Healthcare Provider Details

I. General information

NPI: 1407593577
Provider Name (Legal Business Name): ERIC AMIRKHANI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1162 MONTGOMERY DR STE 300
SANTA ROSA CA
95405-4802
US

IV. Provider business mailing address

1162 MONTGOMERY DR STE 300
SANTA ROSA CA
95405-4802
US

V. Phone/Fax

Practice location:
  • Phone: 707-890-4250
  • Fax: 707-763-7040
Mailing address:
  • Phone: 707-890-4250
  • Fax: 707-763-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number61050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: