Medi-Cal Suspended and Ineligible Provider List - June Update
ADDITIONS:
Physician (susp A)
Abdullah, Alnoor Hassanali A35882 Suspended
43847 Heaton Ave. 00A358820 indefinitely effective
Lancaster, CA 4/3/2012
and
583 Beach Crescent
Ste. #2902
Vancouver, BC
Canada
Altfeld, Donald Jay G18262 Suspended
aka: Don Altfeld M. 00G182620 indefinitely effective
1998 N. Arrowhead Ave. 4/6/2012
San Bernardino, CA
and
149 S. Barrington Ave.
Unit #301
Los Angeles, CA
Chen, Louis C. A79663-CA Suspended
P.O. Box 900 MD60201014-WA indefinitely effective
Seattle, WA 9/1/2011
Gomez, Gregory A90854-CA Suspended
Rodriguez MD27099-OR indefinitely effective
1801 W. Vineyard Rd. 7/1/2011
Phoenix, AZ
Pharmaceutical Technician (susp E)
Riaski, Aimee Christine 41180 Suspended
California Institution for indefinitely effective
Women 4/19/2012
CDS WA8955
16756 Chino-Corona Rd.
Corona, CA
Pharmacist (susp E)
Puccinelli, John Michael Suspended
22477 Santa Paula Ave. indefinitely effective
Cupertino, CA 4/19/2012
Acupuncturist (susp I)
Luk, Peter Kiwai 5572 Suspended
371 E. Bullard Ave. AC0055720 indefinitely effective
Ste. #102 1609036474 4/19/2012
Fresno, CA
and
P.O. Box 26832
Fresno, CA
Clinic Owner (susp O)
Suspended
Hollingsworth, Don indefinitely effective
dba: Do Away With Pain 12/22/2011
Clinic
601 Court St.
Ste. #106
Jackson, CA
Health Care Provider (susp P)
Central Community ADU70180F Suspended
Services, Inc. ADU70063F indefinitely effective
aka: Central ADHC 5/23/2005
Asian Tower Health Center
1825 Beverly Blvd.
Los Angeles, CA
and
709 N. Hill St.
Los Angeles, CA
Home Health Aide (susp P)
Cossey, Bonnie Sue 00155289 Suspended
84975 Echols Rd. indefinitely effective
Thermal, CA 4/19/2012
Teroganisian, Naira 157748 Suspended
aka: Naira Ter Oganisian indefinitely effective
aka: Naira Ter-Oganisian 3/20/2012
8163 Wakefield Ave.
Panorama City, CA
Certified Nurse Assistant (susp R)
Cossey, Bonnie Sue 00301183 Suspended
84975 Echols Rd. indefinitely effective
Thermal, CA 4/19/2012
Dick, Ekpoboaredo 00581890 Suspended
1200 Kendall Dr. indefinitely effective
Apt. #214 4/19/2012
San Bernardino, CA
Ramirez, Erika 566095 Suspended
41861 Maywood St. indefinitely effective
Fremont, CA 2/22/2012
Teroganisian, Naira 514882 Suspended
aka: Naira Ter Oganisian indefinitely effective
aka: Naira Ter-Oganisian 3/20/2012
8163 Wakefield Ave.
Panorama City, CA
Licensed Practical Nurse (susp R)
Anderson, Julie M. 27031814A-IN Suspended
5829 Vesper Ave. indefinitely effective
Van Nuys, CA 7/22/2011
Licensed Vocational Nurse (susp R)
Hopkins, Amy Elizabeth 223493 Suspended
4295 10th St. indefinitely effective
Riverside, CA 4/19/2012
Public Health Nurse (susp R)
Joseph, Carla Mae 56693 Suspended
1306 W. 50th St. indefinitely effective
Los Angeles, CA 7/20/2011
Registered Nurse (susp R)
Adams, Rosalie Elizabeth 727226 Suspended
2115 E. 51st Pl. indefinitely effective
Apt. A 8/5/2011
Tulsa, OK
Anderson, Julie M. 547330-CA Suspended
5829 Vesper Ave. 281452547A-IN indefinitely effective
Van Nuys, CA Unknown-FL 7/22/2011
Registered Nurse (susp R) . . . (continued)
Armstrong-Bowman, 598771 Suspended
Loree Gay indefinitely effective
P.O. Box 67 7/30/2011
Clarksville, OH
Baker, Faith Ann 677832 Suspended
58 Calle Conejo indefinitely effective
Alpine, CA 2/4/2011
Boelman, Daniel John 559836-CA Suspended
113 Timber Ridge Dr. 098009-IA indefinitely effective
Pella, IO 7/19/2011
Crowther, Suzanne Michelle 529579 Suspended
aka: Suzanne Nichelle Fleer indefinitely effective
16 Flossmoor 7/11/2011
Trabuco Canyon, CA
Curtis, Kathie June 464790 Suspended
1411 Del Norte Dr. indefinitely effective
Corona, CA 8/11/2011
Groendyke, Diana Lynne 706017 Suspended
232 Shadow Mountain Cir. indefinitely effective
Gardnerville, NV 7/30/2011
Holland, Jeff Dupont 580001-CA Suspended
245 Peachtree Way 200542591-OR indefinitely effective
Atlanta, GA 7/7/2011
Hopkins, Amy Elizabeth 736672 Suspended
4295 10th St. indefinitely effective
Riverside, CA 4/19/2012
Joseph, Carla Mae 512305 Suspended
1306 W. 50th St. indefinitely effective
Los Angeles, CA 7/20/2011
Kersey, Lori Lee 469106 Suspended
716 Harding Pl. indefinitely effective
Wheatland, CA 7/19/2011
King, Sandra D. 455941 Suspended
aka: Sandra Grayson indefinitely effective
aka: Sandra Debbie Clark 7/21/2011
aka: Sandra Claek-Grayson
7542 Mount Vernon St.
Lemon Grove, CA
Maffucci, Julie not provided Suspended
P.O. Box 233 indefinitely effective
Elk Grove, CA 4/19/2012
Wheeler, Heather Michelle 2004009064-MO Suspended
308 N. Fairland St. 69029-OK indefinitely effective
Pryor, OK 607200-CA 4/19/2012
Respiratory Care Practitioner (susp S)
Holland, Nicole Ashley 29522 Suspended
16426 Rimrock Rd. indefinitely effective
Apple Valley, CA 4/2/2011
Business Manager (susp T)
Odachyan, Petros Onikovic Suspended
RL Medical Supply Inc. indefinitely effective
Correctional Institution Taft 4/19/2012
P.O. Box 7001
Taft, CA
Business Owner (susp T)
Booking, Mikhail Chtivelman Suspended
aka: Michael Chtivelman indefinitely effective
George Bailey Detention 4/19/2012
Facility
Unit #11175815
446 Alta Rd.
Ste. #5300
San Diego, CA
Lyubovnyy, Pavel Suspended
aka: Paul Lyubovnyy indefinitely effective
South Bay Industrial Med 4/19/2012
Clinic
2638 Zorada Dr.
Los Angeles, CA
Private Citizen (susp T)
Ashton, Sean Matthew Suspended
4709 Arlington Ave. indefinitely effective
Unit #33 4/19/2012
Riverside, CA
Carmona, David Suspended
1833 1st St. indefinitely effective
La Verne, CA 4/19/2012
Graham, Arnon Suspended
11927 Stegmeir Dr. indefinitely effective
Rancho Cucamonga, CA 4/19/2012
Tricas, Andy Perry Suspended
903 Lewiston St. indefinitely effective
Duarte, CA 4/19/2012
Adult Day Health Center (susp U)
Central Community ADU70180F Suspended
Services, Inc. ADU70063F indefinitely effective
aka: Central ADHC 5/23/2005
Asian Tower Health Center
1825 Beverly Blvd.
Los Angeles, CA
and
709 N. Hill St.
Los Angeles, CA
In-Home Support Services Provider (susp U)
Ayers, Donte Laron Suspended
2803 Belmont Ct. indefinitely effective
Atwater, CA 4/19/2012
Herrera, Mercedes Suspended
911 MacArthur St. indefinitely effective
Sacramento, CA 4/19/2012
Lopez, Jamie Suspended
aka: Jamie Annos indefinitely effective
2665 Sunset Ln. 4/19/2012
San Bernardino, CA
REINSTATEMENTS:
Physician (susp A)
Davidson, Daniel Shane A56075 3/5/2012 (removed on pg. 23)
aka: Shane Shiebani, M.D. 00A560750
aka: Shahram Shane 00A560751
Sheibani Rad
aka: Shane Shebani Rad
aka: S. Shane Shebanirad
12910 Victory Blvd.
North Hollywood, CA
and
10910 Riverside Dr.
Toluca Lake, CA
and
465 N. Roxbury Dr.
Beverly Hills, CA
Drake, Carl E., M.D. 00C290740 5/10/2012 (removed on pg. 26)
135 San Benito Way
San Francisco, CA
Dentist (susp G)
Ash-Slayter, Carolyn M. B34298 4/25/2012 (removed on pg. 1)
17212 Carranza Dr.
San Diego, CA
Podiatrist (susp K)
Perry, Maurice A. 000E38590 7/26/2001 (removed on pg. 4)
18039 Sherman Way
Reseda, CA
Registered Nurse (susp R)
Werren, Paul 295460 Suspended (removed on pg. 105,
1516 Butler Ave. indefinitely effective reinstatement originally scheduled, but missed, in January 2011)
Unit #8 3/28/2011
Los Angeles, CA
CORRECTIONS:
(Corrections to existing list are bolded)
Chiropractor (susp J)
Pham, Henry Chi 22434 Suspended (added provider number and address on pg. 26)
aka: Chi Van Pham G30157 indefinitely effective
4565 Ponderosa Way 4/10/2011
Yorba Linda, CA
and
Tehachapi CCI
P.O. Box 1031
Tehachapi, CA
Certified Nurse Assistant (susp R)
Tugung, Kauzer 718965 Suspended (added “aka” and address on page 152)
aka: Kauzer Isadalani indefinitely effective
Tugung 3/16/2010
1111 W. Benwood St.
Covina, CA
and
14404 Beckner St.
La Puente, CA
Medical Center (susp T)
Central Community ADU70180F Suspended (added provider numbers on pg. 40)
Services, Inc. ADU70063F indefinitely effective
aka: Central ADHC 5/23/2005
Asian Tower Health Center
1825 Beverly Blvd.
Los Angeles, CA
and
709 N. Hill St.
Los Angeles, CA