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ACTIVITY EVALUATION FORM FOR CALIFORNIA MALE Please complete and return to Provider (Please Print) Provider Name: Los Angeles Copyright Society Provider Number: 2065 If Ideas Are As Free As The Air,
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Start by gathering all the necessary information of the provider located in Los Angeles.
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Provider name Los Angeles refers to the name of the healthcare provider located in Los Angeles.
Healthcare providers operating in Los Angeles are required to file the provider name.
Providers can fill out the name by entering the official name of their healthcare facility.
The purpose of the provider name is to identify the healthcare provider operating in Los Angeles.
The provider name, address, contact information, and type of services offered must be reported.
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