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Provider Nomination Form

To nominate a physician or practitioner for membership in the CFMC Preferred Provider network, please complete the following information (all fields are required), and click "SUBMIT."

Your Name:
Your Employer:
Your Address:
Your City:
Your State:
Your Zip:
Your Phone:
Physician or Practitioner Name:
Title:
Address:
City:
County:
State:
ZIP:
Phone:
Specialty:
 

Completion of this form is for nomination purposes and does not guarantee membership.
 


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California Foundation for Medical Care
Corporate Office
5701 Truxtun Ave, Suite 100
Bakersfield, CA 93309
800-334-7341     Fax: 661-616-6777

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Contact Us
California Foundation for Medical Care
Corporate Office
P.O. Box 2425
Riverside, CA 92516
800-334-7341     Fax: 951-686-1692