Individual
MR. BERMAN IVAN ICABALCETA JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1001 SNEATH LN STE 307, SAN BRUNO, CA 94066
(650) 244-0305
(650) 244-1447
Mailing address
1001 SNEATH LN STE 307, SAN BRUNO, CA 94066-2349
(650) 244-0305
(650) 244-1447
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
174400000X
Specialist
—
—
247200000X
Other Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38472
THE LATINO COMMISSION ADMINISTRATION
CA
Enumeration date
02/18/2015
Last updated
05/08/2025
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