Medi-Cal Suspended and Ineligible Provider List: October Update
Medi-Cal Suspended and Ineligible Provider List: October Update
ADDITIONS:
Osteopath (susp A)
Nguyen, Tuan Hai 20A7361 Suspended
Physician/Surgeon 00AX73610 indefinitely effective
16119 Mount Kenya Ct. 1982771697 8/20/2013
Fountain Valley, CA
and
11180 Warner Ave.
Ste. #153
Fountain Valley, CA
Physician (susp A)
Emerson, Derek Kim A109882 Suspended
1053 Sapphire St. indefinitely effective
Unit #5 4/19/2013
San Diego, CA
Tincopa-Minan, Luis F. A31264 Suspended
7507 Seville Ave. 00A312640 indefinitely effective
Huntington Park, CA 00A312641 6/10/2013
and 1255322707
8420 Lindante Dr.
Whittier, CA
and
6301 Greenleaf Ave.
Whittier, CA
Counselor (susp C)
Alverson, Cynthia Louise Suspended
1014 Flint Ave. indefinitely effective
Wilmington, CA 8/20/2013
Psychologist (susp C)
De Lestang, Katherine PSY 11610 Suspended
3930 Laurel Canyon Blvd. indefinitely effective
Ste. #211 3/28/2013
Studio City, CA
Pharmaceutical Technician (susp E)
Leyva-Gonzalez, VB60090180 Suspended
Francisco J. -WA indefinitely effective
2590 Meadow Brook Ln. TCH38071-CA 8/20/2013
Tracy, CA
Dental Assistant (susp G)
Collins, Katie Diana 71562 Suspended
4425 Mission Ave. indefinitely effective
Unit E203 1/25/2013
Oceanside, CA
Martinez, Delina Renee Suspended
115 Duncan St. indefinitely effective
Stockton, CA 8/20/2013
Dentist (susp G)
Garcelon, Stephen 25799 Suspended
William. B25799 indefinitely effective
530 Arlene Dr. D25799 8/20/2013
Vacaville, CA
Dentist (susp G) …. (continued)
Rucker, Raymond. B27831 Suspended
James Jr. D27831 indefinitely effective
34 6th St. DDS27831 8/20/2013
Apt. #507
San Francisco, CA
Chiropractor (susp J)
Chung, Christian DC27406 Suspended
Eunsung indefinitely effective
Inmate Reg. #41454-086 8/20/2013
FCI Mendota
P.O. Box 9
Mendota, CA
Cleveland, Christopher DC27977 Suspended
Manuel indefinitely effective
945 S. Kern Ave. 9/30/2013
Los Angeles, CA
Lee, Ku II 1508193392 Suspended
Inmate Reg. #61152-112 indefinitely effective
CI Taft 8/20/2013
P.O. Box 7001
Taft, CA
Parks, Erich R. DC14716 Suspended
3720 Grass Valley Hwy. DC0141760 indefinitely effective
Auburn, CA 2/23/2013
and
11879 Kemper Rd.
Ste. #3
Auburn, CA
Certified Nurse Assistant (susp R)
Urbina, Susana A. 511203 Suspended
aka: Susana A. Matute indefinitely effective
3371 Baltic Ave. 8/20/2013
Long Beach, CA
Licensed Vocational Nurse (susp R)
Cody, Joe Daniel Jr. 166026 Suspended
Victorville Correctional indefinitely effective
Center 9/30/2013
Medium II
13777 Air Expressway Blvd.
Victorville, CA
Registered Nurse (susp R)
Alfonso, Victoria Marie 498033 Suspended
14835 Ox Cart Ln. indefinitely effective
Draper, UT 3/28/2013
Eubanks, Patrick Allan 770256 Suspended
133 10th St. indefinitely effective
Unit #2 3/29/2013
Seal Beach, CA
Hughes, Gwen Diane 260423 Suspended
aka: Gwen Geoghegan indefinitely effective
aka: Gwen Newell 9/30/2013
aka: Gwen D. Varga
aka: Gwen D. Hunn
aka: Gwen D. Ruskin
6851 Plymouth Rd.
Stockton, CA
Janiszewski, Frank 620992-CA Suspended
8410 Shining Waters Ln. 569164-TX indefinitely effective
Arlington, TX 4/11/2013
Registered Nurse (susp R) …. (continued)
Kemmer, Michelle Lynn 754744 Suspended
106 5th St. indefinitely effective
Brookville, PA 3/18/2013
Kim, Hwa Ja Suspended
aka: Helen Kim indefinitely effective
Inmate Reg. #62915-112 8/20/2013
FCI Victorville
Medium II
PO Box 3850
Adelanto, CA
Respiratory Care Practitioner (susp S)
Grosman, Vadim 28013 Suspended
1339 N. Sycamore Dr. indefinitely effective
Apt. #202 3/11/2013
Los Angeles, CA
Vera, Raymond 4369 Suspended
1339 N. Sycamore Dr. indefinitely effective
Apt. #202 3/23/2013
Los Angeles, CA
Business Manager (susp T)
Blkhoian, Hasmik Jasmine Suspended
aka: Asmik Blkhoian indefinitely effective
Inmate Reg. #56924-112 8/20/2013
FCI Victorville
Medium II
PO Box 3850
Adelanto, CA
Villanueva, Carlos 1629298831 Suspended
New Beginnings indefinitely effective
Recovery Treatment 8/20/2013
Center
9050 Carron Dr.
Apt. #100
Pico Rivera, CA
Business Owner (susp T)
Davtyan, Anush Suspended
Inmate Reg. #61449-112 indefinitely effective
MDC Los Angeles 8/20/2013
P.O. Box 1500
Los Angeles, CA
Corporation (susp T)
Dental Hygiene Center Suspended
Mobile Service Inc. indefinitely effective
7352 Foothill Blvd. 9/24/2013
Unit #103
Tujunga, CA
Employee (susp T)
Caffrey, Teresa Suspended
6376 Italia Ave. indefinitely effective
Las Vegas, NV 9/24/2013
Kulakova, Olena E. Suspended
aka: Olena Kulakova indefinitely effective
Inmate Reg. #87581-008 8/20/2013
3620 West Bethany Home Rd.
Phoenix, AZ
Rozenberg, Ella Suspended
2309 Apollo Dr. indefinitely effective
Los Angeles, CA 8/20/2013
Employee (susp T) …. (continued)
Scroggins, Alicia Suspended
148 E. Imperial Hwy. indefinitely effective
Los Angeles, CA 9/3/2013
Marketer (susp T)
Seville, Alexander Suspended
Biller indefinitely effective
19301 Superior St. 8/20/2013
Northridge, CA
Medical Assistant (susp T)
Reyes, Raymond Suspended
Inmate Reg. #19206-097 indefinitely effective
c/o FCI Terminal Island 8/20/2013
Federal Correctional
Institution
P.O. Box 3007
San Pedro, CA
Operator (susp T)
Satamyan, Andranik Suspended
aka: Andy Adranik indefinitely effective
Satamyan 8/20/2013
2219 Lenore Dr.
Glendale, CA
Sales Representative (susp T)
Valentine, Thomas C. Suspended
General Manager for Sanofi indefinitely effective
44 Gardenpath 8/20/2013
Irvine, CA
In-Home Support Services Provider (susp U)
Alverson, Cynthia Louise Suspended
1014 Flint Ave. indefinitely effective
Wilmington, CA 8/20/2013
Barker, Vincent Lamar Suspended
659 W. 59th Pl. indefinitely effective
Los Angeles, CA 9/24/2013
Brown, Katrina Patrice Suspended
1823 W. 87th St. indefinitely effective
Apt. #11 9/30/2013
Los Angeles, CA
Byrd, Thomas Ray Suspended
CDC #AN8885 indefinitely effective
c/o Wasco State Prison 8/20/2013
Facility D
701 Scofield Ave.
P.O. Box 4400
Wasco, CA
Cardenas, Maria Del Carmen Suspended
aka: Carmen Cardenas indefinitely effective
3689 N. Fruit Ave. 8/20/2013
Unit B
Fresno, CA
Gross, Sandra L. Suspended
1823 W. 87th St. indefinitely effective
Apt. #11 9/30/2013
Los Angeles, CA
In-Home Support Services Provider (susp U) …. (continued)
Jennings, Paul Russell Suspended
524 E. Hazel St. indefinitely effective
Unit #2 9/9/2013
Inglewood, CA
Sua, Christy Marie Suspended
212 E. Adell St. indefinitely effective
Madera, CA 8/20/2013
Ward, Jonathan Kaofas Suspended
379 Willits St. indefinitely effective
Daly City, CA 8/20/2013
REINSTATEMENTS:
Pharmacy (susp E)
Kim, Martin Choongsub PHY32469 9/4/2013 (removed from pg. 4)
dba: Martin Pharmacy
1303 Beech Ave.
Torrance, CA
and
801 S. Vermont Ave.
Unit #104
Los Angeles, CA
and
3400 Lomita Blvd.
Ste. #102
Torrance, CA
Respiratory Care Practitioner (susp S)
Carter, Michael Anson 10886 9/3/2013 (removed from pg. 4)
10720 Farralone Ave.
Chatsworth, CA
CORRECTIONS:
(Corrections to existing list are bolded)
Physician Assistant (susp A)
Hunter, Marysa S. PA50917 Suspended (corrected on pg. 109)
35150 East Creek Rd. indefinitely effective
Victorville, CA 11/9/2012
Chiropractor (susp J)
El-Shimey, Mohamed 31876 Suspended (corrected on pg. 9)
aka: Mohamed El Shamey indefinitely effective
aka: Mohamed El Sayed El 11/9/2012
Shamey
15564 Hesperian Blvd.
San Lorenzo, CA
and
1929 Carlotta Dr.
Apt. #2
Concord, CA