Individual
MISS CHANTHOL PEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
822 EAST AVENUE K, LANCASTER, CA 93535-5938
(661) 579-9760
(661) 579-9765
Mailing address
2151 E PALMDALE BLVD, SUITE, PALMDALE, CA 93550-4037
(661) 942-2391
(661) 575-0015
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
20656
CA
363LF0000X
Family Nurse Practitioner
9232475
FL
Other
Enumeration date
12/14/2009
Last updated
08/28/2013
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