Healthcare Provider Details

I. General information

NPI: 1083575138
Provider Name (Legal Business Name): SAN GABRIEL VALLEY CHILDRENS SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD STE 800
ENCINO CA
91436-4606
US

IV. Provider business mailing address

16260 VENTURA BLVD STE 800
ENCINO CA
91436-4606
US

V. Phone/Fax

Practice location:
  • Phone: 818-814-9800
  • Fax: 818-814-9888
Mailing address:
  • Phone: 818-814-9800
  • Fax: 818-814-9888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY WHEELER
Title or Position: CEO
Credential:
Phone: 301-494-3000