Medi-Cal Suspended and Ineligible Provider List - March Update
ADDITIONS:
Physician (susp A)
Batanides, Steven G30145 Suspended
Nicholas 00G301450 indefinitely effective
aka: Steven N. 12/14/2012
Batanides, M.D.
1239 R St.
Fresno, CA
and
5150 Graves Ave.
Ste. #11-B
San Jose, CA
Fernandez, Louis G71660 Suspended
Manuel indefinitely effective
4855 Tanglewood Ct. 1/2/2013
Atlanta, GA
Kao, David Peter A87967 Suspended
300 Pasteur Dr. 00A879670 indefinitely effective
Stanford, CA 1982620076 1/2/2013
and
948 Wisconsin St.
San Francisco, CA
Kho, Peter A36350 Suspended
2 Scripps Dr. 00A363500 indefinitely effective
Ste. #310 12/14/2012
Sacramento, CA
and
1525 La Chica Dr.
Chula Vista, CA
Manohara, A34791 Suspended
Sakrepatna 00A347910 indefinitely effective
6001 Truxtum Ave. 1760545974 1/3/2013
Unit #160
Bakersfield, CA
Rowland, John B. A62825 Suspended
7245 Franklin Ave. indefinitely effective
Apt. #25 12/27/2012
Los Angeles, CA
Shah, Bihari M. A37529 Suspended
1401 Garces Hwy. CGP164404 indefinitely effective
Delano, CA 00A375290 1/31/2013
and 1770555724
901 Olive Dr.
Bakersfield, CA
and
P.O. Box 2029
Bakersfield, CA
Singh, Sawraj A42982 Suspended
200 E. 6th Ave. XPY180010 indefinitely effective
Ellensburg, WA 12/28/2012
and
700 E. Mountain
View Ave.
Ste. #502
Ellensburg, WA
Webber, Michael Alan A94978 Suspended
5216 N. New Jersey indefinitely effective
St. 10/9/2012
Indianapolis, IN
Physician/Surgeon (susp A)
Manougian, Edward C17929 Suspended
1517 Summit Rd. 00C179290 indefinitely effective
Berkeley, CA 10/12/2012
and
1132 Lawrence Ct.
El Cerrito, CA
Pharmaceutical Technician (susp E)
GarciaBueno, Cesar 44346 Suspended
Antonio indefinitely effective
P.O. Box 131351 11/30/2012
San Diego, CA
Preble, Douglas Suspended
Parker indefinitely effective
1041 Arbor Ln. 1/31/2013
San Marcos, CA
Dentist (susp G)
Omrani, Behdad 52443 Suspended
aka: Behdad D52443 indefinitely effective
Omarani G87939-01 10/18/2012
1271 Granville Ave. 1356526750
Apt. #202
Los Angeles, CA
Chiropractor (susp J)
Danaher, Steven 30603 Suspended
712 D St. indefinitely effective
Ste. J 1/10/2013
San Rafael, CA
Mills, Benjamin 26103 Suspended
Andrew indefinitely effective
1052 Main St. 1/26/2013
Ste. B
Morrow Bay, CA
Occupational Therapist (susp O)
Yoshino, Kevin OT9052 Suspended
Wesley indefinitely effective
17516 Daphne Ave. 11/17/2012
Torrance, CA
Home Health Aide (susp P)
Wheeler, Forrest 212493 Suspended
Dwayne indefinitely effective
729 S. Union Ave. 11/7/2012
Unit #400
Los Angeles, CA
Certified Nurse Assistant (susp R)
Sosing, Rosemarie 328170 Suspended
1226 Myra Ave. indefinitely effective
Los Angeles, CA 1/20/2013
Wheeler, Forrest 702441 Suspended
Dwayne indefinitely effective
729 S. Union Ave. 11/7/2012
Unit #400
Los Angeles, CA
Licensed Vocational Nurse (susp R)
Alexander, 34232 Suspended
Gwendolyn Anne indefinitely effective
aka: Gwendalyn Ann 2/28/2013
Frazier Alexander
Downs
aka: Gwendolyn
Anne F. Alexander
Downs
aka: Gwendolyn
Frazier Alexander
aka: Gwendolyn
Anne F. Downs
2625 Alcatraz Ave.
Unit #359
Berkeley, CA
Bilyck, Margaret 54382 Suspended
Elizabeth indefinitely effective
230 Dolores St. 8/9/2012
Unit #8
San Francisco, CA
Bond, Shawn Elaine 2044563 Suspended
1608 Cayenne indefinitely effective
Ridge Rd. 8/9/2012
San Diego, CA
Brennan, Dawn 243962 Suspended
Marie indefinitely effective
6690 Peppermint Dr. 8/18/2012
Reno, NV
Devera, Dione 214012 Suspended
Camille indefinitely effective
4150 Marathon St. 8/18/2012
Apt. #417
Los Angeles, CA
Eme, Nina Queen 200220 Suspended
11638 York Ave. indefinitely effective
Unit #14 2/3/2013
Hawthorne, CA
Garcia, Robert 216176 Suspended
Joshua indefinitely effective
4900 Overland Ave. 8/18/2012
Unit #181
Culver City, CA
Hernandez, Kathy D. 18239 Suspended
1118 Carolina St. indefinitely effective
Vallejo, CA 8/18/2012
Hier-Johnson, 221505 Suspended
Alfred J. indefinitely effective
597 Sadeir Way 8/18/2012
Apt. #10
Reno, NV
Jackson, Marqui 208690 Suspended
Rayshel indefinitely effective
1476 E. Chevy 2/3/2013
Chase Dr.
Apt. E
Glendale, CA
Mitchell, Carrie 217869 Suspended
Lynn indefinitely effective
16912 Cumberland 1/31/2013
Cir.
Yorba Linda, CA
Licensed Vocational Nurse (susp R) . . . (continued)
Vagle, Erin Danielle 191771 Suspended
1449 9th Ave. indefinitely effective
San Diego, CA 8/18/2012
Venable, Dorothy 44044 Suspended
Rudine indefinitely effective
601 13th St. 6/4/2012
Marysville, CA
Washington, Belinda 158415 Suspended
Louise indefinitely effective
2157 103rd Ave. 8/18/2012
Oakland, CA
Nurse Anesthetist (susp R)
Khandan-Alai, Goli 3219 Suspended
aka: Goli A. indefinitely effective
Khandan-Alai 12/7/2012
aka: Goli A.
Khandan
P.O. Box 10177
Costa Mesa, CA
Silegy, Eva Monica 2536 Suspended
aka: Eva Monica indefinitely effective
Toth 11/7/2012
P.O. Box 1055
Sun City, CA
Nurse Practitioner (susp R)
Brownlee, Tiffany 12961 Suspended
Laurel indefinitely effective
aka: Tiffany 12/7/2012
Browmlee
aka: Tiffany
Termeer-Brownlee
837 Saltmeadow
Bay Arch
Apt. #311
Virginia Beach, VA
Hernandez, Erika 21762 Suspended
Manuella indefinitely effective
aka: Erika Manuela 11/1/2012
Prieto Hernandez
aka: Diane Kazemian
26437 Whispering
Leaves Dr.
Santa Clarita, CA
Public Health Nurse (susp R)
Esters-Thames, 26874 Suspended
Sharon indefinitely effective
aka: Sharon 11/7/2012
Elizabeth Thames
aka: Sharon E.
Esters
11858 Stoney
Peak Dr.
Unit #521
San Diego, CA
Silegy, Eva Monica 42919 Suspended
aka: Eva Monica indefinitely effective
Toth 11/7/2012
P.O. Box 1055
Sun City, CA
Registered Nurse (susp R)
Ahluwalia, Jasbir 461660 Suspended
Kaur indefinitely effective
73S 55th St. 1/14/2013
Renton, WA
Amen, Cynthia 535528 Suspended
Louise indefinitely effective
1711 3rd St. 1/14/2013
Eureka, CA
Barraza, Edward 524389 Suspended
Lee indefinitely effective
357 Collingwood St. 12/4/2012
Unit #2
San Francisco, CA
Bauer-Smith, 455470 Suspended
Nancy Jean indefinitely effective
1954 N. Greenfield 11/7/2012
Ave.
Clovis, CA
Bellegia, Denise 457484 Suspended
Marie indefinitely effective
aka: Denise 10/26/2012
Marie Lucker
1879 Garland Ln.
Anaheim, CA
Benjamin, Mary 479254 Suspended
Lois indefinitely effective
aka: Mary Lois 1/14/2013
Rahming
217 W. 66th St.
Los Angeles, CA
Bird, Pamela Ann 556783 Suspended
aka: Pamela Ann indefinitely effective
Wright Bird 12/12/2012
276 Carlyle Ct.
Gilroy, CA
Brownlee, Tiffany 585132 Suspended
Laurel indefinitely effective
aka: Tiffany 12/7/2012
Browmlee
aka: Tiffany
Termeer-Brownlee
837 Saltmeadow
Bay Arch
Apt. #311
Virginia Beach, VA
Bushnell, Amanda 810714 Suspended
Linn indefinitely effective
9951 Lemon St. 1/25/2013
Villa Park, CA
Calantas, Thelma T. 486505 Suspended
aka: Thelma indefinitely effective
Bigaran Tulingan 11/16/2012
154 N. Michigan Ave.
Pasadena, CA
Campuzano, 718892 Suspended
Angela Dorothy indefinitely effective
1101 Whitney Ranch 11/15/2012
Pkwy.
Apt. #932
Rocklin, CA
Registered Nurse (susp R) . . . (continued)
Carter, Andrea 380917 Suspended
Marie L. indefinitely effective
aka: Andrea Marie 1/2/2013
Lechowit
12691 Antelope
Hills Dr.
Lakeside, CA
Chanin, Michelle 497255 Suspended
Elaine indefinitely effective
aka: Michelle 1/14/2013
Elaine Giubbini
P.O. Box 1125
Frederick, CO
Cole, Jamie 604968 Suspended
Elizabeth indefinitely effective
563 E. El Paso Ave. 12/12/2012
Unit #101
Fresno, CA
Conner, Jennifer 711719 Suspended
Michelle indefinitely effective
20251 Lake Forest 1/14/2013
Dr.
Unit #339
Lake Forest, CA
Cottrell, Sheri 510410 Suspended
aka: Sheri Lynn indefinitely effective
Cottrell 12/7/2012
P.O. Box 4042
Estes Park, CO
Crescenzo, Vicki 564093 Suspended
Elizabeth indefinitely effective
aka: Vittoria 12/28/2012
Elizabeth
Crescenzo
1616 E. Ocean
Blvd.
Unit 11
Long Beach, CA
Dasher, Anna 683312 Suspended
Catherine indefinitely effective
279 Heritage Glen Ln. 11/5/2012
Rancho Cordova,
CA
Davis, Karen O. 220672 Suspended
aka: Karen O. indefinitely effective
Buckman 10/19/2012
20251 Lake Forest
Dr.
Lake Forest, CA
Depot, Denise 32065 Suspended
Annette indefinitely effective
680 Timbermill Ln. 10/18/2012
Orange Park, FL
Dunbar, Cynthia Lea 312676 Suspended
aka: Cynthia Roth indefinitely effective
716 Paseo Del Mar 11/15/2012
Palos Verdes
Estates, CA
Registered Nurse (susp R) . . . (continued)
Esters-Thames, 270131 Suspended
Sharon indefinitely effective
aka: Sharon 11/7/2012
Elizabeth Thames
aka: Sharon E.
Esters
11858 Stoney
Peak Dr.
Unit #521
San Diego, CA
Flores, Kimberly 602182 Suspended
Mae indefinitely effective
2400 E. Luster Ln. 11/16/2012
Des Moines, IA
Hernandez, 530416 Suspended
Erika Manuela indefinitely effective
aka: Erika Manuela 11/1/2012
Prieto Hernandez
aka: Diane Kazemian
26437 Whispering
Leaves Dr.
Santa Clarita, CA
Khandan-Alai, 580488 Suspended
Goli indefinitely effective
aka: Goli A. 12/7/2012
Khandan-Alai
aka: Goli A.
Khandan
P.O. Box 10177
Costa Mesa, CA
Labute-Goen, 619732 Suspended
Wendy Louise indefinitely effective
7000 S. Paradise 11/5/2012
Rd.
Unit #2057
Las Vegas, NV
Lavin, Laura Jean 350214 Suspended
aka: Laura Jean indefinitely effective
Petruschell 10/5/2012
aka: Laura P.
McMullin
21001 Plummer St.
Unit #103
Chatsworth, CA
Lopez, Katherine 550225 Suspended
Marie indefinitely effective
aka: Katherine 11/9/2012
Notarangelo
aka: Katherine
Marie Williams
14721 Woodland Dr.
Fontana, CA
Lopez, Kirsten Lee 444561 Suspended
aka: Kristen Lee indefinitely effective
Gagliardo 11/30/2013
aka: Kirsten Lee
Lunneberg
10859 Caminito
Colorado
San Diego, CA
Registered Nurse (susp R) . . . (continued)
Lowry, James 601043 Suspended
Michael indefinitely effective
aka: James Lowry 11/1/2012
16795 Roosevelt Land
Unit C
Huntington Beach,
CA
Maughan, 631889 Suspended
Marlene Ann indefinitely effective
5522 Betty 12/7/2012
Jean Dr.
Corpus Christi,
TX
Medina, Beth Ann 575012 Suspended
aka: Beth Ann indefinitely effective
Lankford 11/14/2012
aka: Beth Ann
Barber
1246 Croke Dr.
Thornton, CO
Peace, Traci 608070 Suspended
Leigh indefinitely effective
aka: Traci Leigh 12/7/2012
Hurley Peace
3793 Stemley Rd.
Talladega, AL
Prado, Remedios 196914 Suspended
Nebres indefinitely effective
aka: Remedios 10/3/2012
L. Nebres
16144 Talbot Ct.
Chino Hills, CA
Price, Ginger 535561 Suspended
Dianne indefinitely effective
1476 McCutchen 12/7/2012
Rd.
Cades, SC
Ramirez, Ronnie 675753 Suspended
Ray indefinitely effective
1020 W. Dickens 11/9/2012
St.
Slaton, TX
Roberts, Robin 352098 Suspended
Renee indefinitely effective
aka: Robin R. 10/5/2012
Jackson
P.O. Box 276
Hoopa, CA
Saunders, 606006 Suspended
Betina R. indefinitely effective
50 Donald Ave. 11/6/2012
Oakland, TN
Schweikhard 508784 Suspended
Nancy K. indefinitely effective
1516 Matanzas 10/30/2012
Rd.
Santa Rosa, CA
Scoggins, Stacy 426351 Suspended
Ann indefinitely effective
2118 Myrtle 2/5/2013
Beach Ln.
Unit #1
Danville, CA
Registered Nurse (susp R) . . . (continued)
Seiner, Mary Ann 351250 Suspended
50 Woodside indefinitely effective
Plaza 10/17/2012
Unit #545
Redwood City, CA
Silegy, Eva 401674 Suspended
Monica indefinitely effective
aka: Eva Monica 11/7/2012
Toth
P.O. Box 1055
Sun City, CA
Strika, Margaret 452175 Suspended
5303 Highway 49 N. indefinitely effective
Unit #27 11/28/2012
Mariposa, CA
Sullivan, Charles 452190 Suspended
Adrian indefinitely effective
100 Braddock St. 10/29/2012
Unit #103
Frostburg, MD
Torres, Staci 342131 Suspended
Lin indefinitely effective
aka: Staci Lin 11/7/2012
Avery
708 E. 1st St.
Madison, IN
Valente, Mary 460886 Suspended
Alice indefinitely effective
aka: Mary Valente 11/27/2012
P.O. Box 430
Penryn, CA
West, William 680901 Suspended
Lonnie III indefinitely effective
2429 E. Broadway 2/18/2013
Apt #6
Long Beach, CA
Williams, Alex 524009 Suspended
1010 Pacific Ave. indefinitely effective
Apt. #610 10/26/2012
Santa Cruz, CA
Williams, Michael 516373 Suspended
Gene indefinitely effective
3957 Ridge St. 10/26/2012
Fair Oaks, CA
Wood-Russell 502956 Suspended
Lindy Lee indefinitely effective
aka: Lindy Lee 10/30/2012
Woodrussell
aka: Lindy Wood
8183 Pequenia Ave.
Atascadero, CA
Woodside, Marvin 331347 Suspended
Lee indefinitely effective
1612 48th Ave. 10/3/2012
Unit #11
San Francisco,
CA
Yaley, Dawn Ellen 551069 Suspended
20800 Lake indefinitely effective
Chabot Rd. 10/19/2012
Apt. #310
Castro Valley, CA
Respiratory Care Practitioner (susp S)
Bragg, William Gregory 27770 Suspended
853 Commodore Dr. indefinitely effective
Unit. #345 11/28/2012
San Bruno, CA
Burton, Patti Varee 5741 Suspended
7625 N. 1st St. indefinitely effective
Apt. #176 10/26/2012
Fresno, CA
Castaneda, 26043 Suspended
Miguel Angel indefinitely effective
2227 Foxtail Dr. 9/2/2011
Palmdale, CA
Ford, Mark L. 20578 Suspended
7524 Pinot Pl. indefinitely effective
Rancho 11/21/2012
Cucamonga, CA
Hernandez, Danilo 28372 Suspended
WSP-RC, C-2-B, CDC #AL6061 indefinitely effective
176 Low 2/2/2012
P.O. Box 6600
Wasco, CA
Kausin, Marixa 18656 Suspended
5558 W. Birch Ave. indefinitely effective
Fresno, CA 11/10/2012
Moncrief, Brett Keith 13636 Suspended
9298 Rocky Falls Ct. indefinitely effective
Elk Grove, CA 11/16/2012
Ramsey, Sonja R. 15913 Suspended
aka: Sonja Regina indefinitely effective
Hadnot 11/18/2012
584 Sheffield Way
Perris, CA
Thomson, Ingrid Anne 20909 Suspended
105 Dream St indefinitely effective
Vacaville, CA 10/5/2012
Administrator (susp T)
Senior Vice President Suspended
of Physician Services indefinitely effective
Nicholson, Dante Lee 1/31/2013
aka: Dante L.
Nicholson
aka: Donald
Nicholson
aka: Don Lee
Nicholson
38513 Desert
View Dr.
Palmdale, CA
Business Owner (susp T)
Taylor, Sheryl Ann Suspended
dba: Taylor indefinitely effective
Independent Care 2/21/2013
6333 Fall River Way
Sacramento, CA
and
6245 Dias Ave.
Sacramento, CA
Employee (susp T)
Charchyan, Liparit Suspended
5822 Woodman Ave. indefinitely effective
Unit #3 2/3/2013
Van Nuys, CA
Ehigie, Camillus Ehimen Suspended
aka: Louis Kendry Alexis indefinitely effective
aka: James S.Anders 2/3/2013
aka: Arthur William
Becton
aka: Camillis Chimen
Ehigle
aka: Dave Mic Brown
4800 Reforma Rd.
Woodland Hills, CA
Lewis, Linda Arlene Suspended
aka: Linda Cannady indefinitely effective
205 Standard St. 2/27/2013
Unit F
El Segundo, CA
Padilla, Martin Ortiz Suspended
aka: Jose Sanchez indefinitely effective
aka: Jesse Mendiles 2/21/2013
aka: Carlos
Mark Padilla
23103 Oshua Dr.
Moreno Valley, CA
Wilde, Julie Ann Suspended
965 Eucalyptus Dr. indefinitely effective
El Cajon, CA 2/27/2013
In-Home Support Services Provider (susp U)
Acevedo, Kathleen Suspended
3042 Marysville Blvd. indefinitely effective
Sacramento, CA 2/11/2013
Bayne, Jennifer Diane Suspended
410 W. Elm St. indefinitely effective
Lodi, CA 2/11/2013
Brent, Zena Denise Suspended
aka: Zena Denise indefinitely effective
Chapman 2/11/2013
2443 Mission Ave.
Unit #8
Carmichael, CA
Crosby, Duron Rashawn Suspended
2816 Villarreal Way indefinitely effective
Modesto, CA 2/11/2013
Dawson, Treajetta Suspended
851 Agusta Dr. indefinitely effective
Lathrop, CA 2/11/2013
Gavin, Sharese Suspended
8133 Pinefield Dr. indefinitely effective
Sacramento, CA 2/11/2013
Jones, Robert Earl Suspended
5226 Gordon Dr. indefinitely effective
Sacramento, CA 2/11/2013
Malanchuk, Suspended
Emma Losifvna indefinitely effective
7484 Holworthy Way 2/18/2013
Unit #236
Sacramento, CA
In-Home Support Services Provider (susp U) . . . (continued)
Mclver II, Henry Suspended
aka: Henry indefinitely effective
Mclver III 2/18/2013
409 E. Moore
Haven Dr.
Carson, CA
Patoc, Elvy Ramos Suspended
Ramos indefinitely effective
7616 Downing 2/18/2013
Place Way
Sacramento, CA
Ramirez, Maria Suspended
Lourdes indefinitely effective
1326 W. 7th Pl. 2/18/2013
Kennewick, WA
Reed, Denise Suspended
Lorraine indefinitely effective
2241 Somerset Dr. 2/18/2013
Stockton, CA
Sostre, Crystal Suspended
Leann indefinitely effective
417 Arches Ave. 2/21/2013
El Dorado Hills, CA
Spivey, Montril Lynel Suspended
417 Arches Ave. indefinitely effective
El Dorado Hills, CA 2/21/2013
Stevenson, Tianje Suspended
415 E. 95th St. indefinitely effective
Los Angeles, CA 3/1/2013
Vega-Vega, Suspended
Angelica Yoana indefinitely effective
8176 Essen Way 2/25/2013
Sacramento, CA
REINSTATEMENTS:
Physician (susp A)
De Zubiria, A70728 9/7/2012 (removed from pg. 26)
Rodrigo 00A707280
Castle Family 1215040563
Health Center
Bloss Memorial
District
3605 Hospital Rd.
Ste. H
Atwater, CA
Haduong, Quan G57891 2/7/2013 (removed from pg. 40)