| Doctor Name: | GLEN GRIVAS |
| NPI Number: | 1063888659 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 108325 |
| Business Practice Address: | 139 Lucca Dr South San Francisco, CA - 940807100 |
| Business Phone Number: | 8554244473 |
| Business Fax Number: | 8557377333 |
| Mailing Address: | 139 Lucca Dr, SOUTH SAN FRANCISCO |
| State: | CA |
| Postal Code: | 940807100 |
| Phone Number: | 8554244473 |
| Fax Number: | 8557377333 |
| NPI Enumeration Date: | 08/18/2015 |
| NPI Last Update Date: | 08/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251J00000X |
| License Number: | 108325 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Nursing Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A Nursing Care Agency is an entity that provides skilled nursing care through the services of a Registered Nurse (RN) or a Licensed Practical Nurse (LPN), by employees, contracted individuals, or via a registry, in a variety of settings. The agency may engage in providing private duty nursing and/or staffing services. |