Provider Demographics
NPI:1386315729
Name:BANAL, JENNILYN (PMHNP)
Entity type:Individual
Prefix:
First Name:JENNILYN
Middle Name:
Last Name:BANAL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 CORREA LN
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-6524
Mailing Address - Country:US
Mailing Address - Phone:619-957-7830
Mailing Address - Fax:
Practice Address - Street 1:14860 ROSCOE BLVD STE 304
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4695
Practice Address - Country:US
Practice Address - Phone:747-998-0387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018066363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health