Medi-Cal Suspended and Ineligible Provider List: November Update s1

Medi-Cal Suspended and Ineligible Provider List: November Update

ADDITIONS:

Osteopath (susp A)

Malabed, Helene B., 1447283817 Suspended D.O. 00AX67780 indefinitely effective 6950 65th St. 00AX67782 8/19/2010 Sacramento, CA and 1999 Mowry Ave. Fremont, CA and 11355 Sutters Fort Way Gold River, CA

Physician (susp A)

Anwar, Habib, M.D. A36305 Suspended aka: Habibullah Anwar, CGP062780 indefinitely effective M.D. 00A363050 7/19/2009 5555 Reservoir Dr. 1063476646 Ste. #206 San Diego, CA and 2850 6th Ave. Ste. #407 San Diego, CA and 45879 Corte Carmello Temecula, CA

Baber, James Randall C52817 Suspended 4252 Zion Valley Dr. indefinitely effective Fayetteville, AR 3/24/2010

Burman, Matthew Lloyd, G31513-CA Suspended M.D. 43-01-030145-MI indefinitely effective 10 W. Square Lake Rd. XPY058750 7/16/2009 Ste. #102 Bloomfield Hills, MI

Celniker, Ben M., M.D. USA19451 Suspended 4700 N. 51st Ave. 3729 indefinitely effective Phoenix, AZ FS030210 8/4/2010 and USA194510 406 W. Ocotillo Rd. XPY059180 Phoenix, AZ FS0302105

Charlestham, Sutham, A35696 Suspended M.D. 00A356960 indefinitely effective 26603 Ironwood Ave. 8/4/2010 Moreno Valley, CA and 12129 Vista De Cerros Moreno Valley, CA

Day, Frances Bailey G66391 Suspended 1425 Fourth St. 00G663910 indefinitely effective Eureka, CA 10/4/2010

Fenton, Drew Evan 00G555000 Suspended 316 W. Second 1508837873 indefinitely effective Ste. #112 9/9/2010 Los Angeles, CA

Friedman, Enrique J., A26023 Suspended M.D. 00A260230 indefinitely effective 1321 N. Harbor Blvd. 8/12/2010 Ste. #302 Fullerton, CA and 17759 Catalpa St. Hesperia, CA Physician (susp A) …(continued)

Friedman, Ernest H. CFE19198-CA Suspended 2221 Harcourt Dr. 35021180-OH indefinitely effective Cleveland Heights, OH 3/24/2010

Hsiao, Luke I-Jen, M.D. A32101 Suspended aka: Luke I. Hsiao, M.D. indefinitely effective 756 E. Highland Ave. 8/24/2010 San Bernardino, CA

Johnson, James Bruce C50403 Suspended 4224 Houma Blvd. indefinitely effective Ste. #430 4/15/2010 Metairie, LA

Lieberman, Alex, M.D. A20798 Suspended 6513 Atlantic Ave. indefinitely effective Bell, CA 7/15/2010 and 4651 Gage Ave. Ste. E Bell, CA and P.O. Box 91084 City of Industry, CA

Parikh, Bipin J. A38353-CA Suspended 224 Lafayette St. 25MA03943100 indefinitely effective Williston Park, NY -NJ 7/19/2010

Woodward, Artis, M.D. A40488 Suspended 13300 Hawthorne Blvd. 00A404880 indefinitely effective Hawthorne, CA 00A404887 9/13/2010 and 1023201100 5456 Valley Ridge Ave. #1 Los Angeles, CA and 4477 W. 118th St. Ste. #300 Hawthorne, CA

Yeung, Clement Ka-Chun G43350 Suspended 205 S. Vineyard St. indefinitely effective #203-205 11/10/2009 Honolulu, HI

Psychiatric Technician (susp C)

Lloyd, Kathleen 26667 Suspended 3612 Oregon Dr. indefinitely effective Santa Rosa, CA 10/27/2010

Psychologist (susp C)

Korn, Steven PSY8836 Suspended 155 Montgomery St. PJ0088360 indefinitely effective Ste. #507 9/22/2010 San Francisco, CA

Sick Room Supply (Durable Medical Equipment) (susp F)

Chikwendu, Kieran Suspended aka: Kiewan Chikwendy indefinitely effective Owner/Operator 8/19/2010 Inmate #244759 ASPC-Lewis Bachman Unit P.O. Box 3500 Buckeye, AZ Sick Room Supply (Durable Medical Equipment) (susp F) …(continued)

Movsesyan, Rafayel Suspended Owner/Operator indefinitely effective #56342-112 8/19/2010 FCI Beaumont Medium Federal Correctional Institution P.O. Box 26040 Beaumont, TX

Dentist (susp G)

Ensminger, Aletha M. 35254 Suspended c/o 5210 Valhalla Dr. B35254 indefinitely effective Carmichael, CA 1114076734 8/19/2010

Valde, Jane Dayoan Suspended 3544 Pacific Blvd. indefinitely effective San Mateo, CA 8/19/2010

Chiropractor (susp J)

Flores, Victor Manuel DC28370 Suspended 23952 Aliso Creek Rd. indefinitely effective Laguna Niguel, CA 5/6/2010

Markovich, David J. DC22068 Suspended 9263 N. Saybrook Dr. 1154351898 indefinitely effective #214 8/19/2010 Fresno, CA

Runco, Victor J. 27286 Suspended 4760-C Mission Gorge Pl. indefinitely effective San Diego, CA 10/13/2010

Stephenson, Shawn Jay DC26149 Suspended 953 Industrial Ave. indefinitely effective #115 4/2/2010 Palo Alto, CA

Valencia, Antonio Enrique 22196 Suspended 1053 Oriole Dr. indefinitely effective Point Mugo, CA 4/6/2010

Workman, Rodney Clay DC28921 Suspended 566 S. San Pedro St. indefinitely effective Rm. #284 3/24/2010 Los Angeles, CA

Home Health Aide (susp P)

Tirado, Juana 123363 Suspended 12040 Patton Rd. indefinitely effective Downey, CA 10/29/2009

Certified Nurse Assistant (susp R)

Anderson, Delphine 513175 Suspended 260 Flint Ct. indefinitely effective Apt. #11 8/28/2010 Hayward, CA

Brown, Linda 510800 Suspended 948 Rivera Dr. indefinitely effective Sacramento, CA 4/6/2010

Clemente, Miguel 505981 Suspended 808 San Francis Dr. indefinitely effective Petaluma, CA 10/6/2009

Farr, Alicia 513082 Suspended 2651 Queens Way indefinitely effective Redding, CA 5/18/2010 Certified Nurse Assistant (susp R) …(continued)

Karanja, Scolastica 583309 Suspended 5069 Bandera St. indefinitely effective Montclair, CA 8/5/2010

Perez, Sandra L. 505621 Suspended P.O. Box 585 indefinitely effective Parlier, CA 4/30/2010

Smith, Stephanie 517520 Suspended 1270 Circle Ave. indefinitely effective Apt. G 10/22/2009 Seaside, CA

Tirado, Juana 427315 Suspended 12040 Patton Rd. indefinitely effective Downey, CA 10/29/2009

Licensed Vocational Nurse (susp R)

Mayberry, Joann L. 123043 Suspended aka: Joann Lynece indefinitely effective Mayberry 1/20/2010 aka: Joann Lynece Willis-Mayberry aka: Joann Lynece Willis 1427 Phoenix Dr. #6 Fairfield, CA

Nurse Practitioner (susp R)

Romberg, Susan Jean 798 Suspended aka: Susan Jean De Bie indefinitely effective 20691 Cottonwood Rd. 3/11/2010 Yorba Linda, CA

Public Health Nurse (susp R)

Acevedo, Daniel Allen 71751 Suspended 1124 S. Chapel Ave. indefinitely effective Alhambra, CA 4/5/2010

Registered Nurse (susp R)

Abe, Janice Elaine 342101 Suspended 711 Diablo Ave. indefinitely effective #26 3/25/2010 Novato, CA

Acevedo, Daniel Allen 576072 Suspended 1124 S. Chapel Ave. indefinitely effective Alhambra, CA 4/5/2010

Bennett, Charles Alan 538245-CA Suspended 600 Hosking Ave. 109600-AZ indefinitely effective Unit #80A 4/19/2010 Bakersfield, CA

Casabar, Pacita 179302 Suspended Cavanting indefinitely effective 1707 Randall Way 3/24/2010 West Covina, CA

Delmendo, Milagros 273000 Suspended Malmuric indefinitely effective 20160 Via Cellini 10/3/2010 Northridge, CA

Evje, Katherine Lucille 503100 Suspended 9989 River View Cir. indefinitely effective Stockton, CA 3/11/2010 Registered Nurse (susp R) …(continued)

Freeman, John Eric 601295 Suspended 140 Carol Ln. indefinitely effective Oakley, CA 3/11/2010

Iaquinto, Karen Mortiboy 271519 Suspended 2840 Oak Creek Dr. indefinitely effective San Ramon, CA 3/15/2010

Isles, Andrew Hume 587084 Suspended 55 Poncetta Blvd. indefinitely effective Apt. #110 3/26/2010 Daly City, CA

Jordan, Rhonda Renee 469035 Suspended 9475 La Salle Ave. indefinitely effective Los Angeles, CA 7/30/2010

Kleese, Rhonda Lee 600714 Suspended 711 Diablo Ave. indefinitely effective #26 3/24/2010 Novato, CA

McIntire, Nora L. 503586 Suspended aka: Nora L. McGowan indefinitely effective aka: Nora Lucci 2/23/2010 aka: Nora Lucci McIntire aka: Nora Lucci Stern 201 W. Eucalyptus St. Ojai, CA

Minglee, Beverly Ann 658367 Suspended aka: Beverly Ann Jones indefinitely effective 12223 Highland Ave. 2/22/2010 #543 Rancho Cucamonga, CA

Orosz, Patricia Ann 565327 Suspended aka: Patricia Ann Liegerot indefinitely effective 7676 Masters St. 6/28/2010 Elk Grove, CA

Romberg, Susan Jean 276072 Suspended aka: Susan Jean De Bie indefinitely effective 20691 Cottonwood Rd. 3/11/2010 Yorba Linda, CA

Rouchleau, Jennifer Ann 545333 Suspended aka: Jennifer Ann Miller indefinitely effective 26630 Barton Rd. 3/9/2010 Apt. #2015 Redlands, CA and 191 Skyline Dr. Carpentersville, IL

Ulit, Albert Sarian 452324 Suspended 1224 Myra Ave. indefinitely effective Los Angeles, CA 2/16/2010

Varela, Anna Marie 514619 Suspended 223 La Paz Dr. indefinitely effective Imperial, CA 3/9/2010

White, Mary Kathleen 520892 Suspended 21251 Road U indefinitely effective Cortez, CO 2/22/2010

Respiratory Care Practitioner (susp S)

Brock, Paul 25769 Suspended 1533 W. 11th St. indefinitely effective #67 9/2/2010 Upland, CA

Jones, Cindy Marie 28374 Suspended 1555 Milan Dr. indefinitely effective Simi Valley, CA 3/27/2010 Business Owner (susp T)

Bagdasarian, Teresa Suspended 500 Alexandria St. indefinitely effective Glendale, CA 10/13/2010

Egiazarian, Vardges Suspended aka: David Akerman indefinitely effective 8109 Mammoth Ave. 10/13/2010 Panorama City, CA

Employee (susp T)

Chavez, Veronica Suspended aka: Veronica Chavez Ayala indefinitely effective aka: Maria Chavez 10/3/2010 aka: Veronica Ayala aka: Clara Chavez aka: Maria Luisa Chaves aka: Maria Lisa Chavez aka: Veronica Marie Chavez aka: Clara Perez Chavez aka: Clar Chavez aka: Angela Yadria Chavez 1830 Midfield Ave. Apt. #3 San Jose, CA

Perkins, Keshanna Marie Suspended 351 Red Spruce Pl. indefinitely effective Perris, CA 10/5/2010

In-Home Support Services Provider (susp U)

Achari, Yogesh Nadan Suspended 9245 Laguna Springs Dr. indefinitely effective #273 8/19/2010 Elk Grove, CA

Bagby, Ernest George Suspended 2150 S. Bardell Ave. indefinitely effective Apt. B 8/19/2010 Fresno, CA

Burnside-Hopson, Nina Suspended 7744 George River Ln. indefinitely effective Sacramento, CA 8/19/2010

Collins, Rosiland Yvette Suspended 2590 Capitales Dr. indefinitely effective #39 8/19/2010 Rancho Cordova, CA

Greer, James Marion Suspended 8120 Shada Way indefinitely effective Sacramento, CA 8/19/2010

Juarez, Jason Buddy Suspended 8929 El Oro Plaza indefinitely effective Elk Grove, CA 8/19/2010

Lupo, James Peter Suspended 5217 Moddison Ave. indefinitely effective Sacramento, CA 8/19/2010

Maldonado, Christina Suspended Denice indefinitely effective aka: Christina Maldonado 8/19/2010 aka: Christine Denise Maldonado aka: Christine Earle 3000 Howe Ave. #56 Sacramento, CA In-Home Support Services Provider (susp U) …(continued)

Matthews, Steven Suspended 314 Fairbanks Ave. indefinitely effective #4 8/19/2010 Sacramento, CA

Montue, Deaunie Suspended 4451 Gateway Blvd. indefinitely effective Apt. #559 8/19/2010 Sacramento, CA

Parks, Todd Suspended 5804 Birchwood Ct. indefinitely effective Elk Grove, CA 8/19/2010

Rohani, Mehrdad Suspended 1140 N. Columbus indefinitely effective Apt. #203 8/19/2010 Glendale, CA

Rucker, Sabrina Suspended 1026 E. Nardini St. indefinitely effective Queen Creek, AZ 8/19/2010

Saldana, Frances Dale Suspended 6836 Demaret Dr. indefinitely effective Sacramento, CA 8/19/2010

Seun, Pholla Suspended 2019 S. Hayston Ave. indefinitely effective Apt. #102 8/19/2010 Fresno, CA

Smith, Carrie C. Suspended 8206 La Almendra Way indefinitely effective Sacramento, CA 8/19/2010

REINSTATEMENTS:

Employee (susp T)

Arriola, Alicia 1/20/2010 (removed from pg. 2) 5835 Priory St. Bell Gardens, CA

CORRECTIONS:

(Corrections to the existing list are bolded)

Physician (susp A)

Mukerji, Sasanka, M.D. 00A168480 Suspended (corrected on pg. 62) P.O. Box 210 00A168481 indefinitely effective Napa, CA 00A168482 10/10/2008 and 1972649234 93 N. 14th St. San Jose, CA and 2133 Morrill Ave. San Jose, CA