Provider Demographics
NPI:1992370738
Name:SAKHIZADA, MAGEGAN K (PA-C)
Entity Type:Individual
Prefix:
First Name:MAGEGAN
Middle Name:K
Last Name:SAKHIZADA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MAGEGAN
Other - Middle Name:
Other - Last Name:KHORSAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1617 N CALIFORNIA ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6117
Mailing Address - Country:US
Mailing Address - Phone:707-638-5809
Mailing Address - Fax:
Practice Address - Street 1:1617 N CALIFORNIA ST STE 2A
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6117
Practice Address - Country:US
Practice Address - Phone:707-638-5809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 363A00000X
CAPA63757363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program