Medi-Cal Suspended and Ineligible Provider List: May Update
ADDITIONS:
Physician (susp A)
Ahlschier, Allan D. C33259 Suspended
1705 W. 2nd St. 176251 indefinitely effective
Elk City, OK 2/26/2013
and
P.O. Box 2339
Elk City, OK
and
2323 McCue Rd.
Houston, TX
Pyne, Cuthbert Weston A29958 Suspended
aka: Cuthbert W. Pyne 00A299580 indefinitely effective
18411 Clark St. 00A299581 4/2/2013
Ste. #107 00A299582
Tarzana, CA 00A299583
and 00A299584
3756 Santa Rosalia Dr. 1316999717
Ste. #526
Los Angeles, CA
and
18607 Ventura Blvd.
Ste. #314
Tarzana, CA
and
8703 Venice Blvd.
Los Angeles, CA
and
6014 S. Western Ave.
Los Angeles, CA
and
6727 Radlock Ave.
Los Angeles, CA
Siddiqui, Ruby C50414 Suspended
P.O. Box 49658 indefinitely effective
Los Angeles, CA 2/12/2013
Physician/Surgeon (susp A)
Ingram, Jonathan David A100809 Suspended
9461 Charleville Blvd. indefinitely effective
Unit #607 2/22/2013
Beverly Hills, CA
Kuemmerle, Nathan B. A89368 Suspended
43851 Via Montalban indefinitely effective
Temecula, CA 2/1/2013
Lemus, James Alfred G42274 Suspended
aka: James A. Lemus 00G422741 indefinitely effective
5020 E. Washington Blvd. 4/2/2013
Commerce, CA
Mohamed, Ehab A. A72575 Suspended
815 N. Downs St. 00A725750 indefinitely effective
Ste. A 00A725751 2/21/2013
Ridgecrest, CA
and
1041 N. China Lake Blvd.
Ridgecrest, CA
and
16260 Ventura Blvd.
Ste. #720
Encino, CA
Physician/Surgeon (susp A) . . . (continued)
Tanoura, Tad Tadashi G67703 Suspended
aka: Tad T. Tanoura 00G677030 indefinitely effective
21840 Normandie Ave. 1235248295 4/2/2013
Torrance, CA
and
28429 Covecrest Dr.
Rancho Palos Verdes, CA
Psychologist (susp C)
Ballinger, Simmone 16272 Suspended
12625 High Bluff Dr. indefinitely effective
Ste. #312 3/8/2013
San Diego, CA
Pharmaceutical Distributor (susp E)
CRB Inc. Suspended
dba: American Biologics indefinitely effective
1180 Walnut Ave. 2/20/2013
Chula Vista, CA
Sick Room Supply (susp F)
Offong, Anietie DME03344F Suspended
aka: Aniete Offong 1275559825 indefinitely effective
Life Alert Homecare 3/20/2013
Supplies
320 N. E St.
Ste. #100
San Bernardino, CA
and
Inmate Reg. #32697-298
CI Taft Correctional Institution
P.O. Box 7001
Taft, CA
Chiropractor (susp J)
Lopez, Luis 16704 Suspended
73744 Hwy. 11 1326108788 indefinitely effective
Ste. #7 3/20/2013
Palm Desert, CA
Nguyen, Charlene 23336 Suspended
410 S. Beach Blvd. indefinitely effective
Apt. #4 3/20/2013
La Habra, CA
Home Health Aide (susp P)
Endale, Eleni 212911 Suspended
2081 W. 27th St. indefinitely effective
Unit #301 3/20/2013
Los Angeles, CA
Nur, Amino 236408 Suspended
1219 N. State College indefinitely effective
Blvd. 1/11/2013
Unit #143
Anaheim, CA
Salacup, Pamela Kay 230750 Suspended
9694 Broadway indefinitely effective
Live Oak, CA 1/11/2013
Certified Nurse Assistant (susp R)
Endale, Eleni 702382 Suspended
2081 W. 27th St. indefinitely effective
Unit #301 3/20/2013
Los Angeles, CA
Jones-Saltalamachia, 338213 Suspended
Jennifer indefinitely effective
1495 Ord Grove Ave. 1/30/2013
Seaside, CA
Nainggolan, Dewi 687768 Suspended
181 Highfield Cir. indefinitely effective
Sacramento, CA 1/11/2013
Nur, Amino 779425 Suspended
1219 N. State College indefinitely effective
Blvd. 1/11/2013
Unit #143
Anaheim, CA
Prado, Milton J. 479509 Suspended
1365 Essex Way indefinitely effective
San Jose, CA 1/30/2013
Salacup, Pamela Kay 739908 Suspended
9694 Broadway indefinitely effective
Live Oak, CA 1/11/2013
Smith, Lora Ann 504512 Suspended
126 McGrue Ave. indefinitely effective
Vallejo, CA 2/20/2013
Wolburg, Maria Ernestina 550708 Suspended
7622 Newlin Ave. indefinitely effective
Apt. F 3/20/2013
Whittier, CA
Nurse Anesthetist (susp R)
Allen, John Clifford 2874 Suspended
4319 Atlanta Hwy. indefinitely effective
PMB 183 2/15/2013
Montgomery, AL
Nurse Practitioner (susp R)
Green, Elizabeth Burrell 6446 Suspended
Inmate Reg. #3293011 CNP064460 indefinitely effective
Century Regional 2/20/2013
Detention Facility
11705 Alameda St.
Lynwood, CA
Public Health Nurse (susp R)
Wright Vargas, Janet Kay 49281 Suspended
aka: Janet Kay Wright indefinitely effective
6425 Randall Ct. 2/15/2013
Pleasanton, CA
Registered Nurse (susp R)
Albrecht, Eugina Rose 744819 Suspended
aka: Eugina Emmons indefinitely effective
Albrecht 2/15/2013
P.O. Box 947
Semmes, AL
Allen, John Clifford 603395 Suspended
4319 Atlanta Hwy. indefinitely effective
PMB 183 2/15/2013
Montgomery, AL
Belcher, Mia Susan 636444 Suspended
aka: Mia Belcher indefinitely effective
370 Oakley Dr. 2/15/2013
Unit #816
Nashville, TN
Caraway, Jennifer J. 593602 Suspended
aka: Jennifer Jean indefinitely effective
Caraway 2/8/2013
580 El Reno Dr.
Chico, CA
Dove, Richard Chadwick 586922 Suspended
323 Muse St. indefinitely effective
Newton, KS 2/15/2013
Fulton, Aedin Marie 510157 Suspended
171 Exeter Ave. indefinitely effective
San Carlos, CA 2/8/2013
Garland, Lynne Michele 146088 Suspended
aka: L. Michelle Garland indefinitely effective
aka: Lynn Garland 2/15/2013
aka: Michele Garland
Wegener
3840 Nutmeg Way
Oceanside, CA
Goodwin, Allan David 658695 Suspended
323 Muse St. indefinitely effective
Newton, KS 2/14/2013
Green, Elizabeth Burrell 262615 Suspended
12900 Avalon Blvd. indefinitely effective
Los Angeles, CA 2/20/2013
and
Inmate Reg. #3293011
Century Regional
Detention Facility
11705 Alameda St.
Lynwood, CA
Joiner, Terry Alan 664676 Suspended
506 W. Robert St. indefinitely effective
Hammond, LA 2/15/2013
Jordan, Cheryl Ann 525724 Suspended
445 S. Paseo Sarta indefinitely effective
Apt. C 2/15/2013
Green Valley, AZ
Kilpatrick, Kellie Anita 624396 Suspended
278 Lower Myrick Rd. indefinitely effective
Laurel, MS 2/15/2013
May, Karl Erik 641986 Suspended
401 3rd St. indefinitely effective
San Francisco, CA 2/15/2013
Optenberg, Scott Arthur 761162 Suspended
2315 Eastlake Dr. indefinitely effective
Kelseyville, CA 2/15/2013
Piontkowski, Jennifer Lynn 610556 Suspended
107 Penny Ln. indefinitely effective
Daphne, AL 2/14/2013
Registered Nurse (susp R) … (continued)
Sanchez, Alfonso 628781 Suspended
9828 Mango St. indefinitely effective
Phelan, CA 3/20/2013
Taylor, Cheryl Lynn 445799 Suspended
4106 Donald Dr. indefinitely effective
Olivehurst, CA 2/15/2013
Trapesonian, Sarah Terrell 704868 Suspended
aka: Sarah Terrell Liesik indefinitely effective
27466 Jasmine Ave. 2/15/2013
Mission Viejo, CA
Turner, Jeanne Lashae 618153 Suspended
aka: Jeanne Lashae Bates indefinitely effective
117 Biddle Ln. 2/15/2013
Henagar, AL
Walker, Lisa Renee 739009 Suspended
aka: Lisa Ratliff Walker indefinitely effective
7130 Hwy. 80 2/15/2013
Vicksburg, MS
Wright Vargas, Janet Kay 478083 Suspended
aka: Janet Kay Wright indefinitely effective
6425 Randall Ct. 2/15/2013
Pleasanton, CA
Respiratory Care Practitioner (susp S)
Elguezabal, 31288 Suspended
Benjamin Mairena indefinitely effective
3136 Main St. 1/15/2013
Chula Vista, CA
Norfleet, Lance V. 9170 Suspended
101 Fairmont Ave. indefinitely effective
Unit #6 1/2/2013
Oakland, CA
Operana, 26729 Suspended
Michael Novencido indefinitely effective
367 L St. 1/24/2013
Chula Vista, CA
Wasserstein, Martin Dana 7943 Suspended
38220 6th Pl. W. indefinitely effective
Palmdale, CA 1/2/2013
Witcher, Davena Kay 17989 Suspended
2936 E. Muncie Ave. indefinitely effective
Fresno, CA 1/19/2013
Business Owner (susp T)
Newcomb, James R. Suspended
Executive Owner: Drug Co. indefinitely effective
Inmate Reg. #39310-044 2/20/2013
P.O. Box 019001
USP Atwater
Atwater, CA
Padilla, Theresa Rose Suspended
aka: Theresa Rose indefinitely effective
Mendibles 2/20/2013
aka: Rose Padilla
14644 Rio Hondo Dr.
Moreno Valley, CA
Employees (susp T)
Aguayo, Jesus Duran Suspended
10744 Woodruff Ave. indefinitely effective
Downey, CA 4/2/2013
Owner/Operator (susp T)
Offong, Anietie DME03344F Suspended
aka: Aniete Offong 1275559825 indefinitely effective
320 N. E St. 3/20/2013
Ste. #100
San Bernadino, CA
and
Inmate Reg. #32697-298
CI Taft Correctional Institution
P.O. Box 7001
Taft, CA
Palma, Marlon Osvaldo Suspended
aka: Marlon Osvaldo indefinitely effective
Palma Contreras 3/20/2013
1301 W. 77th St.
Los Angeles, CA
In-Home Support Services Provider (susp U)
Aquiletra, Anita Dedra Suspended
348 N. Prospero Dr. indefinitely effective
Covina, CA 4/2/2013
Castillo, Josephine Alitha Suspended
5570 S. 152nd St. indefinitely effective
Tukwila, WA 4/2/2013
Dony, Steven K. Suspended
4141 Pacific Hwy. indefinitely effective
San Diego, CA 4/2/2013
Evans, Donicesha Marie Suspended
242 W. 43rd St. indefinitely effective
Los Angeles, CA 4/2/2013
Harris, Clarence Suspended
16841 Kingbury St. indefinitely effective
Unit #44 4/2/2013
Granada Hills, CA
Le, Son Binh Suspended
aka: Binh Le Son indefinitely effective
aka: Binh Son Le 2/20/2013
1545 Flanigan Dr.
Apt. #139
San Jose, CA
REINSTATEMENTS:
Physician (susp A)
Cartwright, Kenneth A69363 12/17/2012 (removed from pg. 16)
1401 S. Grand Ave. 00A693630
Los Angeles, CA 16595866451
and
15630 18th Ave.
Clearlake, CA
and
2036 Stanley Hills Dr.
Los Angeles, CA
Hemela, Katherine G. A42074 3/14/2013 (removed from pg. 36)
3178 Sunset Hills Blvd.
Thousand Hills, CA
and
1300 W. Gonzales Rd.
Ste. #102
Oxnard, CA
Seyoum, Mesfin M.D. 00G042634 3/21/2013 (removed from pg. 79)
330 E. Kelso St.
Inglewood, CA
Licensed Vocational Nurse (susp R)
Barker, Bret Alan 223609 11/18/2011 (removed from pg. 184)
4425 Norwalk Dr.
Apt. #35
Nunez, Santiago Rivas 10/23/2005 (removed from pg. 207)
450 W. Springville Dr.
Apt. #207
Porterville, CA
Ponce, David Bruce 102729 3/18/2013 (removed from pg. 209)
1306 W. Puente Ave.
West Covina, CA
Portillo, Jorge Danillo 174250 3/18/2013 (removed from pg. 209)
14819 Gridley Rd.
Norwalk, CA
Registered Nurse (susp R)
McInnis, Clayton Andrew 567657 3/12/2013 (removed from pg. 78)
5710 Riverview
Plantation Dr.
Theodore, AL
In-Home Support Services Provider (susp U)
McIver II, Henry 2/18/2013 (removed from pg. 21)
aka: Henry McIver III
409 E. Moore
Haven Dr.
Carson, CA