Provider Demographics
NPI:1831785237
Name:AMIRKHANI, MONA (PA-C)
Entity type:Individual
Prefix:MS
First Name:MONA
Middle Name:
Last Name:AMIRKHANI
Suffix:
Gender:F
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:PO BOX 6701
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-6701
Mailing Address - Country:US
Mailing Address - Phone:949-436-1144
Mailing Address - Fax:
Practice Address - Street 1:26033 GETTY DR UNIT 421
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-0977
Practice Address - Country:US
Practice Address - Phone:949-436-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program