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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
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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
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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