California
Statewide
Medical Board
Last updated: 2/19/2019
Fictitious Name Permit Notification Of Renewal-Hold Release {FNP-004}
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Description
FNP-004, FICTITIOUS NAME PERMIT NOTIFICATION OF RENEWAL/HOLD RELEASE, In order for the hold to be removed, this form must be completed in its entirety and signed by a current owner. Refer to the enclosed attachment indicating the current owner(s). Note: A fictitious name permit is not transferable. If a medical practice is purchased by another physician, the former owner must submit an “Application for Cancellation of a Fictitious Name Permit” to cancel the permit and the new owner must submit a “Fictitious Name Permit Application.” Both forms should be mailed at the same time to assure the name will be available to the new owner. www.FormsWorkflow.com
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