Letter of Interest Form

Thank you for your interest in becoming an L.A. Care Health Care Provider.

To ensure the proper contract and credentialing packet is generated, complete the Letter of Interest Form below.

Please Note:

If you are not Medicaid certified, please use the form below to apply:

Medi-Cal Physician Application

You can also complete a California Participating Physician Application (CPPA) using the form below:

California Participating Physician Application (CPPA)