Medi-Cal Suspended and Ineligible Provider List: April Update
ADDITIONS:
Physician (susp A)
Bolick, David 33101 Suspended
aka: David R. Bolick 1467431080 indefinitely effective
dba: Arizona Pathology 12/20/2009
Group Inc.
445 N. 5th St.
Ste. #300
Phoenix, AZ
and
P.O. Box 8500
#15180-081
Florence, CO
Chen, Eugene 6251 Suspended
aka: Chen, Eugene Y.T. XPY126060 indefinitely effective
3230 E. Flamingo Rd. 1811987845 6/24/2011
Ste. # 334
Las Vegas, NV
and
2075 E. Flamingo Rd.
Las Vegas, NV
Cox, Brent Taylor G34594 Suspended
749 Richardson Ln. 00G345940 indefinitely effective
Cotati, CA 1/31/2013
and
410 Hilldale Way
Mill Valley, CA
Farahmand, Nooshin A56465 Suspended
aka: Nooshin A. 00A564650 indefinitely effective
Farahmand 1821013293 9/20/2012
1751 W. Romneye Dr.
Ste. A
Anaheim, CA
and
211 Marion Blvd.
Fullerton, CA
Godt, Richard L. G14867 Suspended
aka: Richard Godt 00G148670 indefinitely effective
600 N. Mountain Ave. 1457319964 1/16/2013
Ste. C102
Upland, CA
and
1318 Upland Hills Dr. S.
Upland, CA
Gulick, Alan G41985 Suspended
aka: Alan C. Gulick 00G419850 indefinitely effective
975 Sereno Dr. 1801974613 2/13/2013
Vallejo, CA
and
136 Dartmouth Pl.
Benicia, CA
Kalmansohn, Robert B. C12178 Suspended
852 S. Robertson Blvd. 00C121870 indefinitely effective
Los Angeles, CA CGP036140 1/23/2013
Lippman, Nicol Pamela A62947 Suspended
Margt 00A629470 indefinitely effective
aka: Nicol Lippman 1154363786 12/28/2012
715 S. Averill Ave
San Pedro, CA
and
1094 W. 7th St.
San Pedro, CA
Physician (susp A) . . . (continued)
Mansubi, Fereydun A26289 Suspended
aka: Fred Mansubi 00A262890 indefinitely effective
2577 Samaritan Dr. 00A262891 2/1/2013
Ste. #860 00A262892
San Jose, CA 1770612186
and
225 N. Jackson Ave.
San Jose, CA
Polk, Ernest Keith C39853 Suspended
aka: Ernest K. Polk 00C398530 indefinitely effective
100 W. California Blvd. CGP151810 11/9/2012
Pasadena, CA 1114941051
and
900 N. Almansor St.
Alhambra, CA
Roberts, Eric A17567 Suspended
5901 W. Olympic Blvd. 00A175670 indefinitely effective
Ste. #100 1376561050 1/16/2013
Los Angeles, CA
Thaler, Kenneth Scott G37603 Suspended
14642 Newport Ave. 00G376030 indefinitely effective
Tustin, CA 00G376031 1/14/2013
1790880250
Umali, Rene G71638 Suspended
1141 W. Redondo 00G716380 indefinitely effective
Beach Blvd. 1/10/2013
Ste. #300
Gardena, CA
and
2521 Girvan Rd.
Redding, CA
Wolin, Howard Evan C50320 Suspended
1580 S. Milwaukee Ave. indefinitely effective
Ste. #410 9/23/2010
Libertyville, IL
Psychiatric Technician (susp C)
Alcantar, Vincent 29504 Suspended
1224 W. Date Ave. indefinitely effective
Porterville, CA 2/3/2013
Pharmaceutical Technician (susp E)
Pinarelli, Kristina Marie 102205 Suspended
9022 Calle Del Verde indefinitely effective
Santee, CA 11/19/2012
Shafihie Arash 114951 Suspended
5963 Eldergarden St. indefinitely effective
San Diego, CA 1/11/2013
Registered Dental Hygienist (susp G)
Hesari, Maryam 90 Suspended
Dental Hygiene Center Indefinitely effective
Mobile Svc. Inc. 2/28/2013
347 W. Stoker St.
Glendale, CA
and
1156 Chelsea St.
Unit B
Santa Monica, CA
Chiropractor (susp J)
Kaufmann, Todd Steven 20654 Suspended
640 Channing Way SAT2741 indefinitely effective
Unit #147 SAT4511 2/9/2013
San Rafael, CA
Lopez, Paul Joseph DC26897 Suspended
2417 Whitesands Dr. indefinitely effective
Apt. #2 2/9/2013
Huntington Beach, CA
Young, Stephen W. DC11392 Suspended
90 W. Hwy 246 DC0113920 indefinitely effective
Unit #1 SAT6827 3/12/2013
Buellton, CA SAT8787
and SAT14167
P.O. Box 1651 SAT14168
Buelllton, CA
and
4238 Lantana Ct.
Santa Marie, CA
Certified Nurse Assistant (susp R)
Flores, Juan B. 727996 Suspended
5225 Robinwood Rd. indefinitely effective
Apt. A26 2/28/2013
Bonita, CA
Kurniawan, Steven Suspended
1246 Alta Ave. indefinitely effective
Upland, CA 2/28/2013
Limon, Jose Alfredo 806372 Suspended
9121 Kenwood Dr. indefinitely effective
Apt. #42 2/27/2013
Spring Valley, CA
Osorio, Kenya Rayann F. 678678 Suspended
9253 Midway indefinitely effective
Apt. A 10/5/2012
Durham, CA
Samayoa, Jeffrey 752942 Suspended
316 Wyland Way indefinitely effective
Duarte, CA 12/18/2012
Vecina, Stephanie 617664 Suspended
3463 Sundance Dr. indefinitely effective
Merced, CA 10/5/2012
Nurse Anesthetist (susp R)
McConnell, Kay Oswald 2094 Suspended
301 Demonbreun St. indefinitely effective
Unit #1006 1/14/2013
Nashville, TN
Wohlgemuth, Delwin Jay 2798 Suspended
aka: Delvin Wohlgemuth indefinitely effective
14112 Creek Ct. 1/10/2013
Fort Myers, FL
Nurse Practitioner (susp R)
Martinez, Jennifer Joanne 10262 Suspended
aka: Jennifer Woodward indefinitely effective
Martin 1/15/2013
3401 Par Four Dr.
El Cajon, CA
Nurse Practitioner (susp R) . . . (continued)
Raymond, Barbara Ann 13146 Suspended
aka: Barbara Ann Hicks indefinitely effective
aka: Barbara 1/14/2013
Raymond-Hicks
aka: Barbara Taylor
aka: Barbara A. Chillis
9401 Canyon Shadows
Ln.
Las Vegas, NV
Public Health Nurse (susp R)
Engle, Tina Marie 54845 Suspended
2459 Tulip St. indefinitely effective
Fairfield, CA 1/14/2013
Litowsky, Elizabeth 16498 Suspended
aka: Lisa Litowsky indefinitely effective
260 Live Oak St. 12/15/2012
Auburn, CA
Raymond, Barbara Ann 61337 Suspended
aka: Barbara Ann Hicks indefinitely effective
aka: Barbara 1/14/2013
Raymond-Hicks
aka: Barbara Taylor
aka: Barbara A. Chillis
9401 Canyon Shadows
Ln.
Las Vegas, NV
Registered Nurse (susp R)
Anderson, Charlene Mary 461728 Suspended
3360 Monroe St. indefinitely effective
Carlsbad, CA 10/26/2012
Baisa, Solomon Quesada 678333 Suspended
5430 Oak Park Ln. indefinitely effective
Unit #234 12/7/2012
Oak Park, CA
Curry, Sandra Gail 220444 Suspended
aka: Sandra Gail indefinitely effective
Curry-Winter 1/14/2013
aka: Sandra Gail Saxon
P.O. Box 1285
Palm Springs, CA
Dagdag, Shirley Uy 492705 Suspended
aka: Shirley Uy Dagday indefinitely effective
Monreal 12/20/2012
10376 Via Cinta Ct.
Elk Grove, CA
Davis, Randall Todd 578953 Suspended
12831 Early Run Ln. indefinitely effective
Riverview, FL 1/14/2013
Denzy, Deanna 517956 Suspended
833 S. Cedros Ave. indefinitely effective
Apt. #28 11/5/2012
Solana Beach, CA
Dirr, Denise Lu 336255 Suspended
aka: Denise Lu indefinitely effective
Johansen 1/11/2013
P.O. Box 912
Rancho Cordova, CA
Elliott, Susan Roon 312926 Suspended
2041 Avenue of the Trees indefinitely effective
Carlsbad, CA 1/7/2013
Registered Nurse (susp R) . . . (continued)
Engle, Tina Marie 481640 Suspended
2459 Tulip St. indefinitely effective
Fairfield, CA 1/14/2013
Fairres, Kelly Ann 690103 Suspended
aka: Kelly Ann Sandarg indefinitely effective
3985 Oak Ridge Cir. 12/14/2012
Norco, CA
Ferreira, Kimberly York 768776 Suspended
aka: Kimberly York May indefinitely effective
6672 Pickett Ave. 11/7/2012
Garden Grove, CA
Fontanot, Steven John 645885 Suspended
2491 Larkey Ln. indefinitely effective
Walnut Creek, CA 2/28/2013
Gomez, Gayle Lesley 586899 Suspended
aka: Gayle Lesley indefinitely effective
Glatman 1/14/2013
33112 Marina Vista Dr.
Dana Point, CA
Greene, Marietta Lee 515063 Suspended
aka: Marietta Lee indefinitely effective
Williford 12/14/2012
2277 Grove Ave.
Sacramento, CA
Hershberger, Michael 521121 Suspended
David indefinitely effective
15 Red Hill Cir. Apt D 12/26/2012
Tiburon, CA
Hicks, Kerry Adine 512633 Suspended
aka: Kerry Tormey indefinitely effective
aka: Kerry Adine Mary 12/20/2012
Tormey
6402 Hummingbird St.
Unit #104
Ventura, CA
Jamrozy, Gina M. 602734 Suspended
P.O. Box 313 indefinitely effective
Fairfax, CA 1/14/2013
Johnsen, Laurel Anne 590322 Suspended
10815 E. Clearwater Way indefinitely effective
Clovis, CA 12/14/2012
Johnson, Tanika D. 621967 Suspended
1550 Central Ave. indefinitely effective
Apt. #62 2/5/2013
Riverside, CA
Jung, Richard Brooks 518836 Suspended
P.O. Box 545 indefinitely effective
Mendocino, CA 12/28/2012
Lartch, Miles Shane 410775 Suspended
360 Salina Ct. indefinitely effective
Vista, CA 12/14/2012
Lawson-Lewis, Lynda Ray 672976 Suspended
616 Dexter St. indefinitely effective
Santa Rosa, CA 12/14/2012
Linville, Allison Leigh 621235 Suspended
915 Shorepoint Ct. indefinitely effective
Apt. E319 1/14/2013
Alameda, CA
Litowsky, Elizabeth 217870 Suspended
aka: Lisa Litowsky indefinitely effective
260 Live Oak St. 12/15/2012
Auburn, CA
Registered Nurse (susp R) . . . (continued)
Maland, Erik Timothy 772782 Suspended
aka: Erik Maland indefinitely effective
657 Marshall Ave. 12/24/2012
Saint Paul, MN
Malloy, Anne Ashley 390909 Suspended
aka: Anne Ashley indefinitely effective
Katzakian 12/21/2012
aka: Anne Dawes
7515 Sheldon Rd.
Unit #22101
Elk Grove, CA
Markiewicz, Kim Marie 539643 Suspended
100 Manatee Crossing indefinitely effective
Unit #108 1/14/2013
Daytona Beach, FL
Martinez, Jennifer Joanne 503068 Suspended
aka: Jennifer Woodward indefinitely effective
Martin 1/15/2013
3401 Par Four Dr.
El Cajon, CA
McBride, Elisha 66453 Suspended
10693 Caminito Derecho indefinitely effective
San Diego, CA 2/27/2013
McConnell, Kay Oswald 501447 Suspended
301 Demonbreun St. indefinitely effective
Unit #1006 1/14/2013
Nashville, TN
McDonald, Madeline 534054 Suspended
Izetta indefinitely effective
aka: Madeline Izetta 12/24/2012
Tugwell
218 Shadowrun Ct.
Redding, CA
McGinnis, Patrick Ryan 729467 Suspended
150 Cedar St. indefinitely effective
Rio Dell, CA 12/26/2012
McKenzie, Gloria 428627 Suspended
aka: Gloria Fay Bresson indefinitely effective
aka: Gloria Frieson 1/25/2013
aka: Gloria F. Bresson
1030 E. Green St.
Unit #23
Pasadena, CA
Nelson, Starr Iola 765079 Suspended
aka: Starr Williams indefinitely effective
Nelson 1/14/2013
Ankriston Villa RR No. 3
Shelburne
Nova Scotia, Canada,
B0T 1W0
O'Neal, Mary A. 554160 Suspended
aka: Mary Cascio indefinitely effective
399 W. Via De Palmas 1/14/2013
San Tan Valley, AZ
Patrick, Sherry Ann 620785 Suspended
aka: Shirley Patrick indefinitely effective
26 Gibbs Dr. 1/14/2013
Phenix City, AL
Patterson, Sandra L. 397051 Suspended
3950 Waring Rd. indefinitely effective
Apt. #227 1/14/2013
Oceanside, CA
Phan, Lan Thi 547256 Suspended
9251 Parliament Ave. indefinitely effective
Westminister, CA 3/17/2013
Registered Nurse (susp R) . . . (continued)
Raymond, Barbara Ann 326993 Suspended
aka: Barbara Ann Hicks indefinitely effective
aka: Barbara 1/14/2013
Raymond-Hicks
aka: Barbara Taylor
aka: Barbara A. Chillis
9401 Canyon Shadows
Ln.
Las Vegas, NV
Rice, Lisa Ann 419734 Suspended
349 E. Monmouth St. indefinitely effective
Winston-Salem, NC 1/14/2013
Schinstock, Sean Daniel 752140 Suspended
aka: Sean D. Schinstock indefinitely effective
36916 Meadow Brook Way 1/11/2013
Beaumont, CA
Schmitz, Nicholas James 738152 Suspended
1346 Stevenson St. indefinitely effective
Apt. B302 12/26/2012
San Francisco, CA
Smith, Dotti Irene 306165 Suspended
aka: Dotti Irene Hanson indefinitely effective
aka: Dorothy Irene Smith 12/31/2012
aka: Doroth Irene Hansen
16563 Fox Glen Rd.
Riverside, CA
Smith, Kitren Diane 435870 Suspended
aka: Kitren Diane Endicott indefinitely effective
aka: Kitren D. Willette 1/11/2013
Smith
7224 S. Woodland Dr.
Radcliff, KY
Stanton, Chantal Kathleen 752916 Suspended
1211 Wyoming Dr. indefinitely effective
Santa Rosa, CA 12/24/2012
Tabb, Angelia Corine 670909 Suspended
56885 Dickson Way indefinitely effective
Anza, CA 12/28/2012
Tanner, Pamela Sue 646679 Suspended
aka: Pamela Hofedt indefinitely effective
Tanner 1/11/2013
aka: Pamela Su Tanner
RR 3 Box #3249
Naples, TX
Toler, Kathy Anne 526839 Suspended
P.O. Box 445 indefinitely effective
Cutten, CA 1/11/2013
Wassil, Bradley James 738235 Suspended
563 E. El Paso Ave. indefinitely effective
Unit #101 12/26/2012
Fresno, CA
Weyrauch, Susan Page 514989 Suspended
1214 Prune St. indefinitely effective
Hollister, CA 1/2/2013
Williams-Johnson, 607767 Suspended
Terishalen indefinitely effective
5537 Marburn Ave. 1/2/2013
Los Angeles, CA
Winkler, Jill Marie 269287 Suspended
aka: Jill Marie Kauffman indefinitely effective
4725 Allied Rd. 3/17/2013
San Diego, CA
Registered Nurse (susp R) . . . (continued)
Wohlgemuth, Delwin Jay 592679 Suspended
aka: Delvin Wohlgemuth indefinitely effective
14112 Creek Ct. 1/10/2013
Fort Myers, FL
Zavelsky, Rina 583604 Suspended
12206 Hunter's Glen Ct. indefinitely effective
Glen Allen, VA 1/11/2013
Respiratory Care Practitioner (susp S)
Magalad, Gary Cruz 24124 Suspended
aka: Gary C. Magalad indefinitely effective
903 New Depot St. 12/28/2012
Apt. #9
Los Angeles, CA
Rogers, Cheryl Ann 21511 Suspended
4861 Scotch Ct. indefinitely effective
Carmichael, CA 12/22/2012
Sundaresan, Michael 30764 Suspended
Kannan indefinitely effective
805 Arrowhead Dr. 12/22/2012
Apt. E
Sidney, OH
Talamantes, Lawrence 4704 Suspended
David indefinitely effective
7348 W. 87th Pl. 12/22/2012
Westchester, CA
Business Owner (susp T)
Michel Jr., Angel Suspended
aka: Angel Michel indefinitely effective
aka: Angel Martinez Michel 12/31/2012
aka: Angel Martinez Michel
Jr.
aka: Angel Jr. Michel
aka: Angel Michelle
Inmate Reg. F48431
California State Prison
Los Angeles County
44750 60th St. W.
Lancaster, CA
Raroque, Wilhelmina A. Suspended
aka: Wilhelmina Aquino indefinitely effective
Raroque 3/25/2013
7996 Alton Dr.
Lemon Grove, CA
Employees (susp T)
Lopez, Elsy Suspended
8456 Madison Ave. indefinitely effective
South Gate, CA 2/27/2013
Montgomery, Michelle Y. Suspended
12711 Mitchell Ave. indefinitely effective
Unit #6 2/27/2013
Los Angeles, CA
In-Home Support Services Provider (susp U)
Acree, Rosalind Leann Suspended
2545 Hayes Dr. indefinitely effective
La Verne, CA 3/17/2013
Castillo, Esperanza Suspended
847 W. 93rd St. indefinitely effective
Los Angeles, CA 3/12/2013
In-Home Support Services Provider (susp U) . . . (continued)
Else, Helen Yvette Suspended
aka: Helen Yvette Thomas indefinitely effective
aka: Helen Sampson 3/17/2013
210 N. 5th St.
Apt. #1
Burbank, CA
Hall, Mary Ann Suspended
6101 S. Hobart Blvd. indefinitely effective
Los Angeles, CA 3/12/2013
Haouas, Noelle Nadia Suspended
6034 Bonner Ave. indefinitely effective
North Hollywood, CA 3/17/2013
Martin, Lucette Dorian Suspended
2664 S. Budlong Ave. indefinitely effective
Unit #16 4/1/2013
Los Angeles, CA
Sandukhtyan, Takuhie Suspended
1731 N. Allen Ave. indefinitely effective
Pasadena, CA 3/17/2013
Valentine, Delilah Suspended
321 1/2 W. 51st St. indefinitely effective
Los Angeles, CA 2/27/2013
Villalobos, Martha Suspended
12804 Kalnor Ave. indefinitely effective
Norwalk, CA 3/17/2013
Welch, Rebecca Suspended
aka: Rebecca Marie indefinitely effective
Perez-Welch 4/1/2013
aka: Rebecca Marie
Perez
aka: Rebecca Marie
PerezWelch
11175 Doverwood Dr.
Riverside, CA
and
10262 Cook Ave.
Riverside, CA
Welch, Timothy James Suspended
11175 Doverwood Dr. indefinitely effective
Riverside, CA 4/1/2013
and
10262 Cook Ave.
Riverside, CA
REINSTATEMENTS:
Physician (susp A)
Johnson, Gary R. 27755 2/28/2013 (removed from pg. 50)
P.O. Box 580
San Andreas, CA
Physician Group (susp B)
Suleiman, Mustafa Ismail 1992731400 2/5/2013 (removed from pg. 3)
9400 Rosecrans Ave. 00A480510
Bellflower, CA
Chiropractor (susp J)
Danaher, Steven 30603 2/28/2013 (removed from pg. 7)
712 D St.
Ste. J
San Rafael, CA
Occupational Therapist (susp O)
Harris, Donald Felipe OTA1772 2/20/2013 (removed from pg. 3)
17050 San Bruno St.
Apt E11
Fountain Valley, CA
Home Health Aide (susp P)
Johnson, Lilia E. 392909 12/24/2012 (removed from pg. 8)
aka: Rodriguez, Lilia E.
1225 E Grand Ave.
Unit #201-C
Escondido, CA
CORRECTIONS:
Registered Nurse (susp R)
Cater, Andrea Marie L. 380917 1/2/2013 (removed from pg, 21, added to pg. 22)
aka: Andrea Marie Lechowit
12691 Antelope Hills Dr.
Lakeside, CA