Medi-Cal Suspended and Ineligible Provider List: July Update

ADDITIONS:

Physician (Susp A)

Israeli, Alexander V.A94992Suspended

61-59 Dry Harbor Rd.indefinitely effective

Apt. H-483/18/2011

Middle Village, NY

Kachinas, Matthew JayG79674Suspended

26732 Crown Valley Pkwy.00G796740indefinitely effective

Ste. #541 5/12/2011

Mission Viejo, CA

and

1590 Harbor Cay Ln.

Longboat Key, FL

Levatter, Ross Eli, M.D.G62815Suspended

2601 E. Roosevelt St.00G628150indefinitely effective

Phoenix, AZXPY20546512/23/2010

and

2807 H St.

Bakersfield, CA

and

5640 E. Wonderview Rd.

Phoenix, AZ

Seideman, Susan E., M.D. G33438Suspended

609 W. 6th St.00G334380indefinitely effective

San Pedro, CA00G3343816/27/2011

and00G334382

3171 Los Feliz Blvd..

Ste. #306

Los Angeles, CA

and

1037 E. Pacific Coast Hwy.

Wilmington, CA

and

2104 Vanderbilt Ln.

Unit C

Redondo Beach, CA

Simms, Ernest Lee,C28561Suspended

M.D. Inc.00C285610indefinitely effective

22336 Main St.00C2856114/19/2011

Hayward, CA00C285612

and CGP064065

9925 International Blvd.1275569519

Ste. #11

5900 Shattuck Ave.

Ste. #230

Oakland, CA

and

1002 Central Ave.

Alameda, CA

and

103 Shadow Mountain

Oakland, CA

Psychologist (Susp C)

Berman, Mark Elliot, Ph.D.9698 Suspended

8530 Wilshire Blvd.PSY096980indefinitely effective

Ste. #206 PSY0969815/13/2011

Beverly Hills, CAPF0096980

and 1235144072

44815 Fig Ave.

Ste. B

Lancaster, CA

and

40413 Alabar Dr

Palmdale, CA

Psychiatric Technician (Susp C)

Baynot, Eric Daniel31232Suspended

1522 Via Roseindefinitely effective

Paso Robles, CA8/14/2010

Clinical Social Worker (Susp C)

Rodriguez, Jeannine ASW17034Suspended

Roseannindefinitely effective

Associate Clinical Social Worker5/19/2011

11013 Boren Ave.

Loma Linda, CA

Pharmacist (Susp E)

Lang, Johnny Thomas50571-CASuspended

5504 Ginger Dr.RPH-0010271indefinitely effective

Bakersfield, CA -OR4/20/2011

Mai, MichelleS12319-AZSuspended

Hoa-Chuong 1999140347-MOindefinitely effective

16051 E, Trevino Dr.58012-CA4/20/2011

Fountain Hills, AZ

Voshake, Renee R.45674Suspended

1852 Everglade Ave.indefinitely effective

Clovis, CA4/20/2011

Pharmaceutical Technician (Susp E)

Costere, Randy Alan44904Suspended

aka: Randy Allen Costereindefinitely effective

412 Hillcrest Dr.4/20/2011

Aptos, CA

Dague, Luke D.53510Suspended

7098 Agate St.indefinitely effective

Rancho Cucamonga, CA4/20/2011

Edge, Jaime P.78753Suspended

708 Williams Dr. indefinitely effective

Unit #24/20/2011

Huntington Beach, CA

Ibarra, Angelina18088Suspended

244 Wisteria Dr.indefinitely effective

East Palo Alto, CA4/20/2011

Manto, Jaynalee73450Suspended

Fajilagutan indefinitely effective

aka: Jayna F. Manto4/20/2011

5737 Everwood Ct.

Richmond, CA

Parks, Jennifer ErinTCH57498Suspended

1300 Robbins Ct.indefinitely effective

Suisun City, CA4/20/2011

Tabara, Angelica63715Suspended

aka: Angelica Suyatindefinitely effective

Tabara 4/20/2011

416 88th St.

Apt. #7

Daly City, CA

Sick Room Supply (Susp F)

GMS Ventures, Inc.Suspended

GMS Medical Suppliesindefinitely effective

1155 N. Vermont Ave.4/20/2011

Ste. #203

Los Angeles, CA

Acupuncturist (Susp I)

Chung, HyunMo7067Suspended

902 Stannage Ave.AC0070670indefinitely effective

Albany, CA4/20/2011

and

5358 Case Ave.

Apt. #1013

Pleasanton, CA

Chiropractor (Susp J)

Sweet, WilliamDC25936Suspended

aka: William E. Sweetindefinitely effective

aka: William Edward Sweet6/14/2011

3908 W. Caldwell Ave.

Ste. B

Visalia, CA

Willard, Teresa Darlene20842Suspended

231 E. Mayberry Ave.indefinitely effective

Hemet, CA1/6/2011

Yoo, Casey K. C., D.C.19339Suspended

aka: Casey KwangchoonDC0193390indefinitely effective

Yoo 6/13/2011

3545 Wilshire Blvd.

#315

Los Angeles, CA

Medical Transportation (Susp N)

Advanced MedicalMTN00871GSuspended

Transport Inc.1932329018indefinitely effective

Owner: Yerkanyan, Edgar 6/23/2011

501 S. Fairfax Ave.

Ste. #207

Los Angeles, CA

Clinic (Susp O)

TaharaCenterSuspended

Acupuncture & Weight Lossindefinitely effective

4725 1st St.4/20/2011

Ste. #270

Pleasanton, CA

Occupational Therapist (Susp O)

Clements, Solena AmberOTA 1504Suspended

Occupational Therapist Assistantindefinitely effective

218 W. Valerio St. 6/14/2011

Apt. B

Santa Barbara, CA

Home Health Aide (Susp P)

Guzman, Robert147975Suspended

4040 W. 161st St.indefinitely effective

Lawndale, CA1/10/2011

Silaen, Uliroma N.83449Suspended

7423 Fleming Ave.indefinitely effective

Sacramento, CA11/9/2010

Registered Nurse (Susp R)

Bertschinger, Merrideth Jo575974Suspended

aka: Merrideth Jo Rannowindefinitely effective

1441 Louden Lane7/2/2010

Imperial Beach, CA

Bolong, Teresita C.220963Suspended

28819 Crestridge Rd.indefinitely effective

Rancho Palos Verdes, CA9/17/2010

Registered Nurse (Susp R)…(continued)

Boyer, Timothy Lee647230Suspended

PO Box 1indefinitely effective

Wynona, OK8/20/2010

Dusel, Jan Shell209108Suspended

aka: Jan Shellindefinitely effective

444 Rosalie Dr.12/9/2010

Sonoma, CA

Hadley, Heather Shea671530Suspended

10497 Steeplechase Dr.indefinitely effective

Gulfport, MS12/9/2010

Haldin, Marc Charles627608-CASuspended

15680 Lake Terrace Dr.RN134568-AZindefinitely effective

Lake Elsinore, CA12/7/2010

Krueger, Jeanne Marie690797Suspended

4457 Winding River Cir.indefinitely effective

Stockton, CA9/9/2010

Moreno, Florencio IV548586Suspended

aka: Huey Morenoindefinitely effective

9009 Rieti Ln.6/10/2010

Stockton, CA

Nelson, Margaret Marie415938Suspended

aka: Peggy Marie Periniindefinitely effective

aka: Peggy Marie Mellon9/9/2010

21 S. Peak

Laguna Niguel, CA

O'Connor, Karyn Mary689235Suspended

aka: Karen Mary O'Connorindefinitely effective

aka: Karyn Mary O'Conner8/26/2010

P.O. Box 2114

Upland, CA

Prasad, Catherine489301Suspended

Elizabethindefinitely effective

10841 Fire Island Cir.6/9/2010

Stockton, CA

Salomon, DavidIMF48775Suspended

184 Barrett Rd.indefinitely effective

Riverside, CA5/19/2011

Tracy, Bridget Lynn301574Suspended

1401 S. Grand Ave.indefinitely effective

Los Angeles, CA6/7/2010

and

624 E. Elder St.

Fallbrook, CA

and

245 Evening Canyon Rd.

Corona Del Mar, CA

Vrban, Johnathan Michael452385Suspended

aka: Jon Michael Vrbanindefinitely effective

1980 Vallejo St.10/19/2010

Ninth Floor

San Francisco, CA

Warner, Marion Louise615639Suspended

P.O. Box 604indefinitely effective

Atascadero, CA9/3/2010

Winter, Kimberly Jeanne601747Suspended

5950-B Mission Center Rd.indefinitely effective

San Diego, CA2/4/2011

Certified Nurse Assistant (Susp R)

Braun, Emy690346Suspended

P.O. Box 15indefinitely effective

Delano, CA8/24/2010

Certified Nurse Assistant (Susp R) …(continued)

Dollinger, Janet F.60178Suspended

601 Ribier Ave.indefinitely effective

Lodi, CA12/7/2010

Guzman, Robert188168Suspended

4040 W. 161st St.indefinitely effective

Lawndale, CA1/10/2011

Perry, Kimberly Ann721357Suspended

aka: Kimberly K. Warnerindefinitely effective

aka: Kim Marie Werner8/25/2010

aka: Kimberly Leanne Warner

aka: Kim Knabe Warner

aka: Kimberly Johnson

2308 Harvard Dr.

Visalia, CA

Silaen, Uliroma N.338638Suspended

7423 Fleming Ave.indefinitely effective

Sacramento, CA11/9/2010

Tapia-Ugarte,59348Suspended

Guillermo Diego indefinitely effective

aka: Guillermo Diego Ugarte6/6/2011

247 E. Bobier Dr.

Vista, CA

and

4405 Maple Dr.

Oceanside, CA

Nurse Anesthetist (Susp R)

Tracy, Bridget Lynn, CRNA675 Suspended

1401 S. Grand Ave.RN3015740indefinitely effective

Los Angeles, CA16494663276/7/2010

and

624 E. Elder St.

Fallbrook, CA

and

245 Evening Canyon Rd.

Corona Del Mar, CA

Licensed Vocational Nurse (Susp R)

Betts, Teresa Lynn190165Suspended

3405 Erickson St.indefinitely effective

Unit E86/24/2010

Gig Harbor, WA

Carter, Adrienne Michelle193385Suspended

27537 Stanford Dr.indefinitely effective

Temecula, CA6/4/2010

Denny, Patricia Dawn183944Suspended

6488 Boone Ct.indefinitely effective

Magalia, CA7/24/2010

Forcier, Elissa Kay164106Suspended

12995 Club Dr.indefinitely effective

Redlands, CA6/11/2010

Hunter, Aaron Andreas219130Suspended

1035 Clinton Rd.indefinitely effective

Sacramento, CA6/3/2010

Isik, Bulent185400Suspended

351 Acacia Ave.indefinitely effective

Apt. #256/14/2010

Carlsbad, CA

Jordan, Paul Samuel176650Suspended

17590 Olinda Rd.indefinitely effective

Anderson, CA8/15/2010

Leon, Araceli212460Suspended

2857 Tuberose Dr.indefinitely effective

San Jacinto, CA4/20/2011

Licensed Vocational Nurse (Susp R) …(continued)

Lerwill, Jan Dolores185074Suspended

8444 Sunrise Ave.indefinitely effective

La Mesa, CA6/9/2010

Meinhofer, Anna Mari200151Suspended

aka: Ana Mari Meinhoferindefinitely effective

205 G St.4/17/2010

Petaluma, CA

Nurse Midwife (Susp R)

Dusel, Jan Shell166Suspended

aka: Jan Shellindefinitely effective

444 Rosalie Dr.12/9/2010

Sonoma, CA

Nurse Practitioner (Susp R)

Vrban, Johnathan Michael11632Suspended

aka: Jon Michael VrbanNP Furnisherindefinitely effective

1980 Vallejo St.10/19/2010

Ninth Floor

San Francisco, CA

Public Health Nurse (Susp R)

Dusel, Jan Shell15313Suspended

aka: Jan Shellindefinitely effective

444 Rosalie Dr.12/9/2010

Sonoma, CA

Respiratory Care Practitioner (Susp S)

Lucas, Maria Jean27784Suspended

40435 N. High Noon Wayindefinitely effective

Anthem, AZ11/12/2010

Simhachalam, John12640Suspended

Daniel indefinitely effective

1150 W. Phillips St.11/25/2010

#134

Ontario, CA

Employees (Susp T)

Beard, Brenda GailSuspended

aka: Brenda Gail Zirkleindefinitely effective

15833 Fallen Leaf Rd.6/13/2011

La Puenta, CA

Luna, Andres Ramirez Suspended

Capperindefinitely effective

7355 Bakman Ave.4/20/2011

Sun Valley, CA

Nieto-Rojas, MargaritaSuspended

743 N. Claudina St.indefinitely effective

Apt. #1016/6/2011

Anaheim, CA

Pongo, Alwyn OrtanezSuspended

19822 Main St.indefinitely effective

Apt. #1056/6/2011

Carsen, CA

Employees (Susp T) …(continued)

Sadiqr, Ajibola AdekeunleSuspended

aka: Mohhamad Mansuriindefinitely effective

aka: Jibson Sadior6/6/2011

aka: Agrbola Adekunle Sadiqr

aka: Ajibola Adedeunde Sadiqr

aka: Ajibola Adekunde Sadiqr

aka: Ajibola Adekunle Sadiqr

aka: Adekunle Ajiboias Sadiqr

aka: Bola Sadiqr

aka: Jibson Sadiqr

18930 Sherman Way

Reseda, CA

Sillemon, AnthonySuspended

749 Codington Wayindefinitely effective

Modesto, CA6/23/2011

Thompson, Gary T.Suspended

aka: Gary Timothy Thompsonindefinitely effective

133 Goethe St.6/14/2011

San Francisco, CA

Recipient (Susp T)

Hale, Kathleen CherylSuspended

IHSS Recipient/Beneficiaryindefinitely effective

aka: Kathleen Hill4/20/2011

aka: Kathleen C. Williams

aka: Kathy Marzette

aka: Kathleen Cheryl Marzette

2043 N. Orchard Ave.

Apt. A

Fresno, CA

Marshall, JuanitaSuspended

7556 El Terraza Dr.indefinitely effective

Sacramento, CA4/20/2011

Business Owner (Susp T)

Adzhyan, PetrosSuspended

Valley Vehicle Registration Servicesindefinitely effective

7256 Rubio St.6/27/2011

Van Nuys, CA

Owner / Operator (Susp T)

Palma, Nita AlmueteSuspended

aka: Nita Almuete Paddit Palmaindefinitely effective

aka: Nita Almuete Paddit4/20/2011

aka: Nita Almuete Paod Palma

Managed Care Nursing Services

Register #56122-112

FCI Dublin

Federal Correctional Institution

5701 8th Street-Camp Parks

Dublin, CA

In-Home Support Services Provider (Susp U)

Brophy, ChadSuspended

2931 34th Ave.indefinitely effective

Sacramento, CA4/20/2011

Capers, ReneeSuspended

643-1/2 W. 57th St.indefinitely effective

Los Angeles, CA5/19/2011

Galloway, Patricia AnnSuspended

aka: Patsy Gallowayindefinitely effective

217 W. Valencia Ave.5/19/2011

Fresno, CA

In-Home Support Services Provider (Susp U) …(continued)

Lee, April K.Suspended

aka: Kazoua Leeindefinitely effective

758 S. Adler Ave.5/19/2011

#201

Fresno, CA

Lee, MeeSuspended

1352 N. Willow Ave.indefinitely effective

Fresno, CA5/19/2011

Merriweather, ShanteciaaSuspended

4040 Myrtle Ave.indefinitely effective

#35/19/2011

North Highlands, CA

Morales, Jessica Stephanie Suspended

Camilleindefinitely effective

aka: Jessica Stephanie 5/19/2011

Camille Stafford

643 N. Burgan Ave.

Fresno, CA

Ortiz, JosefinaSuspended

aka: Josephine Ortizindefinitely effective

4350 E. Harvard Ave.5/19/2011

Fresno, CA

Smith, Jimmie LeeSuspended

aka: Jimmy Lee Smithindefinitely effective

2330 S. Tupman Ave.4/20/2011

Fresno, CA

Sok, SamatSuspended

aka: Somat Kimindefinitely effective

aka: Samat Sok Kim4/20/2011

2716 Antonio Ave.

Clovis, CA

Thomas, George Edward Jr.Suspended

CDCR #AG1944indefinitely effective

c/o Wasco State Prison-Reception Ctr.5/19/2011

D-7108U

P.O. Box 7700

Wasco, CA

Timmons, Shameka MarieSuspended

4801 Scarborough Wayindefinitely effective

Sacramento, CA4/20/2011

Vanderschuere, Richard Suspended

Anthony, Sr.indefinitely effective

SID #58637284/20/2011

Mill Creek Correctional Facility

4005 Aumsville Hwy. S.E.

Salem, OR

Wince, Donte TramelSuspended

9924 Flora Vista St.indefinitely effective

#155/19/2011

Bell Flower, CA

REINSTATEMENTS: (REMOVED FROM LIST)

Chiropractor(Susp J)

DeMatteo, Thomas N.20950Suspended(removed from pg. 8)

2418 Gage Ave.DC0209500indefinitely effective

Roseville, CA6/6/2011

and

1273 W. Central Ave.

Brea, CA

Licensed Vocational Nurse (Susp R)

Santos, OrlandVN185572Suspended(removed from pg. 160)

1125 N. Edgemont St. 221865indefinitely effective

Los Angeles, CARN7129805/25/2011

and

4124 Eagle Rock

Apt. #212

Los Angeles, CA