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General NPI Number Information
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NPI Number | 1558401299
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Entity Type | Organization
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Legal Business Name | SAN GABRIEL VALLEY SURGICAL CENTER LP
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 1250 S SUNSET AVE STE 100
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City | WEST COVINA
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State | CA
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Zip | 91790-3912
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Country | US
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Telephone | 626-960-6623
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Fax | 626-962-4341
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Provider Business Mailing Address
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Address Line | 1250 S SUNSET AVE STE 100
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City | WEST COVINA
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State | CA
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Zip | 91790-3912
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Country | US
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Telephone | 626-960-6623
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Fax | 626-962-4341
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Authorized Official
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Title or Position | OFFICER / AUTHORIZED OFFICIAL
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Name | ERIC BOON
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Credential |
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Telephone | 480-567-0269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 930000450
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License Number State | CA
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