Glenn Gange Ibarrientos, R.N.

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

450944 Issued in CA

Practice address

2000 Alameda de Las Pulgas
San Mateo, CA 94403-1269

Phone

(650) 573-2828

Fax

(650) 573-2042

NPI assigned

Nov 19, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• County of San Mateo

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Mateo, CA
  • NPI 1336231646
  NPD (past)
• San Mateo County Family Health Services

  • Case Management Agency
  • San Mateo, CA
  • NPI 1194983957
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251072000000",
    "number": "1104007152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 ALAMEDA DE LAS PULGAS",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944031269",
            "telephone_number": "650-573-2828",
            "fax_number": "650-573-2042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 ALAMEDA DE LAS PULGAS",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944031269",
            "telephone_number": "650-573-2828",
            "fax_number": "650-573-2042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IBARRIENTOS",
        "first_name": "GLENN",
        "middle_name": "GANGE",
        "name_prefix": "Mr.",
        "credential": "R.N.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-19",
        "last_updated": "2009-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "450944",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• I V Radiology Medical Group
• Alex Ibarra
• Evan Anthony Ibarra
• Nicole Elizabeth Ibarra, MFT
• Teresa Ibarra
• Joseph Ibe, D.C.
• Ilona Ignatjeva
• Moira Ikeda, CCC-SLP
• Shannon Keiko Ikeda
• Kathleen Ikuta, PT

• Registered Nurse in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.