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1659763282
BERMAN IVAN ICABALCETA
SAN BRUNO, CA
NPI
1659763282
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
174400000X Specialist
Additional Taxonomies
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2015-02-18
Last Update Date
2019-06-14
Business Address
Mr. BERMAN IVAN ICABALCETA
1001 SNEATH LN STE 307
SAN BRUNO, CA 94066
Phone number: 650-244-0305
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Mailing Address
Mr. BERMAN IVAN ICABALCETA
301 GRAND AVE SUITE 301
SOUTH SAN FRANCISCO, CA 94080-3606
Phone number: 650-244-0305
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