Surgical Clinic
Change of Mailing Address Application Packet

A State license is required to operate a Surgical Clinic​ (SURGC) in California. A SURGC means “a clinic that is not part of a hospital and that provides ambulatory surgical care for patients who remain less than 24 hours. A surgical clinic does not include any place or establishment owned or leased and operated as a clinic or office by one or more physicians or dentists in individual or group practice, regardless of the name used publicly to identify the place or establishment, provided, however, that physicians or dentists may, at their option, apply for licensure,” pursuant to Health and Safety Code (HSC) section 1204(b)(1).

To report a Change of Mailing Address, you must complete the required application packet. Refer to HSC sections 1200 through 1245 for information regarding licensure requirements.

How to Apply

An applicant must submit a completed application packet to the Centralized Applications Branch (CAB). The provider instructions are a resource to guide you through the process. ​The provider checklist identifies the required forms and supporting documents needed to apply for licensure.

Please refer to the following links to get started:

• Provider Instructions
  
• Provider Checklist​
  

Where to Submit Applications

Submit completed application packets to the CAB at the address listed below. Do not send any completed application packets, forms, or supporting documents to the local CDPH, District Office.

          California Department of Public Health
          Licensing and Certification Division
          Centralized Applications Branch
          P.O. Box 997377, MS 3207
          Sacramento, CA 95899-7377