Individual
DR. BANTALE OLUREMI AYISIRE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20623 GREEN ASH LN, WINNETKA, CA 91306-1557
(253) 300-1864
(818) 303-3331
Mailing address
20623 GREEN ASH LN, WINNETKA, CA 91306-1557
(253) 300-1864
(818) 303-3331
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95033816
CA
Other
Enumeration date
03/13/2025
Last updated
03/25/2026
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