Provider Demographics
NPI:1386231363
Name:AGBAYANI, GLENNA (CEAS)
Entity Type:Individual
Prefix:
First Name:GLENNA
Middle Name:
Last Name:AGBAYANI
Suffix:
Gender:F
Credentials:CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3856 FAIRFAX WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3956
Mailing Address - Country:US
Mailing Address - Phone:650-892-4576
Mailing Address - Fax:
Practice Address - Street 1:2171 JUNIPERO SERRA BLVD
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-1906
Practice Address - Country:US
Practice Address - Phone:415-352-5002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker