Medi-Cal Suspended and Ineligible Provider List: May Update
ADDITIONS:
Physician (susp A)
Chung, Raymond, M.D. A68909 Suspended
441 N. Lakeview Ave. 00A689090 indefinitely effective
Anaheim, CA 1922179993 2/20/2011
and
32 Thalia St.
Ladera Ranch, CA
Hernandez-Rivera, Jose A80166 Suspended
1637 3rd Ave. 00A801660 indefinitely effective
Ste. H 1487702379 3/17/2011
Chula Vista, CA
Lefkovitch, Barry, M.D. A44733 Suspended
227 W. Janss Rd. 00A447330 indefinitely effective
Ste. #315 1538111752 2/1/2011
Thousand Oaks, CA
and
2230 Lynn Rd.
Ste. #200
Thousand Oaks, CA
McDonald, Carolyn Scott A40902 Suspended
M.D. indefinitely effective
31314 Heatherstone Dr. 2/10/2011
Wesley Chapel, FL
Pomeroy, Jim Talisman, G41434 Suspended
IV, M.D. 00G414340 indefinitely effective
3035 N. Main St. 1396885034 11/1/2010
Soquel, CA
and
144 Viking Ct.
Soquel, CA
Rahman, Ataur C52374 Suspended
4234 Chadsworth Ln. indefinitely effective
Port Orange, FL 12/6/2010
Riffel, Sergio Roberto, A41494 Suspended
M.D. 00A414940 indefinitely effective
402 E. Holt Blvd. 7/1/2010
Ontario, CA
and
334 Samuel Dr.
Yuba City, CA
Seid, Michael Kevin A90002 Suspended
2542 S. Bascom Ave. indefinitely effective
Ste. #255 10/22/2010
Campbell, CA
Shook, Michale R. C54017 Suspended
20120 N. Key Dr. indefinitely effective
Boca Raton, FL 1/28/2011
Silk, Adnan A35054 Suspended
26 Bluebird Ln. indefinitely effective
Beckley, WV 6/1/2010
Smith, John Wallace G18469 Suspended
3612 W. Lake Ave. indefinitely effective
Wilmette, IL 9/8/2010
Su, Wu-Hsiung, M.D. A33249 Suspended
7295 E. Southgate Dr. 00A332490 indefinitely effective
#204 11/3/2010
Sacramento, CA
and
2828 Mills Park Dr.
Unit D
Rancho Cordova, CA
Licensed Clinical Social Worker (susp C)
Wagner, Mark Richard 10604 Suspended
aka: Mark Wagner indefinitely effective
P.O. Box 4412 2/20/2011
Sonora, CA
Marriage, Family & Child Counselor (susp C)
Wagner, Mark Richard 19834 Suspended
aka: Mark Wagner indefinitely effective
P.O. Box 4412 2/20/2011
Sonora, CA
Registered Counselor (susp C)
Allen, Barbara J. RC00051196 Suspended
aka: Barbara G. Allen indefinitely effective
4304 Ahtanum Rd. 2/20/2011
Unit #18
Yakima, WA
Pharmaceutical Technician (susp E)
Shupe, Bradley Allan 71749 Suspended
2546 Ledgeview Pl. indefinitely effective
Spring Valley, CA 2/20/11
Dentist (susp G)
Coleman, Harold, Jr. Suspended
18851 Goldenwest Dr. indefinitely effective
Huntington, CA 2/20/2011
Mai, Truc Trung D44934 Suspended
dba: Bolsa Dental Center G91609 indefinitely effective
1106 Soto Pl. 4/18/2011
Placentia, CA
and
11695 Slate Ave.
#200
Riverside, CA
Chiropractor (susp J)
Chiu, Douglas Yeu DC29676 Suspended
P.O. Box 431 Sat Cert 6777 indefinitely effective
Cupertino, CA & 7757 10/2/2010
Danchisin, Drew Michael, 20559 Suspended
D.C. DC0205590 indefinitely effective
1304 Castro St. 2/20/2011
Unit C
San Francisco, CA
and
4317 Virginia Ave.
Oakland, CA
Clinic (susp O)
Lim, David Kyu Suspended
Clinic Manager/Med Biller indefinitely effective
1800 Oak St. 3/15/2011
Unit #306
Torrance, CA
Occupational Therapist susp O)
Ryan, Deborah Ann 1853 7/26/2010
25771 Kellog St.
Loma Linda, CA
Home Health Aide (susp P)
Yang, Tianqin 141190 Suspended
115 Sadwoa St. indefinitely effective
San Francisco, CA 11/4/2010
Certified Nurse Assistant (susp R)
Bruno, Lucia Melendez 620877 Suspended
15742 Williams St. indefinitely effective
#93 2/23/2011
Tustin, CA
McIntyre, Sasha 703812 Suspended
2255 S. Maple Ave. indefinitely effective
#116 2/20/2011
Fresno, CA
Pete, Charlene 487443 Suspended
9024 Beryl Creek Way indefinitely effective
Elk Grove, CA 10/29/2010
Yang, Tianqin 463647 Suspended
115 Sadwoa St. indefinitely effective
San Francisco, CA 11/4/2010
Licensed Vocational Nurse (susp R)
Cooney-Clark, Joyce 154620 Suspended
1550 Rimpau Ave. indefinitely effective
Apt. #16 8/14/2010
Corona, CA
Edmond, Frank L.., Jr. 50835 Suspended
212 W. 7th St. indefinitely effective
Stockton, CA 8/25/2010
Finley, Merry Ann 208228 Suspended
1878 S. Saddle St. indefinitely effective
Gilbert, AZ 6/15/2010
Grant, Ulysses 225724 Suspended
Stonetanesi indefinitely effective
375 Jefferson St. 6/4/2010
Daytona Beach, FL
Lusk, Nicole Michelle 205299 Suspended
14312 Dumont Ave. indefinitely effective
Norwalk, CA 8/15/2010
Nurse Anesthetist (susp R)
Engel, Susan Dee 2191 Suspended
aka: Susan Dee Messineo indefinitely effective
aka: Susan Dee Reeves 8/3/2010
4050 Third Ave.
#107
San Diego, CA
Marsh, Nancy Ann 740 Suspended
aka: Nancy Ann Hancock indefinitely effective
9660 N.E. Timberlane Pl. 8/26/2010
Bainbridge, WA
Public Health Nurse (susp R)
Engel, Susan Dee 44288 Suspended
aka: Susan Dee Messineo indefinitely effective
aka: Susan Dee Reeves 8/3/2010
4050 Third Ave.
#107
San Diego, CA
Hamilton, Mary Catherine 49251 Suspended
5107 Lillian St. indefinitely effective
Torrance, CA 7/23/2010
Registered Nurse (susp R)
Bertschinger, Merrideth 575974 Suspended
Jo indefinitely effective
aka: Merrideth Jo Rannow 7/2/2010
1441 Louden Ln.
Imperial Beach, CA
Callueng, Richard Alaba 695159 Suspended
1451 Rocky Ridge Dr. indefinitely effective
Apt. #2004 8/6/2010
Roseville, CA
Chen, Hsui-Hui 287962 Suspended
41156 Canyon Heights Dr. indefinitely effective
Fremont, CA 8/19/2010
Engel, Susan Dee 430530 Suspended
aka: Susan Dee Messineo indefinitely effective
aka: Susan Dee Reeves 8/3/2010
4050 Third Ave.
#107
San Diego, CA
Faires, Kimberly Lynne 549177 Suspended
541 Taraval St. indefinitely effective
San Francisco, CA 7/2/2010
Finnigan, John Joseph, IV 308241 Suspended
532 Lockwood Dr. indefinitely effective
Vallejo, CA 7/9/2010
Gibbs, Laurie 698440 Suspended
aka: Laurie Ruth indefinitely effective
Strickland 7/6/2010
aka: Laurie Jennings
13465 Camino Canada
Ste. #106
PMB #217
El Cajon, CA
Gonzalez, Lillian 600501-CA Suspended
613 Coastal Dreams Ave. 40812-NV indefinitely effective
Las Vegas, CA 11/12/2010
Groover, Lena R. 551520 Suspended
aka: Lena Remay indefinitely effective
Groover 7/2/2010
aka: Lena Ramay
Groover
25690 Crenshaw Blvd.
Torrance, CA
Hamilton, Mary Catherine 226261 Suspended
5107 Lillian St. indefinitely effective
Torrance, CA 7/23/2010
Hansen, Alison Mary 510443 Suspended
16945 Roberts Rd. indefinitely effective
#23 8/2/2010
Los Gatos, CA
Head, Carol Ann 436782 Suspended
P.O. Box 1710 indefinitely effective
Ash Fork, AZ 10/25/2010
Iversen, Diana Arlene 282552 Suspended
Ferreira indefinitely effective
aka: Diana A. Iversen 10/4/2010
aka: Diana Arlene Ferreira
3336 N. Texas St.
#J-165
Fairfield, CA
and
607 Elmira Rd.
#130
Vacaville, CA
Registered Nurse (susp R) (continued)
Jacobs, Sheri Catherine 376027 Suspended
815 Seagull Ln. indefinitely effective
Apt. D307 7/20/2010
Newport Beach, CA
Jacoby, Margaret Elizabeth 245687 Suspended
8152 Sunset Ave. indefinitely effective
Fair Oaks, CA 9/2/2010
Jenkins-Godwin, Donna 51042 Suspended
aka: Dona Jean Johnson indefinitely effective
aka: Donna Johnson Godwin 5/27/2010
19344 Cohasset St.
Reseda, CA
Jones, Sandra Lynn 612359 Suspended
155 Big Valley Rd. indefinitely effective
Folsom, CA 7/2/2010
Kawano, Frances 463344 Suspended
4275 George Ave. indefinitely effective
#1 9/9/2010
San Mateo, CA
Kidd, Rosey 485890 Suspended
113 Ripley Dr. indefinitely effective
Greenville, NC 7/1/2010
Larkin, Sheila Doris 702812 Suspended
906 Pine St. indefinitely effective
Vallejo, CA 9/3/2010
Lewis, Judy Kaye 530127 Suspended
aka: Judy Goforth indefinitely effective
aka: Judy Lewis-Goforth 10/12/2010
9549 Orion Dr.
Windsor, CA
and
2295 Apolinaris Dr.
Ukiah, CA
Limonoff, Jill 513221 Suspended
aka: Jill Renee Limonoff indefinitely effective
aka: Jill Renee 7/19/2010
Vandorhees
aka: Jill Renee
Vandorhees Limonoff
470 E. California Ave.
Arcata, CA
Macias, Marina Pichardo 523480 Suspended
aka: Mariam Marina indefinitely effective
Pichardo 12/6/2010
aka: Miriam Marian Macias
aka: Marina Miriam Macias
2437 Adelia Ave.
South El Monte, CA
Marsh, Nancy Ann 117371 Suspended
aka: Nancy Ann Hancock indefinitely effective
9660 N.E. Timberlane Pl. 8/26/2010
Bainbridge, WA
Martinez, Jose Gerardo 657189 Suspended
720 Nispola Dr. indefinitely effective
Laredo, TX 8/26/2010
McDilda, Glenda Rena 626967 Suspended
2680 Carnival Dr. indefinitely effective
Turlock, CA 2/20/2011
McQueen, Bonnie Lord 658876 Suspended
5010 Saratoga Ave. indefinitely effective
#2 8/26/2010
San Diego, CA
Registered Nurse (susp R) (continued)
Medlin, Chad Josef 277381 Suspended
aka: Joe Hall Cunningham indefinitely effective
Jr. 6/7/2010
2419 Pima Ln.
Ventura, CA
Mou, Guixuam 723346 Suspended
aka: Gui Xuan Mou indefinitely effective
1600 S. Baldwin Ave. 5/18/2010
Apt. #27
Arcadia, CA
Mulloy, Jean Pittman 610145 Suspended
1192 Carter Cir. indefinitely effective
Purvis, MS 10/12/2010
Namkoong, Kyungza 297921 Suspended
19485 Kilfinan St. indefinitely effective
Northridge, CA 9/7/2010
Nelis, Breda Mary 652370 Suspended
2291 Stockton St. indefinitely effective
#407 11/29/2010
San Francisco, CA
Nordfelt, Ray Allan 523637 Suspended
P.O. Box 2024 indefinitely effective
Turlock, CA 6/9/2010
Norris, Mary Lou 387175 Suspended
1003 S. Euclid St. indefinitely effective
Princeton, IL 8/6/2010
Partch, Stacey Lynn 551949 Suspended
350 Sharon Park Dr. indefinitely effective
Apt. B24 8/3/2010
Menlo Park, CA
and
1020 Bear Gulch Rd.
Woodside, CA
Price, Fredonnia Nellie 296229 Suspended
Lynn indefinitely effective
P.O. Box 55069 9/3/2010
Stockton, CA
and
2134 Autumn Oak Pl.
Stockton, CA
Reeder, Betty L. 335002 Suspended
aka: Betty L. Moshier indefinitely effective
3108 Amber Canyon Pl. 11/1/2010
Bakersfield, CA
Saling, Melanie Marie 505574 Suspended
1900 Hemlock Ct. indefinitely effective
Hollister, CA 8/26/2010
Sheppard, Gregory 7033076 Suspended
Thomas indefinitely effective
2675 Brickell Sq. 8/26/2010
Atlanta, GA
Sloan, Heidi Rose 654465 Suspended
P.O. Box 741 indefinitely effective
La Canada, CA 6/22/2010
Tate, Deborah Sue 412620 Suspended
965 E. Vista Chino Dr. indefinitely effective
Apt. #6 7/6/2010
Palm Springs, CA
Taylor, Sandra C. 446731 Suspended
aka: Sandra Corrine indefinitely effective
Taylor Manning 10/19/2010
P.O. Box 434
Marietta, OK
Registered Nurse (susp R) (continued)
Torres, Erick 598590 Suspended
11055 E. Dragoon Ave. indefinitely effective
Mesa, AZ 9/1/2010
Tugas, Roger Corpuz 649521 Suspended
717 Laurel St. indefinitely effective
San Jose, CA 11/30/2010
Wang, Lihua 713627 Suspended
aka: Li Hua Wang indefinitely effective
6415 Rosemead Blvd. 5/19/2010
Apt. #23
San Gabriel, CA
Zimmerman, Madeline 539153 Suspended
777 Concord Ave. indefinitely effective
San Jose, CA 10/18/2010
Respiratory Care Practitioner (susp S)
Loflin, Derek D. 24445 Suspended
1336 River Springs Dr. indefinitely effective
Porterville, CA 4/14/2010
Markee, Tabitha June 25952 Suspended
1076 Shady Ct. indefinitely effective
San Jacinto, CA 4/8/2010
Mena, Antonio, Jr. 17277 Suspended
735 Kelvin Rd. indefinitely effective
El Sobrante, CA 5/12/2010
Employees (susp T)
Beasley, Stanley Jerome Suspended
P.O. Box 64317 indefinitely effective
Sunnyvale, CA 2/20/2010
Digman, Deatrice Suspended
aka: Deatrice Griffin indefinitely effective
P.O. Box 162002 2/20/2010
Sacramento, CA
Gonzalez, Evan Josue Suspended
aka: Heber Josue Gonzalez indefinitely effective
aka: Josue Gonzalez 3/20/2011
630 E. Rialto Ave.
San Bernardino, CA
Miranda, Alvin Onate Suspended
5133 Rockland Ave. indefinitely effective
Los Angeles, CA 2/23/2011
Moreno, Maria Nela Suspended
aka: Mary Guiterrez indefinitely effective
aka: Maria Guiterrez 3/20/2011
Inmate #64771-097
FCI Dublin
5701 8th St.-Camp Parks
Dublin, CA
Medical Assistant (susp T)
Opinion, Virgilio Lopez MTA00041005 Suspended
Clinical Lab Scientist indefinitely effective
290 S. Lemon St. 3/15/2011
Unit #322
Anaheim, CA
Owner/Operator (susp T)
Edmond, Elsie Ruth Suspended
aka: Elsye Ruth Edmond indefinitely effective
aka: Elsie Ruth Edmond 3/15/2011
Duarte
aka: Elsie Aida Ruth Edmond
Duarte
Registration #55187-112
FCI Victorville Medium II
Federal Correctional Institution
P.O. Box 5300
Adelanto, CA
Recipient (susp T)
Serrano, Mary Suspended
IHSS Recipient indefinitely effective
10 River Mount Ct. 3/15/2011
Sacramento, CA
In-Home Support Services Provider (susp U)
Gonsalves, Anthony Suspended
aka: Anthony Guy indefinitely effective
Gonzalez 4/18/2011
1333 W. Garvey Ave. North
#147
West Covina, CA
Johnson, Candace Kaye Suspended
aka: Candace Kaye Dimaio indefinitely effective
aka: Candace Redden 3/15/2011
346 Montague Way
Rio Linda, CA
Pahulu, Lose Hetoafa Lose Suspended
aka: Lose He-Toafa indefinitely effective
Fakalata 2/20/2011
456 Menker Ave.
San Jose, CA
REINSTATEMENTS:
Physician (susp A)
Gadsby, Michael Owen G77223 4/5/2011 (removed from pg. 30)
M.D. 00G772230
Ophthalmologist
2274 Pacific Ave.
#2276
Long Beach, CA
and
Los Angeles Ophthalmology
Medical Group
12021 S. Wilmington Ave.
Ste. #5009
Los Angeles, CA