Name Change

All licensees and registrants are required to professionally use the name under which they are licensed or registered with the Medical Board of California. Using any other name may confuse or mislead the public and may be considered by the Board to be unprofessional conduct.

Any licensee or registrant who wishes to change the professional name under which he/she practices must complete and submit a Notification of Name Change form to the Board along with the required supporting legal documentation.

California law requires each licensee and registrant to report name changes to the Board within 30 days of the name change, providing both the old and new names.

The Medical Board of California may recognize a name change by a licensee/registrant if that name is now the new, adopted name for all purposes and if the change is not made for fraudulent purposes.

Please be aware you cannot practice under your middle name when your license states first, middle, last.

No fee is required to process a name change; however, there are fees to request a duplicate wall certificate and wallet card with the new name.

NOTE: Licensees and registrants who also hold a professional license or registration issued by any of the following California Boards and Bureaus will only need to submit ONE Notification of Name Change Form. The form will create a name change at each of these Board and Bureaus where a license or registration is held.

  • Board of Podiatric Medicine
  • Board of Registered Nursing
  • California Board of Barbering and Cosmetology
  • California Board of Behavioral Science
  • California Board of Psychology
  • Naturopathic Medicine Committee
  • Osteopathic Medical Board of California
  • Physician Assistant Board
  • Respiratory Care Board

If you hold a license or registration with any other California Board or Bureau not included on the above list, you will need to submit a separate name change form directly to that program.

A wall certificate or wallet license reflecting a name change will NOT automatically be issued. If you need a duplicate wall certificate or wallet license printed with your new name, you must complete an Application for Duplicate Certificate and submit the appropriate fees.

Whether or not you request a duplicate wall certificate or wallet license, at the time of your next renewal, your renewal notice and wallet license will automatically print with your new name. If you need a new wall certificate with your new name, you must complete an Application for Duplicate Certificate form and pay the required fee.

Documentation Required:

A current government-issued photographic identification card (e.g., driver license, alien registration, passport, etc.) AND one of the following legal documents as proof of name change:

  • Certified Court Order
  • Marriage Certificate
  • Dissolution of Marriage (Divorce)

Original documents are not required. Photocopies will be accepted. If original documents are mailed, they will be returned by certified mail.