M edi-Cal Suspended and Ineligible Provider List 1




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Medi-Cal Suspended and Ineligible Provider List 1


Employee Provider

Numbers


Abdoyan, Seta Thomas Suspended

7409 Irvine Ave. indefinitely effective

North Hollywood, CA 12/10/2008


Acovera, Moime Suspended

8988 Dalby Cove indefinitely effective

San Diego, CA 8/20/2006


Adamos, Nita Suspended

1317 D Ave. indefinitely effective

Unit #815 6/20/2006

National City, CA


Adeife, Sunday Adelani Suspended

5341 Walnut Ave. indefinitely effective

Unit #125 8/25/2011

Sacramento, CA


Adekunle, Fatai S. Suspended

12909 Hawthorne Blvd. indefinitely effective

Hawthorne, CA 11/21/2007

and

270 N. Canon Dr.

Unit #1369

Beverly Hills, CA


Adem, Sunday Joseph Suspended

aka: Edemenang, Sunday indefinitely effective

Joseph 11/19/2002

Edem, Joseph Enfiok

9277 Lincoln Blvd.

Unit #3273

Los Angeles, CA


Adkins, Jo Ann Suspended

aka: Barnes, Jo Ann indefinitely effective

aka: Walker, Joann 8/14/2006

aka: Moore, Joann

611 N. Van Ness

Fresno, CA


Affleje, Joaquin Suspended

Crisostomo indefinitely effective

631 E. 8th St. 6/20/2006

National City, CA


Afsharian, Payam M. Suspended

631 Georgina Ave. indefinitely effective

Santa Monica, CA 8/18/2005


Afzal-Brown, Valencia Suspended

aka: Cavalier, Mahogany indefinitely effective

aka: Cavalier, Valencia 6/26/2007

109 Prospect St.

Chula Vista, CA


Agazarian, Martiros Suspended

1088 E. Magnolia Blvd. indefinitely effective

Burbank, CA 7/20/2000


Agcaoil, Sonia Maritess Suspended

242 Atlantic Ave. indefinitely effective

Unit #6 11/16/2000

Long Beach, CA


Agopian, Ovsanna Suspended

aka: Agopian, Joanna indefinitely effective

16015 Kingsbury St. 10/20/2005

Granada Hills, CA


Employee Provider

Numbers


Aguaya, Sofia Suspended

10744 Woodruff Ave. indefinitely effective

Downey, CA 12/8/2010


Aguilar, Joel M. Suspended

750 E. Third St. indefinitely effective

Apt. N 5/06/2002

Pomona, CA


Aguirre, Claudia Suspended

aka: Claudia Barajas indefinitely effective

1255 Watson Ranch Way 8/25/2011

Dixon, CA


Ahmed, Khalid Suspended

319 Sandy Ln. indefinitely effective

Apt. E 6/20/2001

Suisun City, CA


Ahmed, Saeed Suspended

110 E. 129th St. indefinitely effective

Unit A8 8/20/2003

New York City, NY


Ahmed, Saeed Suspended

aka: Ashraf, Muhammad indefinitely effective

CDC T80720 8/20/2003

Wasco State Prison

P.O. Box 5500

Wasco, CA


Ahmed, Shahzad Suspended

aka: Ahmed, Bilal Junior indefinitely effective

aka: Shazad, Muhammad 8/20/2003

aka: Ahmed, Shazad

CDC T80718

Wasco State Prison

P.O. Box 5500

Wasco, CA


Akopyan, Daniel Suspended

2282 Gill Village Way indefinitely effective

Unit #1205 6/20/2000

San Diego, CA


Alexander, Mary Suspended

3828 Cypress St. indefinitely effective

Sacramento, CA 2/04/2003


Alfonso, Edna Suspended

9149 Newhall Dr. indefinitely effective

Unit #97 2/20/2011

Sacramento, CA


Allison, Keith Suspended

aka: Allison, Lynn indefinitely effective

3010 S. Normandie Ave. 10/19/2006

Apt. #1

Los Angeles, CA


Almazan, Abner Suspended

4814 Castle Rd. indefinitely effective

La Canada, CA 3/20/2003


Almazan, Maria Directo Suspended

4814 Castle Rd. indefinitely effective

La Canada, CA 11/26/2002


Employee Provider

Numbers


Altman, Charlotte Ethel Suspended

2400 San Dimas Canyon indefinitely effective

Rd. 8/30/2006

Unit #136

La Verne, CA


Alvarenga, Maria Marta Suspended

1319 Ingraham St. indefinitely effective

Unit #306 11/19/2002

Los Angeles, CA


Amirian, Amir Suspended

5608 Hoback Glen Rd. indefinitely effective

Hidden Hills, CA 9/20/2005


Anderson, Cathy Jean Suspended

No. #10504-023 indefinitely effective

Federal Prison Camp 6/18/2004

Dublin

5675 8th Street-Camp

Parks

Dublin, CA


Andrada, Maria Carmela Suspended

2139 Sr. Augusta Ln. indefinitely effective

Hawthorne, CA 11/16/2000


Andrews, Patricia Gail Suspended

aka: Goudeau, Patricia Gail indefinitely effective

687 W. 17th St. 4/25/2006

Ste.#3

San Bernardino, CA


Arciaga, Recy C. Suspended

7143 Kitty Hawk St. indefinitely effective

Fontana, CA 5/12/2004


Anzueto, Rosa Suspended

aka: Baires, Rosa indefinitely effective

9510 Karmont Ave. 8/04/2004

South Gate, CA


Apusen, Paul D. Suspended

2251 E. 21st St. indefinitely effective

Apt. C 3/25/2008

Signal Hill, CA


Armero, Juan Antonio Suspended

136 S. Pasadena Ave. indefinitely effective

Azusa, CA 10/26/2001


Arreola, Stephanie Suspended

2620 W. Ball Rd. indefinitely effective

Apt. #232 8/04/2004

Anaheim, CA


Employee Provider

Numbers


Artsrounian, Haik Suspended

TAFT CI indefinitely effective

P.O. Box 7001 8/19/2004

Taft, CA


Arutunyan, Anait Suspended

10131 Tujunga Canyon indefinitely effective

Blvd. 12/23/2007

Unit #6

Tunjunga, CA


Asares, Angelina Suspended

aka: Chang, Angelina indefinitely effective

214 S. Westmoreland Ave. 4/30/2007

Los Angeles, CA


Attikian, Armen Suspended

Victory Medical Supply indefinitely effective

6908 Mammoth Ave. 6/24/2004

Van Nuys, CA


Augur, Carol Leann Suspended

43800 Wilson Valley Rd. indefinitely effective

Hemet, CA 10/24/2006


Avetissian, Ashot Art Suspended

13227 Van Owen Ave. indefinitely effective

Unit #203 7/20/2000

North Hollywood, CA


Ayala, Aurelio Lopez Suspended

aka: Lopez Leo indefinitely effective

2111 Carnegie Ct. 12/23/2007

Oxnard, CA


Ayala, Danilo Suspended

13355 Wentworth St. indefinitely effective

Arleta, CA 8/30/2010


Ayala, Mauricio A. Suspended

507 Loma Dr. indefinitely effective

Unit #102 7/14/2008

Los Angeles, CA


Ayrapetyan, Tigran Suspended

330 N. Jackson St. indefinitely effective

Unit #218 4/21/2005

Glendale, CA


Bahamon, Ramiro Suspended

700 E. Washington St. indefinitely effective

Unit #206 8/20/2002

Colton, CA


Baird, Karin Lynn Suspended

12431 Windsor Dr. indefinitely effective

Yucaipa, CA 4/20/2003


Employee Provider

Numbers


Baires, Douglas Arturo Suspended

910 Karmont Ave. indefinitely effective

South Gate, CA 8/18/2000


Baghdasaryan, Lilit Suspended

7755 Jayseel St. indefinitely effective

Tujunga, CA 9/7/2010


Baker, Calvin C. Jr. Suspended

1944 Gardenview Ct. indefinitely effective

Santa Rosa, CA 12/25/2008


Baker, Melvin Otis Suspended

1211 Caminito Septimo indefinitely effective

Cardiff by the Sea, CA 8/18/2005


Baladjian, Christine Suspended

7028 Claire Ave. indefinitely effective

Reseda, CA 11/9/2010


Banos, Ana Luz Suspended

13729 E. Penn St. indefinitely effective

Unit #6 8/3/2006

Whittier, CA


Baquedano-Estrada, Elsa Suspended

318 N. Hobart indefinitely effective

Unit #3 8/3/2006

Los Angeles, CA


Barillas, Cesar A. Suspended

8301 S. Vermont Ave. indefinitely effective

A, B & C 8/23/2007

Los Angeles, CA


Barreto, Guillermo Jose Suspended

5338 Riley St. indefinitely effective

San Diego, CA 7/18/2002


Barton, Lupe Eva Suspended

22135 Debra St. indefinitely effective

Lake Forest, CA 8/20/2002


Basiloy, Maria Concepcion Suspended

3551 E. Ave. R-11 indefinitely effective

Palmdale, CA 9/5/2011


Bassey, Kristine A. Suspended

3230 N. Lincoln Ave. indefinitely effective

Unit #220 5/02/2003

Anaheim, CA


Beard, Brenda Gail Suspended

aka: Brenda Gail Zirkle indefinitely effective

15833 Fallen Leaf Rd. 6/13/2011

La Puenta, CA


Beasley, Stanley Jerome Suspended

P.O. Box 64317 indefinitely effective

Sunnyvale, CA 2/20/2011


Employee Provider

Numbers


Beauchamp, Lisa Marie Suspended

509 Sheids St. indefinitely effective

San Francisco, CA 4/09/2003


Beauford, Archie Suspended

Edward, Sr. indefinitely effective

aka: Beauford, James Edward 4/19/2007

aka: Beuford, Archie

1648 S. La Brea Ave.

Unit #1

Los Angeles, CA


Bedrosian, Yepram Suspended

1436 Hermosa Dr. indefinitely effective

Corona, CA 5/25/2001

Bellaire, Emily 296493 Suspended

7740 Watt Ave. indefinitely effective

Unit #105 1/11/2002

Antelope, CA


Bejanzadeh, Emil Suspended

1168 E. Alameda indefinitely effective

Unit #103 8/25/2004


Glendale, CA

Bello, Blasida Medel Suspended

18000 Hwy. 12 indefinitely effective

Unit #18 4/13/2004

Boyes Hot Springs, CA


Berezovsky, Yury Suspended

aka: Yuriy Berzovsky indefinitely effective

11856 Moorpark St. 3/24/2009

Apt. B

Studio City, CA


Bergman, Vanessa Marie Suspended

aka: Vanessa Marie Smith indefinitely effective

aka: Vanessa Keller 9/14/2008

19940 Rod Ct.

Tehachapi, CA


Bettencourt, Aubrie RN602412 Suspended

Elizabeth indefinitely effective

330 Birch St. 8/16/2006

Willows, CA


Bigornia, Susana Suspended

Lorenzana indefinitely effective

aka: Maldonado, Susana 1/19/2005

Lorenzana

Bigornia, Susan

3611 Ashby Ct.

Rowland Heights, CA


Employee Provider

Numbers


Bilben, Raymond Scott Suspended

2824 W. Beech Ave. indefinitely effective

Visalia, CA 2/24/2009


Birt, Angela Suspended

11530 Simms Ave. indefinitely effective

Inglewood, CA 3/24/2004


Blankenship, Kenneth Joseph Suspended

aka: Howe, Steve indefinitely effective

Inmate # 54652198 8/20/2001

USP Lompoc SCP

3901 Klein Blvd.

Lompoc, CA


Blankenship, Ruth Suspended

Christine Ely indefinitely effective

aka: Cruz, Cris 8/20/2001

Cruz, Maria

970 Campo Rd.

Spring Valley, CA


Blodger, Gary Darnell Suspended

1623 E. 33rd St. indefinitely effective

Oakland, CA 9/30/2002


Boettcher, William V. Suspended

#05579-082 indefinitely effective

FCI Sheridan 1/20/2006

Federal Correctional

Institution

P.O. Box 5000

Sheridan, OR


Bolding, Cynthia L. Suspended

555 Matmor Rd. indefinitely effective

Unit #163 7/22/2007

Woodland, CA

and

435 Aspen St.

Woodland, CA


Borja, Cuaujtemoe Suspended

aka: Borja, Peter indefinitely effective

1814 Bluehaven Ct. 5/20/2002

San Diego, CA


Employee Provider

Numbers


Boughton, Lloyd Suspended

Cornelius indefinitely effective

aka: Broughton, Lloyd 10/19/2006

26080 Baseline St.

Apt. V180

San Bernardino, CA


Bratcher, Louis Suspended

3656 N. Shirley Ave. indefinitely effective

Fresno, CA 8/20/2002


Brewer, Lisa Suspended

aka: Lisa Owens indefinitely effective

2072 N. Marks Ave. 5/3/2009

Unit #125

Fresno, CA


Briggs, Pleashette Latoya Suspended

210 N. Beechwood Ave. indefinitely effective

Unit #143 8/31/2006

Rialto, CA


Briseno, Angela Suspended

11080 Omelveny Ave. indefinitely effective

San Fernando, CA 11/23/2010


Brown, Marilyn Faye Suspended

aka: Faye, Marilyn indefinitely effective

aka: Brandon, Marilyn 5/20/2001

4418 2nd Ave.

Los Angeles, CA


Bruce, James Edward Suspended

1925 College Ave. indefinitely effective

and 1/08/2003

1369 N. Wall St.

San Bernardino, CA


Bryan, Anna Marie Suspended

10082 Nebula Way indefinitely effective

Sacramento, CA 8/24/2009


Buckley, Holly Anne Suspended

P. O. Box 96 indefinitely effective

Dutch Flat, CA 12/29/2008


Employee Provider

Numbers


Buendia, Natalie C. Suspended

aka: DeGuzman, Natalie indefinitely effective

Buendia 4/5/2007

587 S. St.

Unit #6

Glendale, CA


Bui, Huynhhoa Thi Suspended

Register # 42151-112 indefinitely effective

FCI Victorville Medium II 6/18/2009

P.O. Box 5700

Adelanto, CA


Bukhari, Samad Suspended

aka: Bukhari, Abdul indefinitely effective

1519 E. 1st St. 11/20/2001

Room #110

Santa Ana, CA


Bun, Sothary Ryan Suspended

aka: Bun, Ryan Sothary indefinitely effective

1683 E. S. St. 5/20/2001

Long Beach, CA


Burbank, Vicky Ann Suspended

2444 Don Pedro Rd. indefinitely effective

Ceres, CA 3/2/2009


Burks, Louis Suspended

aka: Johnson, Larry indefinitely effective

CDC # P20467 8/20/2002

Chuckawalla State Prison

P.O. Box 2349

Blythe, CA


Butler, Jennifer Mae Suspended

6311 Tempe Pass Ct. indefinitely effective

Bakersfield, CA 3/13/2008


Cabezas, Sandra Suspended

4200 Bardoz Ct. indefinitely effective

Antioch, CA 10/19/2009


Cabrera, Teresa Gomez Suspended

730 W. 4th St. indefinitely effective

La Habra, CA 11/19/2002


Calderon, Wendy Suspended

3813 Locke Ave. indefinitely effective

Los Angeles, CA 5/18/2006


Calimbas, Francis Suspended

aka: Calimbas, Frank indefinitely effective

615 Monterey Ave. 9/11/2003

Ste. F

Monrovia, CA


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