Glenn Petillo

Primary specialty

Nurse's AideTaxonomy code 376K00000X

License

00903914 Issued in CA

Practice address

37802 Fischer Rd
Anza, CA 92539-9203

Phone

(951) 551-3204

NPI assigned

Jul 15, 2016

Last updated

Jul 15, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1468540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468540800000",
    "number": "1770936635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37802 FISCHER RD",
            "city": "ANZA",
            "state": "CA",
            "postal_code": "925399203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37802 FISCHER RD",
            "city": "ANZA",
            "state": "CA",
            "postal_code": "925399203",
            "telephone_number": "951-551-3204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETILLO",
        "first_name": "GLENN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-15",
        "last_updated": "2016-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376K00000X",
            "taxonomy_group": "",
            "desc": "Nurse's Aide",
            "state": "CA",
            "license": "00903914",
            "primary": true
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "CA",
            "license": "00270053",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda Hardee
• Monique A Lopez
• Barbara Jeanne May, LVN
• Colleen Ann Murray, LCSW
• Kenneth Wayne Nordlund, N.P
• Rite Time Pharmaceuticals Inc
• Riverside-San Bernardino County Indian Health, Inc (Cahuilla Indian Health Clinic)
• Riverside-San Bernardino County Indian Health, Inc. (Anza Indian Health)
• Riverside-San Bernardino County Indian Health, Inc. (Cahuilla Indian Health Clinic Pharmacy)
• Amber Rowe, CMT, HHP

• Nurse's Aide in Anza, CA
• Providers in Anza, CA by specialty
• Nurse's Aide in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2016; 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.