Medi-Cal Suspended and Ineligible Provider List - August Update

ADDITIONS:

Physician (susp A)

Harris, Darryl Clarence G88191-CA Suspended 2625 W. Alameda Ave. L3676-TX indefinitely effective Unit #412 1982644415 7/15/2012 Burbank, CA and 2126 S. La Brea Unit #104 Los Angeles, CA

Schaller, Douglas Alvin, G61159 Suspended M.D. 00G611590 indefinitely effective 1455 Crenshaw Blvd. 00G611591 2/29/2012 Ste. #110 00G611592 Torrance, CA 00G611593 and 1437 Lomita Blvd. Harbor City, CA and 333 N. Prairie Ave. Inglewood, CA and 10044 Westminister Ave. Garden Grove, CA and P.O. Box 1811 Tustin, CA

Psychologist (susp C)

Eibl, John F. PSY15585 Suspended P.O. Box 1215 indefinitely effective Paso Robles, CA 6/1/2012

Martinez-Romero, Sergio PSY15419 Suspended 11238 East Ave. R6 indefinitely effective Littlerock, CA 9/17/2011

Thompson, Linda PSY16656 Suspended 4540 Marloma Dr. indefinitely effective Rolling Hills Estate, CA 10/12/2011

Sick Room Supply (susp F)

Audcon Group of DME03370F Suspended Companies 1144335589 indefinitely effective Alex Uche – Owner 7/15/2012 4703 Brooks St. Montclair, CA

Dentist (susp G)

Omrani, Behdad 52443 Suspended 1271 Granville Ave. D52443 indefinitely effective Unit #202 G87939-01 7/4/2012 Los Angeles, CA 1356526750

Acupuncturist (susp I)

Lam, Kam Man AC329 Suspended 320 Yale Ave. AC0003290 indefinitely effective Claremont, CA 1437281722 4/19/2012 and 1528 Highpoint St. Upland, CA Chiropractor (susp J)

Bowser, Larry Kreig 11273 Suspended aka: Larry K. Bowser DC0112730 indefinitely effective 18333 Bear Valley Rd. 5/11/2012 Hesperis, CA and P.O. Box 308 Apple Valley, CA

Klassy, Thomas Michael 23031 Suspended 295 Main St. DC0230310 indefinitely effective Weed, CA 1245217884 5/30/2012

Simmons, Drew Phillip DC25099 Suspended 650 Larkfield Center indefinitely effective Ste. A-4 2/18/2012 Santa Rosa, CA

Laboratory Owner/Operator (susp M)

Adjian, Vahan Suspended Community Labs Inc. indefinitely effective 18946 Granada Cir. 7/4/2012 Porter Ranch, CA

Home Health Aide (susp P)

Bell, Taneshula 144993 Suspended 13572 Cheshire St. indefinitely effective Victorville, CA 2/28/2012

Ohringer, Sara H. 221711 Suspended 7319 Hazeltine Ave. indefinitely effective Apt. #17 5/20/2012 Van Nuys, CA

Onofre, Rubi 219169 Suspended P.O. Box 53 indefinitely effective Watsonville, CA 5/20/2012

Certified Nurse Assistant (susp R)

Bell, Taneshula 472593 Suspended 13572 Cheshire St. indefinitely effective Victorville, CA 2/28/2012

Chavez, Monica 730393 Suspended 5420 E. Grove Ave. indefinitely effective Fresno, CA 5/20/2012

Ferguson, Karrie 655207 Suspended 560 N. 4th St. indefinitely effective Portola, CA 5/20/2012

Garcia, Ricardo 766286 Suspended 551 California St. indefinitely effective Portola, CA 5/20/2012

Ohringer, Sara H. 723668 Suspended 7319 Hazeltine Ave. indefinitely effective Apt. #17 5/20/2012 Van Nuys, CA

Onofre, Rubi 677304 Suspended P.O. Box 53 indefinitely effective Watsonville, CA 5/20/2012

Licensed Vocational Nurse (susp R)

Thomas, Larry Charles Jr. 219271 Suspended 1841 Brookside Ct. indefinitely effective Yuba City, CA 7/22/2012 Nurse Practitioner (susp R)

O'Brien, Laura May 6263 Suspended aka: Laura O'Brien NP Furnisher indefinitely effective aka: Laura Roa 1/12/2012 aka: Laura May Cannon P.O. Box 684 Oregon House, CA

Public Health Nurse (susp R)

Bischel, Maureen Ann 55725 Suspended 1556 W. Herndon indefinitely effective Apt. #105 3/5/2012 Fresno, CA

O'Donnell, Stacie Noel 76241 Suspended aka: Stacie Noel McConnell indefinitely effective 15356 Carfax Ave. 12/30/2011 Bellflower, CA

Registered Nurse (susp R)

Addair, Michael Scott 656199 Suspended Rte. 1 Box 235A indefinitely effective Honaker, VA 10/19/2011

Anderson, Janine M. 289444 Suspended aka: Janine Marie Ross indefinitely effective 3200 W. Brenda Loop 10/20/2011 Flagstaff, AZ

Anderson, Sharon Gail 760193 Suspended 7635 69th St. N.E. indefinitely effective Marysville, WA 12/16/2011

Austin, Judith Lynn 525173 Suspended aka: Judith Lynn Zawacki indefinitely effective 25108 Marguerite Pkwy. 10/11/2011 Unit A353 Mission Viejo, CA

Barry, Lisa Alice 698752 Suspended aka: Lisa Alice Lombard indefinitely effective aka: Lisa Alice Holbrook 12/16/2011 315 Gay Rd. Griffin, GA

Bartlett, Pamela Recene 559129 Suspended aka: Pamela Recene Melzer indefinitely effective 11335 Pagosi Rd. 4/10/2012 Apple Valley, CA

Bischel, Maureen Ann 519783 Suspended 1556 W. Herndon indefinitely effective Apt. #105 3/5/2012 Fresno, CA

Biscocho, Glenda 628971 Suspended Deguzman indefinitely effective P.O. Box 934 5/20/2012 Depue, IL

Bradford, Melissa Renae 626642 Suspended 828 High St. indefinitely effective Aberdeen, OH 12/16/2011

Brooks, Roy Gregory 376716 Suspended 1303 S. Acacia St. indefinitely effective Compton, CA 7/14/2011

Bruus, Ann Elisabeth 582649 Suspended aka: Ann Elisabeth indefinitely effective Ledbetter 12/21/2011 513 Airel Ave. Foley, AL Registered Nurse (susp R) . . . (continued)

Byoune, Christina 549551 Suspended Antoinette indefinitely effective aka: Christina Antoinette 1/27/2012 Logan aka: Christina Antoinette Burton 7795 Antelope Rd. Unit #5 Citrus Heights, CA

Caporuscio, Elizabeth 511906 Suspended Lynn indefinitely effective 3101 Peninsula Rd. 11/23/2011 Unit #214 Oxnard, CA

Casper, Diann 372313 Suspended aka: Diann Lynn Casper indefinitely effective 1772 E. Palm Beach Dr 10/28/2011 Chandler, AZ

Cathey, Beverly Dianne 677505 Suspended aka: Beverly Bailey Cathey indefinitely effective 3614 Tonkins St. 9/16/2011 Greensboro, NC and 360 E. Erna Ave. Apt. J La Habra, CA

Celvi, Lynn Marie 668561 Suspended aka: Lynn Marie Thomas indefinitely effective 13210 Uvas Rd. 9/16/2011 Lot #20 Morgan Hill, CA

Chornomud, Barbara Lynn 389323 Suspended 9631 Innsbruck Dr indefinitely effective Huntington Beach, CA 11/23/2011

Christian, Brenda Gail 636067 Suspended 2530 Carriage Ln. indefinitely effective Apt. #1A 11/4/2011 Fredericksburg, VA

Cruz, Reynaldo D. Dela 648036 Suspended 1215 W. Resecrans Ave. indefinitely effective Unit #26 1/27/2012 Gardena, CA

Culver, Brenda Suzanne 498605 Suspended P.O. Box 437 indefinitely effective Moorpark, CA 12/28/2011

Dailey, Nadine Evelyn 443433 Suspended aka: Nadine Combs indefinitely effective 855 Hartzell Ave. 1/27/2012 Redlands, CA

Daoang, Joycelynn 370420 Suspended Geronimo indefinitely effective aka: Joycelynn Daoang 12/28/2011 Geronimo aka: Joycelynn Josephine Geronimo Daoang aka: Josephine Daoang P.O. Box 5344 Carson, CA

Dell'Amico, Mary Lynn 691877 Suspended 7 Judson Dr. indefinitely effective Montpelier, VT 12/2/2011

Dillon, Charles Clyde 380405 Suspended 1301 N. Chester Ave. indefinitely effective Pasadena, CA 7/13/2011 Registered Nurse (susp R) . . . (continued)

Dunn, Laura Mechelle 666693 Suspended aka: Laura M Daughtry indefinitely effective Dunn 12/16/2011 42 Pioneer Dr. Seale, AL

Fabian, Maryann 531816 Suspended aka: Mary Ann Fabian indefinitely effective 39 Park Ave. 12/21/2011 Binghamton, NY

Gassner, Terry Lee 202926 Suspended aka: Terry Lee Payseno indefinitely effective aka: Terry Lee Gross 12/28/2011 6349 Wine Ct. Alta Loma, CA

Giesbrecht, Nathan David 613855 Suspended 10582 French Meadows indefinitely effective Way 12/2/2011 Reno, NV

Hall, Jennifer Ellen not provided Suspended aka: Jennifer Ellen Maschke indefinitely effective aka: Jennifer Ellen Phillips 5/20/2012 911 Madalyn Ave. Tulare, CA

Hauser, Marjorie 691373 Suspended aka: Marjorie Bush indefinitely effective aka: Marjorie Clarice 1/27/2012 P.O. Box 41352 Santa Barbara, CA

Helms, Marilyn Jayne 291225 Suspended aka: Marilyn Jayne Fawley indefinitely effective aka: Marilyn Jayne Helminiak 1/27/2012 aka: Marilyn Jayne Klobertanz 2906 N. Cardell Cir. Tucson, AZ

Henry, April 639278 Suspended aka: April Michelle Darnell indefinitely effective 40409 Jacob Way 12/23/2011 Murrieta, CA

Holcomb, Deborah Sue 723367 Suspended 3 Trentwood Pl. indefinitely effective Rome, GA 10/15/2011

Imouokhome, Juliet 620507 Suspended aka: Juliet Aliletu indefinitely effective Imouokhome 11/7/2011 aka: Juliet Alilety Yakubu 26043 Galena Stone Ln. Katy, TX

James, Roberta 526029 Suspended aka: Roberta Lynn Tinnea indefinitely effective 1205 Alamo Creek Terrace 12/30/2011 Apt. #4 Paso Robles, CA

Jasin, Martha A. 672481 Suspended 3101 Pasadena Ave. indefinitely effective Long Beach, CA 2/16/2012

Jorgensen, Laurel Anne 668160 Suspended aka: Laurel Anne Harvey indefinitely effective P.O. Box 360985 1/27/2012 Milpitas, CA

Lange, Cheryl A. 586009 Suspended 1164 Cota St. indefinitely effective Santa Ynez, CA 1/27/2012 Registered Nurse (susp R) . . . (continued)

Lim, Mariya Vadinovna 667889 Suspended aka: Marya Lim indefinitely effective 20615 Mayall St. 12/16/2011 Chatsworth, CA

Love, Joni Denise 280917 Suspended aka: Joni Denise Hull indefinitely effective aka: Joni Denise Dudley Hull 12/30/2011 35309 U.S. Hwy. 285 Ojo Caliente, NM

Maiorana, Denise Ann 561918 Suspended 4359 Buckingham Ct. indefinitely effective Vadnias Heights, MN 1/27/2012

Maristela, Alfon C. 520468 Suspended 4387 Santa Rita Rd. indefinitely effective El Sobrante, CA 1/27/2012

Matthews, Kimberly Lynn 633940 Suspended P.O. Box 518 indefinitely effective Fultondale, AL 1/13/2012

Meadows, Elizabeth 698746 Suspended Ashley indefinitely effective 928 Pheasant Run 12/21/2011 Williamsburg, VA

Meehleib, Marsha 627696 Suspended Slosarova indefinitely effective 2567 Old Quarry Rd. 1/13/2012 Apt. #2435 San Diego, CA

Morgan, Therese 727875 Suspended 19932 Sweetgum Cir. indefinitely effective Unit #12 1/20/2012 Germantown, MD

Morrison, Katrina 460799 Suspended 807 One Oak Chase indefinitely effective Rosharon, TX 12/21/2011

Nekola, Kelly 714939 Suspended aka: Kelly Jolee Nekola indefinitely effective 7735 Erin Ct. 12/2/2011 Lincoln, NE

Newman, Ann Barbara 480167 Suspended aka: Ann Barbara Parks indefinitely effective aka: Ann Barbara Donaldson 11/4/2011 aka: Ann Barbara Pearce 46 N. Hayes Rd. Lapeer, MI

Nieto, Ignacio Jr. 653690 Suspended 1347 Aquarius Ct. indefinitely effective Bakersfield, CA 12/14/2011

O'Brien, Laura May 421367 Suspended aka: Laura O'Brien indefinitely effective aka: Laura Roa 1/12/2012 aka: Laura May Cannon P.O. Box 684 Oregon House, CA

Ocampo, Adelaida Dizon 511194 Suspended 27808 Gainesville Ave. indefinitely effective Hayward, CA 4/15/2011

O'Donnell, Stacie Noel 561536 Suspended aka: Stacie Noel McConnell indefinitely effective 15356 Carfax Ave. 12/30/2011 Bellflower, CA

Parker, Barry David 727397 Suspended 8019 E. Sundew Dr. indefinitely effective Tucson, AZ 12/16/2011 Registered Nurse (susp R) . . . (continued)

Raskin, Karen H. 321817 Suspended aka: Karen Hope Raskin indefinitely effective aka: Karen Wintroub Raskin 1/12/2012 aka: Karen Hope Wintroub 6211 W. Winchcomb Dr. Scottsdale, AZ

Ray, Eileen Teresa 468301 Suspended aka: Eileen Teresa Fee indefinitely effective 121 Greenbriar Dr. 1/26/2012 Simpsonville, SC

Robinson, Elizabeth Alicia 613715 Suspended 336 Saclan Terrace indefinitely effective Clayton, CA 8/23/2011

Rogers, Jenay Lynn 546340 Suspended aka: Jenay Lynn Venuti indefinitely effective 106 Parkwind Ct. 12/30/2011 Cary, NC

Short, Lisa Himes 698808 Suspended 1358 47th Ave. indefinitely effective San Francisco, CA 10/3/2011

Sibulo, Lemuel Bathan 538749 Suspended P.O. Box 4838 indefinitely effective Downey, CA 1/20/2012

Siveley, Jonathon W. 514247 Suspended aka: Robert Mose Freyta indefinitely effective 1130 Arcadia Ave. 12/30/2011 Unit E Arcadia, CA

Tebo, Carolyn H. 330440 Suspended aka: Carolyn Harpole Tebo indefinitely effective P.O. Box 2002 1/20/2012 Monterey, CA

Thompson, Lea Whitehead 658428 Suspended 7729 San Gabriel St. indefinitely effective Raleigh, NC 1/27/2012

Torti, Mark Anthony 548395 Suspended 5555 Rancho La Loma indefinitely effective Linda 12/30/2011 Paso Robles, CA

Valdez, Teresita Cadelina 229391 Suspended 3122 Penitencia Creek Rd. indefinitely effective San Jose, CA 6/24/2011

Vankham, Sourith 734928 Suspended 8745 Prospect Ave. indefinitely effective Santee, CA 12/30/2011

Vaughan, Marybeth 550145 Suspended aka: Marybeth Alexander indefinitely effective Vaughan 1/27/2012 5215 Pavo Rd. Thomasville, GA

Webster, Fe Isaac 609021 Suspended 533 Moss St. indefinitely effective Unit E-2 3/21/2012 Chula Vista, CA

Weeks, Robert McMillan 607145 Suspended 1300 Winding Ridge Ln. indefinitely effective Unit D6 1/6/2012 Valparaiso, IN Registered Nurse (susp R) . . . (continued)

Wilcox, Preston Walter Jr. 402022 Suspended aka: Preston Walter Murphy indefinitely effective aka: Preston Walter Larry 3/29/2012 Wilcox 1700 Garth Ave. Los Angeles, CA

Wood, Shanda Rae 724533 Suspended 76000 Frank Sinatra Dr. indefinitely effective Palm Desert, CA 1/13/2012

Woods, Michael J. Jr. 496257 Suspended 698 E. Browning Ave. indefinitely effective Fresno, CA 12/16/2011

Respiratory Care Practitioner (susp S)

Capranica, Rick Alan 26701 Suspended 1931 S. 174th Ln. indefinitely effective Goodyear, AZ 2/2/2012

Hillman, Steven Walter 17867 Suspended 30876 Epiplaniea Way indefinitely effective Winchester, CA 9/11/2011

Business Manager (susp T)

Marroquin, Aura Mariz Suspended aka: Aura Maria Soto indefinitely effective 3800 W. 27th St. 5/20/2012 Apt. #333 Los Angeles, CA

Business Owner (susp T)

Uche, Alex DME03370F Suspended Audcon Group of 1144335589 indefinitely effective Companies 7/15/2012 4703 Brooks St. Montclair, CA

Employees (susp T)

Giron, Concepcion Pinco Suspended aka: Connie Pinco Giron indefinitely effective 3400 Richmond Pkwy. 7/22/2012 Apt. #1902 San Pablo, CA

Gomez, Francisco Saucedo Suspended 8749 Tobias Ave. indefinitely effective Apt. #14 5/20/2012 Panorama City, CA

Ground Transportation (susp T)

Aghajanyan, Roman MTN01203F Suspended aka: Mike 1629112065 indefinitely effective Aghajanyan, Roland 7/4/2012 aka: George A & R Medical Transport 5300 Santa Monica Blvd. Ste. #216 Los Angeles, CA Marketer (susp T)

Banares, Elizabeth Suspended aka: Elizabeth Uniza indefinitely effective Banares 5/20/2012 aka: Elizabeth Cruz Uniza FCI Victorville Medium II Unit #56920-112 P.O. Box 5300 Adelanto, CA

Matinenzo, Crisencia T. Suspended aka: Crisencia Tumambing indefinitely effective Matienzo 5/20/2012 aka: Crisencia Tumanbing Ising CCM Long Beach Unit #49063-112 1299 Seaside Ave. San Pedro, CA

Private Citizen (susp T)

Hoskins, Peggy Lee Suspended aka: Peggy Lee Sumner indefinitely effective 559 Wayland Ct. 5/20/2012 Claremont, CA

Zaragoza, Claudia Suspended aka: Claudia Zargoza indefinitely effective aka: Claudia Castillo 5/20/2012 18145 10th St. Bloomington, CA

Recipient (susp T)

Slade, Tamra Lee Suspended aka: Tamra Lee indefinitely effective Slade-Hayes 5/20/2012 5 Natoma Ct. Chico, CA

Unlicensed Caregiver (susp T)

Narisco, Ma Socorro Suspended aka: Ma Socorro Patag indefinitely effective Narcisso 5/20/2012 aka: Masocorro P. Narciso FDC SEATAC Unit #56460-112 P.O. Box 13900 Seattle, WA

In-Home Support Services Provider (susp U)

Alverson, Cynthia Louise Suspended 2272 Fashion Ave. indefinitely effective Long Beach, CA 7/15/2012

David, Dante Alviz Suspended 7642 14th St. indefinitely effective Apt. #2 7/15/2012 Westminster, CA

Dixon, Debra Delorose Suspended 476 E. Ave. indefinitely effective Chico, CA 5/20/2012

Garsuta, Clarita Bayaoa Suspended 2436 43rd Ave. indefinitely effective Sacramento, CA 5/20/2012

Hardy, Betty Joyce Suspended 1319 S. Manhattan Pl. indefinitely effective Los Angeles, CA 7/22/2012 In-Home Support Services Provider (susp U) . . . (continued)

Lichtenauer, Elizabeth Suspended aka: Elizabeth Gloria indefinitely effective Martinez 5/20/2012 aka: Elizabeth Gloria Lichtenhauer 290 Farrell Ave. Gilroy, CA

Mansi, Marilyn Quintanilla Suspended 4408 Aragon Dr. indefinitely effective San Diego, CA 5/20/2012

McKenzie, Leonard Suspended 3836 Dry Creek Rd. indefinitely effective Sacramento, CA 5/20/2012

Ogle, Connie Lynn Suspended 2476 Streamside Ct. indefinitely effective Chico, CA 5/20/2012

Pryor, Angela Elizabeth Suspended 7320 Willowwick Way indefinitely effective Sacramento, CA 5/20/2012

Schuetz, Deborah Jayne Suspended 711 West East Ave. indefinitely effective Unit #13 5/20/2012 Chico, CA

Smith, Samona Sheniqua Suspended 4934 Ferigo Ln. indefinitely effective Sacramento, CA 5/20/2012

Strawn, Dianna Lyn Suspended aka: Diana Lyn Strawn indefinitely effective 3176 Cherokee Rd. 5/20/2012 Oroville, CA

Vang, Lisa Xia Suspended 12455 Alabama Rd. indefinitely effective Herald, CA 5/20/2012

Waller, Eric Lidale Suspended 7200 Jacino Ave. indefinitely effective Unit #4302 5/20/2012 Sacramento, CA

REINSTATEMENTS:

Physician (susp A)

Gray, Jeffrey T., M.D. G56251 6/25/2012 (removed from pg. 36) 354 Cernon St. 00G562510 Vacaville, CA 00G562511 and 00G562512 660 Sanitarium Rd. Deer Park, CA and 3449 Valle Verde Dr. Ste. C Napa, CA and 2443 Fair Oaks Blvd.. Unit #358 Sacramento, CA

Hernandez-Rivera, Jose A80166 6/25/2012 (removed from pg. 41) 1637 3rd Ave. 00A801660 Ste. H 1487702379 Chula Vista, CA

Strub, Daniel A25554 7/13/12 (removed from pg. 96) aka: Strub, Danny 12620 Monte Vista Rd. Ste. E Poway, CA Licensed Vocational Nurse (susp R)

Balley, Raymond E. VN160739 6/25/2012 (removed from pg. 164) 1258 Galen St. Duarte, CA

CORRECTIONS:

Respiratory Care Practitioner (susp S)

Leo, Harold Reith 4770 Suspended (address added on pg. 11) 38964 Mesquite Rd. indefinitely Palmdale, CA 11/21/2000 and 8209 Clemens Ave. Canoga Park, CA