Healthcare Provider Details

I. General information

NPI: 1497312045
Provider Name (Legal Business Name): JASMINE GHALCHI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15477 VENTURA BLVD
SHERMAN OAKS CA
91403-3006
US

IV. Provider business mailing address

15477 VENTURA BLVD
SHERMAN OAKS CA
91403-3006
US

V. Phone/Fax

Practice location:
  • Phone: 818-907-0322
  • Fax: 818-907-0630
Mailing address:
  • Phone: 818-907-0322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number56815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: