
        "last_updated": "2011-10-18",
        "status": "A",
        "authorized_official_last_name": "ANAPOELL",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "FREDERICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-599-6784",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "G6999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ76029Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in San Dimas, CA
• Providers in San Dimas, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.