Who signs the enrollment forms?
The forms must be signed under penalty of perjury by an individual who is the sole proprietor, partner, corporate officer or an official representative of a governmental entity or non-profit organization, and who has the authority to legally bind the applicant seeking enrollment as a Medi-Cal provider. A biller or office manager is not a valid signatory. Include a legible, current copy of the driver’s license or state-issued identification card of the authorized person signing the application. Enlarged copies are appreciated.
