Medi-Cal Suspended and Ineligible Provider List - March Update

ADDITIONS:

Physician (susp A)

Batanides, Steven G30145 SuspendedNicholas 00G301450 indefinitely effectiveaka: Steven N. 12/14/2012Batanides, M.D.1239 R St.Fresno, CAand5150 Graves Ave.Ste. #11-BSan Jose, CA

Fernandez, Louis G71660 SuspendedManuel indefinitely effective4855 Tanglewood Ct. 1/2/2013Atlanta, GA

Kao, David Peter A87967 Suspended300 Pasteur Dr. 00A879670 indefinitely effectiveStanford, CA 1982620076 1/2/2013and948 Wisconsin St.San Francisco, CA

Kho, Peter A36350 Suspended2 Scripps Dr. 00A363500 indefinitely effectiveSte. #310 12/14/2012Sacramento, CAand1525 La Chica Dr.Chula Vista, CA

Manohara, A34791 SuspendedSakrepatna 00A347910 indefinitely effective6001 Truxtum Ave. 1760545974 1/3/2013Unit #160Bakersfield, CA

Rowland, John B. A62825 Suspended7245 Franklin Ave. indefinitely effectiveApt. #25 12/27/2012Los Angeles, CA

Shah, Bihari M. A37529 Suspended1401 Garces Hwy. CGP164404 indefinitely effectiveDelano, CA 00A375290 1/31/2013and 1770555724901 Olive Dr.Bakersfield, CAandP.O. Box 2029Bakersfield, CA

Singh, Sawraj A42982 Suspended200 E. 6th Ave. XPY180010 indefinitely effectiveEllensburg, WA 12/28/2012and700 E. MountainView Ave.Ste. #502Ellensburg, WA

Webber, Michael Alan A94978 Suspended5216 N. New Jersey indefinitely effectiveSt. 10/9/2012Indianapolis, IN

Physician/Surgeon (susp A)

Manougian, Edward C17929 Suspended1517 Summit Rd. 00C179290 indefinitely effectiveBerkeley, CA 10/12/2012and1132 Lawrence Ct.El Cerrito, CA

Pharmaceutical Technician (susp E)

GarciaBueno, Cesar 44346 SuspendedAntonio indefinitely effectiveP.O. Box 131351 11/30/2012San Diego, CA

Preble, Douglas SuspendedParker indefinitely effective1041 Arbor Ln. 1/31/2013San Marcos, CA

Dentist (susp G)

Omrani, Behdad 52443 Suspendedaka: Behdad D52443 indefinitely effectiveOmarani G87939-01 10/18/20121271 Granville Ave. 1356526750Apt. #202Los Angeles, CA

Chiropractor (susp J)

Danaher, Steven 30603 Suspended712 D St. indefinitely effectiveSte. J 1/10/2013San Rafael, CA

Mills, Benjamin 26103 SuspendedAndrew indefinitely effective1052 Main St. 1/26/2013Ste. BMorrow Bay, CA

Occupational Therapist (susp O)

Yoshino, Kevin OT9052 SuspendedWesley indefinitely effective17516 Daphne Ave. 11/17/2012Torrance, CA

Home Health Aide (susp P)

Wheeler, Forrest 212493 SuspendedDwayne indefinitely effective729 S. Union Ave. 11/7/2012Unit #400Los Angeles, CA

Certified Nurse Assistant (susp R)

Sosing, Rosemarie 328170 Suspended1226 Myra Ave. indefinitely effectiveLos Angeles, CA 1/20/2013

Wheeler, Forrest 702441 SuspendedDwayne indefinitely effective729 S. Union Ave. 11/7/2012Unit #400Los Angeles, CA

Licensed Vocational Nurse (susp R)

Alexander, 34232 SuspendedGwendolyn Anne indefinitely effectiveaka: Gwendalyn Ann 2/28/2013Frazier AlexanderDownsaka: GwendolynAnne F. AlexanderDownsaka: GwendolynFrazier Alexanderaka: GwendolynAnne F. Downs2625 Alcatraz Ave.Unit #359Berkeley, CA

Bilyck, Margaret 54382 SuspendedElizabeth indefinitely effective230 Dolores St. 8/9/2012Unit #8San Francisco, CA

Bond, Shawn Elaine 2044563 Suspended1608 Cayenne indefinitely effectiveRidge Rd. 8/9/2012San Diego, CA

Brennan, Dawn 243962 SuspendedMarie indefinitely effective6690 Peppermint Dr. 8/18/2012Reno, NV

Devera, Dione 214012 SuspendedCamille indefinitely effective4150 Marathon St. 8/18/2012Apt. #417Los Angeles, CA

Eme, Nina Queen 200220 Suspended11638 York Ave. indefinitely effectiveUnit #14 2/3/2013Hawthorne, CA

Garcia, Robert 216176 SuspendedJoshua indefinitely effective4900 Overland Ave. 8/18/2012Unit #181Culver City, CA

Hernandez, Kathy D. 18239 Suspended1118 Carolina St. indefinitely effectiveVallejo, CA 8/18/2012

Hier-Johnson, 221505 SuspendedAlfred J. indefinitely effective597 Sadeir Way 8/18/2012Apt. #10Reno, NV

Jackson, Marqui 208690 SuspendedRayshel indefinitely effective1476 E. Chevy 2/3/2013Chase Dr.Apt. EGlendale, CA

Mitchell, Carrie 217869 SuspendedLynn indefinitely effective16912 Cumberland 1/31/2013Cir.Yorba Linda, CA

Licensed Vocational Nurse (susp R) . . . (continued)

Vagle, Erin Danielle 191771 Suspended1449 9th Ave. indefinitely effectiveSan Diego, CA 8/18/2012

Venable, Dorothy 44044 SuspendedRudine indefinitely effective601 13th St. 6/4/2012Marysville, CA

Washington, Belinda 158415 SuspendedLouise indefinitely effective2157 103rd Ave. 8/18/2012Oakland, CA

Nurse Anesthetist (susp R)

Khandan-Alai, Goli 3219 Suspendedaka: Goli A. indefinitely effectiveKhandan-Alai 12/7/2012aka: Goli A.KhandanP.O. Box 10177Costa Mesa, CA

Silegy, Eva Monica 2536 Suspendedaka: Eva Monica indefinitely effectiveToth 11/7/2012P.O. Box 1055Sun City, CA

Nurse Practitioner (susp R)

Brownlee, Tiffany 12961 SuspendedLaurel indefinitely effectiveaka: Tiffany 12/7/2012Browmleeaka: TiffanyTermeer-Brownlee837 SaltmeadowBay ArchApt. #311Virginia Beach, VA

Hernandez, Erika 21762 SuspendedManuella indefinitely effectiveaka: Erika Manuela 11/1/2012Prieto Hernandezaka: Diane Kazemian26437 WhisperingLeaves Dr.Santa Clarita, CA

Public Health Nurse (susp R)

Esters-Thames, 26874 SuspendedSharon indefinitely effectiveaka: Sharon 11/7/2012Elizabeth Thamesaka: Sharon E.Esters11858 StoneyPeak Dr.Unit #521San Diego, CA

Silegy, Eva Monica 42919 Suspendedaka: Eva Monica indefinitely effectiveToth 11/7/2012P.O. Box 1055Sun City, CA

Registered Nurse (susp R)

Ahluwalia, Jasbir 461660 SuspendedKaur indefinitely effective73S 55th St. 1/14/2013Renton, WA

Amen, Cynthia 535528 SuspendedLouise indefinitely effective1711 3rd St. 1/14/2013Eureka, CA

Barraza, Edward 524389 SuspendedLee indefinitely effective357 Collingwood St. 12/4/2012Unit #2San Francisco, CA

Bauer-Smith, 455470 SuspendedNancy Jean indefinitely effective1954 N. Greenfield 11/7/2012Ave.Clovis, CA

Bellegia, Denise 457484 SuspendedMarie indefinitely effectiveaka: Denise 10/26/2012Marie Lucker1879 Garland Ln.Anaheim, CA

Benjamin, Mary 479254 SuspendedLois indefinitely effectiveaka: Mary Lois 1/14/2013Rahming217 W. 66th St.Los Angeles, CA

Bird, Pamela Ann 556783 Suspendedaka: Pamela Ann indefinitely effectiveWright Bird 12/12/2012276 Carlyle Ct.Gilroy, CA

Brownlee, Tiffany 585132 SuspendedLaurel indefinitely effectiveaka: Tiffany 12/7/2012Browmleeaka: TiffanyTermeer-Brownlee837 SaltmeadowBay ArchApt. #311Virginia Beach, VA

Bushnell, Amanda 810714 SuspendedLinn indefinitely effective9951 Lemon St. 1/25/2013Villa Park, CA

Calantas, Thelma T. 486505 Suspendedaka: Thelma indefinitely effectiveBigaran Tulingan 11/16/2012154 N. Michigan Ave.Pasadena, CA

Campuzano, 718892 SuspendedAngela Dorothy indefinitely effective1101 Whitney Ranch 11/15/2012Pkwy.Apt. #932Rocklin, CA

Registered Nurse (susp R) . . . (continued)

Carter, Andrea 380917 SuspendedMarie L. indefinitely effectiveaka: Andrea Marie 1/2/2013Lechowit12691 AntelopeHills Dr.Lakeside, CA

Chanin, Michelle 497255 SuspendedElaine indefinitely effectiveaka: Michelle 1/14/2013Elaine GiubbiniP.O. Box 1125Frederick, CO

Cole, Jamie 604968 SuspendedElizabeth indefinitely effective563 E. El Paso Ave. 12/12/2012Unit #101Fresno, CA

Conner, Jennifer 711719 SuspendedMichelle indefinitely effective20251 Lake Forest 1/14/2013Dr.Unit #339Lake Forest, CA

Cottrell, Sheri 510410 Suspendedaka: Sheri Lynn indefinitely effectiveCottrell 12/7/2012P.O. Box 4042Estes Park, CO

Crescenzo, Vicki 564093 SuspendedElizabeth indefinitely effectiveaka: Vittoria 12/28/2012ElizabethCrescenzo1616 E. OceanBlvd.Unit 11Long Beach, CA

Dasher, Anna 683312 SuspendedCatherine indefinitely effective279 Heritage Glen Ln. 11/5/2012Rancho Cordova,CA

Davis, Karen O. 220672 Suspendedaka: Karen O. indefinitely effectiveBuckman 10/19/201220251 Lake ForestDr.Lake Forest, CA

Depot, Denise 32065 SuspendedAnnette indefinitely effective680 Timbermill Ln. 10/18/2012Orange Park, FL

Dunbar, Cynthia Lea 312676 Suspendedaka: Cynthia Roth indefinitely effective716 Paseo Del Mar 11/15/2012Palos VerdesEstates, CA

Registered Nurse (susp R) . . . (continued)

Esters-Thames, 270131 SuspendedSharon indefinitely effectiveaka: Sharon 11/7/2012Elizabeth Thamesaka: Sharon E.Esters11858 StoneyPeak Dr.Unit #521San Diego, CA

Flores, Kimberly 602182 SuspendedMae indefinitely effective2400 E. Luster Ln. 11/16/2012Des Moines, IA

Hernandez, 530416 SuspendedErika Manuela indefinitely effectiveaka: Erika Manuela 11/1/2012Prieto Hernandezaka: Diane Kazemian26437 WhisperingLeaves Dr.Santa Clarita, CA

Khandan-Alai, 580488 SuspendedGoli indefinitely effectiveaka: Goli A. 12/7/2012Khandan-Alaiaka: Goli A.KhandanP.O. Box 10177Costa Mesa, CA

Labute-Goen, 619732 SuspendedWendy Louise indefinitely effective7000 S. Paradise 11/5/2012Rd.Unit #2057Las Vegas, NV

Lavin, Laura Jean 350214 Suspendedaka: Laura Jean indefinitely effectivePetruschell 10/5/2012aka: Laura P.McMullin21001 Plummer St.Unit #103Chatsworth, CA

Lopez, Katherine 550225 SuspendedMarie indefinitely effectiveaka: Katherine 11/9/2012Notarangeloaka: KatherineMarie Williams14721 Woodland Dr.Fontana, CA

Lopez, Kirsten Lee 444561 Suspendedaka: Kristen Lee indefinitely effectiveGagliardo 11/30/2013aka: Kirsten LeeLunneberg10859 CaminitoColoradoSan Diego, CA

Registered Nurse (susp R) . . . (continued)

Lowry, James 601043 SuspendedMichael indefinitely effectiveaka: James Lowry 11/1/201216795 Roosevelt LandUnit CHuntington Beach,CA

Maughan, 631889 SuspendedMarlene Ann indefinitely effective5522 Betty 12/7/2012Jean Dr.Corpus Christi,TX

Medina, Beth Ann 575012 Suspendedaka: Beth Ann indefinitely effectiveLankford 11/14/2012aka: Beth AnnBarber1246 Croke Dr.Thornton, CO

Peace, Traci 608070 SuspendedLeigh indefinitely effectiveaka: Traci Leigh 12/7/2012Hurley Peace3793 Stemley Rd.Talladega, AL

Prado, Remedios 196914 SuspendedNebres indefinitely effectiveaka: Remedios 10/3/2012L. Nebres16144 Talbot Ct.Chino Hills, CA

Price, Ginger 535561 SuspendedDianne indefinitely effective1476 McCutchen 12/7/2012Rd.Cades, SC

Ramirez, Ronnie 675753 SuspendedRay indefinitely effective1020 W. Dickens 11/9/2012St.Slaton, TX

Roberts, Robin 352098 SuspendedRenee indefinitely effectiveaka: Robin R. 10/5/2012JacksonP.O. Box 276Hoopa, CA

Saunders, 606006 SuspendedBetina R. indefinitely effective50 Donald Ave. 11/6/2012Oakland, TN

Schweikhard 508784 SuspendedNancy K. indefinitely effective1516 Matanzas 10/30/2012Rd.Santa Rosa, CA

Scoggins, Stacy 426351 SuspendedAnn indefinitely effective2118 Myrtle 2/5/2013Beach Ln.Unit #1Danville, CA

Registered Nurse (susp R) . . . (continued)

Seiner, Mary Ann 351250 Suspended50 Woodside indefinitely effectivePlaza 10/17/2012Unit #545Redwood City, CA

Silegy, Eva 401674 SuspendedMonica indefinitely effectiveaka: Eva Monica 11/7/2012TothP.O. Box 1055Sun City, CA

Strika, Margaret 452175 Suspended5303 Highway 49 N. indefinitely effectiveUnit #27 11/28/2012Mariposa, CA

Sullivan, Charles 452190 SuspendedAdrian indefinitely effective100 Braddock St. 10/29/2012Unit #103Frostburg, MD

Torres, Staci 342131 SuspendedLin indefinitely effectiveaka: Staci Lin 11/7/2012Avery708 E. 1st St.Madison, IN

Valente, Mary 460886 SuspendedAlice indefinitely effectiveaka: Mary Valente 11/27/2012P.O. Box 430Penryn, CA

West, William 680901 SuspendedLonnie III indefinitely effective2429 E. Broadway 2/18/2013Apt #6Long Beach, CA

Williams, Alex 524009 Suspended1010 Pacific Ave. indefinitely effectiveApt. #610 10/26/2012Santa Cruz, CA

Williams, Michael 516373 SuspendedGene indefinitely effective3957 Ridge St. 10/26/2012Fair Oaks, CA

Wood-Russell 502956 SuspendedLindy Lee indefinitely effectiveaka: Lindy Lee 10/30/2012Woodrussellaka: Lindy Wood8183 Pequenia Ave.Atascadero, CA

Woodside, Marvin 331347 SuspendedLee indefinitely effective1612 48th Ave. 10/3/2012Unit #11San Francisco,CA

Yaley, Dawn Ellen 551069 Suspended20800 Lake indefinitely effectiveChabot Rd. 10/19/2012Apt. #310Castro Valley, CA

Respiratory Care Practitioner (susp S)

Bragg, William Gregory 27770 Suspended853 Commodore Dr. indefinitely effectiveUnit. #345 11/28/2012San Bruno, CA

Burton, Patti Varee 5741 Suspended7625 N. 1st St. indefinitely effectiveApt. #176 10/26/2012Fresno, CA

Castaneda, 26043 SuspendedMiguel Angel indefinitely effective2227 Foxtail Dr. 9/2/2011Palmdale, CA

Ford, Mark L. 20578 Suspended7524 Pinot Pl. indefinitely effectiveRancho 11/21/2012Cucamonga, CA

Hernandez, Danilo 28372 SuspendedWSP-RC, C-2-B, CDC #AL6061 indefinitely effective176 Low 2/2/2012P.O. Box 6600Wasco, CA

Kausin, Marixa 18656 Suspended5558 W. Birch Ave. indefinitely effectiveFresno, CA 11/10/2012

Moncrief, Brett Keith 13636 Suspended9298 Rocky Falls Ct. indefinitely effectiveElk Grove, CA 11/16/2012

Ramsey, Sonja R. 15913 Suspendedaka: Sonja Regina indefinitely effectiveHadnot 11/18/2012584 Sheffield WayPerris, CA

Thomson, Ingrid Anne 20909 Suspended105 Dream St indefinitely effectiveVacaville, CA 10/5/2012

Administrator (susp T)

Senior Vice President Suspendedof Physician Services indefinitely effectiveNicholson, Dante Lee 1/31/2013aka: Dante L.Nicholsonaka: DonaldNicholsonaka: Don LeeNicholson38513 DesertView Dr.Palmdale, CA

Business Owner (susp T)

Taylor, Sheryl Ann Suspendeddba: Taylor indefinitely effectiveIndependent Care 2/21/20136333 Fall River WaySacramento, CAand6245 Dias Ave.Sacramento, CA

Employee (susp T)

Charchyan, Liparit Suspended5822 Woodman Ave. indefinitely effectiveUnit #3 2/3/2013Van Nuys, CA

Ehigie, Camillus Ehimen Suspendedaka: Louis Kendry Alexis indefinitely effectiveaka: James S.Anders 2/3/2013aka: Arthur WilliamBectonaka: Camillis ChimenEhigleaka: Dave Mic Brown4800 Reforma Rd.Woodland Hills, CA

Lewis, Linda Arlene Suspendedaka: Linda Cannady indefinitely effective205 Standard St. 2/27/2013Unit FEl Segundo, CA

Padilla, Martin Ortiz Suspendedaka: Jose Sanchez indefinitely effectiveaka: Jesse Mendiles 2/21/2013aka: CarlosMark Padilla23103 Oshua Dr.Moreno Valley, CA

Wilde, Julie Ann Suspended965 Eucalyptus Dr. indefinitely effectiveEl Cajon, CA 2/27/2013

In-Home Support Services Provider (susp U)

Acevedo, Kathleen Suspended3042 Marysville Blvd. indefinitely effectiveSacramento, CA 2/11/2013

Bayne, Jennifer Diane Suspended410 W. Elm St. indefinitely effectiveLodi, CA 2/11/2013

Brent, Zena Denise Suspendedaka: Zena Denise indefinitely effectiveChapman 2/11/20132443 Mission Ave.Unit #8Carmichael, CA

Crosby, Duron Rashawn Suspended2816 Villarreal Way indefinitely effectiveModesto, CA 2/11/2013

Dawson, Treajetta Suspended851 Agusta Dr. indefinitely effectiveLathrop, CA 2/11/2013

Gavin, Sharese Suspended8133 Pinefield Dr. indefinitely effectiveSacramento, CA 2/11/2013

Jones, Robert Earl Suspended5226 Gordon Dr. indefinitely effectiveSacramento, CA 2/11/2013

Malanchuk, SuspendedEmma Losifvna indefinitely effective7484 Holworthy Way 2/18/2013Unit #236Sacramento, CA

In-Home Support Services Provider (susp U) . . . (continued)

Mclver II, Henry Suspendedaka: Henry indefinitely effectiveMclver III 2/18/2013409 E. MooreHaven Dr.Carson, CA

Patoc, Elvy Ramos SuspendedRamos indefinitely effective7616 Downing 2/18/2013Place WaySacramento, CA

Ramirez, Maria SuspendedLourdes indefinitely effective1326 W. 7th Pl. 2/18/2013Kennewick, WA

Reed, Denise SuspendedLorraine indefinitely effective2241 Somerset Dr. 2/18/2013Stockton, CA

Sostre, Crystal SuspendedLeann indefinitely effective417 Arches Ave. 2/21/2013El Dorado Hills, CA

Spivey, Montril Lynel Suspended417 Arches Ave. indefinitely effectiveEl Dorado Hills, CA 2/21/2013

Stevenson, Tianje Suspended415 E. 95th St. indefinitely effectiveLos Angeles, CA 3/1/2013

Vega-Vega, SuspendedAngelica Yoana indefinitely effective8176 Essen Way 2/25/2013Sacramento, CA

REINSTATEMENTS:

Physician (susp A)

De Zubiria, A70728 9/7/2012 (removed from pg. 26)Rodrigo 00A707280Castle Family 1215040563Health CenterBloss MemorialDistrict3605 Hospital Rd.Ste. HAtwater, CA

Haduong, Quan G57891 2/7/2013 (removed from pg. 40)533 Plaza Dr. 00G578910Santa Maria, CA 00G578911and 00G578912255 Broken ArrowRd. Nipoma, CAand6235 N. Fresno St. Ste. #103Fresno, CA and2420 ProfessionalCt.Las Vegas, NV

Kamson, A43596 2/7/2013 (removed from pg. 52)Adetokunto O. 00A4359602710 W. Manchester 1598838963Blvd.Inglewood, CAand4314 W. SlausonAve.Los Angeles, CAand2710 W. ManchesterBlvd.Ste. AInglewood, CA

Winkler, Heidi A50311 2/21/2011 (removed from pg. 114)Ann, M.D. 00A50311413132 Studebaker Rd. 1265456636Ste. #7Norwalk, CAand13330 Bloomfield Ave.Ste. #213Norwalk, CA

Psychologist (susp C)

Casey, Simon Andrew 1/30/2013 (removed from pg. 2)aka: John Caseyaka: Andrew Kececi250 L. RamalaSan Clemente, CA

Davenport, Keith PT22733 1/14/2013 (removed from pg. 3)Charles1667 Edgewater Ln.Camarillo, CA

Nurse Midwife (susp R)

Rice, David Michael 109598 5/20/2005 (removed from pg. 226)655 Corbett Ave.Unit #101San Francisco, CA

Registered Nurse (susp R)

Bjorgo, Karen Jean 687726 1/14/2013 (removed from pg. 12)116 E. College Ave.Unit #210Lompoc, CA

CORRECTIONS:

Hospital (susp P)

Los Angeles Doctors GR0053340 6/4/2012 (provider numbers removed from pg. 18)Hospital HSC30644FLA Metropolitan HSM30644FMedical Center HSP40644F2231 S. Western Ave. 1346389905Los Angeles, CA 1639195175

Licensed Vocational Nurse (susp R)

Wickham, Michele Ann EPS016820 9/13/2009 (provider numbers added on pg. 220)14015 Drexel Dr. RVN004950Magalia, CA 1558569343

Medical Center (susp T)

Los Angeles Doctors GR0053340 Suspended (provider numbers removed from pg. 43)Hospital HSC30644F indefinitely effectiveLA Metropolitan HSM30644F 6/4/2012Medical Center HSP40644F2231 S. Western Ave. 1346389905Los Angeles, CA 1639195175