Report Updates to the Provider Directory

Please fill out and submit the following form to report updates to the provider directory. Required fields are labeled with an *.

Identify Yourself

Identify Provider

Identify the provider in the directory that needs updating.

Updated Values

Enter the proposed new values below. Only enter values for fields that need updating.

You may also report updates to the provider directory via:
  • email:
  • phone: 1-800-224-7766
  • or mail:
       2420 Fenton St., Suite 100
       Chula Vista, CA 91914