Icabalceta, Berman Ivan

Icabalceta, Berman Ivan is an sole proprietor health care provider with primary practice located at 1001 Sneath Ln Ste 307 , San Bruno CA 94066. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Other Service Providers / Specialist. Other Service Providers / Specialist is his primary health care specialty. Icabalceta, Berman Ivan can be contacted via phone (650) 244-0305.

Contact Information

Primary practice address
1001 Sneath Ln Ste 307 San Bruno CA 94066
Phone: (650) 244-0305
Fax: (650) 244-1447
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X
Other Service Providers / Specialist 174400000X

Profile Details

NPI number 1659763282
LBN Legal business name Icabalceta, Berman Ivan
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 18th, 2015
Last updated Jun 14th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659763282 NPPES
California Other 38472 THE LATINO COMMISSION ADMINISTRATION

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