Medi-Cal Suspended and Ineligible Provider List - July Update
ADDITIONS:
Physician (susp A)
Flynn, Donna LynnG80223Suspended
aka: Donna Lynn Mareno00G802230indefinitely effective
3291 Loma Vista Rd.10/28/2011
Ventura, CA
and
P.O. Box 2115
Simi Valley, CA
Grant, John FrancisA63101Suspended
aka: John Francis Garcia00A631010indefinitely effective
441 N. Lakeview Ave.12352490129/2/2011
Anaheim, CA
and
4021 Mount Pinos Way
P.O. Box 1446
Frazier Park, CA
Popov, AlexanderA78244 Suspended
9375 San Fernando Rd.00A782440indefinitely effective
Sun Valley, CA11846527606/11/2012
Roque, Andrew A., M.D.A19578Suspended
240 S. Garfield Ave.00A195780indefinitely effective
Monterey Park, CA4/20/2012
and
1014 Ridgeside Dr.
Monterey Park, CA
Sabino, Alan DaleA77362Suspended
4 Tramonti Ct.indefinitely effective
Sacramento, CA3/30/2012
Waterbury, Jude A90991Suspended
Thaddeus, M.D.00A909910indefinitely effective
8100 Timberlake Way14876265943/28/2012
Ste. D
Sacramento, CA
Psychologist (susp C)
Higgins, William LoughmanPSY13206 Suspended
2801 Camino Del Rio S.PSY132060indefinitely effective
Unit #301A13664648104/27/2012
San Diego, CA
Porter, Ross U., Ph.DPSY15749Suspended
7444 Chaminade Ave.indefinitely effective
West Hills, CA3/26/2012
Pharmacist (susp E)
Lee, Daniel InbongRPH42633Suspended
dba: Fed-Rx PharmacyPHY39339indefinitely effective
12265 Berea Ct.PHA39339010/19/2011
Poway, CA1750412854
Pharmacy (susp E)
Lee, Daniel InbongRPH42633Suspended
dba: Fed-Rx PharmacyPHY39339indefinitely effective
12265 Berea Ct.PHA39339010/19/2011
Poway, CA1750412854
Chiropractor (susp J)
Mead, Mark David, D.C.31756Suspended
2370 N. Helm Ave.indefinitely effective
Fresno, CA4/23/2012
Stillings, Donald, D.C.16543Suspended
11340 Mountain View Ave.indefinitely effective
Ste. B14/12/2012
Loma Linda, CA
Health Care Provider (susp P)
Audelo, AnaSuspended
aka: Anita Audeloindefinitely effective
390 Palm Ave.4/19/2012
Chula Vista, CA
Home Health Aide (susp P)
Clark, Kristen205446Suspended
15130 Jenell St.indefinitely effective
Poway, CA3/13/2012
Nisperos, Teresa244797Suspended
786 Bridgeford St.indefinitely effective
Unit C2/17/2012
Gridley, CA
Certified Nurse Assistant (susp R)
Clark, Kristen680663Suspended
15130 Jenell St.indefinitely effective
Poway, CA3/13/2012
Nisperos, Teresa549741Suspended
786 Bridgeford St.indefinitely effective
Unit C2/17/2012
Gridley, CA
Perez, Gabby507228Suspended
2584 Coyote Ridge Terr.indefinitely effective
Chula Vista, CA2/15/2012
Santos, Carolina B.727880Suspended
973 Worthington St.indefinitely effective
San Diego, CA4/12/2012
Washington, Lenell419749Suspended
2394 W. Chatka Ln.indefinitely effective
San Bernardino, CA2/20/2012
Public Health Nurse (susp R)
Lokey, Lillian Marguerite50076Suspended
aka: Lillian Marguerite indefinitely effective
James10/19/2011
13625 Old Hwy. 99
Grenade, CA
Stavig, Leslie Robinson63592Suspended
608 38th St.indefinitely effective
Richmond, CA11/14/2011
Registered Nurse (susp R)
Beckerley, Andrew David688368Suspended
1671 Wagstaff Rd.indefinitely effective
Paradise, CA9/15/2011
Bigalbal, Susan Poblete353110-CASuspended
aka: Susan B. Alaman684275-TXindefinitely effective
aka: Susan Estor1/3/2011
22411 Coral Chase Ct.
Katy, TX
Registered Nurse (susp R). . . (continued)
Capdeville, Katherine306060Suspended
aka: Katherine Ann Gauraindefinitely effective
1327 Olive St.5/20/2012
Santa Barbara, CA
Clark, Ryan B.628668Suspended
875 Gull Dr.indefinitely effective
P.O. Box 3367/27/2011
Bodega Bay, CA
Daley, Lynn Marie502839Suspended
1310 Alma Ave.indefinitely effective
Unit W3037/30/2011
Walnut Creek, CA
Goss, Janice Faith604660-CASuspended
aka: Janice Faith Farris516843-TXindefinitely effective
P.O. Box 4355/19/2011
Sulphur Springs, TX
Jennings, Vicki Lynn574392Suspended
3921 E. 1st St.indefinitely effective
Unit #46/6/2011
Long Beach, CA
Keller, Shari Lorraine528177Suspended
aka: Shari Lorraine Keller indefinitely effective
Bautista5/19/2011
5405 Alton Pkwy.
Unit #5A297
Irvine, CA
Lane-Burbank, Pamela679645Suspended
Jeanindefinitely effective
5821 Hillock Rd.10/20/2011
Knoxville, TN
Lao, Yujun Jane722978Suspended
11321 W. Tonto St.indefinitely effective
Avondale, AZ4/22/2011
Lawless, Louise530385Suspended
aka: Terri Louise Nicholsindefinitely effective
2829 S. Labelle St.6/14/2011
Mesa, AZ
Lincoln, Ruth A.507943Suspended
aka: Ruth Adele Emmonsindefinitely effective
3231 Vineyard Ave.1/26/2012
Unit #126
Pleasanton, CA
Lokey, Lillian Marguerite482388Suspended
aka: Lillian Marguerite indefinitely effective
James10/19/2011
13625 Old Hwy. 99
Grenada, CA
Lundy, Jennifer Beth623347Suspended
aka: Jennifer Cobbindefinitely effective
aka: Jennifer Tofaha12/22/2011
1100 Kilbirnie Rd.
Big Lake, MN
Martin, Lisa Marie416740Suspended
aka: Lisa Marie Kaneindefinitely effective
1009 Coyla St.4/14/2011
Iowa Falls, IA
Mellott, David Michael665392Suspended
927 Wind Drift Dr.indefinitely effective
Carlsbad, CA10/19/2011
Millett, Dorothy Denee633633Suspended
1505 N. Defiance St.indefinitely effective
Unit #2048/25/2011
Tacoma, WA
Registered Nurse (susp R) . . . (continued)
Ogonuwe, Sam Odozie613686Suspended
3405 Violet Ln.indefinitely effective
Dyer, IN2/16/2012
Petersen, Brenda Sue550865Suspended
aka: Brenda Sue Wilsonindefinitely effective
aka: Brenda Petersen12/20/2011
P.O. Box 6973
Los Osos, CA
Powell, John Michael451779Suspended
P.O. Box 6526indefinitely effective
Frazier Park, CA11/10/2011
and
16525 Mill Potrero Hwy.
Pine Mountain Club, CA
Quartiano, Robert James508084Suspended
4629 Cass St.indefinitely effective
Unit #1391/26/2012
San Diego, CA
Ramos, Adriana538018Suspended
aka: Adriana Zuniga Garibayindefinitely effective
8207 Orange St.11/10/2011
Downey, CA
Robertson, Kathleen Rose483750Suspended
aka: Kathleen Rose Raugustindefinitely effective
P.O. Box 368611/3/2011
Santa Cruz, CA
and
1026 Escalona Dr.
Santa Cruz, CA
Rohmann, Leslie Ann685713Suspended
74-800 Sheryl Ave.indefinitely effective
Apt. #12-210/13/2011
Palm Desert, CA
Scovern, Kimberly Ann651109Suspended
4801 Ken Ct.indefinitely effective
New Orleans, LA12/20/2011
Simmons, Darlene Ruth352297Suspended
aka: Darlene Ruth Piercyindefinitely effective
389 Country Rd. 2144/14/2011
Eureka Springs, AR
Smith, Barbara Rose674125Suspended
aka: Barbara R. Travisindefinitely effective
Smith4/11/2011
aka: Barbara Smith
10151 Lake Ave.
Truckee, CA
Smith, Ginger Woodward681432Suspended
16 Kelsie Ln.indefinitely effective
Buffalo Valley, TN8/22/2011
Stavig, Leslie Robinson535172Suspended
608 38th St.indefinitely effective
Richmond, CA11/14/2011
Stevenson, Carmen613342Suspended
2092 New York Rte. 7indefinitely effective
Apt. #512/12/2011
Troy, NY
Swihart, Steve Wade727110Suspended
105 Brookestone Ct.indefinitely effective
Headland, AL11/4/2011
Thomas, Juliann Irene414836Suspended
1191 Adkins Rd.indefinitely effective
McKinleyville, CA4/15/2011
Registered Nurse (susp R) . . . (continued)
Trickett, Robert Michael634993Suspended
4340 State Hwy. 154indefinitely effective
Marshall, TX12/9/2009
Willingham, Timothy Daniel692835Suspended
397 Glynn Dr.indefinitely effective
Birmingham, AL1/27/2012
Yang, Eun Ja539404Suspended
9610 S. E. 282nd Ave.indefinitely effective
Boring, OR11/7/2011
Respiratory Care Practitioner (susp S)
Jones, Garry E.23115Suspended
2394 Cheshire Pl.indefinitely effective
San Leandro, CA7/2/2011
Employees (susp T)
Han, Sonya SoyoungSuspended
8706 Hillcrest Cir.indefinitely effective
Buena Park, CA6/11/2012
Private Citizen (susp T)
Peevy, Orelious AntonioSuspended
aka: Tony Peevyindefinitely effective
11819 Central Ave.5/20/2012
Apt. #514
Chino, CA
In-Home Support Services Provider (susp U)
Friend, Jeffery Lynn Jr.Suspended
2105 E. 103rd St.indefinitely effective
Los Angeles, CA6/11/2012
Jarvis, Sherie ReneeSuspended
aka: Sheire Rene Jarvisindefinitely effective
aka: Cherie Rene Jarvis6/11/2012
aka: Karen Renee Toller
17600 S. Santa Fe Ave.
Ste. A
Compton, CA
REINSTATEMENTS:
Physician (susp A)
Del Real, FrankG583755/15/2012(removed from pg. 24)
2248 N. Warren Ave.
Fresno, CA
Smith, Gregory A., M.D.A405705/16/2012(removed from pg. 93)
121 W. Washington Blvd.00A506800
Culver City, CA00A506801
and
1000 W. Carsons St.
Torrance, CA
and
302 S. Catalina Ave.
Unit #7
Redondo Beach, CA
Dentist (susp G)
Estanque, Rudolfo417224/17/2012(removed from pg. 4)
700 E. Redlands Blvd.D41722
Ste. J692695
Redlands, CA
Reinstatements . . . (continued)
Licensed Vocational Nurse (susp R)
Saroyan, Lucine1872616/11/2012(removed from pg. 193)
aka: Edwards, Lucine
2695 37th Ave.
San Francisco, CA
Registered Nurse (susp R)
Abbott, James T.578435/15/2012(removed from pg. 1)
408 S. Spring St.
Unit #1104
Los Angeles, CA
CORRECTIONS:
Certified Nurse Assistant (susp R)
Marquez, Jocelyn Ibarreta554897Suspended(changed effective date on pg. 140)
572 Vista Del Rioindefinitely effective
San Diego, CA3/10/2011
Registered Nurse (susp R)
Norris, Lisa Anne719115Suspended(added address on pg. 73)
117 Avalon Rd.indefinitely effective
Macon, GA1/19/2012
and
186 Cool Spring Rd.
Fort Valley, GA