susp K

Medi-Cal Suspended and Ineligible List1

PodiatristProvider

Number

Ager, Alan L.E1607Suspended

P.O. Box 123indefinitely effective

San Geronimo, California5/15/01.

Ainsley, William Todd,4471Suspended

D.P.M.indefinitely effective

1755 Purdue Avenue, #1098/7/2007.

Los Angeles, California

Alexander, Donald000E17370Suspended

1845 Jefferson Street000E17371indefinitely effective

San Francisco, California5/4/96.

Alvaro, MichaelE3777Suspended

11256 Whittier Boulevardindefinitely effective

Whittier, California5/23/2006.

and

1200 North State Street,

Box 719

Los Angeles, California

Atry, Francis Farhad, D.P.M.000E36600Suspended

aka: Atrzadeh, Farhadindefinitely effective

1740 West Cameron,8/10/95.

#106

West Covina, California

Austin, Gerald David Jr. E4373 Suspended

956 Willowleaf Drive, EL1397 Iindefinitely effective

#260512/18/03.

San Jose, California

Bailey, BrianSuspended

5952 N. Las Virgenesindefinitely effective

Calabasas, California5//20/98.

Berk, Charles AllenE1790Suspended

32 Crest Havenindefinitely effective

Irvine, California12/20/98.

Bernstone, Martin G.E1690Suspended

15100 Kittridge Streetindefinitely effective

Van Nuys, California3/11/02.

Berquist, Andy O.Suspended

1019 D. Foster Cityindefinitely effective

Boulevard 1/5/97.

Foster City, California

Bilinsky, Ronald DavidE2227Suspended

1390 Kelton Avenueindefinitely effective

Los Angeles, California3/26/02.

Bishop, Alma Rica000E21860Suspended

aka: Mischeaux,000E21861indefinitely effective

Alma Rica000E218623/18/99.

27401 Palmwood Avenue

Hayward, California

PodiatristProvider

Number

Blair, Michael S.000E19690Suspended 6

11645 Wilshire Boulevard,months effective

#90110/28/91.

Los Angeles, California

Blair, Michael S.000E19691Suspended 6

4314 West Victorymonths effective

Boulevard, #10210/28/91.

Burbank, California

Boorstin, Henry S., D.P.M.000E32550Suspended

10656 Valley Boulevard000E32551indefinitely effective

El Monte, California000E325528/8/90.

Brewster, Dennis C., M.D.000E23760Suspended

41 N. Arrroyo Parkwayindefinitely effective

Pasadena, California1/4/91.

Bushnell, Ronald Earl000E23820Suspended

13411 Curry Avenue000E23821indefinitely effective

Lodi, California9/17/98.

Campbell, Steven P.Suspended

680 Grand Avenueindefinitely effective

Long Beach, California10/20/99.

Claussen, Mark W.000E23350Suspended

3580 Bluebell Streetindefinitely effective

Seal Beach, California8/30/83.

Diana, James L.000E22120Suspended

18402 Hawthorne Boulevardindefinitely effective

Torrance, California7/27/89.

Dorman, Patrick L.Suspended

4111 Palmetto Wayindefinitely effective

San Diego, California2/14/96.

Drabinsky, Gerald S.Suspended

2012 Roxbury Driveindefinitely effective

Los Angeles, California9/10/96.

Duff, Jonna CarolynE2297Suspended

723 West Robert Avenueindefinitely effective

Oxnard, California10/19/2006.

and

711 North A Street

Oxnard, California

and

707 South Broadway,

Suite #915

Los Angeles, California

Edwards, Frederick BartE3524Suspended

1937 Callison Streetindefinitely effective

Lomita, California9/9/04.

Elario, Maurice D., D.P.M.000E16210Suspended

1225 Murchison Driveindefinitely effective

Millbrae, California1/23/90.

1 – Medi-Cal Suspended and Ineligible Provider List

September 2007

susp K

2

PodiatristProvider

Number

Fanour, Michael M.000E35440Suspended

23521 Paseo De Valencia,indefinitely effective

#302E4/7/95.

Laguna Hills, California

Feldman, Gary S.E1871Suspended

4645 Havenhurst Avenueindefinitely effective

Encino, California2/12/03.

Freedland, Yosef000E29610Suspended

8215 Beverly Boulevard000E29611indefinitely effective

Los Angeles, California9/20/98.

Frese, James Lyle000E20610Suspended

276 Church Avenue, Suite Bindefinitely effective

Chula Vista, California2/20/00.

Gerardi, Vincent R.000E22580Suspended

1734 N. Riverside Avenueindefinitely effective

Rialto, California6/11/92.

Graves, Richard H.3954Suspended

10821 Oxnard Streetindefinitely effective

N. Hollywood, California6/4/2007.

and

3791 Katella Avenue

Los Alamitos, California

and

18085 S. 2nd Street

Fountain Valley, California

Grossman, Norman000E10090Suspended

Stanley000E100917/20/99

29500 Heathercliff,000E10092for 20 years.

Space 202

Malibu, California

Haddad, Imad Ibrahim3831Suspended

aka: Imad, Haddadindefinitely effective

21307 Romar Street8/23/2007.

Chatsworth, California

and

1833 E. Imperial Highway

Los Angeles, California

and

P.O. Box 617

Los Angeles, California

and

715 Foothill Boulevard

Glendora, California

and

1501 Agate Street

Colton, California

and

1420 E. Cooley Drive, #230

Colton, California

Heard, Geoffrey S.E3700Suspended

1256 Alameda Drive indefinitely effective

De Las Pulgas9/20/2006.

Redwood City, California

PodiatristProvider

Number

Herb, Gregory W.000E20410Suspended

361 Spode Wayfor 10 years

San Jose, California2/19/98.

Hight, Gregory E.E34070Suspended

12549 Madrone Forestindefinitely effective

Drive12/10/03.

Nevada City, California

or

1097 E Main Street, Suite G

Grass Valley, California

Hitchcock, Philip R.000E28310Suspended

6125 Sacramento Avenueindefinitely effective

Dunsmuir, California9/10/96.

Hitchcock, Philip000E28310Suspended

11050 Coloma Road, #G000E28311indefinitely effective

Rancho Cordova, California1/9/89.

Illions, Ronald I.0000E8860Suspended 120

10702 W. Katella Avenuedays effective

Anaheim, California9/14/91.

Jackson, Leondras G.E2555Suspended

16366 East Peak Courtindefinitely effective

Riverside, California11/20/2006.

and

251 Cajon Street,

Suite A

Redlands, California

and

1501 Agate Street

Colton, California

Johnson, Craig B.000E34160Suspended

1227 Sonora Avenue000E34161indefinitely effective

Glendale, California000E3416212/20/99.

Koscinski, Charles EFE1492Suspended

Jeromeindefinitely effective

10527 Wiley Burke Avenue07/16/04.

Downey, California

and

470 Nautilus Street,

Suite 302

La Jolla, California

Kuch, James E.Suspended

10002 Belfair Streetindefinitely effective

Bellflower, California4/20/99.

Lampell, Harvey J.000E14940Suspended

827 Joost Avenueindefinitely effective

San Francisco, California9/4/97.

Landrum, Keith000E28420Suspended

12231 S. Hawthorne000E28421indefinitely effective

Boulevard000E284226/1/95.

Hawthorne, California

1 – Medi-Cal Suspended and Ineligible Provider List

September 2007

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3

PodiatristProvider

Number

Lee, Sherman T.E3605Suspended

aka: Lee, Shermanindefinitely effective

Thomas12/10/02.

1000 Mission Street

South Pasadena, California

and

821 Adelaine Avenue

South Pasadena, California

and

425 West Bonita Avenue,

Suite 110

San Dimas, California

and

518 West Chapman Avenue

Placentia, California

Ledesma, Nester000E15150Suspended

3306 W. 3500indefinitely effective

Salt Lake City, Utah10/21/94.

Lentell, Brian M.Suspended

315 W. Alamos Avenue,indefinitely effective

Apartment 12512/9/96.

Clovis, California

Levy, Richard S.E3465Suspended

177 Main Street, Suite 235indefinitely effective

Fort Lee, New Jersey12/20/01.

Lichau, Kristin Lenore000E20430Suspended

196-A Sotoyome000E20431indefinitely effective

Santa Rosa, California8/20/98.

Liddy, Timothy J.E3631Suspended

8797 Beverly Boulevard, indefinitely effective

Suite 3501/29/03.

West Hollywood, California

Lisnek, Leslie, D.P.M.0000E8310Suspended

6306 York Boulevard, #2indefinitely effective

Los Angeles, California6/7/90.

Loggins, L. C.E3506Suspended

24285 Sunnymeadindefinitely effective

Boulevard3/20/02.

Moreno Valley, California

Lowe, Craig000E19970Suspended

1525 Superior Avenue,indefinitely effective

Suite 10011/12/93.

Newport Beach, California

Marin, Phillip G.000E21820Suspended

12500 Bruceville Road000E2182111/20/97

Elk Grove, Californiafor 10 years.

Maurer, Nelson H.000E28230Suspended

710 Lighthouse000E28231indefinitely effective

Pacific Grove, California1/6/97.

McFarland, James A.000E24160Suspended

2750 Eureka Way, #200indefinitely effective

Redding, California11/21/94.

PodiatristProvider

Number

Mintz, Myron000E14080Suspended

1740 El Camino Real000E14081indefinitely effective

Redwood City, California4/15/96.

Moalem, WilliamE1197Suspended

1495 Bairn Driveindefinitely effective

Hillsborough, California8/26/02.

Morris, Barry WayneEL00000723Suspended

3582 Behler Driveindefinitely effective

San Jose, California2/18/99.

Nybe, E. Edward, D.P.M.000E10940Suspended

1840 N. Bristolindefinitely effective

Santa Ana, California7/7/95.

Ott, Kenneth J.0000E8350Suspended

FPC Boron11/20/97

P.O. Box 500for 10 years.

Boron, California

Perry, Maurice A.000E38590Suspended

18039 Sherman Wayindefinitely effective

Reseda, CA7/19/01.

Pizarro, Joanna C.Suspended

82 Fulmar Laneindefinitely effective

Aliso Viejo, California05/18/00.

Pope, David K.000E34700Suspended

8907 Birch Leafindefinitely effective

Downey, California11/9/94.

Quigley, Michael A.E2651Suspended

2125 Alejandro Driveindefinitely effective

Santa Rosa, California8/7/01.

Rash, Wayne CharlesE3888Suspended

1291 W. Springfield Street,indefinitely effective

#1128/27/02.

Upland, California

Ravis, George000E27000Suspended

16914 Sherman Wayindefinitely effective

Van Nuys, California8/4/87.

Reginato, Richard A.000E12800Suspended

2357 Harrison Avenue000E12801indefinitely effective

Eureka, California5/1/78.

Salz, Joseph AlanEFE1606Suspended

818 North Juanita Avenue, indefinitely effective

Suite B7/8/02.

Redondo Beach, California

1 – Medi-Cal Suspended and Ineligible Provider List

September 2007

susp K

4

PodiatristProvider

Number

Sanders, Raymond000E24260Suspended

6634 Bridgemont Wayindefinitely effective

Citrus Heights, California7/19/96.

Savran, Steven H.E2891Suspended

25500 Rancho Niguel Road,indefinitely effective

#2206/20/01.

Laguna Niguel, California

Scholl, Siegmar000E17320Suspended

824 Wilmac Avenue000E17321indefinitely effective

Novato, California2/6/83.

Community PodiatryZZZ80216Z

GroupZZZ80217Z

Schultz, Alan Edwin000E15870Suspended

2491 Markham000E15871indefinitely effective

Thousand Oaks,000E1587208/28/00.

California

Shaber, Sydney000E26680Suspended

225 Crossroads Boulevard,000E26681indefinitely effective

#3521/5/97.

Carmel, California

Shook, Jon000E12640Suspended

6896 Magnolia Avenue,000E12641indefinitely effective

Suite A12/25/81.

Riverside, California

Shrum, Dale Gary, D.P.M. E3589 Suspended

42-335 Washington Street, indefinitely effective

#F3389/19/03.

Palm Desert, California

and

73730 Highway 111, Suite 4

Palm Desert, California

and

81-709 Drive Carreon

Boulevard, Suite A-3

Indio, California

Shvartsman, Stanley M.E2909Suspended

120 South Swall Drive, indefinitely effective

No. 21203/12/03.

Los Angeles, California

Spatz, Arthur000E30120Suspended

947 Fern Streetindefinitely effective

San Diego, California2/12/92.

Spaulding, Karla L.Suspended

1903 San Jose Avenueindefinitely effective

San Francisco, California6/20/2006.

Spencer, RoderickE1461Suspended

19781 Yorba Linda000E14610indefinitely effective

Boulevard, Suite 106000E1461112/13/00.

Yorba Linda, California000E14612

Sperling, Jerome000E18150Suspended

2680 E. Florence Avenueindefinitely effective

Huntington Park, California10/18/83.

PodiatristProvider

Number

Stagg, David B. E2982Suspended

1369 Felspar Street indefinitely effective

San Diego, California02/19/04.

and

7400 El Cajon Boulevard,

Suite 215

La Mesa, California

Stern, Eli, D.P.M.000E10680Suspended

2605 Mariposa Avenueindefinitely effective

Chico, California9/18/91.

Strugatsky, IgorE4369Suspended

4677 Da Vinci Streetindefinitely effective

San Diego, California4/20/2006.

Ta, Quao-Huan Van000E37350Suspended

271 19th Avenue, #4indefinitely effective

San Francisco, California2/18/99.

Tam, Thomas W., D.P.M.000E12320Suspended

450 Sutter Street, #1535000E12321indefinitely effective

San Francisco, California000E123223/26/79.

000E12323

Tinkle, Jon DennisE3974Suspended

1232 North Kings Roadindefinitely effective

West Hollywood, California07/07/03.

Vihinen, Jeffrie M.E3801Suspended

1940 16th Street, indefinitely effective

Apartment 010608/19/02.

Newport Beach, California

Warford, Mark A.Suspended

425 Cirby Way, Apt. 36indefinitely effective

Roseville, California12/4/94.

Washington, Patricia L.E3794Suspended

aka: Houzell, Patricia L.indefinitely effective

945 West Carson Street, 6/20/01.

Apartment 303

Torrance, California

Wilkes, Craig000E34320Suspended

800 Magnolta, Suite 118indefinitely effective

Corona, California4/23/97.

Williams, David L.Suspended

1155 E. Del Mar, #205indefinitely effective

Pasadena, California12/9/96.

Wong, Wan-Sing Victor Suspended

3754 Brunswick Courtindefinitely effective

San Francisco, California10/20/03.

Worley, Ronald David000E14540Suspended

411 Grand Avenue,000E14541indefinitely effective

Suite 30512/13/96.

Oakland, California

Yagoobian, Edward000E21720Suspended

23341 Golden Springsindefinitely effective

Drive, Suite D10/25/95.

Diamond Bar, California

1 – Medi-Cal Suspended and Ineligible Provider List

September 2007