Pursuant to Business and Professions Code section 2021, licensees are required to report in writing to the Board each name change within 30 days from the date the change occurred.
It is the Board’s policy that the name in which a physician assistant license is issued match their legal name. The physician assistant license detail, available on DCA License Search, reflects both previous and current names.
Name and Gender Change Notification and Request for Confidentiality (SB 372, 2023)
Effective January 1, 2024, under Business and Professions Code section 27.5, licensees may notify the licensing board or bureau within the Department of Consumer Affairs (DCA) of a name and/or gender change and request confidentiality of the previous name or gender information, when meeting certain specified requirements. For more information and to make a request, click here.
How to Report Name Change
The Board does not allow licensees to change their name through their BreEZe account. Licensees are required to mail or email photocopies of the following documents with a Notification of Name Change form (PDF):
- A current government issued photographic identification (e.g., driver’s license, alien registration, passport, etc.)
- One of the following legal documents as proof of name change:
- Certified Court Order
- Marriage Certificate
- Dissolution of Marriage
Physician Assistant Board's Contact Information
2005 Evergreen Street, Suite 2250
Sacramento, CA 95815-3893
Name Changes are completed within 10 business days upon receipt of all required documents. There is no fee for a name change. Due to recent system changes the Duplicate License Request form is temporarily unavailable. The Board is no longer issuing pocket licenses upon the approval of an initial license or renewal application. Licensees can print the pocket license by logging into their BreEZe account and selecting "Print License Certificate – Physician Assistant Pocket Cert PPAPA" from the drop-down menu under the "Manage Your License Information" section. Once selected, the pocket license certificate will open as a PDF on a separate tab. If a new engraved wall certificate is required, please contact the Board by email at email@example.com to request a hard copy of the Duplicate License Request form.
Additionally, the California Department of Consumer Affairs License Search tool is available to verify a license in real-time or anytime the status is changed. Consumers, employers, or any interested party can verify the license status online 24 hours a day, seven days a week.