Provider Demographics
NPI:1154136893
Name:GANGANO, GLENN-CLIFFORD DAVID (RN, CMT)
Entity type:Individual
Prefix:
First Name:GLENN-CLIFFORD
Middle Name:DAVID
Last Name:GANGANO
Suffix:
Gender:M
Credentials:RN, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 BUSH ST STE 303
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5272
Mailing Address - Country:US
Mailing Address - Phone:415-996-7979
Mailing Address - Fax:
Practice Address - Street 1:1801 BUSH ST STE 303
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5272
Practice Address - Country:US
Practice Address - Phone:415-996-7979
Practice Address - Fax:415-887-5411
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84076225700000X
CA751715163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)Group - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist