Provider Demographics
NPI:1710005707
Name:HUMBERTO A. GALLENO, M.D., INC.
Entity Type:Organization
Organization Name:HUMBERTO A. GALLENO, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:A
Authorized Official - Last Name:GALLENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-332-1194
Mailing Address - Street 1:315 N 3RD AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1905
Mailing Address - Country:US
Mailing Address - Phone:626-332-1194
Mailing Address - Fax:626-915-3162
Practice Address - Street 1:315 N 3RD AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1905
Practice Address - Country:US
Practice Address - Phone:626-332-1194
Practice Address - Fax:626-915-3162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38401207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G384010Medicaid
CAG38401Medicare ID - Type Unspecified
CA00G384010Medicaid