Basic Information
Provider Information
NPI: 1710005707
EntityType: 2
ReplacementNPI:  
OrganizationName: HUMBERTO A. GALLENO, M.D., INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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Mailing Information
Address1: 315 N 3RD AVE
Address2: SUITE 302
City: COVINA
State: CA
PostalCode: 917231905
CountryCode: US
TelephoneNumber: 6263321194
FaxNumber: 6269153162
Practice Location
Address1: 315 N 3RD AVE
Address2: SUITE 302
City: COVINA
State: CA
PostalCode: 917231905
CountryCode: US
TelephoneNumber: 6263321194
FaxNumber: 6269153162
Other Information
ProviderEnumerationDate: 03/27/2007
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
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NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: GALLENO
AuthorizedOfficialFirstName: HUMBERTO
AuthorizedOfficialMiddleName: A
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 6263321194
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000XG38401CAY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic Surgery 

ID Information
IDTypeStateIssuerDescription
00G38401005CA MEDICAID


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