Individual
KENYATTA IRVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
PO BOX 3503, GRANADA HILLS, CA 91394-0503
(000) 000-0011
Mailing address
PO BOX 3503, GRANADA HILLS, CA 91394-0503
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95018472
CA
Other
Enumeration date
01/13/2022
Last updated
03/20/2025
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