Provider Demographics
NPI:1407593577
Name:AMIRKHANI, ERIC (PA-C)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:AMIRKHANI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 MONTGOMERY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4802
Mailing Address - Country:US
Mailing Address - Phone:707-890-4250
Mailing Address - Fax:707-763-7040
Practice Address - Street 1:1162 MONTGOMERY DR STE 300
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4802
Practice Address - Country:US
Practice Address - Phone:707-890-4250
Practice Address - Fax:707-763-7040
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA61050363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant