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California PHC
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Provider Information Updates
PHC California is dedicated to maintaining accurate and up-to-date provider information. Updating your information is easy! Simply complete either the online Provider & Group Information form or the Gender-Affirming Services Attestation Form at the links below. Any changes to billing/remit addresses will also require a new W-9 to be submitted. Please submit W-9 documents to our PDM team at [email protected].
All of the update forms are also available below as downloadable PDFs that can be completed offline:
You will need the Adobe Acrobat Reader program to view the above forms. To download this free program click here or use the link above – the link will open a new window and take you to the Adobe website.
Page Updated: June 16, 2025 @ 10:17pm