Individual
KEN IVEN BANTOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
10400 GLORIA AVE, GRANADA HILLS, CA 91344-7123
(818) 867-0500
Mailing address
10400 GLORIA AVE, GRANADA HILLS, CA 91344-7123
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95027351
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95027351
NURSE PRACTITIONER FURNISHING
CA
Enumeration date
02/19/2024
Last updated
02/19/2024
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