Individual
GLENN PETILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
37802 FISCHER RD, ANZA, CA 92539-9203
(951) 551-3204
Mailing address
37802 FISCHER RD, ANZA, CA 92539-9203
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
00270053
CA
376K00000X
Nurse's Aide
Primary
00903914
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00270053
CALIFORNIA DEPARTMENT OF PUBLIC HEALTH HOME HEALTH AIDE
CA
01
—
00903914
CALIFORNIA DEPARTMENT OF PUBLIC HEALTH CERTIFIED NURSING ASSISTANT
CA
Enumeration date
07/15/2016
Last updated
07/15/2016
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