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Fictitious Name Permit Application

medical board OF california Protecting consumers by advancing high quality, safe medical care. Licensing Program 2005 Evergreen Street, Suite 1200 Sacramento, CA 95815-5401 Phone: (916) 263-2382 Fax: (916) 263-2487 Gavin Newsom, Governor, State of california | Business, Consumer Services and Housing Agency | Department o f Consumer Affairs Application CHECKLIST FOR Fictitious NAME Permit For all applications, did you: __ include a check for $50? __ indicate if you have additional practice locations?

** In California you may only practice medicine as a corporation if you are a California Professional M edical C orporation (Business and Professions Code §2402, Corporations Code §13401.5). Fee: $50 (non-refundable) check, money order or cashier’s check Payable to: Medical Board of California

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  Medical, California, Board, Medical board of california

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