Healthcare Provider Details

I. General information

NPI: 1992596852
Provider Name (Legal Business Name): JESSICA MINASSIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 VAN NUYS BLVD STE 302
SHERMAN OAKS CA
91403-1743
US

IV. Provider business mailing address

6906 ZELZAH AVE
RESEDA CA
91335-4831
US

V. Phone/Fax

Practice location:
  • Phone: 818-929-6762
  • Fax:
Mailing address:
  • Phone: 818-929-6762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95026418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: