MR. BERMAN IVAN ICABALCETA JR. (NPI# 1659763282) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659763282 |
| Entity Type | Individual |
| Full Name | MR. BERMAN IVAN ICABALCETA JR. |
| Practice Address |
1001 Sneath Ln Ste 307 San Bruno CA 94066 |
| Mailing Address |
301 Grand Ave Suite 301 South San Francisco CA 94080-3606 |
| Practice Telephone | 6502440305 |
| Practice Fax Number | 6502441447 |
| Mailing Telephone | 6502440305 |
| Mailing Fax Number | 6502441447 |
| Enumeration Date | 2015-02-18 |
| Last Update Date | 2019-06-14 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| Y | 174400000X | Specialist | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | THE LATINO COMMISSION ADMINISTRATION | 38472 | 01 |
| Street Address |
1001 SNEATH LN STE 307 |
| City | SAN BRUNO |
| State | CA |
| Zip Code | 94066 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235318635 | The Latino Commission | Substance Abuse Rehabilitation Facility | 1001 Sneath Ln Ste 307, San Bruno, CA 94066-2349 | 2007-11-01 |
| 1720545197 | Rebeca Cristina Baculpo | Social Worker | 1001 Sneath Ln Ste 307, San Bruno, CA 94066-2349 | 2019-02-21 |
| 1336687359 | Adriana Maria Escobar | Counselor | 1001 Sneath Ln Ste 307, San Bruno, CA 94066 | 2017-02-09 |
| 1306266655 | Luke James Camarillo | Registered Nurse | 1001 Sneath Ln Ste 307, San Bruno, CA 94066-2349 | 2014-04-24 |
| 1952749830 | Maria E Newson | Substance Abuse Rehabilitation Facility | 1001 Sneath Ln Ste 307, San Bruno, CA 94066 | 2013-06-12 |
| 1568750891 | The Latino Commission | Community/Behavioral Health | 1001 Sneath Ln Ste 307, San Bruno, CA 94066-2349 | 2011-07-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497392468 | Harold Relosimon | Behavior Technician | 901 Sneath Lane, Suite 105, San Bruno, Ca 94066, San Bruno, CA 94066 | 2019-12-09 |
| 1093365926 | Liana Greene | Behavior Technician | 1001 Sneath Lane #200, San Bruno, CA 94066 | 2019-09-12 |
| 1568018406 | Susan Page Gadegone | Community Health Worker | 931 San Bruno West Avenue Suite 2, San Bruno, CA 94066 | 2019-08-15 |
| 1184198780 | Sonya Oey Kramer | Pharmacist | 10 Bayhill Drive, San Bruno, CA 94066 | 2019-01-16 |
| 1316410350 | Brennen Marques Mcdowell | Behavioral Analyst | 101 Sneath Lane Ste. 200, 200, San Bruno, CA 94066 | 2019-01-02 |
| 1306317649 | Jacqueline R Lalucis | Behavior Technician | 751 Camino Plaza, San Bruno, Ca 94066, A, San Bruno, CA 94066 | 2018-12-16 |
| 1992275952 | Kenny Malunay | Behavior Technician | 75a El Camino Plaza, San Bruno, CA 94066 | 2018-12-03 |
| 1396236584 | Mariela Pena Yerena | Behavior Technician | 751 El Camino Plaza, Suite A, San Bruno, CA 94066 | 2018-05-23 |
| 1568845816 | Paula Leeanne Park | Physical Therapist | 106 Quail Point Cir, San Bruno, CA 94066 | 2015-07-06 |
| 1275921231 | C & C's Care Home | Assisted Living Facility | 2700 Oakmont Dr., San Bruno, CA 94066 | 2014-12-29 |
| Find all providers in zip 94066 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.