susp L
Medi-Cal Suspended and Ineligible Provider List1
Portable X-RayProvider
Number
Burke, DonaldZZZ59863ZSuspended
1523 California Avenueindefinitely effective
Bakersfield, California10/13/76.
California Medical ServicesZZZ42084ZSuspended
16055 Ventura Boulevard,indefinitely effective
#66/18/82.
Encino, California
Chavez, Elroy G.XR059849FSuspended
Bridges, AlfredZZZ59849Zindefinitely effective
1544 E. Katella Avenue3/31/83.
Anaheim, California
Inland Cities PortableZZZ59890ZSuspended
XRay LabZZZ59877Zindefinitely effective
1140 S. Raymond4/1/83.
Avenue, #F
Fullerton, California
Owner: King, Alan
Innocent, George G.ZZZ59879ZSuspended
3875 Jackson Street,ZZZ76031Zindefinitely effective
#500A0755609/21/83.
Riverside, CaliforniaZZZ76032Z
Robertson PortableZZZ59877ZSuspended
XRay LabZZZ59890Zindefinitely effective
539 S. Raymond4/1/83.
Avenue, #D
Fullerton, California
Owner: King, Alan
1 – Medi-Cal Suspended and Ineligible Provider List
November 1999
susp M
Medi-Cal Suspended and Ineligible Provider List1
LaboratoryProvider
Number
Angson, HadiLAB97553FSuspended
United Health Labindefinitely effective
9144 Las Tunas Drive5/15/97.
Temple City, California
Automated Lab ServicesZZZ58802ZSuspended
15551 Cabrito Wayindefinitely effective
Van Nuys, California6/22/85.
Kohl, Ramon N.
Bionetics MedicalZZZ59028ZSuspended
Diagnosticindefinitely effective
8469 South Van Ness7/14/82.
Avenue
Inglewood, California
BioAnalytical LabLAB03343FSuspended
5365 Walnut Avenue, #MZZZ59389Zindefinitely effective
Chino, California8/19/83.
Fereydoun, Karimi
Bio Technical ClinicalSuspended
Laboratory indefinitely effective
Corporate Officer: 2/8/2006.
Hussain, Abrar
aka: Kiszalbash, Agha Ali
1433 West Merced Avenue
West Covina, California
Bio Scientific Clinical LAB42923FSuspended
Laboratoryindefinitely effective
5385 Walnut Avenue, #712/22/99.
Chico, California
and
6301 Beach Boulevard,
Suite 200
Buena Park, California
Ramon C. Sison, M.D.,
Director
and
Bio Scientific Clinical
Laboratory
9899 Santa Monica
Boulevard, Suite 153
Beverly Hills, California
Mary Michelle Solis, Owner
and
Bio Scientific Clinical
Laboratory
2751 Rio Lempa Drive
Hacienda Heights, California
California MedicZZZ44859ZSuspended
Enterprisesindefinitely effective
3692 Katella Avenue, #B5/19/83.
Los Alamitos, California
Fekri, Mohammed –
President
Callejas, Jauna P. Suspended
and/or indefinitely effective
Jaron Clinical Laboratory08/04/04.
Americare Clinical
Laboratory
20518 Londelius Street
Winnetka, California
LaboratoryProvider
Number
Ciraolo, Juan CarlosSuspended
aka: Ciraolo, Jose Gonzalezindefinitely effective
Ciraolo, John Charles10/15/03.
1447 West Toscanini Drive
Rancho Palos Verdes,
California
and/or
Los Angeles Bio-Clinical Lab
420 East Broadway
Glendale, California
and
P.O.Box 217
Lawndale, California
Dizon, Linda W98930Suspended
aka: Rojas, Lynnindefinitely effective
Chan, Erlinda1/19/05.
Mora, Linda
Singh, Linda
Malibu Camp
1250 South Encinal Canyon
Road
Malibu, California
Epsilon Clinical LabLAB03987GSuspended
1111 N. Kenmore Avenueindefinitely effective
Los Angeles, California4/24/96.
Glendale Clinical LabZZZ30301ZSuspended
1371 East Coloradoindefinitely effective
Glendale, California8/22/72.
Nijinsky, Alexander Sergei
Gonzalez, LuisaSuspended
aka: Gonzalez, Luisaindefinitely effective
Estela8/19/04.
Ciraolo, Luisa Estela
Lombardi, Luisa Estela
DeCiraolo, Luisa Lombardi
FCI Victorville
P.O. Box 5100
Adelanto, California
Hazen Medical LabZZZ30079ZSuspended
7824 East Bay Driveindefinitely effective
North Bend, Oregon7/31/85.
Hazen, Quinten, M.D.
HealthPro MedicalSuspended
Laboratories indefinitely effective
Cancio, Raul Cometa09/24/03.
13151 Yorba Avenue, #11
Chino, California
Hutchings, MichaelSuspended
aka: Sherrill, Michaelindefinitely effective
Sorrels, Michael03/20/03.
Hutchison, Michael
Federal Register #23988112
Lompoc – FPC
3601 West Farm Road
Lompoc, California
and/or
Draw One Arterial Laboratory
12155 Magnolia Avenue,
Suite 3B
Riverside, California
1 – Medi-Cal Suspended and Ineligible Provider List
March 2006
susp M
1
LaboratoryProvider
Number
Imedics Laboratories, Inc. Suspended
280 Henderson Street, #18-Kindefinitely effective
Jersey City, New Jersey06/30/04.
Jimenez, Joaquin JoseSuspended
aka: Jimenez, Jakeindefinitely effective
Pulmonary Testing Services01/20/03.
Federal Register #20670112
MDC Los Angeles
P.O. Box 1500
Los Angeles, California
La Palma Clinical LabZZZ59287ZSuspended
5451 La Palma Ave., #11indefinitely effective
La Palma, California11/12/83.
LA Prompt Clinical LabSuspended
Shugla, Vladislavindefinitely effective
(Co-Owner) 11/19/02.
6221 Wilshire Boulevard,
Suite 207
Los Angeles, California
Levsky, AnatolySuspended
aka: Levsky, Tonyindefinitely effective
Yuzhelevsky, Anatoly7/20/2005.
7913 Vulcan Drive
Los Angeles, California
Liginsky, IgorSuspended
aka: Liginsky, GaryIndefinitely effective
4415 Tedregal Court2/5/04.
Calabasas, California
Los Angeles Bio-Clinical LabSuspended
Ciraolo, Juan Carlosindefinitely effective
aka: Ciraolo, Jose Gonzalez10/15/03.
Ciraolo, John Charles
420 East Broadway
Glendale, California
and
P.O. Box 217
Lawndale, California
Medical and Family Suspended
Diagnostic Lab, Inc. indefinitely effective
5220 Clark Avenue, Suite #33006/30/04.
Lakewood, California
Mkhitarian, OvakimSuspended
Advanced Diagnosticindefinitely effective
Laboratory 02/20/03.
1268 North Hobart Boulevard
Los Angeles, California
Musoyan, SarkisSuspended
aka: Lee, Sakoindefinitely effective
2924 Scott Road3/20/05.
Burbank, California
New Age PulmonarySuspended
Diagnostics Laboratory indefinitely effective
c/o 836 North Winding03/12/99.
Brook Lane
Walnut, California
Nicolas, Daniel L., Sr.Suspended
Diagnostic Laboratoriesindefinitely effective
Network, Inc.3/18/2007.
722 West Broadway
Glendale, California
LaboratoryProvider
Number
Penaflorida, Ernesto Suspended
Del Mundo indefinitely effective
and/or08/12/04.
Medstat Clinical Laboratory
25071 Prospect Avenue
Loma Linda, California
Physician's QualityLAB57358FSuspended
Laboratory, Inc.indefinitely effective
13345 Telegraph Road,08/28/00.
Suite H
Whittier, California
Pomona Medical LabZZZ59389ZSuspended
136 East Artesia BoulevardLAB03343Findefinitely effective
Pomona, California8/19/83.
Fereydoun, Karimi
Pulmonary Testing ServicesSuspended
Jimenez, Joaquin Joseindefinitely effective
(Owner) 1/20/03.
aka: Jimenez, Jake
Federal Register #20670112
MDC Los Angeles
P.O. Box 1500
Los Angeles, California
Rica Lab, Inc. Suspended
618 West Las Tunas Driveindefinitely effective
San Gabriel, California08/04/04.
S & H LaboratoryZZZ59107ZSuspended
7301 South Western Avenueindefinitely effective
Los Angeles, California9/30/84.
Metzenbaum, Leon
Joseph
Salvo, Mario Achilles B.Suspended
aka: Salvo, Markindefinitely effective
and/or06/23/04.
Acculab
1122 Elk Street,
Apartment. #115
Glendale, California
San Martin De Porres A41327Suspended
Medical Labindefinitely effective
Torreblanca, Jose11/19/02.
Manuel (Owner)
10001 California Avenue
South Gate, California
SASB, Inc.Suspended
6800 Reseda Boulevard,indefinitely effective
Suite D03/20/03.
Reseda, California
Sayers, Aaron#95Suspended
Laboratory Owner &indefinitely effective
Respiratory Therapist03/12/99.
836 North Winding Brook
Lane
Walnut, California
SGV Family Medical Suspended
Lab, Inc.indefinitely effective
221 North San Dimas2/14/2007.
Avenue
San Dimas, California
1 – Medi-Cal Suspended and Ineligible Provider List
April 2007
susp M
3
LaboratoryProvider
Number
Sherani, Tahir SaeedSuspended
aka: Mr. Shahindefinitely effective
aka: Eduardo6/28/2006.
215 North Wyoming Avenue
South Orange, New Jersey
Tabibian, FarkhondehSuspended
FTS Enterprises, Inc.indefinitely effective
dba: California Clinical2/19/2007.
Lab
4576 Marson Drive
Encino, California
and
18840 Ventura Boulevard
Tarzana, California
Tecson, Ronaldo C. Suspended
c/o Jaron Clinicalindefinitely effective
Laboratory07/28/04.
dba: American Clinical
Laboratory
20518 Londelius Street
Winnetka, California
World Diagnostic Lab, Inc.LAB04228FSuspended
1402 North Alexandriaindefinitely effective
Street8/31/91.
Los Angeles, California
Zapatero, AdalbartoSuspended
aka: Zapatero, Adalbertoindefinitely effective
Al1/20/03.
Albert
Zapatero, Adalberto Garcia
Federal Register #20543112
Taft Correctional Institution
P.O. Box 7001
Taft, California
Clinical LaboratoryProvider
Number
Family Laboratory, Inc.LAB39016FSuspended
dba: Western Systems Labindefinitely effective
Fathi Ahmed Salem, Director2/3/01.
12013 Firestone Boulevard
Norwalk, California
New Era MedicalLAB13912FSuspended
Laboratory indefinitely effective
1111 West 6th Street,3/18/01.
Suite B1
Los Angeles, California
Owners: Zellipour,
Amir Hassan
Zellipour, Adelaida
Salvador, Virgilio
Sarte, Emil
Del Rosario, Joven
Andrade, Brando
Laboratory Owner/Operator
Baram, GregorySuspended
aka: Barnam, Gregoryindefinitely effective
11327 Dona Pegita Drive3/20/2005.
Studio City, California
Martin, RonSuspended
aka: Rameriz, Ernestoindefinitely effective
Guitierrez, Eduardo7/20/2006.
Martinez, Ernie
Martinez, Ronaldo
Muhammad, Nuir
Miller, Ron
Sarle, Dominik
11123 E. Beck Lane
Scottsdale, Arizona
and
2007 Wilshire Boulevard,
Suite #303
Los Angeles, California
and
4300 Green River Road,
Suite #101
Corona, California
1 – Medi-Cal Suspended and Ineligible Provider List
March 2007