Table: enrolled_medi_cal_fee_for_service_ffs_providers , legal_name like A*

A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z  *

objectid	provider_source	provider_number	npi	owner_number	service_location_number	legal_name	enroll_status_eff_dt	provider_taxonomy	nemt_nmt_provider_type	anc_provider_type	fi_provider_type_cd	fi_provider_type	provider_license	fi_provider_specialty_cd	fi_provider_specialty	out_of_state_indicator	in_out_state	address_attention	address	address2	city	state	zip	zip_4	dhcs_county_cd	fips_county_cd	latitude	longitude	countyname
2	Fee-for-Service	1639596679	1639596679	1	1	ANDERSON, LAUREN R MD	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
23	Fee-for-Service	1760585228	1760585228	1	1	ACKERMAN, JILL L MD	6/11/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	77731	18	Ophthalmology	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
42	Fee-for-Service	1083672950	1083672950	1	1	ALLINA HEALTH SYSTEM	1/12/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	550 OSBORNE RD NE	None	FRIDLEY	MN	55432	2718	00	None	45.10790047	-93.256713	Anoka County
50	Fee-for-Service	1639496961	1639496961	2	1	AP ASSETS CORPORATION	11/13/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	25485 MEDICAL CENTER DR	STE 110	MURRIETA	CA	92562	6927	33	06065	33.55785761	-117.1842222	Riverside County
72	Fee-for-Service	1083144638	1083144638	1	1	ARGUETA, ERICK MD	12/11/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	187618	None	None	0	In state provider	None	25150 HANCOCK AVE	STE 206	MURRIETA	CA	92562	5989	33	06065	33.56635084	-117.1823956	Riverside County
111	Fee-for-Service	1124227285	1124227285	2	1	ALLIED HOME HEALTH CARE CORP	6/29/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	15220 CENTRAL AVE	UNIT A	CHINO	CA	91710	2691	36	06071	33.976467	-117.688949	San Bernardino County
124	Fee-for-Service	1164696969	1164696969	1	1	AKRAM, MUDASSIR MD	1/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2640 E BARNETT RD	E333	MEDFORD	OR	97504	4301	00	None	42.31645852	-122.834421	Jackson County
128	Fee-for-Service	1679034904	1679034904	1	1	ALL FOR HEALTH HEALTH FOR	12/13/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	ALL INC	303 SOUTH GLENOAKS BLVD	SUITE #9	BURBANK	CA	91502	1190	19	06037	34.18156737	-118.3040137	Los Angeles County
151	Fee-for-Service	1154380343	1154380343	1	1	ARAKERE, PUSHPALATH V MD	6/26/2009	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	88072	77	Infectious Disease	0	In state provider	MD	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
156	Fee-for-Service	1447680707	1447680707	1	2	AERTS, ROBERT P LMFT	6/13/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18409 US HWY 18	2	APPLE VALLEY	CA	92307	5686	36	06071	34.53954704	-117.2624839	San Bernardino County
164	Fee-for-Service	1558557736	1558557736	1	1	AM HEALTHCARE, INC	7/20/2007	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	510 E. HARVARD STREET	None	GLENDALE	CA	91205	0000	19	06037	34.14444076	-118.2497186	Los Angeles County
192	Fee-for-Service	1275681769	1275681769	1	1	AMBROSIUS MICHIYO PHD	4/17/2008	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1756 LACASSIE AVE	#200	WALNUT CREEK	CA	94596	7002	07	06013	37.90365538	-122.0665571	Contra Costa County
211	Fee-for-Service	1386346047	1386346047	1	1	ABDULLAH, JONATHAN B LMFT	3/22/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	30941 AGOURA ROAD	STE. 210	WESTLAKE VILLAGE	CA	91361	4658	19	06037	34.14489451	-118.795374	Los Angeles County
218	Fee-for-Service	1578896304	1578896304	2	1	ANGELICARE HOME HEALTH INC	12/22/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12598 CENTRAL AVE	SUITE 210	CHINO	CA	91710	6445	36	06071	34.02430506	-117.6894721	San Bernardino County
231	Fee-for-Service	1164047353	1164047353	1	1	ANDREW ALLEN MD CORPORATION	7/9/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	11878 AVENUE OF INDUSTRY	None	SAN DIEGO	CA	92128	3423	37	06073	32.99058739	-117.0752486	San Diego County
245	Fee-for-Service	1154747020	1154747020	1	8	ACN MEDICAL GROUP, INC	10/10/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2919 FRUITVALE AVE	None	OAKLAND	CA	94602	2108	01	06001	37.79351912	-122.2188931	Alameda County
257	Fee-for-Service	1770609711	1770609711	1	1	ANTELOPE VALLEY KIDNEY	3/10/2008	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	INSTITUTE, A PROF CORP	43932 15TH ST W	STE 103	LANCASTER	CA	93534	5234	19	06037	34.681131	-118.156684	Los Angeles County
273	Fee-for-Service	1336410034	1336410034	1	1	ALBANO, JUDITH LUCIA I LMFT	6/12/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	80 EUREKA SQ	STE 215	PACIFICA	CA	94044	2677	41	06081	37.6325943	-122.488748	San Mateo County
281	Fee-for-Service	1316069511	1316069511	1	1	ARMEN, ROBERT C MD INC	4/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	4875	41	Internal Medicine	0	In state provider	None	845 W LA VETA AVE	STE 107A	ORANGE	CA	92868	3930	30	06059	33.78064548	-117.8611107	Orange County
324	Fee-for-Service	1255394987	1255394987	1	1	AMIT KHERA, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
330	Fee-for-Service	1083672950	1083672950	1	1	ALLINA HEALTH SYSTEM	1/12/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	550 OSBORNE RD NE	None	FRIDLEY	MN	55432	2718	00	None	45.10790047	-93.256713	Anoka County
343	Fee-for-Service	1992778666	1992778666	1	1	ASOMBRADO, DORIS L NP	12/1/2017	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1288 CAMINO DEL RIO N	None	SAN DIEGO	CA	92108	1511	37	06073	32.7668181	-117.150708	San Diego County
416	Fee-for-Service	1679034904	1679034904	1	1	ALL FOR HEALTH HEALTH FOR	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ALL INC	303 SOUTH GLENOAKS BLVD	SUITE #9	BURBANK	CA	91502	1190	19	06037	34.18156737	-118.3040137	Los Angeles County
439	Fee-for-Service	1154380343	1154380343	1	1	ARAKERE, PUSHPALATH V MD	6/26/2009	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	88072	41	Internal Medicine	0	In state provider	MD	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
446	Fee-for-Service	1205450285	1205450285	1	1	ANGEL PATHWAY HOSPICE INC	10/25/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5300 SANTA MONICA BLVD	STE 204	LOS ANGELES	CA	90029	1258	19	06037	34.09075271	-118.305509	Los Angeles County
450	Fee-for-Service	1932125580	1932125580	1	1	AHN MEDICAL GROUP INC	11/1/1993	174400000X	NA	Other	026	PHYSICIANS	45633	02	General Surgery	0	In state provider	None	1300 N VERMONT AVE	STE 100	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
470	Fee-for-Service	1750062675	1750062675	1	1	AL-DUJAILI, HASHEM MD	7/1/2024	2085B0100X	NA	MRI Provider	026	PHYSICIANS	191655	30	Radiology	0	In state provider	None	1101 VAN NESS AVE	3RD FLOOR	SAN FRANCISCO	CA	94109	6919	38	06075	37.78610439	-122.421569	San Francisco County
476	Fee-for-Service	1043366305	1043366305	1	1	ARBID, MASAD I MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35390	40	Pediatrics	0	In state provider	None	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
511	Fee-for-Service	1427467851	1427467851	1	1	ABRAHAM, SANDRA	1/16/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
523	Fee-for-Service	1568700417	1568700417	1	1	AMERICAN COMFORT HOSPICE INC	5/10/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	539 N GLENOAKS BLVD	STE 301-A	BURBANK	CA	91502	3209	19	06037	34.18652984	-118.310858	Los Angeles County
552	Fee-for-Service	1326415373	1326415373	1	1	AU, VALERIE I MD	10/1/2020	207L00000X	NA	Other	026	PHYSICIANS	140717	05	Anesthesiology	0	In state provider	None	CLAY AND BUCHANNAN ST	None	SAN FRANCISCO	CA	94115	0000	38	06075	37.791126	-122.4309105	San Francisco County
569	Fee-for-Service	1316069511	1316069511	1	1	ARMEN, ROBERT C MD INC	4/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	4875	77	Infectious Disease	0	In state provider	None	845 W LA VETA AVE	STE 107A	ORANGE	CA	92868	3930	30	06059	33.78064548	-117.8611107	Orange County
609	Fee-for-Service	1710484001	1710484001	1	1	AMACKER, EMILEE MD	1/27/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	191708	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
625	Fee-for-Service	1891324620	1891324620	1	1	AN DILIGENT HOME HEALTH	3/1/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	17050 CHATSWORTH ST	SUITE 243	GRANADA HILLS	CA	91344	7817	19	06037	34.26477251	-118.5039945	Los Angeles County
632	Fee-for-Service	1598327033	1598327033	1	1	ALMELIGY, ABDALRAHMAN MD	8/29/2022	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
662	Fee-for-Service	1073713004	1073713004	1	1	ADVANCED EYE SURGERY CENTER	12/18/2007	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	627 W EAST AVE	None	CHICO	CA	95926	7201	04	06007	39.7504226	-121.8719084	Butte County
683	Fee-for-Service	1740510494	1740510494	1	1	ACCESS WOMENS HEALTHCARE	3/9/2010	193400000X	NA	Other	026	PHYSICIANS	96748	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	INC	756 E HIGHLAND AVENUE	None	SAN BERNARDINO	CA	92404	4005	36	06071	34.1359593	-117.2706508	San Bernardino County
698	Fee-for-Service	1659457463	1659457463	1	1	ADAMS, KRISTINA M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4245 ROOSEVELT WAY NE	MS 359110	SEATTLE	WA	98105	6008	00	None	47.65883901	-122.3177928	King County
735	Fee-for-Service	1205450285	1205450285	1	1	ANGEL PATHWAY HOSPICE INC	10/25/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5300 SANTA MONICA BLVD	STE 204	LOS ANGELES	CA	90029	1258	19	06037	34.09075271	-118.305509	Los Angeles County
744	Fee-for-Service	1790128296	1790128296	1	1	ALONSO, ALBERTO MD INC	5/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	102197	41	Internal Medicine	0	In state provider	None	6611 SEVILLE AVENUE	None	HUNTINGTON PARK	CA	90255	4801	19	06037	33.9789981	-118.2225949	Los Angeles County
746	Fee-for-Service	1710019039	1710019039	1	1	ARMANIOUS, NADER F MC	7/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	72796	13	Neurology (M.D. only)	0	In state provider	None	418 SAN FERNANDO MISSION	None	SAN FERNANDO	CA	91340	3530	19	06037	34.28283832	-118.4447463	Los Angeles County
760	Fee-for-Service	1235815234	1235815234	1	1	ARIYANDATH SREENIVASAN, SANJ	1/27/2025	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	EEV MD	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
787	Fee-for-Service	1912546292	1912546292	1	1	ARMSTRONG, BRITTANY R LMFT	3/26/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1274 CENTER COURT DR	#112	COVINA	CA	91724	3668	19	06037	34.07278979	-117.8637519	Los Angeles County
810	Fee-for-Service	1689005738	1689005738	1	1	AREVALO BARREIRO, EDITH A	7/11/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
814	Fee-for-Service	1568700417	1568700417	1	1	AMERICAN COMFORT HOSPICE INC	5/10/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	539 N GLENOAKS BLVD	STE 301-A	BURBANK	CA	91502	3209	19	06037	34.18652984	-118.310858	Los Angeles County
876	Fee-for-Service	1073777686	1073777686	1	1	ARMENIAN, PATIL MD	5/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96704	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 N. FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
883	Fee-for-Service	1992752513	1992752513	1	1	ARGO,TANYA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9395 CROWN CREST BLVD	None	PARKER	CO	80138	0000	00	None	39.5497445	-104.7700003	Douglas County
927	Fee-for-Service	1104271360	1104271360	1	1	AKHTAR, ABDULHADI M MD	9/29/2021	208800000X	NA	Other	026	PHYSICIANS	172688	None	None	0	In state provider	None	1127 WILSHIRE BLVD	805	LOS ANGELES	CA	90017	3909	19	06037	34.05270508	-118.2641005	Los Angeles County
962	Fee-for-Service	1225122906	1225122906	1	1	ALDROVANDI, GRACE M MD	9/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	46475	77	Infectious Disease	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
966	Fee-for-Service	1346529658	1346529658	1	1	AUNG, YIN-YIN OD	1/9/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	2020	01	06001	37.87133398	-122.2545466	Alameda County
974	Fee-for-Service	1225629413	1225629413	1	1	ALLIANCE CARE HOSPICE INC	11/6/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6550 VAN BUREN BLVD	STE C	RIVERSIDE	CA	92503	1544	33	06065	33.949953	-117.4540065	Riverside County
978	Fee-for-Service	1336898253	1336898253	1	1	AGUILAR, SABRINA	7/28/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 E GARVEY AVE N	B2	WEST COVINA	CA	91791	1544	19	06037	34.07280989	-117.8995249	Los Angeles County
1011	Fee-for-Service	1255389953	1255389953	1	1	ASHER, RAJIV MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PIONEER CARDIOVASCULAR	2149 E BASELINE RD, #103	None	TEMPE	AZ	85283	0000	00	None	33.377967	-111.894615	Maricopa County
1013	Fee-for-Service	1558565697	1558565697	1	1	ALLE-CORLISS, LUPE A LCSW	11/7/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
1019	Fee-for-Service	1922021070	1922021070	1	1	AGEE, JACKIE L MD	3/16/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	37462	40	Pediatrics	0	In state provider	None	500 UNIVERSITY AVE	None	SACRAMENTO	CA	95825	6504	34	06067	38.568402	-121.418019	Sacramento County
1041	Fee-for-Service	1134895899	1134895899	1	1	AKOPYAN, ANNA NP	3/18/2025	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1245 WILSHIRE BLVD	STE 303	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
1043	Fee-for-Service	1821540006	1821540006	1	1	ASTON, KRISTEN L	11/5/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	13220 JEFFERSON ST	None	YUCAIPA	CA	92399	5170	36	06071	34.01191379	-117.0209165	San Bernardino County
1066	Fee-for-Service	1225173297	1225173297	1	1	AGUILAR, NUBIA R LMFT	11/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
1076	Fee-for-Service	1386814671	1386814671	1	1	ANGEMI, CHRISTOPHER J DO	1/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	9812	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
1085	Fee-for-Service	1174723860	1174723860	1	1	ARISTIDES A. CAPIZZANO M.D.	8/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
1086	Fee-for-Service	1962161125	1962161125	1	2	ABDELHAK, ASHRAF	5/17/2023	342000000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	10630 TOWN CENTER DR	111	RANCHO CUCAMONGA	CA	91730	6805	36	06071	34.11112305	-117.5729644	San Bernardino County
1105	Fee-for-Service	1396772596	1396772596	1	1	AHMED, RABIA	8/31/1991	207P00000X	NA	Other	026	PHYSICIANS	44227	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
1111	Fee-for-Service	1760440036	1760440036	1	1	ANGULO-ZEVALLOS, GABRIE	12/3/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50195	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
1120	Fee-for-Service	1326425661	1326425661	1	1	ALGOS INC, A MEDICAL CORPOR	4/11/2018	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	PORATION	3434 MIDWAY DRIVE	SUITE 2001	SAN DIEGO	CA	92110	4924	37	06073	32.75065153	-117.2126147	San Diego County
1128	Fee-for-Service	1295211431	1295211431	1	1	AZARMI, HELEN MD	4/17/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	180939	None	None	0	In state provider	None	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	37	06073	32.90618683	-117.1814064	San Diego County
1151	Fee-for-Service	1033138714	1033138714	1	1	ATIGA, SCHUBERT J MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	53756	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
1167	Fee-for-Service	1972921567	1972921567	1	1	AGHENTA, ESE B MD	5/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	2825 E BARNETT ROAD	None	MEDFORD	OR	97504	0001	00	None	42.31650147	-122.8306005	Jackson County
1188	Fee-for-Service	1548521875	1548521875	1	1	ASSAAD, MARIAM M Y MD	11/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134023	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
1192	Fee-for-Service	1750303020	1750303020	1	1	ANCHETA, MARK V MD	7/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81200	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
1213	Fee-for-Service	1790041028	1790041028	1	1	AGUILUZ DUBON, ALLAN M MD	5/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127171	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
1241	Fee-for-Service	1033590211	1033590211	1	1	AMANO, JESSICA C DPM	9/4/2019	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
1247	Fee-for-Service	1225122906	1225122906	1	1	ALDROVANDI, GRACE M MD	9/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	46475	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
1259	Fee-for-Service	1225629413	1225629413	1	1	ALLIANCE CARE HOSPICE INC	11/6/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6550 VAN BUREN BLVD	STE C	RIVERSIDE	CA	92503	1544	33	06065	33.949953	-117.4540065	Riverside County
1294	Fee-for-Service	1245402072	1245402072	1	1	AMINI, MARYAM MD	10/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106088	41	Internal Medicine	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
1318	Fee-for-Service	1295817716	1295817716	1	1	ARVIN CHUN-YIN GEE, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	501 N GRAHAM ST	STE 580	PORTLAND	OR	97227	2003	00	None	45.54285348	-122.671035	Multnomah County
1329	Fee-for-Service	1417586017	1417586017	1	1	ADAMS, JAMAL D LPCC	12/15/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
1331	Fee-for-Service	1821540006	1821540006	1	1	ASTON, KRISTEN L	11/5/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	13220 JEFFERSON ST	None	YUCAIPA	CA	92399	5170	36	06071	34.01191379	-117.0209165	San Bernardino County
1360	Fee-for-Service	1346794112	1346794112	1	1	AVONDALE HME	10/30/2017	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	10750 W MCDOWELL ROAD	STE A110	AVONDALE	AZ	85392	5959	00	None	33.464916	-112.2911235	Maricopa County
1382	Fee-for-Service	1679798433	1679798433	1	1	ATWATER ELEM SD	6/16/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1401 BROADWAY AVE	None	ATWATER	CA	95301	3546	24	06047	37.34777935	-120.6114041	Merced County
1390	Fee-for-Service	1144541764	1144541764	1	1	AKHBARI, KAVEH DPM	3/2/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
1399	Fee-for-Service	1760440036	1760440036	1	1	ANGULO-ZEVALLOS, GABRIE	12/3/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50195	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
1408	Fee-for-Service	1326425661	1326425661	1	1	ALGOS INC, A MEDICAL CORPOR	4/11/2018	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	PORATION	3434 MIDWAY DRIVE	SUITE 2001	SAN DIEGO	CA	92110	4924	37	06073	32.75065153	-117.2126147	San Diego County
1411	Fee-for-Service	1538187786	1538187786	1	1	AZHAR,TURAB ALI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	166 4TH ST E T	None	ST PAUL	MN	55010	1142	00	None	44.94748068	-93.08830943	Ramsey County
1414	Fee-for-Service	1760527360	1760527360	1	1	AGHAYAN, CHRIS MD	8/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98179	08	Family Practice	0	In state provider	None	25775 MCBEAN PKWY	None	VALENCIA	CA	91355	3708	19	06037	34.40042013	-118.5511416	Los Angeles County
1415	Fee-for-Service	1699355222	1699355222	1	1	ANDERS, BRIAN P PA-C	8/6/2024	208M00000X	NA	Other	026	PHYSICIANS	22477	41	Internal Medicine	0	In state provider	None	1595 SOQUEL DR	STE 400	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
1438	Fee-for-Service	1720178387	1720178387	2	1	ANAND, KANWALJEET S MD	10/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138692	66	Emergency Medicine (Urgent Care)	0	In state provider	None	725 WELCH ROAD	STE 435	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
1439	Fee-for-Service	1033138714	1033138714	1	1	ATIGA, SCHUBERT J MD	6/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	53756	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
1440	Fee-for-Service	1528248267	1528248267	1	1	ARIEL, DANIT MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	105110	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
1512	Fee-for-Service	1922657592	1922657592	1	1	AIE, ANGELA PT	7/12/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
1562	Fee-for-Service	1740866615	1740866615	1	1	ATTENDA MEDICAL GROUP INC	5/3/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	4690 HOEN AVE	None	SANTA ROSA	CA	95405	7823	49	06097	38.441646	-122.665032	Sonoma County
1676	Fee-for-Service	1851692503	1851692503	1	1	AUM PHARMACEUTICALS INC	1/31/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 N EUCLID STREET	UNIT 103	ANAHEIM	CA	92801	4115	30	06059	33.8420837	-117.9415765	Orange County
1686	Fee-for-Service	1821176660	1821176660	1	1	ANICETTI, JOHN P MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80197	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
1696	Fee-for-Service	1326425661	1326425661	1	1	ALGOS INC, A MEDICAL CORPOR	4/11/2018	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	PORATION	3434 MIDWAY DRIVE	SUITE 2001	SAN DIEGO	CA	92110	4924	37	06073	32.75065153	-117.2126147	San Diego County
1728	Fee-for-Service	1528248267	1528248267	1	1	ARIEL, DANIT MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	105110	67	Endocrinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
1764	Fee-for-Service	1306992904	1306992904	1	1	AHLUWALIA, RAJ S MD	7/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96910	20	Orthopedic Surgery	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1285	19	06037	34.27904453	-118.459944	Los Angeles County
1769	Fee-for-Service	1609869296	1609869296	1	1	ALI, NAUSHEEN B MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	56510	45	Nephrology (Renal-Kidney)	0	In state provider	None	1801 W ROMNEYA DR	STE 207	ANAHEIM	CA	92801	1825	30	06059	33.8506615	-117.946413	Orange County
1772	Fee-for-Service	1831191386	1831191386	1	1	ADELMAN, WILLIAM P MD	1/3/2024	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	191122	None	None	0	In state provider	None	1120 W LA VETA AVE	STE 125	ORANGE	CA	92868	4235	30	06059	33.78029455	-117.864369	Orange County
1839	Fee-for-Service	1679680607	1679680607	1	1	AUNG, MAUNG H MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	32498	13	Neurology (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
1840	Fee-for-Service	1558302893	1558302893	2	1	ALLYN, D LANCY MD	11/1/1971	No Taxonomy Provided	NA	None	026	PHYSICIANS	21696	01	General Practice	0	In state provider	None	900 N DOUTY ST	None	HANFORD	CA	93230	3918	16	06031	36.33417687	-119.646063	Kings County
1850	Fee-for-Service	1740866615	1740866615	1	1	ATTENDA MEDICAL GROUP INC	5/3/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	4690 HOEN AVE	None	SANTA ROSA	CA	95405	7823	49	06097	38.441646	-122.665032	Sonoma County
1906	Fee-for-Service	1649493172	1649493172	1	1	AMPUERO, MARIA J LMFT	1/25/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15434 W SAGE ST	None	VICTORVILLE	CA	92395	3965	36	06071	34.51210263	-117.3272335	San Bernardino County
1915	Fee-for-Service	1023589124	1023589124	1	1	AMARAL, BEVERLY LMFT	3/7/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
1922	Fee-for-Service	1396961538	1396961538	1	1	ABDELKERIM, ASHRAF I MD	6/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94228	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
1951	Fee-for-Service	1952533960	1952533960	1	1	ABRAHAMIAN, HAROUTUN MD	5/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112196	30	Radiology	0	In state provider	None	43731 N 15TH ST WEST	None	LANCASTER	CA	93534	4785	19	06037	34.67731742	-118.1564784	Los Angeles County
1958	Fee-for-Service	1538184676	1538184676	1	1	ABARCA, ALEJANDRO LCSW	11/5/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17775 PLAZA DEL SUR RD	None	SONORA	CA	95370	8726	55	06109	37.94544802	-120.384072	Tuolumne County
1965	Fee-for-Service	1144934613	1144934613	1	1	ARAGON PRUDENCIO, KAREN I DO	2/20/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
1985	Fee-for-Service	1326425661	1326425661	1	1	ALGOS INC, A MEDICAL CORPOR	5/2/2018	103TB0200X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	PORATION	3434 MIDWAY DRIVE	SUITE 2001	SAN DIEGO	CA	92110	4924	37	06073	32.75065153	-117.2126147	San Diego County
2002	Fee-for-Service	1619124864	1619124864	1	1	ATHALE, NINAD R MD	5/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108914	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 230	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
2014	Fee-for-Service	1083130587	1083130587	1	1	ADVENTIST HEALTH PHYSICIANS	3/1/2021	207X00000X	NA	Orthopedic Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	222 W EULALIA ST	300	GLENDALE	CA	91204	2851	19	06037	34.12653215	-118.257121	Los Angeles County
2051	Fee-for-Service	1205966728	1205966728	1	1	ACKS-STEWART, CYNTHIA L PSYD	7/6/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	435 PETALUMA AVE	STE 136	SEBASTOPOL	CA	95472	4277	49	06097	38.39899727	-122.8215695	Sonoma County
2052	Fee-for-Service	1295114965	1295114965	1	1	ADVANCED CARE MEDICAL GROUP	8/17/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	3130 W CALDWELL AVE	None	VISALIA	CA	93277	7063	54	06107	36.298728	-119.326248	Tulare County
2057	Fee-for-Service	1609869296	1609869296	1	1	ALI, NAUSHEEN B MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	56510	41	Internal Medicine	0	In state provider	None	1801 W ROMNEYA DR	STE 207	ANAHEIM	CA	92801	1825	30	06059	33.8506615	-117.946413	Orange County
2083	Fee-for-Service	1215222153	1215222153	1	1	AZADEH, SHAADI M MD	8/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122960	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
2125	Fee-for-Service	1679680607	1679680607	1	1	AUNG, MAUNG H MD	2/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	32498	01	General Practice	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
2127	Fee-for-Service	1558302893	1558302893	2	1	ALLYN, D LANCY MD	11/1/1971	No Taxonomy Provided	NA	None	026	PHYSICIANS	21696	20	Orthopedic Surgery	0	In state provider	None	900 N DOUTY ST	None	HANFORD	CA	93230	3918	16	06031	36.33417687	-119.646063	Kings County
2136	Fee-for-Service	1063754745	1063754745	1	1	AVILA, JONATHAN T MD	2/26/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	139957	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
2138	Fee-for-Service	1740866615	1740866615	1	1	ATTENDA MEDICAL GROUP INC	5/3/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	None	4690 HOEN AVE	None	SANTA ROSA	CA	95405	7823	49	06097	38.441646	-122.665032	Sonoma County
2177	Fee-for-Service	1497725808	1497725808	1	1	ALEXANDER,RAJEEV MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 HILLYARD ST	STE 140	EUGENE	OR	97401	0000	00	None	44.04616862	-123.082151	Lane County
2194	Fee-for-Service	1881448926	1881448926	1	1	ANGELES DEL SOL CBAS LLC	12/18/2024	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	820 N DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	1309	19	06037	34.03449442	-117.8069812	Los Angeles County
2198	Fee-for-Service	1366270621	1366270621	1	1	AGANYA, MARK	10/7/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	548 UNIVERSITY DR	None	LEMOORE	CA	93245	3455	16	06031	0	0	None
2214	Fee-for-Service	1215178090	1215178090	1	1	AVERY, SAMANTHA DO	8/3/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	20839	None	None	0	In state provider	None	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
2216	Fee-for-Service	1114153905	1114153905	1	1	AVULA, LAKSHMI R MD	1/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106205	41	Internal Medicine	0	In state provider	None	250 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
2248	Fee-for-Service	1841837929	1841837929	1	1	ABRAHAM, BUSHRA	8/7/2021	156FX1800X	NA	Other	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	2370 CRENSHAW BLVD	STE O	TORRANCE	CA	90501	3352	19	06037	33.82340482	-118.3284822	Los Angeles County
2259	Fee-for-Service	1063971372	1063971372	1	1	ADEOSUN, ANTHONY DO	4/5/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	23411	41	Internal Medicine	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
2263	Fee-for-Service	1558348946	1558348946	1	1	AUSTIN, ARMAITY V MD	11/15/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42707	08	Family Practice	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06287152	-118.2029433	Los Angeles County
2268	Fee-for-Service	1942511571	1942511571	1	1	AKELLA, SAILAJA V DO	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	14137	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
2272	Fee-for-Service	1326425661	1326425661	1	1	ALGOS INC, A MEDICAL CORPOR	6/2/2021	103TB0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PORATION	3434 MIDWAY DRIVE	SUITE 2001	SAN DIEGO	CA	92110	4924	37	06073	32.75065153	-117.2126147	San Diego County
2339	Fee-for-Service	1376595140	1376595140	1	1	AGUILERA, BRIAN G MD	5/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94414	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	102 SAN MIGUEL AVE	None	SALINAS	CA	93901	3057	27	06053	36.65895947	-121.6556795	Monterey County
2414	Fee-for-Service	1922427913	1922427913	1	1	ANAYA, ANDRES M MD	10/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140174	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 MALL DR	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
2417	Fee-for-Service	1952651325	1952651325	1	1	ALAINA E MOORE	3/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7026 OLD KATY RD	STE 276	HOUSTON	TX	77024	2187	00	None	29.78388299	-95.44503208	Harris County
2424	Fee-for-Service	1386165421	1386165421	1	1	ARMSTRONG HOME HEALTH	12/20/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	SERVICES LLC	6216 MAIN AVE	STE B3	ORANGEVALE	CA	95662	4306	34	06067	38.678553	-121.2016275	Sacramento County
2426	Fee-for-Service	1740866615	1740866615	1	1	ATTENDA MEDICAL GROUP INC	5/3/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	4690 HOEN AVE	None	SANTA ROSA	CA	95405	7823	49	06097	38.441646	-122.665032	Sonoma County
2427	Fee-for-Service	1548217680	1548217680	1	1	ARULANANTHAM, KARUNYAN	7/19/2007	207RE0101X	NA	Endocrinology	026	PHYSICIANS	31408	67	Endocrinology	0	In state provider	MD	45074 10TH ST WEST	STE 109	LANCASTER	CA	93534	4826	19	06037	34.70233303	-118.1480513	Los Angeles County
2429	Fee-for-Service	1447855911	1447855911	1	1	ABRAHAM, CHRISTIANA NP	9/24/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
2476	Fee-for-Service	1275964371	1275964371	1	1	ATHAVALE, ANAND H MD	6/9/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	186474	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
2509	Fee-for-Service	1811941198	1811941198	1	1	ANDERSON, PETER G MD	7/31/1989	207P00000X	NA	Other	026	PHYSICIANS	25988	66	Emergency Medicine (Urgent Care)	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
2560	Fee-for-Service	1326425661	1326425661	1	1	ALGOS INC, A MEDICAL CORPOR	5/8/2018	103TB0200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	PORATION	3434 MIDWAY DRIVE	SUITE 2001	SAN DIEGO	CA	92110	4924	37	06073	32.75065153	-117.2126147	San Diego County
2589	Fee-for-Service	1689710436	1689710436	1	1	ACEVEDO GUTIERREZ, JUAN DAVI	4/7/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	79589	-	NOT APPLICABLE	0	In state provider	D LMFT	14140 BEACH BLVD	STE 120, 155, 200	WESTMINSTER	CA	92683	4453	30	06059	33.756966	-117.9894915	Orange County
2632	Fee-for-Service	1053532986	1053532986	1	1	ARCE-GOMEZ, LAURA E MD	5/24/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	123604	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
2666	Fee-for-Service	1992236780	1992236780	1	1	ANDERSON SMITH, NICOLE B MD	4/2/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	160604	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
2668	Fee-for-Service	1275578304	1275578304	1	1	ASHER, DAVID T MD	8/11/2019	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	67110	-	NOT APPLICABLE	0	In state provider	None	527 S ARCHER ST	None	ANAHEIM	CA	92804	2421	30	06059	33.82544775	-117.9572676	Orange County
2681	Fee-for-Service	1467867135	1467867135	1	1	ARDESHANA, MOHITKUMAR K MD	9/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146912	41	Internal Medicine	0	In state provider	None	2 WEST FERN ST	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
2708	Fee-for-Service	1821088519	1821088519	1	1	AUDELL, LAURA G MD	7/31/1995	207LP2900X	NA	Other	026	PHYSICIANS	52527	05	Anesthesiology	0	In state provider	None	11601 SANTA MONICA BLVD	None	LOS ANGELES	CA	90025	2907	19	06037	34.04458879	-118.4542015	Los Angeles County
2712	Fee-for-Service	1386165421	1386165421	1	1	ARMSTRONG HOME HEALTH	12/20/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	SERVICES LLC	6216 MAIN AVE	STE B3	ORANGEVALE	CA	95662	4306	34	06067	38.678553	-121.2016275	Sacramento County
2715	Fee-for-Service	1548217680	1548217680	1	1	ARULANANTHAM, KARUNYAN	7/19/2007	207RE0101X	NA	Endocrinology	026	PHYSICIANS	31408	01	General Practice	0	In state provider	MD	45074 10TH ST WEST	STE 109	LANCASTER	CA	93534	4826	19	06037	34.70233303	-118.1480513	Los Angeles County
2777	Fee-for-Service	1548467244	1548467244	1	1	ALHAMBRA UNIFIED SCHOOL DIST	1/1/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	HEALTH SERVICES DEPT	1515 WEST MISSION RD	None	ALHAMBRA	CA	91803	1618	19	06037	34.08224297	-118.1404375	Los Angeles County
2850	Fee-for-Service	1558306795	1558306795	1	1	ABOU-ZAMZAM, AHMED MD	8/1/2000	208600000X	NA	General Surgery	026	PHYSICIANS	85695	33	Thoracic Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
2909	Fee-for-Service	1639381619	1639381619	1	1	ALTAMIMI, SADIQ L MD	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128441	13	Neurology (M.D. only)	0	In state provider	None	2895 N TOWNE AVE	None	POMONA	CA	91767	9009	19	06037	34.098525	-117.7368955	Los Angeles County
2922	Fee-for-Service	1649493172	1649493172	1	2	AMPUERO, MARIA J LMFT	7/27/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	OLOGICAL SERVICES	15431 ANACAPA RD	F	VICTORVILLE	CA	92392	2458	36	06071	34.50544107	-117.3250832	San Bernardino County
2931	Fee-for-Service	1508886235	1508886235	1	1	ABERNATHY, SHIELDS B MD	8/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	42752	41	Internal Medicine	0	In state provider	None	1050 LAS TABLAS RD	STE 3	TEMPLETON	CA	93465	9792	40	06079	35.55442352	-120.7183455	San Luis Obispo County
2938	Fee-for-Service	1871907477	1871907477	1	1	ARNALL, ELIZABETH J DO	12/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15267	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
2970	Fee-for-Service	1679927578	1679927578	1	1	AKRAWE, SANDY P MD	4/14/2022	207R00000X	NA	Other	026	PHYSICIANS	173310	None	None	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
2981	Fee-for-Service	1851868491	1851868491	1	1	AUYEUNG, ISAAC PT	9/15/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
2985	Fee-for-Service	1457849333	1457849333	1	1	ASSEFA, MICHAEL MD	9/26/2024	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
3004	Fee-for-Service	1881776219	1881776219	1	1	ADETOLA, ADEGBENGA A MD	9/6/2010	207RN0300X	NA	Nephrology	026	PHYSICIANS	55507	45	Nephrology (Renal-Kidney)	0	In state provider	None	3591 E IMPERIAL HWY	SUITE 1	LYNWOOD	CA	90262	2684	19	06037	33.93048952	-118.205541	Los Angeles County
3017	Fee-for-Service	1639661127	1639661127	1	1	ARISE FORWARD CORP	11/23/2020	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	400 S.RAMONA AVE	212 A	CORONA	CA	92879	1443	33	06065	33.87678898	-117.5650086	Riverside County
3057	Fee-for-Service	1982700837	1982700837	1	1	AMAR SAFDAR	3/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	125 W HAGUE RD	STE 130	EL PASO	TX	79902	5814	00	None	31.77017683	-106.4996599	El Paso County
3066	Fee-for-Service	1174936207	1174936207	1	1	AGATEP, REY DO	12/9/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	19401	None	None	0	In state provider	None	250 5TH ST	None	HANFORD	CA	93230	5029	16	06031	36.32439821	-119.6472235	Kings County
3070	Fee-for-Service	1215227244	1215227244	1	2	ADACHI, KATYA MD	11/28/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	124695	-	NOT APPLICABLE	0	In state provider	None	135 CARMEN LANE	None	SANTA MARIA	CA	93458	7729	42	06083	34.92484952	-120.4374645	Santa Barbara County
3129	Fee-for-Service	1619745379	1619745379	1	1	APOLLO MEDICAL TRANSPORTATIO	5/23/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	N LLC	1049 BROADWAY	None	EL CAJON	CA	92021	4804	37	06073	32.8076427	-116.9453678	San Diego County
3145	Fee-for-Service	1386916138	1386916138	1	1	AVALON PEDIATRICS, INC.	4/5/2024	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	911 OAK PARK BLVD	STE 107	PISMO BEACH	CA	93449	3406	40	06079	35.13435006	-120.6051746	San Luis Obispo County
3146	Fee-for-Service	1437671005	1437671005	1	1	ALWAHAB, UNS K MD	9/18/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164450	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
3155	Fee-for-Service	1205034055	1205034055	1	1	ALSARRAF-ROPE, ILHAM H LMFT	9/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
3165	Fee-for-Service	1588642847	1588642847	1	1	AQUILINA, JOSEPH C MD	5/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81828	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
3167	Fee-for-Service	1356851695	1356851695	1	1	ADVENTIST HEALTH PHYSICIANS	8/6/2018	207X00000X	NA	Orthopedic Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	815 S FAIRMONT AVE	None	LODI	CA	95240	5116	39	06077	38.124	-121.2858895	San Joaquin County
3211	Fee-for-Service	1649440991	1649440991	1	1	AXIOM PAIN MANAGEMENT	11/10/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92411	1217	36	06071	34.131303	-117.3225325	San Bernardino County
3238	Fee-for-Service	1407591811	1407591811	1	1	AFRASIABI, ALANNA	2/27/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2208 CAMINO RAMON	None	SAN RAMON	CA	94583	1328	07	06013	37.77746122	-121.9677166	Contra Costa County
3249	Fee-for-Service	1255661658	1255661658	1	1	ABNOOSIAN, ARIN MD	6/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	112195	36	Psychiatry	0	In state provider	None	11165 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1113	19	06037	34.2738618	-118.4678337	Los Angeles County
3253	Fee-for-Service	1952492860	1952492860	1	1	ASSOCIATION OF SOUTH BAY	12/27/2013	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SURGEONS	23451 MADISON ST	STE 340	TORRANCE	CA	90505	4762	19	06037	33.81197627	-118.3478154	Los Angeles County
3271	Fee-for-Service	1184094229	1184094229	1	1	A CARE HOSPICE, INC	9/19/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	24445 HAWTHORNE BLVD	STE 105	TORRANCE	CA	90505	6562	19	06037	33.800319	-118.3512355	Los Angeles County
3311	Fee-for-Service	1013961630	1013961630	1	1	ADVANCED CARDIAC IMAGING	3/18/2005	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	INC	12632 BELLFLOWER BLVD	None	DOWNEY	CA	90242	4812	19	06037	33.9167831	-118.125273	Los Angeles County
3334	Fee-for-Service	1508816810	1508816810	1	1	ASADIFAR, MEHRDAD MD	12/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	5400 S RAINBOW BLVD	None	LAS VEGAS	NV	89118	1859	00	None	36.090072	-115.2405585	Clark County
3353	Fee-for-Service	1033467386	1033467386	1	1	AMERICAN HOSPICE CARE, INC	4/14/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	930 OAK ST	SUITE B	BAKERSFIELD	CA	93304	1060	15	06029	35.366463	-119.0387735	Kern County
3385	Fee-for-Service	1215227244	1215227244	1	1	ADACHI, KATYA A MD	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124695	01	General Practice	0	In state provider	None	3883 AIRWAY DR	STE 202	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
3397	Fee-for-Service	1659637833	1659637833	1	1	ANSARI, JESSICA R MD	12/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129780	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
3498	Fee-for-Service	1306073820	1306073820	1	1	ADVANCED SPINAL REHABILITATI	2/13/2024	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ON, INC	1585 BUTTE HOUSE RD	A	YUBA CITY	CA	95993	2200	51	06101	39.14802201	-121.643823	Sutter County
3499	Fee-for-Service	1548226442	1548226442	1	1	ARTHROSCOPIC & LASER	3/1/1998	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	5471 KEARNY VILLA RD	STE 100	SAN DIEGO	CA	92123	1141	37	06073	32.83480543	-117.138158	San Diego County
3501	Fee-for-Service	1457000432	1457000432	1	1	ALWAYS BY YOUR SIDE DOULA SE	1/24/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
3515	Fee-for-Service	1982789343	1982789343	1	1	AMERICAN BAPTIST HOMES OF	12/18/1980	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	THE WEST	819 SALEM DR	None	REDLANDS	CA	92373	8502	36	06071	34.04398086	-117.1722978	San Bernardino County
3517	Fee-for-Service	1255448924	1255448924	1	1	ALVAREZ, DAVID R MD	9/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82467	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
3524	Fee-for-Service	1740549419	1740549419	1	1	AVILA, JACOB O MD	9/6/2021	207P00000X	NA	Other	026	PHYSICIANS	173756	None	None	0	In state provider	None	31700 TEMECULA PKWY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
3538	Fee-for-Service	1386707651	1386707651	1	1	AZIZIRAD, OMEED MD	4/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99519	41	Internal Medicine	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
3554	Fee-for-Service	1598770471	1598770471	1	5	ALLISON CURTIS KINGSLEY MEOZ	1/16/2018	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	1	Border provider	MICHAEL & SANCHEZ PC	3730 S EASTERN AVE	None	LAS VEGAS	NV	89169	3321	00	None	36.12109698	-115.1188877	Clark County
3559	Fee-for-Service	1184094229	1184094229	1	1	A CARE HOSPICE, INC	9/19/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	24445 HAWTHORNE BLVD	STE 105	TORRANCE	CA	90505	6562	19	06037	33.800319	-118.3512355	Los Angeles County
3562	Fee-for-Service	1093885527	1093885527	1	1	AFFILIATED HOME HEALTH	7/12/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	240 SOUTH JACKSON STREET	SUITE 210	GLENDALE	CA	91205	1594	19	06037	34.14328301	-118.250071	Los Angeles County
3599	Fee-for-Service	1376533638	1376533638	1	1	ANDOLSEN, RICHARD J MD	1/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	31940	08	Family Practice	0	In state provider	None	465 MARCH AVE	STE A	HEALDSBURG	CA	95448	3371	49	06097	38.62593845	-122.8639725	Sonoma County
3601	Fee-for-Service	1316691900	1316691900	1	1	ARMSTRONG, GINGER BIRTH DOU	12/22/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
3602	Fee-for-Service	1639512239	1639512239	1	1	ADEWOLE, VIRGINIA A MD	1/27/2022	208M00000X	NA	Other	026	PHYSICIANS	163226	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
3627	Fee-for-Service	1346200425	1346200425	1	1	ALLEYNE, NEVILLE MD	12/31/1988	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	46085	20	Orthopedic Surgery	0	In state provider	None	3905 WARING RD	None	OCEANSIDE	CA	92056	4405	37	06073	33.18781249	-117.2923383	San Diego County
3640	Fee-for-Service	1649631011	1649631011	1	1	AMATYA, POOJA L PSYD	3/3/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
3641	Fee-for-Service	1033467386	1033467386	1	1	AMERICAN HOSPICE CARE, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	930 OAK ST	SUITE B	BAKERSFIELD	CA	93304	1060	15	06029	35.366463	-119.0387735	Kern County
3672	Fee-for-Service	1629121512	1629121512	1	1	ASANTE	12/1/1977	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	2825 E BARNET RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
3685	Fee-for-Service	1659637833	1659637833	1	1	ANSARI, JESSICA R MD	12/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129780	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
3704	Fee-for-Service	1790709202	1790709202	1	1	ALEXANDER, STEVEN MD	9/30/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	35106	45	Nephrology (Renal-Kidney)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
3709	Fee-for-Service	1174214050	1174214050	1	1	AMERICAN CARE MEDICAL TRANSP	6/7/2024	251T00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ORTATION	531 ENCINITAS BLVD	201	ENCINITAS	CA	92024	3773	37	06073	33.04711796	-117.2797731	San Diego County
3739	Fee-for-Service	1215003553	1215003553	1	1	AUDIOSCOPE AUDIOLOGY	10/15/1991	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	APC	7510 CLAIREMONT MESA BLV	STE 100	SAN DIEGO	CA	92111	1539	37	06073	32.83274153	-117.1574235	San Diego County
3775	Fee-for-Service	1902148091	1902148091	1	1	AU, ELIZABETH H MD	10/18/2020	207RC0200X	NA	Other	026	PHYSICIANS	134190	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
3789	Fee-for-Service	1275717647	1275717647	1	1	ARENAS, FRANCIS MD	8/5/2009	207R00000X	NA	Other	026	PHYSICIANS	105582	41	Internal Medicine	0	In state provider	None	5401 WHITE LANE	None	BAKERSFIELD	CA	93309	6279	15	06029	35.31803715	-119.0627831	Kern County
3791	Fee-for-Service	1881247807	1881247807	1	1	AHPC ORANGE COUNTY INC	8/12/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5000 BIRCH STREET	WEST TOWER, SUITE 3000	NEWPORT BEACH	CA	92660	2140	30	06059	33.66605605	-117.8586733	Orange County
3809	Fee-for-Service	1558658492	1558658492	1	1	AHUJA, NEHA K MD	8/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148498	01	General Practice	0	In state provider	None	411 30TH ST	STE 314	OAKLAND	CA	94609	3312	01	06001	37.81903474	-122.2649444	Alameda County
3819	Fee-for-Service	1447417258	1447417258	1	1	AKIMI, KHALIL MD	7/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108628	41	Internal Medicine	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
3820	Fee-for-Service	1952792467	1952792467	1	1	AHINASI, SONNIA A NP	10/3/2018	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1101 BRYAN AVE	STE E	TUSTIN	CA	92780	4401	30	06059	33.74272355	-117.8149529	Orange County
3827	Fee-for-Service	1386707651	1386707651	1	1	AZIZIRAD, OMEED MD	4/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99519	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
3844	Fee-for-Service	1598770471	1598770471	1	5	ALLISON CURTIS KINGSLEY MEOZ	1/16/2018	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	68	Hematology	1	Border provider	MICHAEL & SANCHEZ PC	3730 S EASTERN AVE	None	LAS VEGAS	NV	89169	3321	00	None	36.12109698	-115.1188877	Clark County
3849	Fee-for-Service	1508200700	1508200700	1	1	AVILES, CRISTINA V LMFT	7/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17326 EDWARD RD	None	CERRITOS	CA	90703	2444	19	06037	33.87401441	-118.0344613	Los Angeles County
3866	Fee-for-Service	1316123383	1316123383	1	1	ALEMU, ABNET A MD	1/3/2020	2086S0102X	NA	General Surgery	026	PHYSICIANS	115475	24	Plastic Surgery	0	In state provider	None	590 S INDIAN HILL BLVD	None	CLAREMONT	CA	91711	5212	19	06037	34.085313	-117.7191945	Los Angeles County
3925	Fee-for-Service	1417104076	1417104076	1	1	AGUAYO, JENNIFER MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109774	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
3953	Fee-for-Service	1952323719	1952323719	1	1	ANDREW EVAN MUCK, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	551 HILL COUNTRY DR	None	KERRVILLE	TX	78028	6085	00	None	30.04481871	-99.15170303	Kerr County
3962	Fee-for-Service	1801806674	1801806674	1	1	ARENE, IKECHUKWU O MD	7/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51962	41	Internal Medicine	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
3965	Fee-for-Service	1629121512	1629121512	1	1	ASANTE	12/1/1977	273Y00000X	NA	Other	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	2825 E BARNET RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
3968	Fee-for-Service	1407417744	1407417744	1	1	ARCHULETA, ANDY DPM	9/28/2023	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1300 W LODI AVE	STE W	LODI	CA	95242	3038	39	06077	38.13001447	-121.289931	San Joaquin County
3984	Fee-for-Service	1053052522	1053052522	1	1	ALLMED OF LOS ANGELES INC	1/31/2024	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	11001 MAIN ST	SUITE 301E	EL MONTE	CA	91731	2620	19	06037	34.07388835	-118.0353001	Los Angeles County
4010	Fee-for-Service	1184234726	1184234726	1	1	ACCESS COMMUNITY HEALTH	5/1/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER	520 NORTH MAIN STREET	SUITE 120	SANTA ANA	CA	92701	4623	30	06059	33.749316	-117.868123	Orange County
4030	Fee-for-Service	1750908109	1750908109	1	1	ALOE VERA HOSPICE LLC	2/10/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	18345 VENTURA BLVD	SUITE 206	TARZANA	CA	91356	4241	19	06037	34.16738049	-118.5325057	Los Angeles County
4081	Fee-for-Service	1881247807	1881247807	1	1	AHPC ORANGE COUNTY INC	8/12/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5000 BIRCH STREET	WEST TOWER, SUITE 3000	NEWPORT BEACH	CA	92660	2140	30	06059	33.66605605	-117.8586733	Orange County
4095	Fee-for-Service	1295888543	1295888543	1	2	AMERICADE HEALTH SERVICES	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	420 N MONTEBELLO BLVD	SUITE 203	MONTEBELLO	CA	90640	4263	19	06037	34.01651383	-118.1060207	Los Angeles County
4098	Fee-for-Service	1558658492	1558658492	1	1	AHUJA, NEHA K MD	8/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148498	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	411 30TH ST	STE 314	OAKLAND	CA	94609	3312	01	06001	37.81903474	-122.2649444	Alameda County
4157	Fee-for-Service	1457624793	1457624793	1	1	ARMSTRONG, JUDITH L NP	10/23/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
4198	Fee-for-Service	1831378470	1831378470	1	1	ADAMS, JAMES C MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51227	01	General Practice	0	In state provider	None	1911 OAK PARK BLVD	None	PLEASANT HILL	CA	94523	4601	07	06013	37.93369052	-122.0746005	Contra Costa County
4226	Fee-for-Service	1609062702	1609062702	1	1	ASIN LEONARD BD	1/1/1979	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	6200 WILSHIRE BLVD	None	LOS ANGELES	CA	90048	5801	19	06037	34.06319291	-118.3636025	Los Angeles County
4258	Fee-for-Service	1457926214	1457926214	1	1	ALPHA MEDICAL TRANSPORTATION	6/2/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LLC	555 5TH ST	36030	LOS ANGELES	CA	90013	1010	19	06037	34.04988385	-118.2534052	Los Angeles County
4285	Fee-for-Service	1700012457	1700012457	1	1	AVERBACH, SARAH H MD	4/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128990	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	RM 6D	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
4293	Fee-for-Service	1184743544	1184743544	1	1	ANAND, WAYNEINDER S MD	10/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93383	41	Internal Medicine	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
4299	Fee-for-Service	1184234726	1184234726	1	1	ACCESS COMMUNITY HEALTH	5/1/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER	520 NORTH MAIN STREET	SUITE 120	SANTA ANA	CA	92701	4623	30	06059	33.749316	-117.868123	Orange County
4311	Fee-for-Service	1013971001	1013971001	1	1	ANDERSON, MARK S MD	4/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87117	67	Endocrinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
4318	Fee-for-Service	1750908109	1750908109	1	1	ALOE VERA HOSPICE LLC	2/10/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18345 VENTURA BLVD	SUITE 206	TARZANA	CA	91356	4241	19	06037	34.16738049	-118.5325057	Los Angeles County
4326	Fee-for-Service	1184234726	1184234726	1	2	ACCESS COMMUNITY HEALTH	2/28/2023	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	24953 PASEO DE VALENCIA	STE 7C	LAGUNA HILLS	CA	92653	4337	30	06059	33.60028568	-117.7010887	Orange County
4327	Fee-for-Service	1215199781	1215199781	1	1	AUDREY K MCMACKEN	10/26/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2615 FAIRWAY ST	None	DICKINSON	ND	58601	2590	00	None	46.88685143	-102.8241973	Stark County
4349	Fee-for-Service	1881222974	1881222974	1	1	AKANUMA, NAOKI MD	8/19/2024	390200000X	NA	Other	026	PHYSICIANS	186454	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
4393	Fee-for-Service	1922133354	1922133354	1	1	AGUILAR, ELSA M MD	5/31/1984	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	54577	40	Pediatrics	0	In state provider	None	1000 N STUDEBAKER RD	None	LONG BEACH	CA	90815	4957	19	06037	33.78042309	-118.1026918	Los Angeles County
4396	Fee-for-Service	1770760951	1770760951	1	1	ANTONIO, KEVIN N MD	6/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99518	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
4420	Fee-for-Service	1871523019	1871523019	1	1	AICHOURI, ABDELLATIF A MD	5/10/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	87435	None	None	0	In state provider	None	536 CAMINO MERCADO	STE.306	ARROYO GRANDE	CA	93420	1418	40	06079	35.12986992	-120.6006027	San Luis Obispo County
4459	Fee-for-Service	1174716344	1174716344	1	1	ASARAVALA, MANISH R MD	4/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111168	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
4465	Fee-for-Service	1336201482	1336201482	1	1	AURORA GRACE HWANG MD	9/3/2008	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	835 N SEQUOIA AVE	None	LINDSAY	CA	93247	1424	54	06107	36.21351337	-119.0961199	Tulare County
4472	Fee-for-Service	1457414658	1457414658	1	1	AZIZIAN, VAHE T MD	2/8/2015	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	39786	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2840 E LOS ANGELES AVE	None	SIMI VALLEY	CA	93065	3937	56	06111	34.27167882	-118.7404467	Ventura County
4509	Fee-for-Service	1093314296	1093314296	1	1	ARISTIZABAL, KIM RCP	1/13/2024	2278P1006X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
4513	Fee-for-Service	1326242983	1326242983	1	2	ANDREW GINZEL MD	7/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7600 BEECHNUT ST	None	HOUSTON	TX	77074	4302	00	None	29.69169348	-95.521563	Harris County
4516	Fee-for-Service	1871694398	1871694398	1	1	AXELRODE, STEPHEN G DO	11/17/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	4852	None	None	0	In state provider	None	26585 W AGOURA ROAD	SUITE 270	CALABASAS	CA	91302	1958	19	06037	34.14240621	-118.7027109	Los Angeles County
4547	Fee-for-Service	1093021008	1093021008	1	1	ARCHILA, AUDREY PA	8/5/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	21120	-	NOT APPLICABLE	0	In state provider	None	1103 SIBLEY ST	None	FOLSOM	CA	95630	3274	34	06067	38.665224	-121.172931	Sacramento County
4549	Fee-for-Service	1881996205	1881996205	1	1	ARNOLD, SARAH J PT	3/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	29798 HAUN	201	MENIFEE	CA	92586	6541	33	06065	33.68787713	-117.1748638	Riverside County
4554	Fee-for-Service	1831776806	1831776806	1	1	ABOUDIAB, MYRNA MD	3/19/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
4595	Fee-for-Service	1144458951	1144458951	1	1	ACHARI, AROTI MD	2/18/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168193	None	None	0	In state provider	None	321 MIDDLEFIELD ROAD	SUITE 165,260	MENLO PARK	CA	94025	3500	41	06081	37.45657153	-122.168099	San Mateo County
4609	Fee-for-Service	1841653441	1841653441	1	1	ABRAMYAN, SHOGIK MD	7/25/2022	204F00000X	NA	General Surgery	026	PHYSICIANS	166547	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
4637	Fee-for-Service	1124439781	1124439781	1	1	AGOSTON, ENDRE MD	7/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140051	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
4641	Fee-for-Service	1255438370	1255438370	1	1	ACKERMAN, BARBARA L MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	84156	02	General Surgery	0	In state provider	None	1133 W SYCAMORE ST	None	WILLOWS	CA	95988	2601	11	06021	39.5205105	-122.2082775	Glenn County
4660	Fee-for-Service	1346634698	1346634698	1	1	ANG, JOYCE MD	9/4/2018	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	143735	40	Pediatrics	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
4727	Fee-for-Service	1467545590	1467545590	1	1	AGUILAR, SHANA N OD INC	5/24/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5138 E IMPERIAL HWY	None	LYNWOOD	CA	90262	3009	19	06037	33.93081747	-118.1821519	Los Angeles County
4728	Fee-for-Service	1669920443	1669920443	1	1	ANGULO, ANNETTE LMFT	7/27/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	840 HINCKLEY RD	215	BURLINGAME	CA	94010	1516	41	06081	37.59825831	-122.3684871	San Mateo County
4747	Fee-for-Service	1962583104	1962583104	1	1	ARORA, SUNIL MD	6/6/1997	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	None	None	0	In state provider	None	401 E HIGHLAND AVE	STE 552	SAN BERNARDINO	CA	92404	3838	36	06071	34.1358627	-117.2757778	San Bernardino County
4751	Fee-for-Service	1336201482	1336201482	1	1	AURORA GRACE HWANG MD	4/16/2013	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	835 N SEQUOIA AVE	None	LINDSAY	CA	93247	1424	54	06107	36.21351337	-119.0961199	Tulare County
4764	Fee-for-Service	1275893752	1275893752	1	1	ALLISON, SIDNEY H MD	5/22/2017	207R00000X	NA	Other	026	PHYSICIANS	138279	41	Internal Medicine	0	In state provider	None	450 STANYAN ST	FL 6	SAN FRANCISCO	CA	94117	1019	38	06075	37.7738933	-122.4544685	San Francisco County
4772	Fee-for-Service	1639611627	1639611627	1	1	ALDAZ, EDWARD LCSW	3/8/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5850 EL CAMINO REAL	None	ATASCADERO	CA	93422	3318	40	06079	35.48962035	-120.670989	San Luis Obispo County
4791	Fee-for-Service	1346480985	1346480985	1	1	AXIS COMMUNITY HEALTH, INC.	4/28/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	6666 OWENS DRIVE	None	PLEASANTON	CA	94588	3334	01	06001	37.69743706	-121.9098578	Alameda County
4802	Fee-for-Service	1205422466	1205422466	1	1	AYAS HOSPICE INC	3/28/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7401 OWENSMOUTH AVE	STE 105-B	CANOGA PARK	CA	91303	2057	19	06037	34.2047103	-118.6016508	Los Angeles County
4822	Fee-for-Service	1831499573	1831499573	1	1	ASSOCIATION OF PROFESSIONAL	8/31/2010	2084N0400X	NA	Neurology	026	PHYSICIANS	36466	13	Neurology (M.D. only)	0	In state provider	MEDICAL CENTERS INC	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
4892	Fee-for-Service	1407387962	1407387962	1	1	AL-HIALI, RAFEL MD	8/21/2020	207R00000X	NA	Other	026	PHYSICIANS	169740	41	Internal Medicine	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
4909	Fee-for-Service	1811285901	1811285901	1	1	AGUILAR DONIS, MARIA E MD	2/23/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	170632	None	None	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
4966	Fee-for-Service	1942829114	1942829114	1	1	ARA VILLE RESIDENTIAL CARE	10/13/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	HOME, INC	15955 KALISHER STREET	None	GRANADA HILLS	CA	91344	3951	19	06037	34.27732352	-118.4800531	Los Angeles County
4974	Fee-for-Service	1558547588	1558547588	1	1	ALI, SARAH MD	3/9/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	172957	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
5027	Fee-for-Service	1285932145	1285932145	1	1	ALTERNATIVE HEALTH CARE INC	2/11/2022	247200000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	491 QUIET CT	None	SIMI VALLEY	CA	93065	5719	56	06111	34.24607693	-118.7706155	Ventura County
5028	Fee-for-Service	1306817705	1306817705	1	1	ALARCON,LOUIS H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 LOTHROP STREET	None	PITTSBURG	PA	15213	0000	00	None	40.44188737	-79.96079711	Allegheny County
5034	Fee-for-Service	1124022983	1124022983	1	1	ATKINS, BROADUS Z MD	11/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54897	33	Thoracic Surgery	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
5039	Fee-for-Service	1336201482	1336201482	1	1	AURORA GRACE HWANG MD	9/3/2008	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	835 N SEQUOIA AVE	None	LINDSAY	CA	93247	1424	54	06107	36.21351337	-119.0961199	Tulare County
5049	Fee-for-Service	1477748242	1477748242	2	1	AERO MOBILITY, INC	12/4/2014	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1001 WEIR CANYON ROAD	None	ANAHEIM	CA	92807	2517	30	06059	33.873408	-117.7469254	Orange County
5077	Fee-for-Service	1346480985	1346480985	1	1	AXIS COMMUNITY HEALTH, INC.	1/30/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	6666 OWENS DRIVE	None	PLEASANTON	CA	94588	3334	01	06001	37.69743706	-121.9098578	Alameda County
5092	Fee-for-Service	1205422466	1205422466	1	1	AYAS HOSPICE INC	3/28/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7401 OWENSMOUTH AVE	STE 105-B	CANOGA PARK	CA	91303	2057	19	06037	34.2047103	-118.6016508	Los Angeles County
5104	Fee-for-Service	1730195447	1730195447	1	1	AFFILIATES IN MED SPECIA	9/20/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL GROUP INC	7345 MEDICAL CENTER DR	FL 6	WEST HILLS	CA	91307	1910	19	06037	34.20369349	-118.629837	Los Angeles County
5109	Fee-for-Service	1578955084	1578955084	1	1	ABOVE ALL CARE FACILITY LLC	6/1/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	479 S WELLINGTON	None	ORANGE	CA	92869	4731	30	06059	33.780897	-117.8189025	Orange County
5137	Fee-for-Service	1801155593	1801155593	1	1	AJIBOYE, ONAOPEMIPO B MD	7/13/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	171616	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
5143	Fee-for-Service	1922693233	1922693233	1	1	ARGIL, KIMBERLY A	12/19/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12440 FIRESTONE BLVD	3001	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
5147	Fee-for-Service	1578955084	1578955084	1	2	ABOVE ALL CARE FACILITY LLC	6/1/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1255 BERING ST	None	PLACENTIA	CA	92870	3901	30	06059	33.884982	-117.838169	Orange County
5160	Fee-for-Service	1508037292	1508037292	1	1	APPASAMY, SURESH MD	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129092	45	Nephrology (Renal-Kidney)	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
5165	Fee-for-Service	1689755852	1689755852	1	1	ARAI, RANDY C MD	5/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42756	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
5205	Fee-for-Service	1962503581	1962503581	1	1	ALLGOWER, LANCE MD	5/18/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	ALLGOWER LANCE MD	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
5218	Fee-for-Service	1750647343	1750647343	1	1	AGARWAL, SHILPA R MD	1/7/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	155484	07	Dermatology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
5235	Fee-for-Service	1720612948	1720612948	1	1	ALEXANDER KASSAR MD INC	9/20/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	255 E BONITA AVE	None	POMONA	CA	91767	1923	19	06037	34.097913	-117.7474635	Los Angeles County
5277	Fee-for-Service	1902993140	1902993140	1	1	ALTA VERDUGO CONSULTING	2/25/2004	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	VERDUGO HOSPICE CARE CTR	4170 VERDUGO RD	None	LOS ANGELES	CA	90065	3821	19	06037	34.12699791	-118.2320973	Los Angeles County
5282	Fee-for-Service	1154786408	1154786408	1	1	AMDAL TRANSPORT SERVICES INC	3/8/2016	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	8315 MORRO ROAD	STE 101	ATASCADERO	CA	93422	3949	40	06079	35.47225824	-120.6688566	San Luis Obispo County
5289	Fee-for-Service	1609212000	1609212000	1	1	ANENE-MAIDOH, OGUGUA MD	4/22/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
5345	Fee-for-Service	1457577801	1457577801	1	1	ANDERSON, ANNA S MD	1/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95199	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
5346	Fee-for-Service	1427314020	1427314020	1	1	AQEEL, KHALED MD	9/11/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	149152	-	NOT APPLICABLE	0	In state provider	None	6127 FAIR OAKS BLVD	None	CARMICHAEL	CA	95608	4818	34	06067	38.61252	-121.329387	Sacramento County
5365	Fee-for-Service	1346480985	1346480985	1	1	AXIS COMMUNITY HEALTH, INC.	4/28/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	6666 OWENS DRIVE	None	PLEASANTON	CA	94588	3334	01	06001	37.69743706	-121.9098578	Alameda County
5390	Fee-for-Service	1124365184	1124365184	2	1	AVON HOSPICE CARE, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	9007 ARROW ROUTE	SUITE 180	RANCHO CUCAMONGA	CA	91730	4459	36	06071	34.09930349	-117.6077025	San Bernardino County
5404	Fee-for-Service	1477619062	1477619062	1	1	ALVORD UNIF SCHOOL DIST	2/21/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	10365 KELLER AVE	None	RIVERSIDE	CA	92505	1349	33	06065	33.9337051	-117.478854	Riverside County
5446	Fee-for-Service	1922080852	1922080852	1	1	AUGHINBAUGH, LAURA A NP	3/21/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
5447	Fee-for-Service	1508037292	1508037292	1	1	APPASAMY, SURESH MD	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129092	41	Internal Medicine	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
5450	Fee-for-Service	1811166234	1811166234	1	1	AYRES, ELLEN S MSW LCSW	12/6/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2820 ADELINE ST	SUITE #2	BERKELEY	CA	94703	2264	01	06001	37.8575394	-122.268253	Alameda County
5451	Fee-for-Service	1689755852	1689755852	1	1	ARAI, RANDY C MD	5/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42756	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
5456	Fee-for-Service	1114171493	1114171493	1	1	ALLIED HOME MEDICAL, INC	3/24/2014	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	417 E BROAD ST	None	SMITHVILLE	TN	37166	1816	00	None	35.95755509	-85.80611347	DeKalb County
5465	Fee-for-Service	1396351656	1396351656	1	1	ANDERSON, REBECCA LPCC	1/3/2025	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
5513	Fee-for-Service	1992741912	1992741912	1	1	ABSHIRE,BRET B MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71689	14	Neurological Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
5532	Fee-for-Service	1174042519	1174042519	1	1	ADVANCED PAIN DIAGNOSTIC & S	4/20/2020	261QP3300X	NA	Other	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	OLUTIONS INC	650 HOWE AVE	SUITE 600	SACRAMENTO	CA	95825	4731	34	06067	38.577294	-121.4146395	Sacramento County
5551	Fee-for-Service	1427670025	1427670025	1	1	ACOSTA DE GONZALEZ, MARIA I	1/2/2025	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	189397	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MD	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
5564	Fee-for-Service	1902993140	1902993140	1	1	ALTA VERDUGO CONSULTING	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	VERDUGO HOSPICE CARE CTR	4170 VERDUGO RD	None	LOS ANGELES	CA	90065	3821	19	06037	34.12699791	-118.2320973	Los Angeles County
5567	Fee-for-Service	1003423864	1003423864	1	1	ARNDT, TYLER H PT	12/28/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
5606	Fee-for-Service	1174882047	1174882047	1	1	ABU EL HAIJA, MARWA A MD	7/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153410	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
5650	Fee-for-Service	1871255364	1871255364	1	1	ASCENDANCE THERAPEUTIC SOLUT	8/15/2022	1041C0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	IONS-A LICENSED CLINICAL	16041 KAMANA RD	STE A	APPLE VALLEY	CA	92307	1331	36	06071	34.54277199	-117.2713892	San Bernardino County
5677	Fee-for-Service	1124365184	1124365184	2	1	AVON HOSPICE CARE, INC	5/21/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	9007 ARROW ROUTE	SUITE 180	RANCHO CUCAMONGA	CA	91730	4459	36	06071	34.09930349	-117.6077025	San Bernardino County
5690	Fee-for-Service	1720093347	1720093347	2	2	AHCS MENTAL HEALTH & WELLNES	12/13/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1377 N FAIR OAKS AVE	None	PASADENA	CA	91103	2101	19	06037	34.169598	-118.1507175	Los Angeles County
5704	Fee-for-Service	1104985621	1104985621	1	1	ANDERSON, SUSAN G MD	5/31/1992	207P00000X	NA	Other	026	PHYSICIANS	74164	41	Internal Medicine	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
5711	Fee-for-Service	1457888687	1457888687	1	1	AHDOUT, JULIANNE MD	9/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	136558	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
5738	Fee-for-Service	1689755852	1689755852	1	1	ARAI, RANDY C MD	5/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42756	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
5788	Fee-for-Service	1770512840	1770512840	1	1	ALBRECHT, LINDSEY A MD	6/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89161	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
5790	Fee-for-Service	1164835237	1164835237	1	1	AHAMBA, ONYINYE N MD	9/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147546	41	Internal Medicine	0	In state provider	None	2 WEST FERN STREET	None	REDLANDS	CA	92373	5202	36	06071	34.05016907	-117.1793443	San Bernardino County
5793	Fee-for-Service	1992154074	1992154074	1	1	ALLIANCE HOSPICE AND	5/10/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	11770 WARNER AVE	STE 201	FOUNTAIN VALLEY	CA	92708	2661	30	06059	33.71573417	-117.9239528	Orange County
5802	Fee-for-Service	1518583301	1518583301	1	1	ARTHUR, CALEB MD	10/20/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191280	None	None	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
5810	Fee-for-Service	1255033247	1255033247	1	1	ABOVE THE CLOUDS PROFESSIONA	3/26/2023	101YM0800X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	L CLINICAL COUNSELORS, I	101 E REDLANDS BLVD	244	REDLANDS	CA	92373	4725	36	06071	34.05731952	-117.181197	San Bernardino County
5815	Fee-for-Service	1871014027	1871014027	1	1	ABDALLAH, MAHMOUD Y DO	10/1/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	16964	None	None	0	In state provider	None	7955 WESTMINSTER BLVD	None	WESTMINSTER	CA	92683	4001	30	06059	33.75932839	-117.9902744	Orange County
5822	Fee-for-Service	1457334864	1457334864	1	1	AHMAD, TANVIR MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	A PROF CORP	2650 N TENAYA WAY	STE 280	LAS VEGAS	NV	89128	1111	00	None	36.20804839	-115.2501292	Clark County
5883	Fee-for-Service	1609038256	1609038256	1	1	AMIRPOUR, VAHDATYAR MD	2/1/1998	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	44475	20	Orthopedic Surgery	0	In state provider	None	1524 27TH ST	STE 202	BAKERSFIELD	CA	93301	2056	15	06029	35.38387747	-119.0197575	Kern County
5898	Fee-for-Service	1578166948	1578166948	1	1	APOLLO DRUGS, INC.	1/21/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7256 W SUNSET BLVD	None	LOS ANGELES	CA	90046	3410	19	06037	34.09796948	-118.3485465	Los Angeles County
5905	Fee-for-Service	1790974970	1790974970	1	1	ANTHON, LARRY R DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	LR ANTHON DPM A PODIATRY	3400 W BALL RD	STE 211	ANAHEIM	CA	92804	3735	30	06059	33.81724472	-118.0083216	Orange County
5909	Fee-for-Service	1457657140	1457657140	1	1	AHDOOT, MORRIS M MD INC	11/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	67668	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	15775 LAGUNA CANYON ROAD	SUITE 200	IRVINE	CA	92618	3191	30	06059	33.6663745	-117.760682	Orange County
5911	Fee-for-Service	1710342969	1710342969	1	1	ALLEN, DECINDA S LMFT	9/5/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	734 W OAK AVE	None	VISALIA	CA	93291	6036	54	06107	36.332118	-119.2998195	Tulare County
5923	Fee-for-Service	1720428485	1720428485	1	1	ARGUEZA, BIANCA FATIMA VERON	8/10/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	145804	40	Pediatrics	0	In state provider	ICA R MD MPH	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
5932	Fee-for-Service	1013049683	1013049683	1	1	ANDERSON, ALEXANDRA L MD	10/19/2010	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	98897	05	Anesthesiology	0	In state provider	None	500 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.76351054	-122.4579681	San Francisco County
5937	Fee-for-Service	1871255364	1871255364	1	1	ASCENDANCE THERAPEUTIC SOLUT	8/15/2022	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	IONS-A LICENSED CLINICAL	16041 KAMANA RD	STE A	APPLE VALLEY	CA	92307	1331	36	06071	34.54277199	-117.2713892	San Bernardino County
5938	Fee-for-Service	1639731854	1639731854	1	1	AYEMA, LILLIAN	12/9/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1229 MARKHAM AVE	None	MODESTO	CA	95358	6910	50	06099	37.60336504	-121.0092182	Stanislaus County
5995	Fee-for-Service	1669039038	1669039038	1	1	ADVENTIST HEALTH PHYSICIANS	10/12/2020	208800000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	414 G	STE 240	MARYSVILLE	CA	95901	5670	58	06115	39.13913942	-121.5934649	Yuba County
6081	Fee-for-Service	1992154074	1992154074	1	1	ALLIANCE HOSPICE AND	5/10/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	11770 WARNER AVE	STE 201	FOUNTAIN VALLEY	CA	92708	2661	30	06059	33.71573417	-117.9239528	Orange County
6090	Fee-for-Service	1386779908	1386779908	1	1	ARIAS, BETTY L LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	39939	-	NOT APPLICABLE	0	In state provider	None	649 EAST ALBERTONI ST	SUITE 100	CARSON	CA	90746	1538	19	06037	33.87194399	-118.2643054	Los Angeles County
6099	Fee-for-Service	1700020823	1700020823	1	1	AZIZAD, SHAMEEM MD	4/19/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	159052	30	Radiology	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
6111	Fee-for-Service	1891768644	1891768644	1	1	AMESBURY, ERIC C MD	3/4/2008	207W00000X	NA	Ophthalmology	026	PHYSICIANS	63436	18	Ophthalmology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
6114	Fee-for-Service	1336321165	1336321165	1	1	ARC OF SAN DIEGO	7/1/1990	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LETICIA GROUP HOME	9235 TODOS SANTOS DR	None	SANTEE	CA	92071	4821	37	06073	32.82648447	-116.997039	San Diego County
6192	Fee-for-Service	1508853011	1508853011	1	1	AVASARALA, KISHOR MD	5/31/1995	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	63007	41	Internal Medicine	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
6199	Fee-for-Service	1114232923	1114232923	1	1	ALMANZA, ELIZABETH LCSW	7/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
6204	Fee-for-Service	1356413165	1356413165	1	1	ASLAM, ANISUL MD	12/8/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52630	41	Internal Medicine	0	In state provider	None	2180 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93408	7001	40	06079	35.27488974	-120.6468257	San Luis Obispo County
6209	Fee-for-Service	1366677486	1366677486	1	1	ALVAREZ, ALAI MD	2/14/2011	207P00000X	NA	Other	026	PHYSICIANS	114602	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
6228	Fee-for-Service	1639731854	1639731854	1	1	AYEMA, LILLIAN	12/9/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1229 MARKHAM AVE	None	MODESTO	CA	95358	6910	50	06099	37.60336504	-121.0092182	Stanislaus County
6271	Fee-for-Service	1013440981	1013440981	1	1	AMIN, AISHA MD	10/5/2020	207R00000X	NA	Other	026	PHYSICIANS	169657	41	Internal Medicine	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
6385	Fee-for-Service	1881613669	1881613669	1	1	AMPLA HEALTH	3/12/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	285 COHASSET RD	None	CHICO	CA	95926	5513	04	06007	39.75085452	-121.8507177	Butte County
6402	Fee-for-Service	1811728405	1811728405	1	2	ADVANCED & NEURO-INTERVENTIO	2/6/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	27	Psychiatry Neurology (D.O. only)	0	In state provider	NAL PSYCHIATRY INC	201 HARTNELL AVE	None	REDDING	CA	96002	1843	45	06089	40.56739956	-122.3690135	Shasta County
6432	Fee-for-Service	1093409161	1093409161	1	1	ALINEA PSYCHOLOGY INC	12/10/2024	103T00000X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	265 S RANDOLPH AVE	STE 120	BREA	CA	92821	5798	30	06059	33.91513051	-117.8897392	Orange County
6448	Fee-for-Service	1932628146	1932628146	1	1	ABBOT HOMEHEALTH INC	2/21/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11030 ARROW ROUTE	UNIT 203 B	RANCHO CUCAMONGA	CA	91730	4837	36	06071	34.0991145	-117.563265	San Bernardino County
6452	Fee-for-Service	1598451627	1598451627	1	1	ADVENTIST HEALTH PHYSICIANS	2/1/2024	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1548 HIGHWAY 99	None	GRIDLEY	CA	95948	3121	04	06007	39.360969	-121.6878835	Butte County
6479	Fee-for-Service	1508853011	1508853011	1	1	AVASARALA, KISHOR MD	5/31/1995	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	63007	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
6488	Fee-for-Service	1114043601	1114043601	1	1	ANWAR, MOHAMMAD M MD	8/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121793	66	Emergency Medicine (Urgent Care)	0	In state provider	None	11500 BROOKSHIRE AVENUE	None	DOWNEY	CA	90241	4917	19	06037	33.93500365	-118.1321119	Los Angeles County
6510	Fee-for-Service	1568070662	1568070662	1	1	ATLAS URGENT CARE CORPORATIO	6/21/2021	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	N	5531 BUSINESS PARK S	101	BAKERSFIELD	CA	93309	1668	15	06029	35.35738668	-119.0601246	Kern County
6552	Fee-for-Service	1215315247	1215315247	1	1	ACME TRANS LLC	12/13/2018	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	15540 ROXFORD ST	None	SYLMAR	CA	91342	1263	19	06037	34.3123726	-118.4704929	Los Angeles County
6569	Fee-for-Service	1649407081	1649407081	1	1	ABDEL KADER ABIR	1/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	888 SWIFT BLVD	None	RICHLAND	WA	99352	3514	00	None	46.28046647	-119.28231	Benton County
6604	Fee-for-Service	1326086703	1326086703	1	1	ATLAS, THOMAS L MD	2/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	74535	30	Radiology	0	In state provider	TUSTIN TELERADIOLOGY MED	13422 NEWPORT AVE	STE I	TUSTIN	CA	92780	3746	30	06059	33.74458883	-117.8154469	Orange County
6678	Fee-for-Service	1801201843	1801201843	1	1	ACSB LLC	6/26/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5240 SEPULVEDA BOULEVARD	None	CULVER CITY	CA	90230	5214	19	06037	33.99902328	-118.3999115	Los Angeles County
6679	Fee-for-Service	1881613669	1881613669	1	1	AMPLA HEALTH	3/12/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	285 COHASSET RD	None	CHICO	CA	95926	5513	04	06007	39.75085452	-121.8507177	Butte County
6689	Fee-for-Service	1811728405	1811728405	1	2	ADVANCED & NEURO-INTERVENTIO	2/6/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	NAL PSYCHIATRY INC	201 HARTNELL AVE	None	REDDING	CA	96002	1843	45	06089	40.56739956	-122.3690135	Shasta County
6698	Fee-for-Service	1770784563	1770784563	1	1	ALAMEDA COUNTY MED CTR	7/1/1998	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	NEWARK HEALTH CENTER	6066 CIVIC TERRACE AVE	None	NEWARK	CA	94560	3746	01	06001	37.53623835	-122.0285012	Alameda County
6717	Fee-for-Service	1467034983	1467034983	1	1	ALONZO, LAUREN LMFT	5/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
6718	Fee-for-Service	1093409161	1093409161	1	1	ALINEA PSYCHOLOGY INC	3/15/2024	103T00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	265 S RANDOLPH AVE	STE 120	BREA	CA	92821	5798	30	06059	33.91513051	-117.8897392	Orange County
6734	Fee-for-Service	1386911642	1386911642	1	1	APEX HEALTHCARE MEDICAL	4/20/2012	193400000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	CENTER INC	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
6738	Fee-for-Service	1124056627	1124056627	1	1	ABBOT, CHRISTOPHER M MD	10/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105367	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	5 MEDICAL PLAZA DRIVE	STE 140	ROSEVILLE	CA	95661	2865	31	06061	38.76604411	-121.2466761	Placer County
6743	Fee-for-Service	1902576937	1902576937	1	1	ANDERSON, BLAIR E NP	4/21/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
6760	Fee-for-Service	1235167321	1235167321	1	1	ACHAR, SURAJ MD	2/28/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	80093	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
6763	Fee-for-Service	1811068869	1811068869	2	1	AL QAISI, YAKDAN T MD	4/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	88720	01	General Practice	0	In state provider	None	4040 SAN DIMAS ST	SUITE A	BAKERSFIELD	CA	93301	1299	15	06029	35.396595	-119.0081515	Kern County
6783	Fee-for-Service	1831539485	1831539485	1	1	ANVAR MEDICAL GROUP	3/6/2022	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	9335 RESEDA BLVD	STE 100	NORTHRIDGE	CA	91324	2968	19	06037	34.24019062	-118.5361007	Los Angeles County
6791	Fee-for-Service	1659791689	1659791689	1	1	AKOON, ANIL MD	9/10/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	186742	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
6807	Fee-for-Service	1881621662	1881621662	1	1	ALEXIE, ION MD	8/15/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2435 FIRE MESA ST	SUITE 120	LAS VEGAS	NV	89128	9009	00	None	36.20469539	-115.2575248	Clark County
6875	Fee-for-Service	1225476500	1225476500	1	1	AGHDASI, BAYAN	9/21/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	168885	20	Orthopedic Surgery	0	In state provider	None	2545 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.0214303	-121.3461515	San Joaquin County
6877	Fee-for-Service	1508023318	1508023318	1	1	AVANES, EMIL MD	6/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110814	41	Internal Medicine	0	In state provider	None	1030 S GLENDALE AVE	STE 404	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
6879	Fee-for-Service	1518997378	1518997378	1	1	AUSTIN, JOHN C MD	1/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	55502	20	Orthopedic Surgery	0	In state provider	None	435 H STREET	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
6885	Fee-for-Service	1053966994	1053966994	1	1	ASEMOTA, BEAUTY I	8/20/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	13931 CHADRON AVE	APT 15	HAWTHORNE	CA	90250	8564	19	06037	33.90456357	-118.3287199	Los Angeles County
6894	Fee-for-Service	1225328818	1225328818	1	1	AMIN, FAISAL MD	5/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128656	None	None	0	In state provider	None	5320 CARRINGTON CIRCLE	None	STOCKTON	CA	95210	3515	39	06077	38.00512188	-121.2937141	San Joaquin County
6962	Fee-for-Service	1043569528	1043569528	1	1	ALIOTO, JILL L NP	8/11/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
7006	Fee-for-Service	1093409161	1093409161	1	1	ALINEA PSYCHOLOGY INC	3/15/2024	103T00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	265 S RANDOLPH AVE	STE 120	BREA	CA	92821	5798	30	06059	33.91513051	-117.8897392	Orange County
7036	Fee-for-Service	1588195424	1588195424	1	1	AL-KHAYYAT, MOHAMMED A MD	7/31/2020	207R00000X	NA	Other	026	PHYSICIANS	166446	41	Internal Medicine	0	In state provider	None	9655 MONTE VISTA AVE	STE 402	MONTCLAIR	CA	91763	2238	36	06071	34.07991502	-117.6982245	San Bernardino County
7048	Fee-for-Service	1033793500	1033793500	1	1	AKHTAR, ASLAM	12/27/2023	390200000X	NA	Other	026	PHYSICIANS	184682	None	None	0	In state provider	None	1401 S GRANDE AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
7063	Fee-for-Service	1962798983	1962798983	1	1	AULT, BRIAN W DO	8/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
7070	Fee-for-Service	1487153136	1487153136	1	1	ALBA HOME HEALTH INC	8/16/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	143 S GLENDALE AVE	SUITE 103	GLENDALE	CA	91205	1137	19	06037	34.14478204	-118.2478537	Los Angeles County
7123	Fee-for-Service	1003952797	1003952797	1	1	AKHAVAN, AFSHIN D DO	11/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	7610	None	None	0	In state provider	None	3009 S VERMONT AVE	None	LOS ANGELES	CA	90007	3033	19	06037	34.02747	-118.2915685	Los Angeles County
7143	Fee-for-Service	1972989580	1972989580	1	1	AKHAVAN, BIJAN DO	10/23/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16144	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
7173	Fee-for-Service	1053966994	1053966994	1	1	ASEMOTA, BEAUTY I	8/20/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	13931 CHADRON AVE	APT 15	HAWTHORNE	CA	90250	8564	19	06037	33.90456357	-118.3287199	Los Angeles County
7183	Fee-for-Service	1376593871	1376593871	1	1	AHMED, RIAZ M MD	5/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71370	41	Internal Medicine	0	In state provider	None	1127 WILSHIRE BLVD	STE 600	LOS ANGELES	CA	90017	3907	19	06037	34.05270508	-118.2641005	Los Angeles County
7194	Fee-for-Service	1568401016	1568401016	1	1	AVERA MARSHALL	11/8/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	300 S BRUCE ST	None	MARSHALL	MN	56258	1934	00	None	44.4480227	-95.77622697	Lyon County
7226	Fee-for-Service	1518429901	1518429901	1	1	AYOUB, MAYA C MD	5/31/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	180159	40	Pediatrics	0	In state provider	None	1260 15TH STREET	1024	SANTA MONICA	CA	90404	1145	19	06037	34.02648965	-118.4867439	Los Angeles County
7255	Fee-for-Service	1417096033	1417096033	1	1	ARANA LOUBRIEL, DENISE	2/25/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1260 N DUTTON AVE	STE 185	SANTA ROSA	CA	95401	7146	49	06097	38.449197	-122.7320775	Sonoma County
7266	Fee-for-Service	1346267267	1346267267	1	1	ALLIED ANESTHESIA MED	4/1/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
7292	Fee-for-Service	1093409161	1093409161	1	1	ALINEA PSYCHOLOGY INC	3/15/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	265 S RANDOLPH AVE	STE 120	BREA	CA	92821	5798	30	06059	33.91513051	-117.8897392	Orange County
7321	Fee-for-Service	1962816033	1962816033	1	1	ASENCIO, JESSICA M MD	7/1/2019	2080P0204X	NA	Other	026	PHYSICIANS	149587	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
7324	Fee-for-Service	1558611228	1558611228	1	1	ARDENT HOSPICE & PALLIATIVE	11/28/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	16486 BERNARDO CENTER DR	SUITE 348	SAN DIEGO	CA	92128	2518	37	06073	33.01375281	-117.0777466	San Diego County
7330	Fee-for-Service	1851673511	1851673511	2	1	ALBORZIAN, SHERVIN MD PC	8/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107093	18	Ophthalmology	0	In state provider	None	9834 GENESEE AVE	STE 209	LA JOLLA	CA	92037	1225	37	06073	32.884074	-117.225855	San Diego County
7359	Fee-for-Service	1588799670	1588799670	1	3	ARC IMPERIAL VALLEY #1	11/11/1996	320900000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	585 SNAPDRAGON WAY	None	IMPERIAL	CA	92251	8948	13	06025	32.82257477	-115.5849896	Imperial County
7360	Fee-for-Service	1316909419	1316909419	1	1	ASHLEY, JENNIFER R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	747 BROADWAY	None	SEATTLE	WA	98122	4379	00	None	47.608326	-122.3207985	King County
7403	Fee-for-Service	1578918744	1578918744	1	1	AYALA-ORTIZ, DANIEL MD	12/17/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165457	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
7407	Fee-for-Service	1114060969	1114060969	1	1	ASCHRAFNIA, SALAHUDDIN S	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63732	01	General Practice	0	In state provider	None	3610 ATLANTIC AVE	None	LONG BEACH	CA	90807	3418	19	06037	33.822621	-118.185002	Los Angeles County
7412	Fee-for-Service	1790927747	1790927747	1	1	ALSUA, AL KHAN C MD	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118497	08	Family Practice	0	In state provider	None	2185 WEST GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
7415	Fee-for-Service	1720158314	1720158314	1	1	ARY, KANDALENA T LCSW	12/30/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
7422	Fee-for-Service	1154958924	1154958924	1	1	ASHIR, ARIA MD	5/11/2023	390200000X	NA	Other	026	PHYSICIANS	179907	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
7452	Fee-for-Service	1457939928	1457939928	1	1	ASKAR, MINA MD	9/9/2024	207R00000X	NA	Other	026	PHYSICIANS	187343	41	Internal Medicine	0	In state provider	None	2732 NAVAJO RD	202A	EL CAJON	CA	92020	2149	37	06073	32.80217534	-117.0025853	San Diego County
7468	Fee-for-Service	1821235110	1821235110	1	1	ALVARADO, JULIE LMFT	4/4/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
7484	Fee-for-Service	1568401016	1568401016	1	1	AVERA MARSHALL	11/8/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	300 S BRUCE ST	None	MARSHALL	MN	56258	1934	00	None	44.4480227	-95.77622697	Lyon County
7501	Fee-for-Service	1457352783	1457352783	1	1	ALIX, PATRICK JOSEPH S	1/30/2018	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	75322	38	Geriatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
7504	Fee-for-Service	1467973230	1467973230	1	1	ALVAREZ, AUDREY DPM	4/7/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	20130 LAKE CHABOT ROAD	SUITE 202	CASTRO VALLEY	CA	94546	5306	01	06001	37.69738066	-122.087041	Alameda County
7515	Fee-for-Service	1801139993	1801139993	1	1	AMANO, KEIKO MD	9/26/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	133558	None	None	0	In state provider	None	604 N MAGNOLIA AVE	100	CLOVIS	CA	93611	9204	10	06019	36.83939464	-119.6661479	Fresno County
7528	Fee-for-Service	1952040859	1952040859	1	1	ABARCA, VANESSA DO	1/14/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21864	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
7551	Fee-for-Service	1326206624	1326206624	2	1	ATG DESIGNING MOBLILITY INC	12/26/2018	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	9428 ETON AVENUE	STE D & E	CHATSWORTH	CA	91311	5866	19	06037	34.24151682	-118.5963598	Los Angeles County
7582	Fee-for-Service	1093409161	1093409161	1	1	ALINEA PSYCHOLOGY INC	12/11/2024	103T00000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	265 S RANDOLPH AVE	STE 120	BREA	CA	92821	5798	30	06059	33.91513051	-117.8897392	Orange County
7613	Fee-for-Service	1558611228	1558611228	1	1	ARDENT HOSPICE & PALLIATIVE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	16486 BERNARDO CENTER DR	SUITE 348	SAN DIEGO	CA	92128	2518	37	06073	33.01375281	-117.0777466	San Diego County
7614	Fee-for-Service	1881075646	1881075646	1	1	ALI, NIDA MD	10/15/2018	207R00000X	NA	Other	026	PHYSICIANS	156233	41	Internal Medicine	0	In state provider	None	6555 COYLE AVENUE	SUITE 280	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
7641	Fee-for-Service	1255387254	1255387254	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	43543 20TH ST W	None	LANCASTER	CA	93536	5961	19	06037	34.67416843	-118.1658212	Los Angeles County
7659	Fee-for-Service	1306981758	1306981758	1	1	ALL MEDICAL SUPPLY	5/1/1991	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2001 WESTWIND DR	STE 15	BAKERSFIELD	CA	93301	3034	15	06029	35.37695737	-119.0425295	Kern County
7660	Fee-for-Service	1841552502	1841552502	1	1	ARTOUN, CATHERINE DO	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15270	09	Gynecology (D.O. only)	0	In state provider	None	1095 IRVINE BOULEVARD	None	TUSTIN	CA	92780	3526	30	06059	33.74821163	-117.8097851	Orange County
7696	Fee-for-Service	1417351073	1417351073	1	1	ALVARADO PHYSICIANS MEDICAL	11/4/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP	6699 ALVARADO RD	SUITE 2309	SAN DIEGO	CA	92120	5241	37	06073	32.77665383	-117.0540279	San Diego County
7714	Fee-for-Service	1235433228	1235433228	1	1	ARMAGAN, OSEP E MD INC	10/7/2015	207XX0004X	NA	Orthopedic Surgery	026	PHYSICIANS	88110	20	Orthopedic Surgery	0	In state provider	None	141 TRIUNFO CANYON RD	STE 101	WESTLAKE VILLAGE	CA	91361	2525	56	06111	34.15961207	-118.8342816	Ventura County
7749	Fee-for-Service	1205924180	1205924180	2	1	ARONSON, JODY B MD	4/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	56720	10	Gastroenterology (M.D. only)	0	In state provider	None	3440 LOMITA BLVD	STE 120	TORRANCE	CA	90505	4814	19	06037	33.81328127	-118.3452927	Los Angeles County
7767	Fee-for-Service	1922103076	1922103076	1	2	AHSAN, SYED F MD	11/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	83077	04	Otology, Laryngology, Rhinology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
7775	Fee-for-Service	1942257258	1942257258	1	1	ANGELA C.W GRUESEN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	GREEN BAY EMERGENCY PHYS	835 S VAN BUREN ST	None	GREEN BAY	WI	54301	3526	00	None	44.50145491	-88.01280959	Brown County
7811	Fee-for-Service	1245442193	1245442193	1	1	ALI, ARSHAD MD	12/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109835	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
7822	Fee-for-Service	1578597886	1578597886	1	1	AMERICAN MEDICAL RESPONSE	3/29/1995	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	AMBULANCE SERVICE, INC	879 MARLBOROUGH AVE	None	RIVERSIDE	CA	92507	0410	33	06065	33.99751149	-117.3302505	Riverside County
7858	Fee-for-Service	1124694443	1124694443	1	1	ACAYAN, IVAN KIRK PT	2/23/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
7884	Fee-for-Service	1457844169	1457844169	1	1	AWAIZ, AIMAN MD	9/1/2022	207L00000X	NA	Other	026	PHYSICIANS	176178	None	None	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
7891	Fee-for-Service	1457573529	1457573529	1	1	AMERICAN COLLEGE OF	7/16/1982	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	TRADITIONAL CHINESE MED	455 ARKANSAS ST	None	SAN FRANCISCO	CA	94107	2813	38	06075	37.76051359	-122.3982452	San Francisco County
7910	Fee-for-Service	1659634798	1659634798	1	1	AGARWAL, RISHI R MD	8/1/2020	207L00000X	NA	Other	026	PHYSICIANS	126641	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
7925	Fee-for-Service	1518217330	1518217330	1	1	ARCH HEALTH PARTNERS	10/19/2012	207RI0011X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1955 W CITRACADO PKWY	SUITE 300	ESCONDIDO	CA	92029	4113	37	06073	33.11301099	-117.1202081	San Diego County
7939	Fee-for-Service	1447384490	1447384490	1	1	ALTMAN, ADRIENNE C MD	3/7/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	46651	None	None	0	In state provider	None	504 S SIERRA MADRE BLVD	None	PASADENA	CA	91107	5240	19	06037	34.137603	-118.101464	Los Angeles County
7961	Fee-for-Service	1326675257	1326675257	1	1	AZADI, NEGIN MD	8/7/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
7968	Fee-for-Service	1841552502	1841552502	1	1	ARTOUN, CATHERINE DO	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15270	15	Obstetrics (D.O. only)	0	In state provider	None	1095 IRVINE BOULEVARD	None	TUSTIN	CA	92780	3526	30	06059	33.74821163	-117.8097851	Orange County
7976	Fee-for-Service	1578526620	1578526620	2	1	ALI, ALTAF L MD INC	8/18/2000	193400000X	NA	Other	026	PHYSICIANS	42679	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5365 WALNUT AVE	SUITE H	CHINO	CA	91710	2622	36	06071	34.02626051	-117.6883155	San Bernardino County
7989	Fee-for-Service	1962701219	1962701219	1	1	AHN, BYUNG CHAN T MD	9/19/2018	2084N0400X	NA	Neurology	026	PHYSICIANS	-	13	Neurology (M.D. only)	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
8028	Fee-for-Service	1336469790	1336469790	1	2	ALEXANDER REYZELMAN D P M IN	2/23/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	6600 MERCY COURT	STE 150	FAIR OAKS	CA	95628	3190	34	06067	38.666565	-121.309857	Sacramento County
8038	Fee-for-Service	1205924180	1205924180	2	1	ARONSON, JODY B MD	4/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	56720	01	General Practice	0	In state provider	None	3440 LOMITA BLVD	STE 120	TORRANCE	CA	90505	4814	19	06037	33.81328127	-118.3452927	Los Angeles County
8100	Fee-for-Service	1245442193	1245442193	1	1	ALI, ARSHAD MD	12/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109835	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
8111	Fee-for-Service	1114459179	1114459179	1	1	ABBASSI, MASHYA T MD	7/4/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175569	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
8142	Fee-for-Service	1962494997	1962494997	1	1	AHMAD, IMTIAZ MD	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75702	30	Radiology	0	In state provider	None	FRESNO & R STREETS	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
8194	Fee-for-Service	1093558769	1093558769	1	1	ALMA CARE PHARMACY A PROFESS	7/26/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15475 SENECA RD	C	VICTORVILLE	CA	92392	2299	36	06071	34.51422048	-117.326322	San Bernardino County
8205	Fee-for-Service	1174742175	1174742175	1	1	AXTELL, JILL E	4/9/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6 WILLARD	None	IRVINE	CA	92604	4694	30	06059	33.67534801	-117.7900415	Orange County
8220	Fee-for-Service	1427759224	1427759224	1	1	AMY'S COMFORT CARE INC	6/14/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	4917 AU CHOCOLAT DR	None	BAKERSFIELD	CA	93311	9684	15	06029	35.31002745	-119.1089277	Kern County
8252	Fee-for-Service	1174085260	1174085260	1	1	ADAMS, ANDREW T MD	7/5/2022	207P00000X	NA	Other	026	PHYSICIANS	177816	None	None	0	In state provider	None	31872 COAST HWY	None	LAGUNA BEACH	CA	92651	6773	30	06059	33.49961197	-117.7420867	Orange County
8267	Fee-for-Service	1578526620	1578526620	2	1	ALI, ALTAF L MD INC	8/18/2000	193400000X	NA	Other	026	PHYSICIANS	42679	41	Internal Medicine	0	In state provider	None	5365 WALNUT AVE	SUITE H	CHINO	CA	91710	2622	36	06071	34.02626051	-117.6883155	San Bernardino County
8276	Fee-for-Service	1174642839	1174642839	1	1	ALAM, TARIQ MD	2/21/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	187937	None	None	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
8289	Fee-for-Service	1497880645	1497880645	1	2	A TO Z HOME HEALTH, INC.	6/13/2019	251E00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	212 N GLENDALE AVE	STE 200	GLENDALE	CA	91206	4454	19	06037	34.14873322	-118.2461855	Los Angeles County
8306	Fee-for-Service	1609063718	1609063718	1	1	ASRANI, HIYA D MD	2/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104653	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
8324	Fee-for-Service	1487031605	1487031605	1	1	ALSYOUF, MUHANNAD M MD	7/2/2021	208800000X	NA	Other	026	PHYSICIANS	152001	None	None	0	In state provider	None	1520 SAN PABLO ST	STE 1300	LOS ANGELES	CA	90033	5312	19	06037	34.06269295	-118.2030006	Los Angeles County
8339	Fee-for-Service	1790162204	1790162204	1	1	AHN, JOSEPH C H MD	7/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148213	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
8369	Fee-for-Service	1215323522	1215323522	1	1	ADBULKHABIR, WAJIDAH MD	4/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145525	41	Internal Medicine	0	In state provider	None	17095 MAIN STREET	None	HESPERIA	CA	92345	6004	36	06071	34.41984761	-117.2904344	San Bernardino County
8407	Fee-for-Service	1285253120	1285253120	1	1	AYERS, LORRETTE LCSW	12/13/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
8459	Fee-for-Service	1952386583	1952386583	1	1	AGATSTEIN, ERNEST H MD	7/1/2002	193400000X	NA	Other	026	PHYSICIANS	48418	34	Urology and Urological Surgery	0	In state provider	None	575 E HARDY ST	STE 205	INGLEWOOD	CA	90301	4044	19	06037	33.94909392	-118.3477665	Los Angeles County
8483	Fee-for-Service	1427496264	1427496264	1	1	AREITER, ERIC J MD	3/7/2025	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	2621 S BRISTOL ST	STE 205	SANTA ANA	CA	92704	5700	30	06059	33.711876	-117.885371	Orange County
8512	Fee-for-Service	1770587107	1770587107	1	1	ASANTE	12/1/1977	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
8528	Fee-for-Service	1912972126	1912972126	1	1	ARORA, ASHIM MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	51729	41	Internal Medicine	0	In state provider	A MEDICAL CORPORATION	158 MACAW LN	None	SIMI VALLEY	CA	93065	3152	56	06111	34.2595826	-118.7943507	Ventura County
8573	Fee-for-Service	1245278928	1245278928	1	1	AYAD, AZZA H MD	2/28/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	35256	40	Pediatrics	0	In state provider	None	18200 YORBA LINDA BLVD	None	YORBA LINDA	CA	92886	4056	30	06059	33.88842824	-117.8154698	Orange County
8579	Fee-for-Service	1376798413	1376798413	1	1	ASIAN & PACIFIC ISLANDER	6/2/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	WELLNESS CENTER INC	726 POLK STREET	4TH FLOOR	SAN FRANCISCO	CA	94109	7813	38	06075	37.78379532	-122.4192766	San Francisco County
8622	Fee-for-Service	1043861719	1043861719	1	1	AMATO, MEGAN A LMFT	2/28/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 PIO PICO DR	STE 105	CARLSBAD	CA	92008	1951	37	06073	33.16162799	-117.3408476	San Diego County
8637	Fee-for-Service	1477699601	1477699601	1	1	ADLER, ERIC D MD	6/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116525	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
8650	Fee-for-Service	1164441663	1164441663	1	1	ANTHONY, ELIZABETH A MD	7/31/1987	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34387	01	General Practice	0	In state provider	None	2970 HILLTOP MALL RD	STE 304	RICHMOND	CA	94806	5274	07	06013	37.97819764	-122.329244	Contra Costa County
8653	Fee-for-Service	1912347535	1912347535	1	1	ADAMS, JORDAN A PT	2/13/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
8670	Fee-for-Service	1346246469	1346246469	1	1	ALLEN, LESLEY L NP	3/4/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
8709	Fee-for-Service	1669477121	1669477121	1	2	AMICABLE HOMECARE INC	12/28/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11829 SOUTH ST	# 100	CERRITOS	CA	90703	6828	19	06037	33.85850426	-118.0811251	Los Angeles County
8717	Fee-for-Service	1154747020	1154747020	1	3	ACN MEDICAL GROUP, INC	10/10/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	718 BARLETT AVE	None	HAYWARD	CA	94541	3698	01	06001	37.66946085	-122.1181444	Alameda County
8720	Fee-for-Service	1932547536	1932547536	1	1	AZIMI, HASSAN J MD	12/24/2020	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	132540	None	None	0	In state provider	None	8008 FROST ST	403	SAN DIEGO	CA	92123	4209	37	06073	32.80027859	-117.1524832	San Diego County
8725	Fee-for-Service	1508499666	1508499666	1	1	AGOP, NATALENE OD	2/9/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	44407 10TH STREET WEST	B	LANCASTER	CA	93534	3345	19	06037	34.68965953	-118.148053	Los Angeles County
8735	Fee-for-Service	1679328058	1679328058	1	1	AFFINITY PSYCHIATRIC NURSING	6/7/2024	364SP0808X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	SERVICES, PC	13781 AMBERVIEW PL	None	EASTVALE	CA	92880	5530	33	06065	33.94682116	-117.5837586	Riverside County
8761	Fee-for-Service	1609098037	1609098037	1	1	AKOPYAN, OGANES J MD	8/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	105942	01	General Practice	0	In state provider	None	12660 RIVERSIDE DR	SUITE 310	NORTH HOLLYWOOD	CA	91607	3431	19	06037	34.1575795	-118.409499	Los Angeles County
8788	Fee-for-Service	1245256049	1245256049	1	1	ALLERGY, SINUS, & ASTHMA	7/17/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	CONSULTANTS INC	440 N MOUNTAIN AVE	STE 301	UPLAND	CA	91786	5183	36	06071	34.09896749	-117.6700715	San Bernardino County
8799	Fee-for-Service	1770587107	1770587107	1	1	ASANTE	12/1/1977	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
8816	Fee-for-Service	1912972126	1912972126	1	1	ARORA, ASHIM MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	51729	29	Pulmonary Diseases (M.D. only)	0	In state provider	A MEDICAL CORPORATION	158 MACAW LN	None	SIMI VALLEY	CA	93065	3152	56	06111	34.2595826	-118.7943507	Ventura County
8843	Fee-for-Service	1851058986	1851058986	1	1	ANTELOPE VALLEY TRANSIT AUTH	4/5/2022	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ORITY	42210 6TH ST W	None	LANCASTER	CA	93534	7124	19	06037	34.64978988	-118.1412123	Los Angeles County
8854	Fee-for-Service	1679774558	1679774558	1	1	AFSHAR, GHAZALEH MD	5/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95943	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
8867	Fee-for-Service	1376798413	1376798413	1	1	ASIAN & PACIFIC ISLANDER	6/2/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	WELLNESS CENTER INC	726 POLK STREET	4TH FLOOR	SAN FRANCISCO	CA	94109	7813	38	06075	37.78379532	-122.4192766	San Francisco County
8939	Fee-for-Service	1164441663	1164441663	1	1	ANTHONY, ELIZABETH A MD	7/31/1987	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34387	08	Family Practice	0	In state provider	None	2970 HILLTOP MALL RD	STE 304	RICHMOND	CA	94806	5274	07	06013	37.97819764	-122.329244	Contra Costa County
8945	Fee-for-Service	1104402064	1104402064	1	1	AFFECT THERAPEUTICS, INC.	10/2/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3550 WATT AVE	STE 140, ROOM 202	SACRAMENTO	CA	95821	2666	34	06067	38.630115	-121.3819245	Sacramento County
8953	Fee-for-Service	1902133424	1902133424	1	1	ARMSTRONG, WILLIAM K MD	8/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108913	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
8961	Fee-for-Service	1326244096	1326244096	1	1	ALLIANCE MEDICAL CENTER	3/1/1997	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	49	06097	38.62729851	-122.8637785	Sonoma County
8968	Fee-for-Service	1669407839	1669407839	1	1	ANESTHESIA MEDICAL GROUP	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	OF RIVERSIDE INC	6969 BROCKTON AVE	STE B	RIVERSIDE	CA	92506	3870	33	06065	33.94701	-117.396786	Riverside County
8981	Fee-for-Service	1982163796	1982163796	1	1	ABBAS, LAUREN E MD	12/29/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178843	40	Pediatrics	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
9004	Fee-for-Service	1235187766	1235187766	1	1	AKBAR, MUHAMMAD K MD	12/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52053	25	Physical Medicine and Rehabilitation	0	In state provider	None	1187 E HERNDON AVE	STE 101	FRESNO	CA	93720	3166	10	06019	36.83640179	-119.7674647	Fresno County
9013	Fee-for-Service	1467648329	1467648329	1	1	ARUTYOUNIAN, NARINE MD	6/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72468	08	Family Practice	0	In state provider	WEST COAST DOCTORS	814 E BROADWAY ST	SUITE 1	GLENDALE	CA	91205	1218	19	06037	34.14625151	-118.244826	Los Angeles County
9034	Fee-for-Service	1114943610	1114943610	2	1	APRIA HEALTHCARE LLC	5/5/2010	332B00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	2612 NE INDUSTRIAL DRIVE	None	KANSAS CITY	MO	64117	2648	00	None	39.14925002	-94.53307159	Clay County
9074	Fee-for-Service	1144675869	1144675869	1	1	AIC HEALTH CARE INC	6/18/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4049 1ST STREET	SUITE 229	LIVERMORE	CA	94551	4924	01	06001	37.6934302	-121.7483657	Alameda County
9155	Fee-for-Service	1376798413	1376798413	1	1	ASIAN & PACIFIC ISLANDER	6/2/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	WELLNESS CENTER INC	726 POLK STREET	4TH FLOOR	SAN FRANCISCO	CA	94109	7813	38	06075	37.78379532	-122.4192766	San Francisco County
9159	Fee-for-Service	1740242627	1740242627	1	1	ALLAVIE, JOHN J MD	7/18/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	47555	18	Ophthalmology	0	In state provider	None	4605 BROCKTON AVENUE	100	RIVERSIDE	CA	92506	0106	33	06065	33.97611422	-117.3860257	Riverside County
9178	Fee-for-Service	1760708341	1760708341	1	1	AL-AEDAN, NAIF M MD	10/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126155	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	SUITE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
9180	Fee-for-Service	1649259797	1649259797	1	1	APPLE HOMECARE MED SUPPLY	4/27/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	APPLE HOMECARE MED SUPLY	1400 SOUTH SHERMAN ST	STE 124	RICHARDSON	TX	75081	6511	00	None	32.93400717	-96.74634763	Dallas County
9279	Fee-for-Service	1386785806	1386785806	1	1	APTE, PAVLINA B MD	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96503	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
9296	Fee-for-Service	1952520447	1952520447	1	1	ANDERSON, MATTHEW S	5/29/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7300 N FRESNO ST	None	FRENSO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno
9299	Fee-for-Service	1720710619	1720710619	1	1	ACEVEDO, GLAMARYS E LCSW	1/3/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
9320	Fee-for-Service	1194498667	1194498667	1	1	ABL HOSPICE LLC	5/28/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6150 MISSION STREET	SUITE 103	DALY CITY	CA	94014	2063	41	06081	37.70686536	-122.4584578	San Mateo County
9343	Fee-for-Service	1588919716	1588919716	1	1	ALI, TAREQ MD APC	2/8/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51048	01	General Practice	0	In state provider	None	1520 W KETTLEMAN LN	STE B	LODI	CA	95242	9290	39	06077	38.11535595	-121.2911606	San Joaquin County
9345	Fee-for-Service	1861059263	1861059263	1	1	ARMAN, FARID MD	3/14/2024	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	700 W 7TH ST	S-270-D	LOS ANGELES	CA	90017	3977	19	06037	34.04833759	-118.2582588	Los Angeles County
9424	Fee-for-Service	1316993843	1316993843	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	39140 WINCHSTER RD	None	MURRIETA	CA	92563	3500	33	06065	33.55141943	-117.1405548	Riverside County
9434	Fee-for-Service	1881723658	1881723658	1	1	ANSARI, MOHSIN K MD	12/19/2007	2084N0400X	NA	Neurology	026	PHYSICIANS	91429	13	Neurology (M.D. only)	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
9456	Fee-for-Service	1205877669	1205877669	1	1	ANDREADIS, CHARALAMBOS I	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103639	78	Neoplastic Diseases/Oncology	0	In state provider	MD	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
9476	Fee-for-Service	1619319217	1619319217	1	1	AHMAD, FAIZAN I MD	11/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132283	41	Internal Medicine	0	In state provider	None	3000 LAS POSITAS ROAD	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
9483	Fee-for-Service	1871639823	1871639823	1	1	AUTH, JONATHAN P MD	2/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93816	01	General Practice	0	In state provider	None	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
9510	Fee-for-Service	1730266883	1730266883	1	1	AJIT HEALTHCARE INC	4/1/2004	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	316 S WESTLAKE AVE	None	LOS ANGELES	CA	90057	4500	19	06037	34.06197859	-118.2717397	Los Angeles County
9523	Fee-for-Service	1477761963	1477761963	1	1	AGRAWAL, SIDDHARTHA	6/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102877	45	Nephrology (Renal-Kidney)	0	In state provider	None	285 COHASSET RD	STE 100	CHICO	CA	95926	5513	04	06007	39.75085452	-121.8507177	Butte County
9526	Fee-for-Service	1013614262	1013614262	1	1	ASSB LLC	2/1/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2120 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1337	34	06067	38.558079	-121.461885	Sacramento County
9548	Fee-for-Service	1942384250	1942384250	1	1	ACKERMAN, STUART E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	39732	05	Anesthesiology	0	In state provider	None	11999 SAN VICENTE BLVD	STE 440	LOS ANGELES	CA	90049	5042	19	06037	34.05233327	-118.4727195	Los Angeles County
9608	Fee-for-Service	1194498667	1194498667	1	1	ABL HOSPICE LLC	5/28/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6150 MISSION STREET	SUITE 103	DALY CITY	CA	94014	2063	41	06081	37.70686536	-122.4584578	San Mateo County
9621	Fee-for-Service	1720456247	1720456247	1	1	ALAWENEH, ALIA M DO	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15473	41	Internal Medicine	0	In state provider	None	1420 S CENTRAL	None	GLENDALE	CA	91204	1000	19	06037	34.12811155	-118.2577764	Los Angeles County
9622	Fee-for-Service	1093852865	1093852865	1	1	ANGEL VIEW INC	8/29/1989	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	67440 DESERT VIEW AVE	None	DESERT HOT SPRING	CA	92240	4110	33	06065	33.95776606	-116.48451	Riverside County
9626	Fee-for-Service	1811997570	1811997570	1	1	ATLANTIC MEMORIAL HEALTHCARE	1/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES INC	2750 ATLANTIC AVE	None	LONG BEACH	CA	90806	2713	19	06037	33.806835	-118.185003	Los Angeles County
9649	Fee-for-Service	1396814505	1396814505	1	1	ARELLANO, RICHARD P LCSW	12/3/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	63587	-	NOT APPLICABLE	0	In state provider	None	3340 KEMPER ST	SUITE 103	SAN DIEGO	CA	92110	4907	37	06073	32.7529355	-117.2146751	San Diego County
9661	Fee-for-Service	1568564193	1568564193	1	1	AMIN, JAY MD	8/4/2020	207R00000X	NA	Other	026	PHYSICIANS	40490	08	Family Practice	0	In state provider	None	29525 CANWOOD ST	200	AGOURA HILLS	CA	91301	4233	19	06037	34.14724223	-118.7675471	Los Angeles County
9665	Fee-for-Service	1215231378	1215231378	1	1	AMIN, HITHA V MD	3/25/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	118180	None	None	0	In state provider	None	16800 ASTON	STE 175	IRVINE	CA	92606	4820	30	06059	33.70035445	-117.8435881	Orange County
9686	Fee-for-Service	1558316133	1558316133	1	1	ANDERSON, DANIEL R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
9688	Fee-for-Service	1942318373	1942318373	1	2	AHN, DUKE MD	5/13/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	84554	None	None	0	In state provider	None	3700 KATELLA AVE	STE C	LOS ALAMITOS	CA	90720	6409	30	06059	33.80299714	-118.0681431	Orange County
9716	Fee-for-Service	1306015425	1306015425	1	1	ALTAMED HEALTH SERVICES CORP	4/20/2009	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	HUNTINGTON BCH COMM CLIN	8041 NEWMAN AVE	None	HUNTINGTON BEACH	CA	92647	7034	30	06059	33.70481104	-117.9882948	Orange County
9722	Fee-for-Service	1255359436	1255359436	1	1	ACCOMAZZO, RONALD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	18686	04	Otology, Laryngology, Rhinology	0	In state provider	A MEDICAL CORP	18350 ROSCOE BLVD	STE 318	NORTHRIDGE	CA	91325	4164	19	06037	34.22071855	-118.5341175	Los Angeles County
9736	Fee-for-Service	1548551997	1548551997	1	1	ALAMEDA COUNTY MEDICAL	4/27/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER	1411 E 31ST STREET	KORET BLDG, 6TH FLOOR	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
9738	Fee-for-Service	1801997440	1801997440	1	1	ALSHAHWANY, SINAN N MD	9/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96392	41	Internal Medicine	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
9745	Fee-for-Service	1205877669	1205877669	1	1	ANDREADIS, CHARALAMBOS I	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103639	68	Hematology	0	In state provider	MD	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
9755	Fee-for-Service	1003979618	1003979618	1	1	ADLER, BRADFORD S MD	7/1/2000	207ZP0101X	NA	Other	026	PHYSICIANS	48039	22	Pathology (M.D. only)	0	In state provider	None	10445 BALBOA BLVD	None	GRANADA HILLS	CA	91344	7323	19	06037	34.259094	-118.5023365	Los Angeles County
9757	Fee-for-Service	1891127403	1891127403	1	1	AMADOR, KEITH O LMFT	2/27/2019	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SHIP	1408 W MAIN ST	A	RIPON	CA	95366	3013	39	06077	37.73948391	-121.1389398	San Joaquin County
9762	Fee-for-Service	1700431392	1700431392	1	1	ASSISTIVE HEALTH SYSTEMS INC	11/22/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	AND PALLIATIVE CARE	4540 KEARNY VILLA ROAD	SUITE 213	SAN DIEGO	CA	92123	1586	37	06073	32.82260734	-117.144126	San Diego County
9763	Fee-for-Service	1477550788	1477550788	1	1	ATLANTIC AVE MED CLINIC	8/1/2001	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7503 ATLANTIC AVE	STE D	CUDAHY	CA	90201	6805	19	06037	33.96785429	-118.1876544	Los Angeles County
9765	Fee-for-Service	1124419809	1124419809	1	1	AGARWAL, CARRIE H MD	9/30/2021	390200000X	NA	Other	026	PHYSICIANS	172859	09	Gynecology (D.O. only)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
9810	Fee-for-Service	1295202943	1295202943	1	1	ANTHONY BENIGNO, PSYD., PSYC	4/12/2021	261QM0801X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	800 FERRARI	SUITE 200	ONTARIO	CA	91764	5031	36	06071	34.07149256	-117.5624985	San Bernardino County
9832	Fee-for-Service	1427758127	1427758127	1	1	ADHC IRVINE LLC	1/3/2024	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	1882 MCGAW AVE	None	IRVINE	CA	92614	5741	30	06059	33.69370916	-117.8464363	Orange County
9842	Fee-for-Service	1144345653	1144345653	1	1	ALVAREZ, LUZ M MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77656	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
9846	Fee-for-Service	1558595082	1558595082	1	1	AZADI, NAZANIN MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107597	41	Internal Medicine	0	In state provider	None	8536 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90048	1804	19	06037	34.06550726	-118.3775199	Los Angeles County
9878	Fee-for-Service	1396069944	1396069944	1	1	AHIR, NIMESHKUMAR-RAGHAVBHAI	1/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144975	41	Internal Medicine	0	In state provider	MD	2335 E KASHIAN LANE	STE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
9903	Fee-for-Service	1700924941	1700924941	1	1	ANTONINI, MICHAEL J MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84850	02	General Surgery	0	In state provider	None	3257 PROFESSIONAL DR	STE E	AUBURN	CA	95602	2460	31	06061	38.943405	-121.1008195	Placer County
9941	Fee-for-Service	1710191283	1710191283	1	1	ALTAMED HEALTH SERVICES	1/7/2021	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	9436 SLAUSON AVE	None	PICO RIVERA	CA	90660	4748	19	06037	33.96800305	-118.0956362	Los Angeles County
9944	Fee-for-Service	1407272685	1407272685	1	1	AMADA MENDOZA NURSING CORPOR	12/19/2014	193400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ATION	11735 FIRESTONE BLVD	None	NORWALK	CA	90650	2808	19	06037	33.91353706	-118.0831749	Los Angeles County
10003	Fee-for-Service	1306015425	1306015425	1	1	ALTAMED HEALTH SERVICES CORP	4/18/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	HUNTINGTON BCH COMM CLIN	8041 NEWMAN AVE	None	HUNTINGTON BEACH	CA	92647	7034	30	06059	33.70481104	-117.9882948	Orange County
10008	Fee-for-Service	1285844456	1285844456	1	1	APPLESTEIN, ESPERANZA LMFT	7/21/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16935 W BERNARDO DR	STE 104	SAN DIEGO	CA	92127	1623	37	06073	33.02335619	-117.0804364	San Diego County
10013	Fee-for-Service	1043639107	1043639107	1	1	ART OF HOSPICE CARE INC	7/1/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7710 BALBOA AVE	SUITE 329	SAN DIEGO	CA	92111	2230	37	06073	32.82185956	-117.1580911	San Diego County
10025	Fee-for-Service	1548551997	1548551997	1	1	ALAMEDA COUNTY MEDICAL	4/27/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER	1411 E 31ST STREET	KORET BLDG, 6TH FLOOR	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
10047	Fee-for-Service	1831529049	1831529049	1	1	ALAMEDA HEALTH SYSTEM	7/1/2016	No Taxonomy Provided	NA	None	060	COUNTY HOSPITAL INPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	2070 CLINTON AVENUE	None	ALAMEDA	CA	94501	4399	01	06001	37.76333626	-122.253868	Alameda County
10049	Fee-for-Service	1700431392	1700431392	1	1	ASSISTIVE HEALTH SYSTEMS INC	11/22/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	AND PALLIATIVE CARE	4540 KEARNY VILLA ROAD	SUITE 213	SAN DIEGO	CA	92123	1586	37	06073	32.82260734	-117.144126	San Diego County
10053	Fee-for-Service	1124419809	1124419809	1	1	AGARWAL, CARRIE H MD	9/30/2021	390200000X	NA	Other	026	PHYSICIANS	172859	15	Obstetrics (D.O. only)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
10076	Fee-for-Service	1487603312	1487603312	1	1	ALONSO, MISAEL C MD	12/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
10086	Fee-for-Service	1962513051	1962513051	1	1	ADLER-SHOHET, FELICE MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	83777	40	Pediatrics	0	In state provider	None	455 S MAIN STREET	None	ORANGE	CA	92868	3874	30	06059	33.78077578	-117.8673468	Orange County
10095	Fee-for-Service	1437643376	1437643376	1	1	ARDESHIRZADEH, SHIRIN MD	12/7/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	190576	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
10098	Fee-for-Service	1295202943	1295202943	1	1	ANTHONY BENIGNO, PSYD., PSYC	4/3/2020	261QM0801X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	800 FERRARI	SUITE 200	ONTARIO	CA	91764	5031	36	06071	34.07149256	-117.5624985	San Bernardino County
10101	Fee-for-Service	1184234726	1184234726	1	3	ACCESS COMMUNITY HEALTH	2/28/2023	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	14642 NEWPORT AVE	STE 101	TUSTIN	CA	92780	6058	30	06059	33.73082212	-117.8293987	Orange County
10105	Fee-for-Service	1750313235	1750313235	1	1	ALURU, DEEPIKA MD	5/1/1999	207L00000X	NA	Other	026	PHYSICIANS	68210	None	None	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
10112	Fee-for-Service	1841728508	1841728508	1	1	ABILITY HOME HEALTH SERVICES	11/21/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	9560 CANDIDA ST	None	SAN DIEGO	CA	92126	4540	37	06073	32.89667903	-117.121893	San Diego County
10115	Fee-for-Service	1154968956	1154968956	1	1	AUSTIN, JENNIFER H	12/18/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	12524 DOUGLAS ST	None	IRVINE	CA	92399	4923	36	06071	34.026192	-117.0301065	San Bernardino County
10119	Fee-for-Service	1801530167	1801530167	1	1	AHMADIEH-YAZDI, PUYA PSYD	11/14/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
10129	Fee-for-Service	1790122687	1790122687	1	1	AVAGYAN, HRIPSIME DO	2/1/2022	207LP2900X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	830 S CITRUS AVE	SUITE 201	AZUSA	CA	91702	5942	19	06037	34.108074	-117.8902345	Los Angeles County
10170	Fee-for-Service	1770661639	1770661639	1	1	ANDREWS, CHRIS E DC	2/8/2015	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4140 MOTHER LODE DR	#116	SHINGLE SPRINGS	CA	95682	8038	09	06017	38.66359686	-120.9322835	El Dorado County
10179	Fee-for-Service	1639141740	1639141740	1	2	ARBOLEDA, ANTONIO L MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	46476	40	Pediatrics	0	In state provider	None	191 S BUENA VISTA ST	STE 240	BURBANK	CA	91505	4559	19	06037	34.15872557	-118.3283863	Los Angeles County
10211	Fee-for-Service	1952781080	1952781080	1	2	AGUILAR, JULISSA LMFT	5/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
10230	Fee-for-Service	1710191283	1710191283	1	1	ALTAMED HEALTH SERVICES	8/1/1991	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	9436 SLAUSON AVE	None	PICO RIVERA	CA	90660	4748	19	06037	33.96800305	-118.0956362	Los Angeles County
10231	Fee-for-Service	1407272685	1407272685	1	1	AMADA MENDOZA NURSING CORPOR	3/28/2023	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ATION	11735 FIRESTONE BLVD	None	NORWALK	CA	90650	2808	19	06037	33.91353706	-118.0831749	Los Angeles County
10237	Fee-for-Service	1982770152	1982770152	1	1	ASHLEY-WILLIAMS, STACIE A	12/7/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	10900 E 183RD ST	SUITE 105	CERRITOS	CA	90703	7743	19	06037	33.86553452	-118.101933	Los Angeles County
10280	Fee-for-Service	1215093125	1215093125	1	1	AHMED, EDNAN MD	5/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107504	18	Ophthalmology	0	In state provider	None	800 FAIRMOUNT AVE	SUITE 312	PASADENA	CA	91105	3150	19	06037	34.13193177	-118.1517805	Los Angeles County
10291	Fee-for-Service	1306015425	1306015425	1	1	ALTAMED HEALTH SERVICES CORP	2/13/2008	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HUNTINGTON BCH COMM CLIN	8041 NEWMAN AVE	None	HUNTINGTON BEACH	CA	92647	7034	30	06059	33.70481104	-117.9882948	Orange County
10302	Fee-for-Service	1043639107	1043639107	1	1	ART OF HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7710 BALBOA AVE	SUITE 329	SAN DIEGO	CA	92111	2230	37	06073	32.82185956	-117.1580911	San Diego County
10315	Fee-for-Service	1548551997	1548551997	1	1	ALAMEDA COUNTY MEDICAL	10/10/2011	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	CENTER	1411 E 31ST STREET	KORET BLDG, 6TH FLOOR	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
10317	Fee-for-Service	1154747020	1154747020	1	4	ACN MEDICAL GROUP, INC	10/10/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	955 23RD ST	None	RICHMOND	CA	94804	1250	07	06013	37.946313	-122.347509	Contra Costa County
10333	Fee-for-Service	1831529049	1831529049	1	1	ALAMEDA HEALTH SYSTEM	5/1/2014	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2070 CLINTON AVENUE	None	ALAMEDA	CA	94501	4399	01	06001	37.76333626	-122.253868	Alameda County
10340	Fee-for-Service	1396599874	1396599874	1	1	ATTISHA, LANZA	5/1/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11750 SORRENTO VALLEY	STE 130	SAN DIEGO	CA	92121	1019	37	06073	32.91461387	-117.2343576	San Diego County
10355	Fee-for-Service	1972081412	1972081412	1	1	AHRA CHO, M.D., INC	12/14/2018	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	2727 W OLYMPIC BLVD STE	None	LOS ANGELES	CA	90006	2640	19	06037	34.0527015	-118.2931155	Los Angeles County
10386	Fee-for-Service	1295202943	1295202943	1	1	ANTHONY BENIGNO, PSYD., PSYC	4/10/2020	261QM0801X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	800 FERRARI	SUITE 200	ONTARIO	CA	91764	5031	36	06071	34.07149256	-117.5624985	San Bernardino County
10400	Fee-for-Service	1154968956	1154968956	1	1	AUSTIN, JENNIFER H	12/18/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	12524 DOUGLAS ST	None	IRVINE	CA	92399	4923	36	06071	34.026192	-117.0301065	San Bernardino County
10405	Fee-for-Service	1750358412	1750358412	1	1	ALL CITY PODIATRY CLINIC	10/1/2000	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	610 EUCLID AVE	STE 304	NATIONAL CITY	CA	91950	2953	37	06073	32.68419388	-117.0829524	San Diego County
10407	Fee-for-Service	1568608636	1568608636	1	1	ARAIZA, ERNESTINA PSYD	10/21/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
10412	Fee-for-Service	1497453328	1497453328	1	1	A-1 BOARDING CARE, INC.	4/20/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6511 BONNER AVENUE	None	NORTH HOLLYWOOD	CA	91606	2703	19	06037	34.18884942	-118.3737518	Los Angeles County
10422	Fee-for-Service	1760534101	1760534101	1	1	ALLEN, DEBORAH A LCSW	10/1/2001	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	23 W MISSION ST	None	SANTA BARBARA	CA	93101	8460	42	06083	34.43022721	-119.7153091	Santa Barbara County
10445	Fee-for-Service	1558689216	1558689216	1	1	ABUABARA, KATRINA E MD	8/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137584	05	Anesthesiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
10457	Fee-for-Service	1740274547	1740274547	1	1	ABDULLAH, EDWARD E MD	12/29/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	59365	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	18113 BROOKHURST ST	None	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
10482	Fee-for-Service	1770695181	1770695181	1	1	ASAIKAR, SHAILESH M	5/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	49354	None	None	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
10487	Fee-for-Service	1316370950	1316370950	1	1	ACADIAN DIAGNOSTIC LABORATOR	11/20/2018	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	IES LLC	11842 JUSTICE AVE	None	BATON ROUGE	LA	70816	5324	00	None	30.423879	-91.049328	East Baton Rouge Parish
10513	Fee-for-Service	1639200801	1639200801	1	1	ALAMILLO, MARTHA S LCSW	7/14/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
10514	Fee-for-Service	1235254848	1235254848	1	1	AVANTS, TERESA P MD	8/21/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	56066	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
10516	Fee-for-Service	1710191283	1710191283	1	1	ALTAMED HEALTH SERVICES	4/28/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	9436 SLAUSON AVE	None	PICO RIVERA	CA	90660	4748	19	06037	33.96800305	-118.0956362	Los Angeles County
10530	Fee-for-Service	1437885837	1437885837	1	1	ALVAREZ, NANCY A NP	8/9/2022	207QG0300X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	22419 KENT AVE	None	TORRANCE	CA	90505	2303	19	06037	33.824448	-118.3564765	Los Angeles County
10561	Fee-for-Service	1922171099	1922171099	1	1	ANEGAWA, NORIFUSA J MD	7/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85366	13	Neurology (M.D. only)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
10580	Fee-for-Service	1306015425	1306015425	1	1	ALTAMED HEALTH SERVICES CORP	2/13/2008	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HUNTINGTON BCH COMM CLIN	8041 NEWMAN AVE	None	HUNTINGTON BEACH	CA	92647	7034	30	06059	33.70481104	-117.9882948	Orange County
10602	Fee-for-Service	1720021397	1720021397	1	1	AMIN, JATIN N MD	11/2/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	82118	41	Internal Medicine	0	In state provider	None	36320 INLAND VALLEY DR	STE 301	WILDOMAR	CA	92595	7512	33	06065	33.592158	-117.2367705	Riverside County
10646	Fee-for-Service	1629630314	1629630314	1	1	ARCHWAY HEALTH CARE SERVICES	8/4/2020	207QA0401X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INC	8950 CAL CENTER DR	STE 112	SACRAMENTO	CA	95826	3236	34	06067	38.555721	-121.3745985	Sacramento County
10649	Fee-for-Service	1831275916	1831275916	1	1	APODACA, DONALD B OD	4/13/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	22550 E SAVI RANCH PKWY	None	YORBA LINDA	CA	92887	4670	30	06059	33.87448406	-117.7441707	Orange County
10666	Fee-for-Service	1164006946	1164006946	1	1	ALMOG, ROY MD	7/1/2024	390200000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
10671	Fee-for-Service	1952781080	1952781080	1	1	AGUILAR, JULISSA LMFT	7/1/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	107392	-	NOT APPLICABLE	0	In state provider	None	1303 W WALNUT PKWY	None	COMPTON	CA	90220	5030	19	06037	33.87724562	-118.2446904	Los Angeles County
10672	Fee-for-Service	1013027424	1013027424	1	1	ANNES, JUSTIN P MD	12/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55432	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
10673	Fee-for-Service	1295202943	1295202943	1	1	ANTHONY BENIGNO, PSYD., PSYC	5/3/2021	261QM0801X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	800 FERRARI	SUITE 200	ONTARIO	CA	91764	5031	36	06071	34.07149256	-117.5624985	San Bernardino County
10727	Fee-for-Service	1114930435	1114930435	1	1	AUSTIN, DAVID L MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64619	08	Family Practice	0	In state provider	None	2501 N SEPULVEDA BLVD	STE 100	MANHATTAN BEACH	CA	90266	2735	19	06037	33.895098	-118.396119	Los Angeles County
10760	Fee-for-Service	1790802114	1790802114	2	1	ADRIENNE RUTH M.D.	12/16/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 EXEMPLA CIR	None	LAFAYETTE	CO	80026	3370	00	None	39.97232464	-105.086171	Boulder County
10761	Fee-for-Service	1457399339	1457399339	1	1	ATKIN, THOMAS W MD	3/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	29367	30	Radiology	0	In state provider	None	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
10768	Fee-for-Service	1346569332	1346569332	1	1	ANDRAS, LYDIA E MD	9/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131318	05	Anesthesiology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
10776	Fee-for-Service	1033196795	1033196795	1	1	ANDREINI, SONI L MD	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	69451	01	General Practice	0	In state provider	None	2037 HWY 4	None	ARNOLD	CA	95223	0067	05	06009	38.241954	-120.3606855	Calaveras County
10799	Fee-for-Service	1700976610	1700976610	1	1	ADAMS, AMY L MD	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86901	66	Emergency Medicine (Urgent Care)	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
10804	Fee-for-Service	1861649055	1861649055	1	1	AMINI HADJIBASHI,	9/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109487	02	General Surgery	0	In state provider	ANOUSHIRAVAN MD	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
10805	Fee-for-Service	1710191283	1710191283	1	1	ALTAMED HEALTH SERVICES	8/1/1991	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	9436 SLAUSON AVE	None	PICO RIVERA	CA	90660	4748	19	06037	33.96800305	-118.0956362	Los Angeles County
10846	Fee-for-Service	1609424753	1609424753	1	1	AM PM TRANSPORTATION LLC	5/26/2022	2278P4000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1890 PARK MARINA DR	STE 218	REDDING	CA	96001	0961	45	06089	40.58479944	-122.3751499	Shasta County
10881	Fee-for-Service	1083641617	1083641617	1	1	ACE MEDICAL SUPPLY LLC	12/1/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ACE MEDICAL SUPPLY LLC	15030 PRAIRIE AVE	None	HAWTHORNE	CA	90250	8316	19	06037	33.89526	-118.3437705	Los Angeles County
10907	Fee-for-Service	1457034027	1457034027	1	1	AVERSANO, ALEXA LMFT	11/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
10932	Fee-for-Service	1629630314	1629630314	1	1	ARCHWAY HEALTH CARE SERVICES	8/4/2020	207QA0401X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	8950 CAL CENTER DR	STE 112	SACRAMENTO	CA	95826	3236	34	06067	38.555721	-121.3745985	Sacramento County
10967	Fee-for-Service	1326242983	1326242983	1	1	ANDREW GINZEL MD	7/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	16100 SOUTH FWY	None	PEARLAND	TX	77584	1895	00	None	29.56697428	-95.38754979	Brazoria County
10995	Fee-for-Service	1306240908	1306240908	1	1	ALEXANDER, JOSHUA C PSYD	3/11/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
11019	Fee-for-Service	1841307477	1841307477	1	1	AMY TESAR DO	9/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1316 S MAIN ST	None	CLARION	IA	50525	2019	00	None	42.72125987	-93.7326632	Wright County
11056	Fee-for-Service	1780082081	1780082081	1	1	ALVAREZ, JANEV A	12/20/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	65 S MAIN ST STE 101	None	TEMPLETON	CA	93465	8703	40	06079	35.55478617	-120.7015206	San Luis Obispo County
11064	Fee-for-Service	1760651814	1760651814	1	5	ALTAMED HEALTH SERVICES	4/17/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	3002 W CENTENNIAL ROAD	None	SANTA ANA	CA	92704	3904	30	06059	33.72431197	-117.9128436	Orange County
11074	Fee-for-Service	1508965476	1508965476	1	1	AMADPOUR, MOE MD	10/7/2010	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	81182	41	Internal Medicine	0	In state provider	None	2796 SYCAMORE DR	STE 204	SIMI VALLEY	CA	93065	1549	56	06111	34.28595701	-118.7437588	Ventura County
11161	Fee-for-Service	1003583212	1003583212	1	1	ARLITT, ADAM	11/5/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	500 W GLENOAKS BLVD	None	GLENDALE	CA	91202	2813	19	06037	34.15937082	-118.2644042	Los Angeles County
11176	Fee-for-Service	1356775878	1356775878	1	2	ALTAMED HEALTH SERVICES CORP	8/27/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	6336 PASSONS BLVD	None	PICO RIVERA	CA	90660	3355	19	06037	33.98515856	-118.0862644	Los Angeles County
11209	Fee-for-Service	1720212384	1720212384	1	1	ALFONSO, JANE J LMFT	5/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1761 BROADWAY ST	None	VALLEJO	CA	94589	2226	48	06095	38.13049234	-122.2522422	Solano County
11234	Fee-for-Service	1841510385	1841510385	1	1	AKINGBEMI, OLUMIDE M MD	9/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112199	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
11278	Fee-for-Service	1861711863	1861711863	1	1	AME MEDICAL GROUP, INC.	6/15/2010	193200000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11942 PARAMOUNT BLVD	STE B	DOWNEY	CA	90242	2306	19	06037	33.93374098	-118.1445557	Los Angeles County
11286	Fee-for-Service	1871846501	1871846501	1	1	ALBRIGHT, HEIDI LCSW	11/2/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	57463 29 PALMS HWY	STE 202	YUCCA VALLEY	CA	92284	2925	36	06071	34.12447835	-116.4106891	San Bernardino County
11314	Fee-for-Service	1417995655	1417995655	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	543 SWEETWATER RD	None	SPRING VALLEY	CA	91977	5627	37	06073	32.708178	-117.008559	San Diego County
11319	Fee-for-Service	1003972654	1003972654	2	2	AEGIS TREATMENT CENTERS, LLC	6/11/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	115 E FESLER ST	None	SANTA MARIA	CA	93454	4404	42	06083	34.95648451	-120.435021	Santa Barbara County
11350	Fee-for-Service	1760651814	1760651814	1	5	ALTAMED HEALTH SERVICES	4/17/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	3002 W CENTENNIAL ROAD	None	SANTA ANA	CA	92704	3904	30	06059	33.72431197	-117.9128436	Orange County
11358	Fee-for-Service	1154747020	1154747020	1	1	ACN MEDICAL GROUP, INC	10/10/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3025 HIGH ST	None	OAKLAND	CA	94619	1807	01	06001	37.78454091	-122.2002993	Alameda County
11363	Fee-for-Service	1508965476	1508965476	1	1	AMADPOUR, MOE MD	10/7/2010	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	81182	10	Gastroenterology (M.D. only)	0	In state provider	None	2796 SYCAMORE DR	STE 204	SIMI VALLEY	CA	93065	1549	56	06111	34.28595701	-118.7437588	Ventura County
11399	Fee-for-Service	1255982849	1255982849	1	1	ACEVEDO, NICHOLAS D PT	2/26/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	14682 CENTRAL AVE	None	CHINO	CA	91710	9505	36	06071	33.986601	-117.689039	San Bernardino County
11419	Fee-for-Service	1760651814	1760651814	1	1	ALTAMED HEALTH SERVICES	1/15/2009	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	2720 S BRISTOL STREET	SUITE 110	SANTA ANA	CA	92704	6210	30	06059	33.710463	-117.8854565	Orange County
11428	Fee-for-Service	1952776833	1952776833	1	1	ALI, IFRAH A MD	1/11/2021	207P00000X	NA	Other	026	PHYSICIANS	171102	None	None	0	In state provider	None	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
11445	Fee-for-Service	1770014979	1770014979	1	1	ANDONIAN, NICOLE MD	8/19/2021	207L00000X	NA	Other	026	PHYSICIANS	159217	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
11480	Fee-for-Service	1508825027	1508825027	1	1	ALAV, FARAMARZ M MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74033	41	Internal Medicine	0	In state provider	None	8110 MANGO AVE	None	FONTANA	CA	92335	3603	36	06071	34.10549796	-117.4314604	San Bernardino County
11485	Fee-for-Service	1477088037	1477088037	1	1	ANITA HOME HEALTH INC	8/7/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11100 VALLEY BLVD	STE 342	EL MONTE	CA	91731	2533	19	06037	34.07383477	-118.0332998	Los Angeles County
11492	Fee-for-Service	1326272691	1326272691	1	1	ALLAR, RORY T MD	6/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125939	18	Ophthalmology	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
11527	Fee-for-Service	1871928689	1871928689	1	1	ASSAR, SARA PSYD	5/20/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
11546	Fee-for-Service	1639480718	1639480718	1	1	ACKER, PETER C MD	7/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124940	66	Emergency Medicine (Urgent Care)	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
11563	Fee-for-Service	1548502487	1548502487	1	1	AU, ALICE OD	9/2/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
11564	Fee-for-Service	1023375847	1023375847	1	1	AHN, ESTHER S MD	8/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128139	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
11565	Fee-for-Service	1861711863	1861711863	1	1	AME MEDICAL GROUP, INC.	6/15/2010	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	11942 PARAMOUNT BLVD	STE B	DOWNEY	CA	90242	2306	19	06037	33.93374098	-118.1445557	Los Angeles County
11605	Fee-for-Service	1003972654	1003972654	2	2	AEGIS TREATMENT CENTERS, LLC	6/11/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	115 E FESLER ST	None	SANTA MARIA	CA	93454	4404	42	06083	34.95648451	-120.435021	Santa Barbara County
11654	Fee-for-Service	1760651814	1760651814	1	4	ALTAMED HEALTH SERVICES	4/17/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2301 WEST MACARTHUR BLVD	None	SANTA ANA	CA	92704	7168	30	06059	33.70007909	-117.9001656	Orange County
11661	Fee-for-Service	1760651814	1760651814	1	2	ALTAMED HEALTH SERVICES	11/21/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	BROADWAY	1515 S BROADWAY	None	SANTA ANA	CA	92707	2253	30	06059	33.72651495	-117.8698759	Orange County
11675	Fee-for-Service	1821594359	1821594359	1	1	ASTASHCHANKA, ANNA MD	6/27/2023	207R00000X	NA	Other	026	PHYSICIANS	164791	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
11676	Fee-for-Service	1851349278	1851349278	1	1	ADAMS, PAUL M OD	8/27/2008	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1900 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4833	36	06071	34.132662	-117.2787965	San Bernardino County
11702	Fee-for-Service	1760871230	1760871230	1	1	ADVENTIST HEALTH PHYSICIANS	2/6/2019	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	15322 LAKESHORE DR	STE 101	CLEARLAKE	CA	95422	9814	17	06033	38.95045805	-122.6255271	Lake County
11705	Fee-for-Service	1760651814	1760651814	1	1	ALTAMED HEALTH SERVICES	2/24/2010	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	2720 S BRISTOL STREET	SUITE 110	SANTA ANA	CA	92704	6210	30	06059	33.710463	-117.8854565	Orange County
11725	Fee-for-Service	1376729483	1376729483	1	2	ACCENTCARE HOME HEALTH	9/6/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2280 MARKET STREET	SUITE 220	RIVERSIDE	CA	92501	2120	33	06065	33.99828881	-117.3720693	Riverside County
11732	Fee-for-Service	1669934626	1669934626	1	3	ACCEPT FAMILY COUNSELING INC	5/6/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	14350 CIVIC DR	SUITE 100	VICTORVILLE	CA	92392	2338	36	06071	34.51177135	-117.3236721	San Bernardino County
11754	Fee-for-Service	1457019184	1457019184	1	1	ALWAYS BEST HOME HEALTH CARE	5/29/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	13517 VENTURA BLVD	STE 6A	SHERMAN OAKS	CA	91423	3867	19	06037	34.14745553	-118.4276951	Los Angeles County
11764	Fee-for-Service	1386225316	1386225316	1	1	ABDOU, EDMOND A MD	3/13/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186698	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
11779	Fee-for-Service	1033309513	1033309513	1	1	AJANTA SEN	8/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2636 TIBBETS DR	None	BEDFORD	TX	76022	6919	00	None	32.83276376	-97.1237339	Tarrant County
11793	Fee-for-Service	1447200761	1447200761	1	1	ABACI, PETER A MD	4/30/1995	207L00000X	NA	Other	026	PHYSICIANS	76565	05	Anesthesiology	0	In state provider	None	16795 LARK AVE	STE 230	LOS GATOS	CA	95032	7650	43	06085	37.25302151	-121.966891	Santa Clara County
11800	Fee-for-Service	1760554919	1760554919	1	1	ASKARI, ALI ASGHAR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1331 N 7TH ST	STE 400	PHOENIX	AZ	85006	0000	00	None	33.463404	-112.0643505	Maricopa County
11813	Fee-for-Service	1548452550	1548452550	1	1	AARON HULTGREN, MD	8/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 1ST AVE	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
11816	Fee-for-Service	1689883712	1689883712	2	1	ARTESIA ADULT DAY HEALTH	2/29/2016	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE INC	716 S BEACH BLVD	None	ANAHEIM	CA	92084	0000	30	06059	33.821892	-117.993182	Orange County
11817	Fee-for-Service	1386818227	1386818227	1	1	ATTENELLO, FRANK J III MD	7/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	116573	14	Neurological Surgery	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06269295	-118.2030006	Los Angeles County
11834	Fee-for-Service	1467647982	1467647982	1	1	ANDREWS, TODD PSYD	6/4/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	601 DUBOCE AVE	STE 250	SAN FRANCISCO	CA	94117	3389	38	06075	37.7691148	-122.4344597	San Francisco County
11867	Fee-for-Service	1184049140	1184049140	1	1	ANDERSON, RYAN L MD	8/16/2021	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	151182	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
11897	Fee-for-Service	1295294676	1295294676	1	1	ANDEMEL, NAISSEM L MD MPH	11/27/2022	207R00000X	NA	Other	026	PHYSICIANS	181196	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
11904	Fee-for-Service	1013071539	1013071539	1	2	AUSTIN & VATAVE MDS INC	3/11/2011	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	12675 LA MIRADA BLVD	STE 300	LA MIRADA	CA	90638	2235	19	06037	33.91589551	-118.0119734	Los Angeles County
11912	Fee-for-Service	1780690222	1780690222	1	1	AZODO, UCHENDU MD	6/16/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	136387	30	Radiology	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
11916	Fee-for-Service	1144673286	1144673286	1	1	AZIZ, MUHAMMAD U MD	3/13/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	3001 SAINT ROSE PKWY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
11931	Fee-for-Service	1811349525	1811349525	1	1	ALAMO RAMOS, KRISTY	1/3/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
11939	Fee-for-Service	1205994464	1205994464	1	1	AMES, RALPH L PHD	10/6/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	865 3RD ST.	STE 203	SANTA ROSA	CA	95404	4519	49	06097	38.442276	-122.708232	Sonoma County
11941	Fee-for-Service	1760651814	1760651814	1	4	ALTAMED HEALTH SERVICES	4/17/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2301 WEST MACARTHUR BLVD	None	SANTA ANA	CA	92704	7168	30	06059	33.70007909	-117.9001656	Orange County
11943	Fee-for-Service	1760847909	1760847909	1	1	ANN, PHOEBE MD	2/21/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	181600	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
11947	Fee-for-Service	1760651814	1760651814	1	2	ALTAMED HEALTH SERVICES	11/21/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	BROADWAY	1515 S BROADWAY	None	SANTA ANA	CA	92707	2253	30	06059	33.72651495	-117.8698759	Orange County
11993	Fee-for-Service	1760651814	1760651814	1	1	ALTAMED HEALTH SERVICES	1/15/2009	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	2720 S BRISTOL STREET	SUITE 110	SANTA ANA	CA	92704	6210	30	06059	33.710463	-117.8854565	Orange County
11997	Fee-for-Service	1538748223	1538748223	1	1	ARANGURI, KEVIN X MD	1/16/2025	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
12031	Fee-for-Service	1124272067	1124272067	1	1	ASIAN AMERICAN DRUG ABUSE	3/30/2016	251S00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	PROGRAM INC	13931 VAN NESS AVENUE	None	GARDENA	CA	90249	2941	19	06037	33.905079	-118.3178875	Los Angeles County
12045	Fee-for-Service	1437186111	1437186111	1	1	ATHENS REGIONAL MED CTR	6/5/2008	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1199 PRINCE AVENUE	None	ATHENS	GA	30606	2797	00	None	33.96240476	-83.39810578	Clarke County
12046	Fee-for-Service	1750306791	1750306791	2	1	ARS HEALTH CARE INC	9/29/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12500 RIVERSIDE DR	SUITE 205	VALLEY VILLAGE	CA	91607	3423	19	06037	34.15758653	-118.4056605	Los Angeles County
12056	Fee-for-Service	1750364048	1750364048	1	1	ANDERSON, MARJORIE P MD	7/25/2014	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	64693	01	General Practice	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
12062	Fee-for-Service	1871025957	1871025957	1	1	ARSHAD, SABA MD	1/27/2024	207R00000X	NA	Other	026	PHYSICIANS	170379	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
12084	Fee-for-Service	1659767572	1659767572	1	1	ASIAN HEALTHLINK	2/1/2018	193200000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2147 MOWRY AVE	STE D3	FREMONT	CA	94538	1724	01	06001	37.55758233	-121.9810516	Alameda County
12094	Fee-for-Service	1184032351	1184032351	1	1	ANMANGANDLA, DILIP MD INC	5/18/2015	207R00000X	NA	Other	026	PHYSICIANS	119597	41	Internal Medicine	0	In state provider	None	28040 DOROTHY DR	STE 103	AGOURA HILLS	CA	91301	4915	19	06037	34.14223259	-118.7380778	Los Angeles County
12098	Fee-for-Service	1992363535	1992363535	1	1	ACEVEDO, MARIA D CNP	2/21/2020	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
12100	Fee-for-Service	1518912211	1518912211	1	1	ALTMAN, KAREN D MD INC	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	56064	13	Neurology (M.D. only)	0	In state provider	None	8733 BEVERLY BLVD	STE 404	LOS ANGELES	CA	90048	1842	19	06037	34.07688048	-118.3815765	Los Angeles County
12134	Fee-for-Service	1639189434	1639189434	1	1	ARENSON, KENNETH J MDINC	6/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	28845	18	Ophthalmology	0	In state provider	WARNER VICTORY CTR	6325 TOPANGA CANYON BLVD	STE 224	WOODLAND HILLS	CA	91367	2017	19	06037	34.184934	-118.6059175	Los Angeles County
12138	Fee-for-Service	1306862859	1306862859	1	1	ARZOO, KARO K MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64524	68	Hematology	0	In state provider	None	2601 W ALAMEDA AVE	STE 210	BURBANK	CA	91505	4810	19	06037	34.15783817	-118.3293969	Los Angeles County
12148	Fee-for-Service	1447540547	1447540547	1	1	AVAGYAN, SERINE MD	1/20/2023	2080P0207X	NA	Hematology	026	PHYSICIANS	183791	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
12150	Fee-for-Service	1700862794	1700862794	1	1	ADAMS, ALLEN D MD	5/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86964	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
12154	Fee-for-Service	1235351206	1235351206	1	1	ALFARO-MCFIELD, EDGAR E	8/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100540	40	Pediatrics	0	In state provider	MD	647 E ARROW HWY	None	AZUSA	CA	91702	5802	19	06037	34.1068263	-117.8982008	Los Angeles County
12161	Fee-for-Service	1235149741	1235149741	2	1	ADVANTACARE HEALTH, INC	12/26/2007	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ADVANTACARE MEDICAL	5 MANDEVILLE COURT	STE 200	MONTEREY	CA	93940	5745	27	06053	36.57541006	-121.8125248	Monterey County
12191	Fee-for-Service	1013071539	1013071539	1	2	AUSTIN & VATAVE MDS INC	3/11/2011	207R00000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	12675 LA MIRADA BLVD	STE 300	LA MIRADA	CA	90638	2235	19	06037	33.91589551	-118.0119734	Los Angeles County
12195	Fee-for-Service	1396454252	1396454252	1	1	ACHARA, CHARITY E NP	2/7/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7301 S WESTERN AVE	None	LOS ANGELES	CA	90047	2254	19	06037	33.973479	-118.309018	Los Angeles County
12233	Fee-for-Service	1518498815	1518498815	1	1	ADVENTIST HEALTH PHYSICIANS	9/15/2017	207X00000X	NA	Orthopedic Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	8120 TIMBERLAKE WAY	SUITE 112	SACRAMENTO	CA	95823	5413	34	06067	38.461023	-121.41414	Sacramento County
12238	Fee-for-Service	1588212278	1588212278	1	1	ABSOLUTE HOME HEALTH	5/13/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	& HOSPICE INC	4740 MURPHY CANYON RD	STE 205	SAN DIEGO	CA	92123	4376	37	06073	32.82724116	-117.1194932	San Diego County
12252	Fee-for-Service	1417474248	1417474248	1	1	ANDERSON, ELAINE K OT	1/25/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
12259	Fee-for-Service	1720265671	1720265671	1	1	ANDERSON, CARRIE F LMFT	12/16/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	50219	-	NOT APPLICABLE	0	In state provider	None	1816 SCENIC AVENUE	None	BERKELEY	CA	94709	1324	01	06001	37.87558576	-122.2622904	Alameda County
12280	Fee-for-Service	1760651814	1760651814	1	1	ALTAMED HEALTH SERVICES	4/9/2009	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	2720 S BRISTOL STREET	SUITE 110	SANTA ANA	CA	92704	6210	30	06059	33.710463	-117.8854565	Orange County
12285	Fee-for-Service	1144479221	1144479221	1	1	AHUJA, YACHNA MD	7/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120825	18	Ophthalmology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
12333	Fee-for-Service	1437186111	1437186111	1	1	ATHENS REGIONAL MED CTR	6/5/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1199 PRINCE AVENUE	None	ATHENS	GA	30606	2797	00	None	33.96240476	-83.39810578	Clarke County
12358	Fee-for-Service	1487090221	1487090221	1	2	AEGIS TREATMENT CENTERS, LLC	6/2/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	201 D ST	G, T & W	MARYSVILLE	CA	95901	5952	58	06115	39.13753087	-121.5885645	Yuba County
12360	Fee-for-Service	1821556499	1821556499	1	1	ALDER, NADIA R MD FAAP	7/13/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	75475	40	Pediatrics	0	In state provider	None	1 SCRIPPS DRIVE	STE 102	SACRAMENTO	CA	95825	6206	34	06067	38.573181	-121.4118135	Sacramento County
12371	Fee-for-Service	1659767572	1659767572	1	1	ASIAN HEALTHLINK	3/14/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2147 MOWRY AVE	STE D3	FREMONT	CA	94538	1724	01	06001	37.55758233	-121.9810516	Alameda County
12379	Fee-for-Service	1275696585	1275696585	1	1	ASLAMY, ZAKI MD	3/31/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	4409	00	None	33.480864	-112.0795155	Maricopa County
12420	Fee-for-Service	1598339582	1598339582	1	1	AHDI, HEAVEEN MD	11/13/2024	207P00000X	NA	Other	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
12425	Fee-for-Service	1306862859	1306862859	1	1	ARZOO, KARO K MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64524	78	Neoplastic Diseases/Oncology	0	In state provider	None	2601 W ALAMEDA AVE	STE 210	BURBANK	CA	91505	4810	19	06037	34.15783817	-118.3293969	Los Angeles County
12441	Fee-for-Service	1124641907	1124641907	1	1	ASHARY, AHMED A MD	7/11/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187356	None	None	0	In state provider	None	10250 SANTA MONICA BLVD	2440	LOS ANGELES	CA	90067	6469	19	06037	34.05998846	-118.4200204	Los Angeles County
12505	Fee-for-Service	1710424130	1710424130	1	1	ADVANCED ADULT CLINIC INC	5/23/2017	207RA0000X	NA	Pediatric Primary Care	026	PHYSICIANS	134155	41	Internal Medicine	0	In state provider	None	1326 H ST	SUITE 1	BAKERSFIELD	CA	93301	5134	15	06029	35.370198	-119.021191	Kern County
12509	Fee-for-Service	1639337843	1639337843	1	1	ANKIT, SARIN MD	2/16/2011	390200000X	NA	Other	026	PHYSICIANS	114985	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
12525	Fee-for-Service	1588212278	1588212278	1	1	ABSOLUTE HOME HEALTH	5/13/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	& HOSPICE INC	4740 MURPHY CANYON RD	STE 205	SAN DIEGO	CA	92123	4376	37	06073	32.82724116	-117.1194932	San Diego County
12531	Fee-for-Service	1013760248	1013760248	1	1	A MU D O INC	10/26/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	77	Infectious Disease	0	In state provider	None	1303 HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
12536	Fee-for-Service	1568812139	1568812139	1	1	ARAGON, MEREDITH L MD	10/18/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	170066	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
12557	Fee-for-Service	1528544665	1528544665	1	1	ALAM, ZAYNAH MD	6/24/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	185390	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
12558	Fee-for-Service	1023208733	1023208733	1	1	ALLEN, SWEET V MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112878	38	Geriatrics	0	In state provider	None	1263 E ARQUES AVE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
12620	Fee-for-Service	1114170776	1114170776	1	1	ALEX, BRADFORD L DC	8/8/2016	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	11177 TAMPA AVE	STE A	PORTER RANCH	CA	91326	2254	19	06037	34.27373836	-118.5564202	Los Angeles County
12647	Fee-for-Service	1487090221	1487090221	1	2	AEGIS TREATMENT CENTERS, LLC	6/2/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	201 D ST	G, T & W	MARYSVILLE	CA	95901	5952	58	06115	39.13753087	-121.5885645	Yuba County
12653	Fee-for-Service	1932145513	1932145513	1	1	ACOSTA, IGNACIO MD	3/25/2008	208600000X	NA	General Surgery	026	PHYSICIANS	26640	02	General Surgery	0	In state provider	None	1808 VERDUGO BLVD	STE 409	GLENDALE	CA	91208	1487	19	06037	34.2056211	-118.2154553	Los Angeles County
12707	Fee-for-Service	1598339582	1598339582	1	1	AHDI, HEAVEEN MD	11/13/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
12721	Fee-for-Service	1225528102	1225528102	1	1	AM PHARMACY INC	12/13/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16330 WALNUT ST	STE 4	HESPERIA	CA	92345	3623	36	06071	34.42123923	-117.3065624	San Bernardino County
12729	Fee-for-Service	1649346842	1649346842	1	1	AI, WEIYUN Z MD	2/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78202	78	Neoplastic Diseases/Oncology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
12745	Fee-for-Service	1700974748	1700974748	1	1	ALPERN, FREDERICK D	7/1/1998	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	758 RANCHO SANTA FE RD	None	ENCINITAS	CA	92024	6651	37	06073	33.05157069	-117.2328748	San Diego County
12758	Fee-for-Service	1841617925	1841617925	1	1	ANDERSON, NORIKO T MD	8/1/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	141072	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
12765	Fee-for-Service	1497172480	1497172480	1	1	AIDEN, AVIVA MD	10/23/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	170169	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
12790	Fee-for-Service	1730464413	1730464413	1	1	ABERCROMBIE, ELENA G	1/17/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
12816	Fee-for-Service	1699712026	1699712026	1	2	ALBERTSONS LLC	5/30/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	1	Border provider	None	2378 W 24TH ST	None	YUMA	AZ	85364	6124	00	None	32.684094	-114.648849	Yuma County
12839	Fee-for-Service	1780782979	1780782979	1	2	ALONZO, RONALIE B MD	5/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	76400	None	None	0	In state provider	None	2880 ATLANTIC AVE	STE 180	LONG BEACH	CA	90806	1736	19	06037	33.809382	-118.185001	Los Angeles County
12853	Fee-for-Service	1790765428	1790765428	1	1	AVILLA, RODNEY JAMES DO	1/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	5487	01	General Practice	0	In state provider	None	2101 GEER RD	STE 303	TURLOCK	CA	95382	2470	50	06099	37.512324	-120.8489985	Stanislaus County
12854	Fee-for-Service	1205036456	1205036456	1	1	AMINI, PAYAM MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107595	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
12856	Fee-for-Service	1568827210	1568827210	1	1	ALTURA CENTERS FOR HEALTH	5/19/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1500 W TULARE DRIVE	None	TULARE	CA	93274	3424	54	06107	36.20637928	-119.3688387	Tulare County
12857	Fee-for-Service	1437611464	1437611464	1	1	ALJAMMAL, ANAS M MD	9/28/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178322	None	None	0	In state provider	None	1198 PACIFIC COAST HWY	STE I	SEAL BEACH	CA	90740	6248	30	06059	33.74325823	-118.1004531	Orange County
12882	Fee-for-Service	1215314984	1215314984	1	1	ANDERSON, KRISTEN J CRNA	2/17/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
12899	Fee-for-Service	1174089049	1174089049	1	1	ADLAKHA, ALIA A LMFT	11/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	26 W MISSION ST	STE. 7	SANTA BARBARA	CA	93101	0403	42	06083	34.42998638	-119.7156355	Santa Barbara County
12933	Fee-for-Service	1851363907	1851363907	1	2	AGGARWAL, SHUSHMA MD	5/30/2018	174400000X	NA	Other	026	PHYSICIANS	139097	None	None	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
12935	Fee-for-Service	1255911814	1255911814	1	1	AVANT GARDE HOME HEALTH CARE	11/7/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	400 S GLENDALE AVE	SUITE N2	GLENDALE	CA	91205	2282	19	06037	34.14160575	-118.2497584	Los Angeles County
12965	Fee-for-Service	1992926075	1992926075	1	1	AYOUBI, AHMAD S	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102267	41	Internal Medicine	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
12970	Fee-for-Service	1891416335	1891416335	1	1	AMERIHOME INC	9/29/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	17019 MARLIN PL	None	VAN NUYS	CA	91406	4528	19	06037	34.19715448	-118.504125	Los Angeles County
13029	Fee-for-Service	1275681116	1275681116	1	1	ALSKAF, SAMI MD	12/1/1995	207R00000X	NA	Other	026	PHYSICIANS	56058	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
13039	Fee-for-Service	1720373954	1720373954	1	1	ATALLAH, BRIDGETTE PSYD	4/3/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6615 E PACIFIC COAST HWY	SUITE 255	LONG BEACH	CA	90803	4227	19	06037	33.75463355	-118.1079597	Los Angeles County
13043	Fee-for-Service	1437387677	1437387677	1	1	ALEXANDER, JOSHUA DO	9/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11431	25	Physical Medicine and Rehabilitation	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
13047	Fee-for-Service	1609258458	1609258458	1	1	AL-SABEK, KARIM M MD	9/17/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
13063	Fee-for-Service	1487685368	1487685368	1	1	ALVAREZ, LUIS MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69276	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
13071	Fee-for-Service	1205084464	1205084464	1	1	ARCINIEGAS RODRIGUEZ,	9/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	SILVANA R MD	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
13102	Fee-for-Service	1497298798	1497298798	1	1	ALVIZURES, MIRIAM A LMFT	11/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
13103	Fee-for-Service	1205369790	1205369790	1	1	ALAGH, AMY	10/7/2024	207VF0040X	NA	Obstetrics & Gynecology	026	PHYSICIANS	158687	09	Gynecology (D.O. only)	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
13116	Fee-for-Service	1639791627	1639791627	1	1	ALTIGNIS HEALTH, LLC	11/10/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	31642 S COAST HWY	STE 102	LAGUNA BEACH	CA	92651	7017	30	06059	33.50297967	-117.7446885	Orange County
13133	Fee-for-Service	1992923221	1992923221	1	1	ANN MARTIN CHILDRENS CENTER	3/6/2013	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	1375 55TH STREET	None	EMERYVILLE	CA	94608	2609	01	06001	37.8377628	-122.2860396	Alameda County
13145	Fee-for-Service	1568827210	1568827210	1	1	ALTURA CENTERS FOR HEALTH	2/21/2019	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 W TULARE DRIVE	None	TULARE	CA	93274	3424	54	06107	36.20637928	-119.3688387	Tulare County
13151	Fee-for-Service	1790177582	1790177582	1	7	ALTAMED HEALTH SERVICES	1/16/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2661 E WASHINGTON BLVD	None	PASADENA	CA	91107	1412	19	06037	34.16910574	-118.0955603	Los Angeles County
13169	Fee-for-Service	1396339826	1396339826	1	1	ALERACARE MEDICAL GROUP OF C	3/26/2024	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ALIFORNIA	1580 W EL CAMINO REAL	5	MOUNTAIN VIEW	CA	94040	2461	43	06085	37.39001812	-122.0922931	Santa Clara County
13183	Fee-for-Service	1245690502	1245690502	1	1	ADKINS, SHAWNA LCSW	9/29/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
13215	Fee-for-Service	1598196255	1598196255	1	1	AUNG, THAUNG M MD	4/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132611	41	Internal Medicine	0	In state provider	None	1221 E SPRUCE AVE	None	FRESNO	CA	93720	3374	10	06019	36.84197867	-119.761714	Fresno County
13224	Fee-for-Service	1780353565	1780353565	1	1	AGUILAR, JOSE-ANTONIO PSYD	11/27/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	31194 LA BAYA DR	STE 100	WESTLAKE VILLAGE	CA	91362	6420	19	06037	34.15643887	-118.8025233	Los Angeles County
13250	Fee-for-Service	1598770471	1598770471	1	4	ALLISON CURTIS KINGSLEY MEOZ	5/24/2016	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	1	Border provider	None	6190 S FORT APACHE RD	None	LAS VEGAS	NV	89148	6702	00	None	36.076095	-115.2976405	Clark County
13259	Fee-for-Service	1609313022	1609313022	1	1	AZINKHAN, TANNAZ H	1/25/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1435 S VERMONT AVE	SUITE 100	LOS ANGELES	CA	90006	4543	19	06037	34.045335	-118.2916355	Los Angeles County
13263	Fee-for-Service	1487091575	1487091575	1	1	ADHLAKHA, AADHAR MD	9/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146430	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	STE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
13328	Fee-for-Service	1801322458	1801322458	1	1	AHMED, SANA MD	3/18/2021	207P00000X	NA	Other	026	PHYSICIANS	156960	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
13342	Fee-for-Service	1952476236	1952476236	1	1	AIKEN, MARGOT J MD	8/13/2019	207RE0101X	NA	Endocrinology	026	PHYSICIANS	40833	67	Endocrinology	0	In state provider	None	625 W CITRACADO PKWY	108	ESCONDIDO	CA	92025	6428	37	06073	33.09166731	-117.0784699	San Diego County
13358	Fee-for-Service	1437848025	1437848025	1	1	ADVENTIST HEALTH PHYSICIANS	11/21/2023	208600000X	NA	General Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	8311 BRIMHALL RD	1903	BAKERSFIELD	CA	93312	4367	15	06029	35.365491	-119.094858	Kern County
13360	Fee-for-Service	1205084464	1205084464	1	1	ARCINIEGAS RODRIGUEZ,	9/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	SILVANA R MD	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
13366	Fee-for-Service	1669934626	1669934626	1	2	ACCEPT FAMILY COUNSELING INC	12/2/2022	104100000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	10722 ARROW ROUTE	SUITE 712	RANCHO CUCAMONGA	CA	91730	4841	36	06071	34.09917725	-117.5708877	San Bernardino County
13373	Fee-for-Service	1740203595	1740203595	1	1	AHMAD, BORHAAN S MD	8/14/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49848	40	Pediatrics	0	In state provider	None	11401 HEACOCK ST	STE 330	MORENO VALLEY	CA	92557	7908	33	06065	33.954858	-117.243978	Riverside County
13389	Fee-for-Service	1225195035	1225195035	1	1	AKRONOWITZ, JOSEPH F LCSW	9/3/2019	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	270 E DOUGLAS AVE	SUITE 100A	EL CAJON	CA	92020	4514	37	06073	32.7938777	-116.9592516	San Diego County
13401	Fee-for-Service	1053504472	1053504472	1	1	AGREDANO, PATRICE E LMFT	10/29/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8421 AUBURN BLVD	SUITE 110	CITRUS HEIGHTS	CA	95610	0359	34	06067	38.719026	-121.291335	Sacramento County
13429	Fee-for-Service	1902984867	1902984867	1	1	ALEXANDER, SAM H MD	1/31/1980	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	34014	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1301 20TH ST	STE 510	SANTA MONICA	CA	90404	2094	19	06037	34.02976782	-118.4812493	Los Angeles County
13432	Fee-for-Service	1568827210	1568827210	1	1	ALTURA CENTERS FOR HEALTH	5/19/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1500 W TULARE DRIVE	None	TULARE	CA	93274	3424	54	06107	36.20637928	-119.3688387	Tulare County
13439	Fee-for-Service	1790177582	1790177582	1	7	ALTAMED HEALTH SERVICES	1/16/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2661 E WASHINGTON BLVD	None	PASADENA	CA	91107	1412	19	06037	34.16910574	-118.0955603	Los Angeles County
13452	Fee-for-Service	1609964154	1609964154	1	1	AGARWAL, VIJAY MD	9/20/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	43699	None	None	0	In state provider	None	1330 N INDIAN CANYON DR	STE F	PALM SPRINGS	CA	92262	4880	33	06065	33.84144	-116.5455715	Riverside County
13455	Fee-for-Service	1396339826	1396339826	1	1	ALERACARE MEDICAL GROUP OF C	11/6/2023	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ALIFORNIA	1580 W EL CAMINO REAL	5	MOUNTAIN VIEW	CA	94040	2461	43	06085	37.39001812	-122.0922931	Santa Clara County
13462	Fee-for-Service	1396100285	1396100285	1	1	ALBERTSONS LLC	7/6/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12475 RANCHO BERNARDO RD	None	SAN DIEGO	CA	92128	2143	37	06073	33.0185611	-117.0619766	San Diego County
13465	Fee-for-Service	1134768294	1134768294	1	1	ALPHACARE HOME HEALTH CORP	1/11/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	903 SNEATH LANE	SUITE 225	SAN BRUNO	CA	94066	2400	41	06081	37.63536981	-122.424259	San Mateo County
13467	Fee-for-Service	1801178132	1801178132	1	1	ALADORT, DINA LCSW	2/28/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 UCLA MEDICAL PLZ	None	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
13481	Fee-for-Service	1205148848	1205148848	1	1	AMORIM DE CERQUEIRA FILHO, E	6/4/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	162349	13	Neurology (M.D. only)	0	In state provider	DILBERTO MD	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
13504	Fee-for-Service	1417008426	1417008426	2	1	AHMADI, ERBRAHIM MD	12/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	50313	08	Family Practice	0	In state provider	None	39190 STATE STREET	None	FREMONT	CA	94538	1436	01	06001	37.54945968	-121.9834643	Alameda County
13531	Fee-for-Service	1730335084	1730335084	1	1	ABDUL SATTAR, SABEEN H MD	4/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	96796	08	Family Practice	0	In state provider	None	5256 MISSION BLVD	None	RUBIDOUX	CA	92509	4624	33	06065	33.99259607	-117.3987687	Riverside County
13537	Fee-for-Service	1598770471	1598770471	1	4	ALLISON CURTIS KINGSLEY MEOZ	5/24/2016	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	68	Hematology	1	Border provider	None	6190 S FORT APACHE RD	None	LAS VEGAS	NV	89148	6702	00	None	36.076095	-115.2976405	Clark County
13560	Fee-for-Service	1063418028	1063418028	1	1	ALSON, MARK D MD	8/31/1993	261QR0200X	NA	Mammography/MRI Provider	026	PHYSICIANS	73190	None	None	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
13562	Fee-for-Service	1336469790	1336469790	1	3	ALEXANDER REYZELMAN D P M IN	8/13/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1511 CLEMENT STREET	None	SAN FRANCISCO	CA	94118	1031	38	06075	37.7823969	-122.475506	San Francisco County
13589	Fee-for-Service	1326107202	1326107202	1	1	ALLEN, HEATHER	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
13607	Fee-for-Service	1760765788	1760765788	1	1	ANOTHER CHOICE, ANOTHER	2/27/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	CHANCE	5445 LAUREL HILLS DRIVE	STE A,B,C,D,RM 107,108	SACRAMENTO	CA	95841	3105	34	06067	38.662227	-121.3378965	Sacramento County
13648	Fee-for-Service	1093960403	1093960403	1	1	ALSHIFA MEDICAL GROUP INC	10/7/2024	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	TIONAL HEALTH	10200 TRINITY PKWY	SUITE 202	STOCKTON	CA	95219	7288	39	06077	38.04745959	-121.3721294	San Joaquin County
13652	Fee-for-Service	1669934626	1669934626	1	2	ACCEPT FAMILY COUNSELING INC	10/27/2020	104100000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	10722 ARROW ROUTE	SUITE 712	RANCHO CUCAMONGA	CA	91730	4841	36	06071	34.09917725	-117.5708877	San Bernardino County
13664	Fee-for-Service	1821042334	1821042334	1	1	ANGLETON, PETER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	323 E RIVERSIDE DR	None	EAGLE	ID	63616	0000	00	None	43.68954632	-116.3500565	Ada County
13681	Fee-for-Service	1588673750	1588673750	1	1	ALAMEDA INPATIENT	6/4/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL INC	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4399	01	06001	37.76333626	-122.253868	Alameda County
13697	Fee-for-Service	1245464098	1245464098	1	1	AMES, JULIE A MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130561	04	Otology, Laryngology, Rhinology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
13709	Fee-for-Service	1972893790	1972893790	1	1	ALEM, NAVID MD	5/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109866	05	Anesthesiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
13720	Fee-for-Service	1548230287	1548230287	1	1	ARYA, AFSHIN MD	11/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55423	41	Internal Medicine	0	In state provider	None	THREE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3088	31	06061	38.76566391	-121.2457432	Placer County
13723	Fee-for-Service	1710314448	1710314448	1	1	ANGELUCCI, ERINA P CNM	2/2/2015	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3343 4TH AVE	None	SAN DIEGO	CA	92103	5703	37	06073	32.740353	-117.1612435	San Diego County
13788	Fee-for-Service	1477737385	1477737385	1	1	ALTAMED HEALTH SERVICES	7/1/1993	261QA0600X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	5425 EAST POMONA BLVD	None	LOS ANGELES	CA	90022	1716	19	06037	34.03338446	-118.1488966	Los Angeles County
13819	Fee-for-Service	1346312964	1346312964	1	1	ANDERSON, ERIC J MD	8/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91428	68	Hematology	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
13835	Fee-for-Service	1245528926	1245528926	1	1	AUTUMN HILLS OPERATING	11/1/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	COMPANY LP	430 N GLENDALE AVE	None	GLENDALE	CA	91206	3309	19	06037	34.15304031	-118.2439552	Los Angeles County
13884	Fee-for-Service	1609806041	1609806041	1	1	ARUNASALAM, SIVA MD	5/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	66022	41	Internal Medicine	0	In state provider	None	12780 HESPERIA ROAD	None	VICTORVILLE	CA	92395	5806	36	06071	34.4833646	-117.2904386	San Bernardino County
13886	Fee-for-Service	1487875795	1487875795	1	1	AHMADI, MASHAL A MD	11/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97897	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
13896	Fee-for-Service	1568810679	1568810679	1	1	ABDEL-AL, MOHAMMED MD	12/4/2020	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
13900	Fee-for-Service	1982682381	1982682381	1	1	ANDICH, BRUCE R MD	6/28/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	23109	41	Internal Medicine	0	In state provider	None	88 MADRONE ST	None	WILLITS	CA	95490	4249	23	06045	39.40096191	-123.3522096	Mendocino County
13903	Fee-for-Service	1033137591	1033137591	1	1	AHMED, MUSHTAQ MD	7/1/1988	207R00000X	NA	Other	026	PHYSICIANS	45378	41	Internal Medicine	0	In state provider	None	3550 Q ST	STE 201	BAKERSFIELD	CA	93301	1645	15	06029	35.391978	-119.0105025	Kern County
13904	Fee-for-Service	1376937557	1376937557	1	1	ABDALLA, JACQUELINE M MD	12/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145419	01	General Practice	0	In state provider	None	23 MAIN ST	None	WINTERS	CA	95694	1722	57	06113	38.52163272	-121.9695765	Yolo County
13911	Fee-for-Service	1194433938	1194433938	1	1	ANTELOPE VALLEY HEALTH CARE	5/24/2024	3336H0001X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ER	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
13919	Fee-for-Service	1104040674	1104040674	1	1	ALEXSON, EDWARD R MD INC	5/22/1995	207RH0003X	NA	Oncology	026	PHYSICIANS	27314	None	None	0	In state provider	None	1401 N TUSTIN AVE	SUITE 220	SANTA ANA	CA	92705	8689	30	06059	33.757254	-117.8341425	Orange County
13925	Fee-for-Service	1194160143	1194160143	1	1	AGUIRRE, SAMANTHA CCC-SLP	5/19/2022	2355S0801X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	630 S INDIAN HILL BLVD S	None	CLAREMONT	CA	91711	5461	19	06037	34.084494	-117.7191945	Los Angeles County
13926	Fee-for-Service	1730183633	1730183633	2	1	ADVANCED MED SUPPLY INC	1/29/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ADVANCED MED SUPPLY INC	1621 S RCHO STA FE RD	STE H	SAN MARCOS	CA	92078	2125	37	06073	33.10600328	-117.2253125	San Diego County
13942	Fee-for-Service	1275769655	1275769655	1	1	ADUSUMALLI, ANIL K MD	4/27/2020	207L00000X	NA	Other	026	PHYSICIANS	137318	05	Anesthesiology	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
13969	Fee-for-Service	1528259413	1528259413	1	1	APRIL TURNER DO	3/23/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6327	00	None	34.744437	-92.3813595	Pulaski County
13998	Fee-for-Service	1720124886	1720124886	1	1	ADHIKARI, SADHAHA PHD	8/12/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2185 WEST GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
14029	Fee-for-Service	1891112090	1891112090	1	1	ALI, WAQAR MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140687	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
14074	Fee-for-Service	1477737385	1477737385	1	1	ALTAMED HEALTH SERVICES	7/1/1993	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	5425 EAST POMONA BLVD	None	LOS ANGELES	CA	90022	1716	19	06037	34.03338446	-118.1488966	Los Angeles County
14081	Fee-for-Service	1902288277	1902288277	1	1	ADVENTIST HEALTH PHYSICIANS	4/11/2016	193200000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	505 S VIRGIL AVE	SUITE 300	HANFORD	CA	90020	1406	16	06031	34.064883	-118.287086	Los Angeles County
14109	Fee-for-Service	1346312964	1346312964	1	1	ANDERSON, ERIC J MD	8/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91428	78	Neoplastic Diseases/Oncology	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
14165	Fee-for-Service	1144724428	1144724428	1	1	AHADY, BAHAR M MD	9/1/2022	207L00000X	NA	Other	026	PHYSICIANS	166134	None	None	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
14172	Fee-for-Service	1609806041	1609806041	1	1	ARUNASALAM, SIVA MD	5/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	66022	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	12780 HESPERIA ROAD	None	VICTORVILLE	CA	92395	5806	36	06071	34.4833646	-117.2904386	San Bernardino County
14175	Fee-for-Service	1881757888	1881757888	1	1	AKINCILAR, ELIZABETH H PT	3/26/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	340 DARDANELLI LANE	23	LOS GATOS	CA	95032	1418	43	06085	37.262079	-121.9673345	Santa Clara County
14179	Fee-for-Service	1790824878	1790824878	1	2	ARASU, JUMNAH MD	6/28/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	34831	None	None	0	In state provider	None	204 E.BEACH ST	None	WATSONVILLE	CA	95076	4809	44	06087	36.91224802	-121.7541363	Santa Cruz County
14191	Fee-for-Service	1033137591	1033137591	1	1	AHMED, MUSHTAQ MD	7/1/1988	207R00000X	NA	Other	026	PHYSICIANS	45378	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3550 Q ST	STE 201	BAKERSFIELD	CA	93301	1645	15	06029	35.391978	-119.0105025	Kern County
14197	Fee-for-Service	1164685616	1164685616	1	1	ALSHVANG, SVETLANA	12/28/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3329 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1911	38	06075	37.78809053	-122.4474648	San Francisco County
14222	Fee-for-Service	1770593105	1770593105	2	1	AHMED, MOHAMMED H MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	69198	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 JOSE FIGUERES AVE	SUITE 325	SAN JOSE	CA	95116	1592	43	06085	37.36122014	-121.8505998	Santa Clara County
14302	Fee-for-Service	1992884324	1992884324	1	1	ALOMAR, WAEL A MD	8/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	85066	None	None	0	In state provider	None	38588 9TH STREET EAST	SUITE A	PALMDALE	CA	93550	3883	19	06037	34.58410849	-118.1143567	Los Angeles County
14319	Fee-for-Service	1427176783	1427176783	1	1	ARAYATA, CHARINA A MD	9/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105238	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
14321	Fee-for-Service	1366527889	1366527889	1	1	ALPINE ALLERGY AND	5/19/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	ASTHMA ASSOCIATES, INC	3254 PROFESSIONAL DR	None	AUBURN	CA	95602	2412	31	06061	38.943378	-121.1007625	Placer County
14338	Fee-for-Service	1750316139	1750316139	1	1	ALAM, MOHAMMED F MD	10/31/1984	207RN0300X	NA	Nephrology	026	PHYSICIANS	33746	41	Internal Medicine	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
14343	Fee-for-Service	1760415004	1760415004	2	1	ALLISON, THERESA A MD	2/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	87438	38	Geriatrics	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
14374	Fee-for-Service	1295140150	1295140150	1	1	ADEBAYO, ADEDEJI MD	3/20/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	164443	36	Psychiatry	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
14395	Fee-for-Service	1346312964	1346312964	1	1	ANDERSON, ERIC J MD	8/2/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91428	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
14404	Fee-for-Service	1861447179	1861447179	1	1	AURORA HEALTH CARE METRO	5/24/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	INC	2900 W OKLAHOMA AVE	None	MILWAUKEE	WI	53215	4330	00	None	42.98858952	-87.950682	Milwaukee County
14411	Fee-for-Service	1447369236	1447369236	1	1	APRIA HEALTHCARE LLC	9/24/1998	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	6680 LOCKHEED DR	STE 100	REDDING	CA	96002	9003	45	06089	40.50863357	-122.3029609	Shasta County
14431	Fee-for-Service	1063547917	1063547917	1	1	ALFON, REGINALD M LMFT	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	49156	-	NOT APPLICABLE	0	In state provider	None	1625 WEST OLYMPIC BLVD	SUITE 600	LOS ANGELES	CA	90015	3809	19	06037	34.04957404	-118.2750068	Los Angeles County
14434	Fee-for-Service	1174525612	1174525612	1	1	ALVAREZ, FRANCISCO J MD	9/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151409	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
14453	Fee-for-Service	1649785825	1649785825	1	2	AGUIAR, ERICA P	3/19/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	92510	3377	39	06077	38.017701	-121.297869	San Joaquin County
14459	Fee-for-Service	1821183732	1821183732	1	1	ARROYO, JAVIER DC	4/15/2016	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	925 BEVINS CT	None	LAKEPORT	CA	95453	9754	17	06033	39.03772106	-122.9223338	Lake County
14461	Fee-for-Service	1396195541	1396195541	1	1	ARRIBAS, MIGUEL A MD	7/1/2020	207P00000X	NA	Other	026	PHYSICIANS	167445	None	None	0	In state provider	None	351 S PATTERSON AVE	None	SANTA BARBARA	CA	93111	2403	42	06083	34.43295562	-119.8098287	Santa Barbara County
14480	Fee-for-Service	1164413472	1164413472	1	1	AJAYI, ANDREA B MD	7/24/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72668	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
14502	Fee-for-Service	1932632700	1932632700	1	1	AL-HILLAN, ALSADIQ W MD	2/1/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	None	None	0	In state provider	None	100 UCLA MEDICAL PLZ	755	LOS ANGELES	CA	90024	6990	19	06037	34.06544724	-118.4459249	Los Angeles County
14506	Fee-for-Service	1578018396	1578018396	1	1	ALBRECHT, CHRISTINE NP	10/1/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1101 BRYAN AVE	STE E	TUSTIN	CA	92780	4401	30	06059	33.74272355	-117.8149529	Orange County
14525	Fee-for-Service	1235151275	1235151275	1	1	ALLERGY & IMMUNOLOGY MED	6/1/1994	207KA0200X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	GROUP	2067 W VISTA WAY	STE 140	VISTA	CA	92083	6032	37	06073	33.18505594	-117.285958	San Diego County
14526	Fee-for-Service	1730292350	1730292350	1	1	ALTESMAN, RICHARD MD	6/28/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	146958	None	None	0	In state provider	None	1551 BISHOP ST	A 150	SAN LUIS OBISPO	CA	93401	4635	40	06079	35.27475609	-120.6454494	San Luis Obispo County
14539	Fee-for-Service	1578616686	1578616686	1	1	ARYANPUR, JOHN MD	7/17/1995	207T00000X	NA	General Surgery	026	PHYSICIANS	76773	14	Neurological Surgery	0	In state provider	None	3798 JANES RD	STE 20	ARCATA	CA	95521	4746	12	06023	40.89649119	-124.0930501	Humboldt County
14551	Fee-for-Service	1366856213	1366856213	1	1	ACOSTA, NIVIA M MD	10/13/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	155529	15	Obstetrics (D.O. only)	0	In state provider	None	7601 STONERIDGE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
14581	Fee-for-Service	1235182544	1235182544	1	1	ALPERT, RUSSELL T MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67486	08	Family Practice	0	In state provider	None	2213 BUCHANAN RD	STE 103	ANTIOCH	CA	94509	4265	07	06013	37.99879828	-121.8360576	Contra Costa County
14586	Fee-for-Service	1497735906	1497735906	1	1	ABSOOD, MARY G MD	5/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	73772	41	Internal Medicine	0	In state provider	None	315 N THIRD AVE	SUITE 103	COVINA	CA	91723	1905	19	06037	34.08873786	-117.8923869	Los Angeles County
14591	Fee-for-Service	1023460243	1023460243	1	1	AHN, JI WON MD	10/28/2024	207ND0101X	NA	Dermatology	026	PHYSICIANS	None	07	Dermatology	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
14601	Fee-for-Service	1609857077	1609857077	1	1	AMSTERDAM, EZRA A MD	4/1/1974	No Taxonomy Provided	NA	None	026	PHYSICIANS	18041	41	Internal Medicine	0	In state provider	UCD PROF SVC GRP	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
14609	Fee-for-Service	1366527889	1366527889	1	1	ALPINE ALLERGY AND	5/19/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	ASTHMA ASSOCIATES, INC	3254 PROFESSIONAL DR	None	AUBURN	CA	95602	2412	31	06061	38.943378	-121.1007625	Placer County
14619	Fee-for-Service	1205464468	1205464468	1	1	ARIAS ARANDA, ANAHI LMFT	1/13/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7170 N FINANCIAL DR.	STE 110	FRESNO	CA	93720	2939	10	06019	36.84000952	-119.7711439	Fresno County
14635	Fee-for-Service	1306405501	1306405501	1	1	ADDEPALLI, SINDHU MD	7/5/2024	390200000X	NA	Other	026	PHYSICIANS	183184	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
14647	Fee-for-Service	1588680250	1588680250	1	1	AYOUB, ELIAS MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	39256	None	None	0	In state provider	None	3654 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2653	19	06037	33.93176152	-118.2020943	Los Angeles County
14649	Fee-for-Service	1699721613	1699721613	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	26521 AGOURA RD	None	CALABASAS	CA	91302	1958	19	06037	34.14393164	-118.6996508	Los Angeles County
14679	Fee-for-Service	1760049134	1760049134	1	1	ARNEMETIA HOME HEALTH INC	1/19/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	110 S ROSEMEAD BLVD	STE H	PASADENA	CA	91107	3954	19	06037	34.144533	-118.073274	Los Angeles County
14684	Fee-for-Service	1528531993	1528531993	1	1	AVON HOME HEALTH CARE	6/28/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14328 VICTORY BLVD	STE 207	VAN NUYS	CA	91401	1432	19	06037	34.1866137	-118.4454117	Los Angeles County
14696	Fee-for-Service	1861447179	1861447179	1	1	AURORA HEALTH CARE METRO	1/1/2002	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	INC	2900 W OKLAHOMA AVE	None	MILWAUKEE	WI	53215	4330	00	None	42.98858952	-87.950682	Milwaukee County
14701	Fee-for-Service	1821514399	1821514399	1	1	ARMAR HOSPICE AND PALLIATIVE	12/15/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	229 N CENTRAL AVE	STE 202	GLENDALE	CA	91203	3550	19	06037	34.14910181	-118.2579537	Los Angeles County
14733	Fee-for-Service	1922033737	1922033737	1	1	ALVAREZ, FELIX N MD	11/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
14758	Fee-for-Service	1871668566	1871668566	1	1	ALLIANCE PROSTHETICS & ORTHO	3/15/2002	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	TICS, INC	12458 WASHINGTON BLVD	None	WHITTIER	CA	90602	1005	19	06037	33.96771912	-118.0457772	Los Angeles County
14767	Fee-for-Service	1346838422	1346838422	1	1	APEX THERAPY GROUP, A MARRIA	12/8/2021	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	GE AND FAMILY THERAPY CO	4401 SEPULVEDA BLVD	210	SHERMAN OAKS	CA	91403	3934	19	06037	34.150356	-118.467397	Los Angeles County
14786	Fee-for-Service	1871527655	1871527655	1	1	AIYLAM, PARAMESWARAN SMD	11/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	32990	36	Psychiatry	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
14807	Fee-for-Service	1558656637	1558656637	1	1	ATMAR, AKMAL DPM	4/4/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2345 E 8TH ST	SUITE 105	NATIONAL CITY	CA	91950	2866	37	06073	32.68268563	-117.082682	San Diego County
14827	Fee-for-Service	1437336534	1437336534	1	1	ANTONIEWICZ, LEAH W MD	10/1/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
14859	Fee-for-Service	1053193979	1053193979	1	1	ABRAHAM, NICOLE L PT	12/1/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
14863	Fee-for-Service	1659455640	1659455640	1	1	ANDERSEN, NICOLAJ MD	9/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90797	68	Hematology	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
14888	Fee-for-Service	1609857077	1609857077	1	1	AMSTERDAM, EZRA A MD	4/1/1974	No Taxonomy Provided	NA	None	026	PHYSICIANS	18041	06	Cardiovascular Disease (M.D. only)	0	In state provider	UCD PROF SVC GRP	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
14921	Fee-for-Service	1568881829	1568881829	1	1	AMARE, RACHEL	5/5/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	138204	15	Obstetrics (D.O. only)	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
14961	Fee-for-Service	1447348032	1447348032	1	1	AMAR, ARUN P MD	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81011	14	Neurological Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
14991	Fee-for-Service	1821514399	1821514399	1	1	ARMAR HOSPICE AND PALLIATIVE	12/15/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	229 N CENTRAL AVE	STE 202	GLENDALE	CA	91203	3550	19	06037	34.14910181	-118.2579537	Los Angeles County
15023	Fee-for-Service	1902108731	1902108731	1	1	ALGOS INC, A MEDICAL CORPOR	5/10/2018	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	ATION	23530 HAWTHORNE BLVD	BLDG 1, STE. 290	TORRANCE	CA	90505	4765	19	06037	33.811983	-118.351014	Los Angeles County
15052	Fee-for-Service	1407925597	1407925597	1	1	AIZARANI-HALLAK, ANTOINE	1/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87305	24	Plastic Surgery	0	In state provider	AIZARANI-HALLAK MD INC	16766 BERNARDO CENTER DR	STE 109	SAN DIEGO	CA	92128	2501	37	06073	33.01756519	-117.0759175	San Diego County
15055	Fee-for-Service	1346838422	1346838422	1	1	APEX THERAPY GROUP, A MARRIA	8/11/2022	103TC0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GE AND FAMILY THERAPY CO	4401 SEPULVEDA BLVD	210	SHERMAN OAKS	CA	91403	3934	19	06037	34.150356	-118.467397	Los Angeles County
15076	Fee-for-Service	1134843857	1134843857	1	1	ALEIADIH, JOCELYN M	10/14/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3769 TIBBETTS ST	STE A	RIVERSIDE	CA	92506	2638	33	06065	33.94726645	-117.3990645	Riverside County
15080	Fee-for-Service	1134380439	1134380439	1	1	ATWAL, MANINDERJIT K MD	8/22/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	103499	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
15085	Fee-for-Service	1144471673	1144471673	1	1	ANDERSON, LISA M	11/4/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
15099	Fee-for-Service	1023040748	1023040748	1	1	AMIREH, RASHEED A MD	2/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71934	05	Anesthesiology	0	In state provider	None	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
15105	Fee-for-Service	1083830822	1083830822	1	1	ASMA, AZHAR DO	1/23/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	9468	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
15130	Fee-for-Service	1720499023	1720499023	1	1	ARODAKI, FADI DO	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15654	41	Internal Medicine	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
15137	Fee-for-Service	1194392555	1194392555	1	1	ALLEN'S PALM COVE RESIDENCE	9/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	CARE INC	630 N WEST STREET	None	ANAHEIM	CA	92801	4706	30	06059	33.83892888	-117.9291427	Orange County
15146	Fee-for-Service	1093248726	1093248726	1	1	AHMED, OSAMA MD	12/19/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	191236	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
15188	Fee-for-Service	1184716821	1184716821	3	1	AV PHARMA CORP	8/9/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1703 TERMINO AVE	STE 101	LONG BEACH	CA	90804	2126	19	06037	33.7883073	-118.1459488	Los Angeles County
15248	Fee-for-Service	1609065754	1609065754	1	1	ANWARUDDIN, RAANA MD	3/24/2008	207L00000X	NA	Other	026	PHYSICIANS	94730	None	None	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
15280	Fee-for-Service	1508323866	1508323866	1	1	ANDERSEN, JOHN	1/14/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5000 WINDPLAY DR	#1	EL DORADO HILLS	CA	95762	9365	09	06017	38.63978974	-121.0710527	El Dorado County
15293	Fee-for-Service	1174805618	1174805618	1	1	ASKEA, REBECCA K MD	2/25/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	174140	None	None	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
15298	Fee-for-Service	1801078522	1801078522	1	1	AYSENNE, AIMEE M MD	6/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120701	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
15304	Fee-for-Service	1649637315	1649637315	1	2	ADVANCE CARE SERVICES INC	6/25/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4990 ARLINGTON	SUITE A	RIVERSIDE	CA	92504	2757	33	06065	33.94604554	-117.4117995	Riverside County
15306	Fee-for-Service	1255785648	1255785648	1	1	ADVANCED HEALTHCARE CENTER	12/12/2017	193400000X	NA	Other	026	PHYSICIANS	55154	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	APC	10737 CAMINO RUIZ	STE 114	SAN DIEGO	CA	92126	2361	37	06073	32.91416051	-117.1437943	San Diego County
15312	Fee-for-Service	1902108731	1902108731	1	1	ALGOS INC, A MEDICAL CORPOR	2/28/2024	103TB0200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ATION	23530 HAWTHORNE BLVD	BLDG 1, STE. 290	TORRANCE	CA	90505	4765	19	06037	33.811983	-118.351014	Los Angeles County
15336	Fee-for-Service	1912083437	1912083437	1	1	ARMSTRONG, RICHARD B MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	84003	40	Pediatrics	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
15339	Fee-for-Service	1457403834	1457403834	1	1	ALLISON, DANIEL C MD	10/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87437	20	Orthopedic Surgery	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
15360	Fee-for-Service	1922240407	1922240407	1	1	ALAN HARTSOOK, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10750 W MCDOWELL RD	STE G700	AVONDALE	AZ	85392	5972	00	None	33.464916	-112.2911235	Maricopa County
15371	Fee-for-Service	1285722694	1285722694	1	1	ALOHA FAMILY OPTOMETRIC	6/17/2010	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP	7215 N FIRST ST	STE 101	FRESNO	CA	93720	2985	10	06019	36.8415811	-119.7748385	Fresno County
15386	Fee-for-Service	1225084759	1225084759	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3450 MARRON RD	None	OCEANSIDE	CA	92056	4672	37	06073	33.17824695	-117.2957151	San Diego County
15391	Fee-for-Service	1477871036	1477871036	1	1	ABARY, ROSANNA V MD	7/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123601	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	SUITE 104	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
15409	Fee-for-Service	1548794639	1548794639	1	1	ATCHESON, DANIEL W DO	8/14/2022	207P00000X	NA	Other	026	PHYSICIANS	18742	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
15424	Fee-for-Service	1255090551	1255090551	1	1	AROPAGA INCORPORATED	3/16/2023	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5809 E MARITA ST	None	LONG BEACH	CA	90815	3248	19	06037	33.7910285	-118.119168	Los Angeles County
15495	Fee-for-Service	1093086316	1093086316	1	1	ANEL, MARY JANE T CRNA	10/8/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
15536	Fee-for-Service	1073909370	1073909370	1	1	ALNASER, AMMAR M MD	8/17/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	151516	45	Nephrology (Renal-Kidney)	0	In state provider	None	11550 INDIAN HILLS RD	STE 371	MISSION HILLS	CA	91345	1252	19	06037	34.28024575	-118.4588775	Los Angeles County
15542	Fee-for-Service	1467892984	1467892984	1	1	ADEPOJU, YEWANDE M DO	3/18/2020	207R00000X	NA	Other	026	PHYSICIANS	17552	67	Endocrinology	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
15543	Fee-for-Service	1841811346	1841811346	2	1	ARCHWAY RECOVERY SERVICES, I	11/4/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	NC.	1234 TRAVIS BLVD	ABCD	FAIRFIELD	CA	94533	4802	48	06095	38.25822052	-122.047947	Solano County
15558	Fee-for-Service	1740576388	1740576388	1	1	ALMVDHAFAR, FARAH MD	3/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130949	01	General Practice	0	In state provider	None	4310 ORANGE STREET	None	RIVERSIDE	CA	92501	3829	33	06065	33.97629981	-117.3766255	Riverside County
15570	Fee-for-Service	1649736687	1649736687	1	1	ADVENTIST HEALTH PHYSICIANS	5/31/2019	207RH0003X	NA	Oncology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	95 DECLARATION DR STE 1	None	CHICO	CA	95973	4916	04	06007	39.77211427	-121.8720024	Butte County
15597	Fee-for-Service	1902108731	1902108731	1	1	ALGOS INC, A MEDICAL CORPOR	5/10/2018	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	ATION	23530 HAWTHORNE BLVD	BLDG 1, STE. 290	TORRANCE	CA	90505	4765	19	06037	33.811983	-118.351014	Los Angeles County
15640	Fee-for-Service	1497129050	1497129050	1	1	ALL FAMILY HEALTH CLINIC, IN	6/27/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	24159 MAGIC MOUNTAIN PKW	None	VALENCIA	CA	91355	3904	19	06037	34.41824519	-118.556987	Los Angeles County
15643	Fee-for-Service	1992891808	1992891808	1	1	ANDERSON, DAVID B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56515	02	General Surgery	0	In state provider	None	15141 WHITTIER BLVD	STE 330	WHITTIER	CA	90603	2168	19	06037	33.94810044	-118.0039419	Los Angeles County
15666	Fee-for-Service	1811352313	1811352313	1	1	ALBERTSONS LLC	7/6/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 NORTH H ST	None	LOMPOC	CA	93436	2812	42	06083	34.66220342	-120.4575977	Santa Barbara County
15689	Fee-for-Service	1164584900	1164584900	1	1	AGATEP, DENISE K T LCSW	12/1/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
15701	Fee-for-Service	1225616006	1225616006	1	1	ACEVEDO, RIGO MD	7/1/2024	390200000X	NA	Other	026	PHYSICIANS	181760	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
15715	Fee-for-Service	1811250723	1811250723	2	1	AMERICARE HOSPICE INC	7/18/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3200 W BURBANK BLVD	101	BURBANK	CA	91505	2201	19	06037	34.17627396	-118.3454285	Los Angeles County
15722	Fee-for-Service	1528090115	1528090115	1	1	ANOFF, DEBRA L MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
15742	Fee-for-Service	1104003458	1104003458	1	1	AYUSTE, BRIAN B MD	7/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99851	41	Internal Medicine	0	In state provider	None	16907 DEVONSHIRE ST	None	GRANADA HILLS	CA	91344	7407	19	06037	34.25754015	-118.5004161	Los Angeles County
15747	Fee-for-Service	1689077679	1689077679	1	1	AMONN, EMILY C LMFT	12/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
15780	Fee-for-Service	1487277174	1487277174	1	1	ALTAMED HEALTH SERVICES CORP	8/11/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	S	6336 PASSONS BLVD	ROOM 100	PICO RIVERA	CA	90660	3355	19	06037	33.98515856	-118.0862644	Los Angeles County
15807	Fee-for-Service	1346766714	1346766714	1	1	ABRAMYAN, ANNA LCSW	3/28/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9431 HAVEN AVE	STE 100	RANCHO CUCAMONGA	CA	91730	5879	36	06071	34.082244	-117.5756135	San Bernardino County
15808	Fee-for-Service	1265404446	1265404446	1	1	ALPERT, JOSEPH S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
15823	Fee-for-Service	1265604490	1265604490	1	1	AULUCK, DAVE S MD	4/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	113673	36	Psychiatry	0	In state provider	None	2155 IRON POINT ROAD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
15836	Fee-for-Service	1396044293	1396044293	1	1	AVIK, ANNA L DO	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11495	20	Orthopedic Surgery	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
15838	Fee-for-Service	1700862596	1700862596	1	1	ALAN DAVIDOFF M.D.	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5171 W OLIVE AVE	None	GLENDALE	AZ	85302	4204	00	None	33.567093	-112.1719365	Maricopa County
15857	Fee-for-Service	1083963631	1083963631	1	1	ABU, MARY GRACE L MD	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136578	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
15867	Fee-for-Service	1942636782	1942636782	1	1	ANDERSON, DAWNETTE R LCSW	4/5/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
15871	Fee-for-Service	1336305036	1336305036	1	1	ASHOURI, ANOUSHEH MD	10/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113709	None	None	0	In state provider	None	1818 N ORANGE GROVE AVE	#204	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
15882	Fee-for-Service	1427713247	1427713247	1	1	AYALASOMAYAJULA, FRANCES A	1/12/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
15908	Fee-for-Service	1629156534	1629156534	1	1	ALIMOHAMMADI, BEHZAD MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91280	45	Nephrology (Renal-Kidney)	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
15926	Fee-for-Service	1497129050	1497129050	1	1	ALL FAMILY HEALTH CLINIC, IN	6/27/2016	193200000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	24159 MAGIC MOUNTAIN PKW	None	VALENCIA	CA	91355	3904	19	06037	34.41824519	-118.556987	Los Angeles County
15954	Fee-for-Service	1255379624	1255379624	1	1	ANNADATA, RADHIKA S MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	56396	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
15971	Fee-for-Service	1205173580	1205173580	1	1	ATKINSON, IAN L MD	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123381	None	None	0	In state provider	None	141 LYNCH CREEK WAY	STE C	PETALUMA	CA	94954	2390	49	06097	38.25192092	-122.6341929	Sonoma County
15977	Fee-for-Service	1437353034	1437353034	1	1	ASUNCION, LLOYD P MD	3/7/2011	207R00000X	NA	Other	026	PHYSICIANS	112991	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
15978	Fee-for-Service	1184919011	1184919011	1	1	ADVANCED INSTITUTE OF	1/1/2017	207N00000X	NA	Dermatology	026	PHYSICIANS	None	None	None	0	In state provider	DERMATOLOGY INC	41990 COOK STREET	F1006	PALM DESERT	CA	92211	6105	33	06065	33.748371	-116.356173	Riverside County
15998	Fee-for-Service	1043214075	1043214075	1	1	ARNOLD, BARBARA J MD INC	6/30/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	24407	18	Ophthalmology	0	In state provider	None	7551 TIMBERLAKE WAY	STE 100	SACRAMENTO	CA	95823	5421	34	06067	38.466225	-121.415958	Sacramento County
16003	Fee-for-Service	1811250723	1811250723	2	1	AMERICARE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3200 W BURBANK BLVD	101	BURBANK	CA	91505	2201	19	06037	34.17627396	-118.3454285	Los Angeles County
16008	Fee-for-Service	1508939729	1508939729	1	1	ANGELA IRENE CARRICK, D.O.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	901 N PORTER AVE	None	NORMAN	OK	73071	6404	00	None	35.23022019	-97.44110859	Cleveland County
16018	Fee-for-Service	1245836022	1245836022	1	1	ARENAS, JESSICA LMFT	10/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
16051	Fee-for-Service	1003907197	1003907197	1	1	ATLAS, SCOTT W MD	1/1/1998	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	59953	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
16061	Fee-for-Service	1306265863	1306265863	1	1	ADVANCE HOSPICE SERVICES INC	7/22/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3602 INLAND EMPIRE BLVD	STE A-238	ONTARIO	CA	91764	4900	36	06071	34.07022	-117.572877	San Bernardino County
16082	Fee-for-Service	1790813822	1790813822	2	1	ABILITY PATHWAYS	6/19/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED	9003 TERHUNE AVE	None	SUN VALLEY	CA	91352	2020	19	06037	34.23251583	-118.3634054	Los Angeles County
16100	Fee-for-Service	1750803219	1750803219	1	1	APEL, SHANNON J	8/9/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
16101	Fee-for-Service	1770713190	1770713190	1	1	ANDRADE, ALEJANDRO MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115629	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
16112	Fee-for-Service	1144570508	1144570508	1	1	AVERY, STEFANIE NP	1/25/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
16149	Fee-for-Service	1063608701	1063608701	1	1	AGUIRRE, JOSE A MD PC	10/6/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	1600 MEDICAL PARKWAY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
16154	Fee-for-Service	1376758656	1376758656	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	27702 CROWN VALLEY PKWY	STE B	LADERA RANCH	CA	92694	0609	30	06059	33.56422147	-117.6458007	Orange County
16160	Fee-for-Service	1003029877	1003029877	1	1	ABINGTON SPEECH PATHOLOGY SE	11/28/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	RVICES INC.	23101 LAKE CENTER DR	240	LAKE FOREST	CA	92630	2801	30	06059	33.62739598	-117.716948	Orange County
16175	Fee-for-Service	1184992331	1184992331	1	2	ADDICTION RESEARCH AND TREAT	10/21/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	795 WILLOW RD	BLDG 332	MENLO PARK	CA	94025	2539	41	06081	37.466676	-122.160384	San Mateo County
16180	Fee-for-Service	1780167346	1780167346	1	1	ASARNOW, LAUREN PHD	12/12/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
16181	Fee-for-Service	1992279038	1992279038	1	1	ANZURES, NATALIE G PT	8/19/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
16208	Fee-for-Service	1942285507	1942285507	1	1	ALCID, CARLA M MD	9/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	52709	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
16243	Fee-for-Service	1871983833	1871983833	1	1	ADAMS, SHEILAH NP	6/12/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2830 GLENDESSARY LANE	None	SANTA BARBARA	CA	93105	2960	42	06083	34.44509477	-119.7186392	Santa Barbara County
16248	Fee-for-Service	1972183648	1972183648	1	1	ARISE PSYCHIATRIC MEDICAL GR	3/29/2022	2084P0804X	NA	Psychiatry	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	OUP INC	1500 HAGGIN OAKS BLVD	SUITE 202	BAKERSFIELD	CA	93311	1333	15	06029	35.341758	-119.1011105	Kern County
16267	Fee-for-Service	1083662654	1083662654	1	1	ALLEN, MICHAEL S MD	4/1/2010	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	50999	None	None	0	In state provider	None	2800 L ST	STE 610	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
16270	Fee-for-Service	1093013260	1093013260	1	1	ATKINSON, CHRISTOPHER J MD	9/20/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	179390	None	None	0	In state provider	None	12602 AMARGOSA RD	STE F	VICTORVILLE	CA	92392	7640	36	06071	34.47936072	-117.3397257	San Bernardino County
16274	Fee-for-Service	1871890160	1871890160	1	1	ARSLANIAN, SAHAG A MD AMC	1/1/1979	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	37370	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	318 W COLORADO STREET	SUITE 3	GLENDALE	CA	91204	1671	19	06037	34.14252447	-118.258893	Los Angeles County
16284	Fee-for-Service	1093015828	1093015828	1	1	AKANE INSTITUTE OF ALLERGY,A	5/10/2012	207KA0200X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	ASTHMA & SLEEP MEDICINE	10755 SCRIPPS POWAY PKWY	STE 455	SAN DIEGO	CA	92131	3924	37	06073	32.93676635	-117.0972323	San Diego County
16302	Fee-for-Service	1568231371	1568231371	1	1	ANAHEIM PALACE INC	1/6/2025	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	525 W LA PALMA AVE	None	ANAHEIM	CA	92801	2432	30	06059	33.84722347	-117.925218	Orange County
16303	Fee-for-Service	1811549439	1811549439	1	1	ARTEMIS HOME HEALTH INC	10/12/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	600 W BROADWAY	STE 225	GLENDALE	CA	91204	1021	19	06037	34.14678282	-118.2666498	Los Angeles County
16312	Fee-for-Service	1629043740	1629043740	1	1	ALLEN, STAN D	11/1/1996	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	2000 HIGHWAY 95	STE 95	BULLHEAD CITY	AZ	86442	6050	00	None	35.11494	-114.5975085	Mohave County
16321	Fee-for-Service	1639162100	1639162100	1	1	ALLEN, JAMES V MD	4/29/1999	207L00000X	NA	Other	026	PHYSICIANS	69843	05	Anesthesiology	0	In state provider	MEDICAL PROVIDERS BLLG	317 COURT ST	STE A	WOODLAND	CA	95695	3202	57	06113	38.67882701	-121.7773611	Yolo County
16326	Fee-for-Service	1841588092	1841588092	1	1	AARON, GREGORY T CO	5/16/2011	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	2425 STOCKTON BLVD	#236	SACRAMENTO	CA	95817	2215	34	06067	38.553012	-121.45545	Sacramento County
16347	Fee-for-Service	1316291503	1316291503	1	1	AUBURN ORTHOPEDIC & SPORTS P	5/3/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	HYSICAL THERAPY	11879 KEMPER RD.	SUITE 4	AUBURN	CA	95603	9021	31	06061	38.93136899	-121.0916266	Placer County
16351	Fee-for-Service	1306265863	1306265863	1	1	ADVANCE HOSPICE SERVICES INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3602 INLAND EMPIRE BLVD	STE A-238	ONTARIO	CA	91764	4900	36	06071	34.07022	-117.572877	San Bernardino County
16353	Fee-for-Service	1366140907	1366140907	1	1	ADOBE RESIDENTIAL CARE	8/21/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2108 ADOBE AVE	None	CORONA	CA	92882	5664	33	06065	33.86462627	-117.6116724	Riverside County
16374	Fee-for-Service	1851779151	1851779151	1	1	ALAGHA, AYHAM	10/18/2023	208M00000X	NA	Other	026	PHYSICIANS	178968	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
16388	Fee-for-Service	1942602883	1942602883	1	1	ADVENTIST HEALTH PHYSICIANS	4/20/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1700 E CESAR E CHAVEZ AV	2700	LOS ANGELES	CA	90033	2424	19	06037	34.05101259	-118.217259	Los Angeles County
16395	Fee-for-Service	1013075035	1013075035	1	1	ANCINAS-GEE, CARMEN LMFT	6/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
16399	Fee-for-Service	1548358369	1548358369	2	1	AINTABLIAN, IGHIA MD	3/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	42047	40	Pediatrics	0	In state provider	None	1510 SOUTH CENTRAL AVE	SUITE 450	GLENDALE	CA	92104	2510	19	06037	34.12709764	-118.2577911	Los Angeles County
16400	Fee-for-Service	1831881788	1831881788	1	1	ANIELLO, YING LAC	9/28/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	18958 DAISETTA ST	205	ROWLAND HEIGHTS	CA	91748	2278	19	06037	33.9900706	-117.8904576	Los Angeles County
16451	Fee-for-Service	1679638001	1679638001	1	1	ABALA PHARMACY	6/18/2003	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ABALA PHARMACY	550-B EATON AVE	None	TRACY	CA	95376	3422	39	06077	37.74328054	-121.434723	San Joaquin County
16459	Fee-for-Service	1154335040	1154335040	1	1	AVAKIAN, MICHAEL A DPM	11/1/1993	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2544 E WASHINGTON BLVD	STE C	PASADENA	CA	91107	1465	19	06037	34.16911248	-118.097577	Los Angeles County
16462	Fee-for-Service	1184992331	1184992331	1	2	ADDICTION RESEARCH AND TREAT	10/21/2021	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	795 WILLOW RD	BLDG 332	MENLO PARK	CA	94025	2539	41	06081	37.466676	-122.160384	San Mateo County
16468	Fee-for-Service	1275843369	1275843369	1	2	ACADEMIA MODERNA	4/1/2022	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	2410 BROADWAY	None	WALNUT PARK	CA	90255	6342	19	06037	33.96712228	-118.2296628	Los Angeles County
16478	Fee-for-Service	1437224458	1437224458	1	1	AMIR H MONFARED MD INC	3/1/2013	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	31378	None	None	0	In state provider	None	8631 WEST 3RD ST	STE 230-E	LOS ANGELES	CA	90048	5941	19	06037	34.07361928	-118.3803143	Los Angeles County
16484	Fee-for-Service	1710253737	1710253737	1	1	ALLEN, BAXTER B MD	7/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148960	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	8346	19	06037	34.06473399	-118.445865	Los Angeles County
16490	Fee-for-Service	1619945821	1619945821	1	1	ASUNCION, ROBERT J PT	5/20/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7311 GREENHAVEN	200	SACRAMENTO	CA	95831	3572	34	06067	38.492622	-121.5219195	Sacramento County
16496	Fee-for-Service	1942285507	1942285507	1	1	ALCID, CARLA M MD	9/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	52709	40	Pediatrics	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
16500	Fee-for-Service	1356418255	1356418255	1	1	ALCARAZ, LISA-JAN M MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71093	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
16534	Fee-for-Service	1790177582	1790177582	1	12	ALTAMED HEALTH SERVICES	11/2/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	10127 GARVEY AVE	None	EL MONTE	CA	91733	2066	19	06037	34.06276016	-118.04823	Los Angeles County
16540	Fee-for-Service	1245506989	1245506989	1	1	AJEMBA, OGUGUA G MD	1/8/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	135148	22	Pathology (M.D. only)	0	In state provider	None	15248 ELEVENTH ST	None	VICTORVILLE	CA	92395	3704	36	06071	34.52825401	-117.2925587	San Bernardino County
16548	Fee-for-Service	1831165174	1831165174	1	1	ANDERSON, WILLIAM D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	4409	00	None	33.480864	-112.0795155	Maricopa County
16584	Fee-for-Service	1891710091	1891710091	1	1	ANDREW STAIGER MD	3/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1901 CONNECTICUT AVE S	None	SARTELL	MN	56377	2554	00	None	45.59432076	-94.20160002	Stearns County
16591	Fee-for-Service	1538588561	1538588561	1	1	ALVARADO, JORGE L MD	7/20/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	139473	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
16593	Fee-for-Service	1619073988	1619073988	1	1	ABBEY J.HARDY-FAIRBANKS MD	4/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
16601	Fee-for-Service	1124022108	1124022108	1	1	AGCAOILI, JACQUELINE MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	46231	41	Internal Medicine	0	In state provider	None	4000 14TH ST	STE 208	RIVERSIDE	CA	92501	4018	33	06065	33.97771007	-117.3818381	Riverside County
16627	Fee-for-Service	1740286616	1740286616	1	1	ASHLEY MEDICAL CENTER	3/26/2010	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	612 CENTER AVE N	None	ASHLEY	ND	58413	7013	00	None	46.039995	-99.37173752	McIntosh County
16643	Fee-for-Service	1740662469	1740662469	1	1	ABDULLA, MAHA B DO	2/28/2022	207ZP0102X	NA	Other	026	PHYSICIANS	15951	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
16646	Fee-for-Service	1093870792	1093870792	1	1	AULT, RICHARD J PHD	3/3/1994	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2511 N MOUNTAIN AVE	None	CLAREMONT	CA	91711	1545	19	06037	34.12957271	-117.7299125	Los Angeles County
16649	Fee-for-Service	1457842866	1457842866	1	1	AGHAZADEH, SHIRIN DO	3/21/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17690	None	None	0	In state provider	None	4560 ADMIRALTY WAY	STE 100	MARINA DEL REY	CA	90292	5424	19	06037	33.98364904	-118.4449069	Los Angeles County
16665	Fee-for-Service	1518217330	1518217330	1	5	ARCH HEALTH PARTNERS	7/19/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1955 CITRACADO PKWY	STE 302	ESCONDIDO	CA	92029	4159	37	06073	33.11301099	-117.1202081	San Diego County
16705	Fee-for-Service	1477526028	1477526028	1	1	ARMSTRONG, RALPH B DO	10/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	9256	09	Gynecology (D.O. only)	0	In state provider	None	931 SUNSET DR	None	HOLLISTER	CA	95023	5602	35	06069	36.83504284	-121.3855641	San Benito County
16754	Fee-for-Service	1154747020	1154747020	1	6	ACN MEDICAL GROUP, INC	10/10/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3030 WEBSTER ST	None	OAKLAND	CA	94609	3411	01	06001	37.81938475	-122.2632718	Alameda County
16785	Fee-for-Service	1720130198	1720130198	1	1	ALAVERDIAN, VAROOSH MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	29531	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 E ROSECRANS BLVD	None	BELLFLOWER	CA	90706	0000	19	06037	33.9040752	-118.1328995	Los Angeles County
16803	Fee-for-Service	1366494668	1366494668	1	1	ARNOLD, THOMAS W. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8000 CENTERVIEW PKWY	STE 300	CORDOVA	TN	38018	4254	00	None	35.12820288	-89.79601531	Shelby County
16812	Fee-for-Service	1396872818	1396872818	1	1	AGAVNI TOROSYAN	8/20/2008	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	DBA INTER-TRANS MEDICAL	610 N. CENTRAL AVE	STE 104	GLENDALE	CA	91203	1421	19	06037	34.15531106	-118.2579125	Los Angeles County
16824	Fee-for-Service	1790177582	1790177582	1	12	ALTAMED HEALTH SERVICES	11/2/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	10127 GARVEY AVE	None	EL MONTE	CA	91733	2066	19	06037	34.06276016	-118.04823	Los Angeles County
16854	Fee-for-Service	1356445522	1356445522	1	1	AL-AHMAD, LAMIS MD	11/9/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	500 40TH STREET	None	BAKERSFIELD	CA	93301	1224	15	06029	35.39619932	-119.0074457	Kern County
16880	Fee-for-Service	1508843699	1508843699	1	1	AKHANJEE, NARGIS R MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	42277	01	General Practice	0	In state provider	None	2105 BEVERLY BLVD	STE 217A	LOS ANGELES	CA	90057	2216	19	06037	34.06682861	-118.2706286	Los Angeles County
16914	Fee-for-Service	1740286616	1740286616	1	1	ASHLEY MEDICAL CENTER	3/26/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	612 CENTER AVE N	None	ASHLEY	ND	58413	7013	00	None	46.039995	-99.37173752	McIntosh County
16919	Fee-for-Service	1306853585	1306853585	1	1	ARNOLD, JOHN E MD	3/31/1986	207L00000X	NA	Other	026	PHYSICIANS	44876	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
17019	Fee-for-Service	1376159962	1376159962	1	1	ARORA, AMITA MD	9/28/2023	207R00000X	NA	Other	026	PHYSICIANS	187323	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
17027	Fee-for-Service	1700143013	1700143013	1	1	ABDOU, RAMI MD	9/28/2017	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	147320	04	Otology, Laryngology, Rhinology	0	In state provider	None	1700 E CESAR E CHAVEZ AV	SUITE 2500	LOS ANGELES	CA	90033	2434	19	06037	34.05101259	-118.217259	Los Angeles County
17028	Fee-for-Service	1770818395	1770818395	1	1	AYAD, MARIANNE B MD	11/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106240	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
17035	Fee-for-Service	1356411771	1356411771	1	1	AYE, MG S MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	26642	18	Ophthalmology	0	In state provider	None	160 E ARTESIA ST	STE 325	POMONA	CA	91767	2922	19	06037	34.07556833	-117.7507835	Los Angeles County
17069	Fee-for-Service	1881249522	1881249522	1	1	ADKINS, BLAKNEY E OT	5/12/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
17131	Fee-for-Service	1801138243	1801138243	1	1	AMIN, AVNI MD	9/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124652	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
17140	Fee-for-Service	1679958151	1679958151	1	1	ADAMS, MARISELA LMFT	9/7/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5055 CANYON CREST DR	202	RIVERSIDE	CA	92507	6015	33	06065	33.95862536	-117.3310726	Riverside County
17157	Fee-for-Service	1497769145	1497769145	1	1	ANWAR, MUHAMMAD MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63134	41	Internal Medicine	0	In state provider	None	12626 RIVERSIDE DR	STE 404	NORTH HOLLYWOOD	CA	91607	3456	19	06037	34.15758449	-118.408131	Los Angeles County
17169	Fee-for-Service	1508843699	1508843699	1	1	AKHANJEE, NARGIS R MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	42277	08	Family Practice	0	In state provider	None	2105 BEVERLY BLVD	STE 217A	LOS ANGELES	CA	90057	2216	19	06037	34.06682861	-118.2706286	Los Angeles County
17204	Fee-for-Service	1568095776	1568095776	1	1	ANGELS PURE HOSPICE CARE INC	7/22/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3800 LA CRESCENTA AVE	SUITE 204	LA CRESCENTA	CA	91214	3948	19	06037	34.2115128	-118.2399309	Los Angeles County
17244	Fee-for-Service	1902974595	1902974595	1	1	AOCHI, NANCY	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
17254	Fee-for-Service	1629076708	1629076708	1	1	AFSHAR, LEILA MD	3/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52556	40	Pediatrics	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
17312	Fee-for-Service	1700143013	1700143013	1	1	ABDOU, RAMI MD	9/28/2017	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	147320	84	Surgery-Head and Neck	0	In state provider	None	1700 E CESAR E CHAVEZ AV	SUITE 2500	LOS ANGELES	CA	90033	2434	19	06037	34.05101259	-118.217259	Los Angeles County
17320	Fee-for-Service	1356382717	1356382717	1	1	ABOULHOSN, JAMIL A MD	9/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74157	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3650 SOUTH ST	STE 310	LAKEWOOD	CA	90712	1519	19	06037	33.86019847	-118.149255	Los Angeles County
17331	Fee-for-Service	1831247865	1831247865	1	1	ALFAROBREEZE, MARIE A MD	4/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	89875	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
17346	Fee-for-Service	1053309120	1053309120	1	1	ATLANTIC GENERAL HOSPITAL	9/23/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9733 HEALTHWAY DR	None	BERLIN	MD	21811	1155	00	None	38.33964322	-75.21212158	Worcester County
17359	Fee-for-Service	1972573046	1972573046	1	1	ASMUTH, DAVID M MD	7/17/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86575	77	Infectious Disease	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
17373	Fee-for-Service	1033397120	1033397120	1	1	ANDERSON, SHELLY CRNA	2/17/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
17374	Fee-for-Service	1174206239	1174206239	1	1	A&M NORCAL LLC	7/23/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1400 COLEMAN AVE	G21	SANTA CLARA	CA	95050	4360	43	06085	37.35715822	-121.9362064	Santa Clara County
17376	Fee-for-Service	1376141499	1376141499	1	1	ALPHA HOSPICE LLC	10/20/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	15455 DEVONSHIRE ST	STE 100A	MISSION HILLS	CA	91345	2618	19	06037	34.2573693	-118.469237	Los Angeles County
17423	Fee-for-Service	1821165846	1821165846	1	1	AHN, DEAN MD	11/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83801	02	General Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
17444	Fee-for-Service	1730287160	1730287160	1	1	ANESTHESIA MED GROUP	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	SANTA BARBARA INC	PUEBLO AT BATH STREETS	None	SANTA BARBARA	CA	93105	0000	42	06083	34.430526	-119.72196	Santa Barbara County
17448	Fee-for-Service	1497769145	1497769145	1	1	ANWAR, MUHAMMAD MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63134	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	12626 RIVERSIDE DR	STE 404	NORTH HOLLYWOOD	CA	91607	3456	19	06037	34.15758449	-118.408131	Los Angeles County
17455	Fee-for-Service	1962513846	1962513846	1	1	ALI, ALIYA I MD FAAP	9/30/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50859	None	None	0	In state provider	AL CENTER	8135 PAINTER AVE	205	WHITTIER	CA	90602	3102	19	06037	33.965829	-118.032738	Los Angeles County
17457	Fee-for-Service	1871942805	1871942805	1	1	ALCANTAR, DIANA I LMFT	7/17/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1095 IRVINE BLVD	None	TUSTIN	CA	92780	3526	30	06059	33.74821163	-117.8097851	Orange County
17469	Fee-for-Service	1356051478	1356051478	1	1	ALEXANDER, KATHLEEN M PT	1/3/2023	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39650 LIBERTY ST	SUITE 140	FREMONT	CA	94538	2225	01	06001	37.54662058	-121.9736002	Alameda County
17491	Fee-for-Service	1568095776	1568095776	1	1	ANGELS PURE HOSPICE CARE INC	7/22/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3800 LA CRESCENTA AVE	SUITE 204	LA CRESCENTA	CA	91214	3948	19	06037	34.2115128	-118.2399309	Los Angeles County
17533	Fee-for-Service	1477502300	1477502300	1	1	ACQUARELLI, ROBERT A	11/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72124	None	None	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
17542	Fee-for-Service	1952472987	1952472987	1	1	ALLYN, DAVID	12/22/2002	2084P0804X	NA	Psychiatry	026	PHYSICIANS	49752	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
17554	Fee-for-Service	1881127215	1881127215	1	1	ADVANCED WELLNESS HOME CARE	1/31/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	4959 PALO VERDE ST	STE 206 C-5	MONTCLAIR	CA	91763	2302	36	06071	34.08129954	-117.6966135	San Bernardino County
17568	Fee-for-Service	1295715340	1295715340	1	1	AHMADPOUR, SAEID MD	10/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	51678	41	Internal Medicine	0	In state provider	None	2450 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	52	06103	40.14921426	-122.2216794	Tehama County
17607	Fee-for-Service	1356382717	1356382717	1	1	ABOULHOSN, JAMIL A MD	9/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74157	41	Internal Medicine	0	In state provider	None	3650 SOUTH ST	STE 310	LAKEWOOD	CA	90712	1519	19	06037	33.86019847	-118.149255	Los Angeles County
17609	Fee-for-Service	1265524433	1265524433	1	1	ALLEMANN, PATRICIA I MD	1/23/2008	207R00000X	NA	Other	026	PHYSICIANS	95903	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
17620	Fee-for-Service	1497701015	1497701015	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	19640 BEACH BLVD	None	HUNTINGTON BEACH	CA	92648	2905	30	06059	33.67711421	-117.9884946	Orange County
17634	Fee-for-Service	1164031282	1164031282	1	1	ANDRE, THOMAS J LMFT	1/26/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	512 MAIN ST.	STE 2	EL SEGUNDO	CA	90245	3065	19	06037	33.92258115	-118.415961	Los Angeles County
17647	Fee-for-Service	1972573046	1972573046	1	1	ASMUTH, DAVID M MD	7/17/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86575	41	Internal Medicine	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
17661	Fee-for-Service	1689643140	1689643140	1	1	AMATRUDA, JAMES F MD	1/7/2020	2080P0207X	NA	Hematology	026	PHYSICIANS	164492	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
17664	Fee-for-Service	1376141499	1376141499	1	1	ALPHA HOSPICE LLC	10/20/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	15455 DEVONSHIRE ST	STE 100A	MISSION HILLS	CA	91345	2618	19	06037	34.2573693	-118.469237	Los Angeles County
17685	Fee-for-Service	1215919477	1215919477	1	1	ABIDI, ALIREZA MD	8/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90381	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
17715	Fee-for-Service	1740389444	1740389444	1	1	ABJELINA, ANNALISA A MD	7/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	56211	40	Pediatrics	0	In state provider	None	950 N STATE ST	None	HEMET	CA	92543	1485	33	06065	33.763266	-116.9717935	Riverside County
17723	Fee-for-Service	1104076504	1104076504	1	1	AHN, HELEN H LMFT	6/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1661 N. RAYMOND AVE	#214	ANAHEIM	CA	92801	1120	30	06059	33.858234	-117.906788	Orange County
17731	Fee-for-Service	1639304546	1639304546	1	1	AMERICAN HOME HEALTH CARE	2/25/2010	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	6850 REGIONAL STREET	SUITE 110	DUBLIN	CA	94568	2939	01	06001	37.70205259	-121.933262	Alameda County
17757	Fee-for-Service	1114109949	1114109949	1	1	ARC OF SAN DIEGO	6/24/1994	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	329A D ST	None	CHULA VISTA	CA	91910	1701	37	06073	32.64786255	-117.0839384	San Diego County
17809	Fee-for-Service	1013198506	1013198506	1	2	AID HOME HEALTH CARE INC	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1007 S CENTRAL AVE	SUITE 208	GLENDALE	CA	91204	3909	19	06037	34.13452405	-118.2579006	Los Angeles County
17847	Fee-for-Service	1437533296	1437533296	1	1	APEX HEALTHCARE SERVICES LLC	3/1/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4950 HAMILTON AVENUE	SUITE 208	SAN JOSE	CA	95130	1748	43	06085	37.28991321	-121.9880695	Santa Clara County
17873	Fee-for-Service	1932659547	1932659547	1	1	ADVANCED SLEEP MEDICINE SRVS	7/3/2018	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	5400 BALBOA BLVD	SUITE 126	ENCINO	CA	91316	5202	19	06037	34.169283	-118.501072	Los Angeles County
17880	Fee-for-Service	1548560857	1548560857	1	1	ADLER, NAOMI A MD	7/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119176	66	Emergency Medicine (Urgent Care)	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
17918	Fee-for-Service	1790396216	1790396216	1	1	AT EASE HOME HEALTH CARE INC	6/20/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	22801 VENTURA BLVD	SUITE 202	WOODLAND HILLS	CA	91364	1266	19	06037	34.16600568	-118.6234567	Los Angeles County
17926	Fee-for-Service	1891114583	1891114583	1	1	ASGHARI, HANNAH H MD	9/1/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	169846	68	Hematology	0	In state provider	None	44151 15TH ST W	101	LANCASTER	CA	93534	4079	19	06037	34.68551775	-118.1568686	Los Angeles County
17950	Fee-for-Service	1871193763	1871193763	1	1	ANTELOPE VALLEY OUTPATIENT I	6/4/2021	2085R0202X	NA	Mammography/MRI Provider	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	MAGING CENTER, LLC	44105 15TH ST W	STE 100	LANCASTER	CA	93534	4090	19	06037	34.684218	-118.1568465	Los Angeles County
17955	Fee-for-Service	1962100420	1962100420	1	1	AGAJANIAN, TARA	4/12/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2275 S. MAIN ST.	SUITE 201	CORONA	CA	92882	5303	33	06065	33.85511663	-117.5694892	Riverside County
18003	Fee-for-Service	1083888960	1083888960	1	1	ANGELO, PADEN D MD	11/16/2010	207R00000X	NA	Other	026	PHYSICIANS	112759	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
18005	Fee-for-Service	1891159190	1891159190	1	1	ALVA, HEATHER L MD	9/3/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	168458	68	Hematology	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
18018	Fee-for-Service	1063571651	1063571651	1	1	ANDERSON, DAVID R MD	12/1/1997	204D00000X	NA	Other	026	PHYSICIANS	66924	20	Orthopedic Surgery	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
18025	Fee-for-Service	1760625289	1760625289	1	1	AKPAN, IMO M MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120089	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
18045	Fee-for-Service	1043290778	1043290778	1	1	AGGARWAL, ATUL MD	11/12/2008	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	53451	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5945 TRUXTUN EXT	None	BAKERSFIELD	CA	93390	0610	15	06029	35.36322921	-119.0706029	Kern County
18061	Fee-for-Service	1295709665	1295709665	1	1	ADAN, JOHN MD	9/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	44024	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2141 COLORADO AVE	None	TURLOCK	CA	95382	2011	50	06099	37.51231802	-120.8353115	Stanislaus County
18063	Fee-for-Service	1609887124	1609887124	1	1	ALEXANDER N ORSINI MD	11/27/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3050 TWIN RIVERS DR	None	ARKADELPHIA	AR	71923	4218	00	None	34.123185	-93.088503	Clark County
18088	Fee-for-Service	1780710111	1780710111	1	1	AHLUWALIA, SANDEEP S MD	8/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116368	30	Radiology	0	In state provider	None	3800 DALE RD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
18114	Fee-for-Service	1003256421	1003256421	1	1	ABEBE, SAMUEL MD	11/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144270	40	Pediatrics	0	In state provider	None	2825 CAPITOL AVE	None	SACRAMENTO	CA	95816	5615	34	06067	38.570805	-121.4696385	Sacramento County
18201	Fee-for-Service	1447708730	1447708730	1	1	AMPONSAH, MELABI PSYD	2/10/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
18203	Fee-for-Service	1033711056	1033711056	1	1	ANGELS OF VALLEY HOSPICE	5/23/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	13609 VICTORY	STE 127	VAN NUYS	CA	91401	6412	19	06037	34.18671049	-118.429353	Los Angeles County
18207	Fee-for-Service	1417087230	1417087230	1	1	AHN, YUNG SOON MD	4/15/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	41686	40	Pediatrics	0	In state provider	None	3544 W OLYMPIC BLVD	STE 20314	LOS ANGELES	CA	90019	3500	19	06037	34.05246985	-118.3163186	Los Angeles County
18212	Fee-for-Service	1891114583	1891114583	1	1	ASGHARI, HANNAH H MD	9/1/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	169846	41	Internal Medicine	0	In state provider	None	44151 15TH ST W	101	LANCASTER	CA	93534	4079	19	06037	34.68551775	-118.1568686	Los Angeles County
18217	Fee-for-Service	1336990506	1336990506	1	1	AXIS COMMUNITY HEALTH, INC.	10/16/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1686 SECOND STREET	None	LIVERMORE	CA	94550	4328	01	06001	37.67897798	-121.7749588	Alameda County
18267	Fee-for-Service	1336556224	1336556224	1	1	ANAGOR, CHUDE A MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146064	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
18271	Fee-for-Service	1891744538	1891744538	1	1	AZZAM, SAMIR J MD	12/19/2008	174400000X	NA	Other	026	PHYSICIANS	51621	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1211 WEST LA PALMA AVE	STE 707	ANAHEIM	CA	92801	2815	30	06059	33.84718298	-117.933758	Orange County
18278	Fee-for-Service	1659484566	1659484566	1	1	ARAKEL, ARTOON MD PC	12/15/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	49849	41	Internal Medicine	0	In state provider	None	1030 S GLENDALE AVE	STE 407	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
18282	Fee-for-Service	1275161150	1275161150	1	1	AHMAD, TESSNIM MD	7/8/2024	208600000X	NA	General Surgery	026	PHYSICIANS	179389	18	Ophthalmology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
18290	Fee-for-Service	1215089453	1215089453	1	1	ADKINS, KELSEY M LMFT	10/17/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15 ILAHEE LN	STE 100	CHICO	CA	95973	7205	04	06007	39.75224248	-121.8701858	Butte County
18291	Fee-for-Service	1083888960	1083888960	1	1	ANGELO, PADEN D MD	11/16/2010	207R00000X	NA	Other	026	PHYSICIANS	112759	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
18300	Fee-for-Service	1639227622	1639227622	1	1	ALLEN, FORREST B MD	7/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43004	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
18316	Fee-for-Service	1689763781	1689763781	1	1	ARJOMAND, MARYAM MD	12/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	61705	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	136 NORTH SAN MATEO DR	SUITE 101	SAN MATEO	CA	94401	2779	41	06081	37.56923131	-122.3291888	San Mateo County
18361	Fee-for-Service	1982888962	1982888962	1	1	AGUILAR ALICIA NP	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1601 W SAINT MARYS RD	None	TUCSON	AZ	85745	2623	00	None	32.228199	-111.0000825	Pima County
18435	Fee-for-Service	1093723371	1093723371	1	1	AZIZZADEH, NASSER	3/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	35304	None	None	0	In state provider	None	1141 W REDONDO BEACH BLV	STE 407	GARDENA	CA	90247	3582	19	06037	33.89247036	-118.2941482	Los Angeles County
18467	Fee-for-Service	1689243321	1689243321	1	1	ALI, MARIAM M DO	8/28/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22386	08	Family Practice	0	In state provider	None	955 W IMPERIAL HWY	SUITE 110	BREA	CA	92821	3812	30	06059	33.91745451	-117.9133065	Orange County
18468	Fee-for-Service	1326166349	1326166349	1	1	ALMARIO, MAY S PT	10/18/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	17046 MARYGOLD AVE	None	FONTANA	CA	92335	1722	36	06071	34.07488008	-117.4335119	San Bernardino County
18492	Fee-for-Service	1033711056	1033711056	1	1	ANGELS OF VALLEY HOSPICE	5/23/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	13609 VICTORY	STE 127	VAN NUYS	CA	91401	6412	19	06037	34.18671049	-118.429353	Los Angeles County
18503	Fee-for-Service	1336990506	1336990506	1	1	AXIS COMMUNITY HEALTH, INC.	10/16/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1686 SECOND STREET	None	LIVERMORE	CA	94550	4328	01	06001	37.67897798	-121.7749588	Alameda County
18567	Fee-for-Service	1689067290	1689067290	1	1	ARIZMENDI-HOLGUIN, WANDA D N	6/28/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	P	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
18572	Fee-for-Service	1962268870	1962268870	1	1	ANNA ROMERO ADVANCED PRACTIC	3/5/2024	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	E NURSING INC	2240 NORTHROP AVE	None	SACRAMENTO	CA	95825	7408	34	06067	38.581128	-121.4132625	Sacramento County
18574	Fee-for-Service	1639461601	1639461601	1	1	ABBIGAIL LYNN TITTLE	5/25/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	20701 N SCOTTSDALE RD	STE 107	SCOTTSDALE	AZ	85255	6413	00	None	33.6750627	-111.9253307	Maricopa County
18580	Fee-for-Service	1154372852	1154372852	1	1	ARITA, HARUO MD	7/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77775	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
18587	Fee-for-Service	1184611816	1184611816	1	1	ATKINSON, HENRI C MD	3/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	48088	01	General Practice	0	In state provider	None	8420 S 8TH AVE	# 1	INGLEWOOD	CA	90305	1333	19	06037	33.96187764	-118.326548	Los Angeles County
18614	Fee-for-Service	1033225388	1033225388	1	1	ATTARAN, HOMAYOUN MD	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	64776	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
18629	Fee-for-Service	1871587964	1871587964	1	1	AVALON CARE CENTER-	12/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	FRANCISCAN LLC	3169 M ST	None	MERCED	CA	95348	2404	24	06047	37.320534	-120.478447	Merced County
18643	Fee-for-Service	1245585090	1245585090	1	1	ANTELOPE PHARMACY,INC	3/25/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4207 ELVERTA RD	109	ANTELOPE	CA	95843	4735	34	06067	38.715318	-121.3661565	Sacramento County
18652	Fee-for-Service	1124373006	1124373006	1	1	ALMARIO, DAVID SEAN R MD	10/7/2019	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	141656	39	Preventive (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
18670	Fee-for-Service	1679970099	1679970099	2	1	AMPLA HEALTH	6/30/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2800 LINCOLN STREET	SUITE B	OROVILLE	CA	95966	5961	04	06007	39.50159288	-121.5513942	Butte County
18708	Fee-for-Service	1295729648	1295729648	1	1	ARDILA, EDGAR A MD INC	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	54539	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4500 BROCKTON AVE	STE 301	RIVERSIDE	CA	92501	4028	33	06065	33.97785263	-117.3836152	Riverside County
18733	Fee-for-Service	1811398373	1811398373	1	1	ABU DAMOUS, HIBA	5/26/2022	364SP0810X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
18741	Fee-for-Service	1760559041	1760559041	1	1	ASUNCION-TAPALLA, CHRISTINE	8/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	93798	40	Pediatrics	0	In state provider	M MD	1900 DRESDEN DRIVE	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
18744	Fee-for-Service	1780722033	1780722033	1	2	ADDICTION RESEARCH AND TREAT	11/30/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1111 MARKET STREET	1ST AND 2ND FLOORS	SAN FRANCISCO	CA	94103	1513	38	06075	37.78018987	-122.4128297	San Francisco County
18762	Fee-for-Service	1265456768	1265456768	1	1	ALAMAR HEALTHCARE INC	8/20/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	58 WEST LOOP DR	None	CAMARILLO	CA	93010	2035	56	06111	34.23642208	-119.0416885	Ventura County
18783	Fee-for-Service	1093787855	1093787855	1	1	ARVOLD,BRUCE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	301 BECKER AV SW	None	WILLMAR	MN	56201	3302	00	None	45.1205233	-95.04619753	Kandiyohi County
18835	Fee-for-Service	1265642052	1265642052	1	1	ARCINIEGA, JOSE I MD	1/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10123	08	Family Practice	0	In state provider	None	17171 FOOTHILL BLVD	STE E	FONTANA	CA	92235	9047	36	06071	34.10655349	-117.430695	San Bernardino County
18859	Fee-for-Service	1922172758	1922172758	1	1	AVERY, DAVID C	1/13/1992	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	SERENITY PLUS	6604 CAVALRY CT	None	ORANGEVALE	CA	95662	3103	34	06067	38.686086	-121.2614775	Sacramento County
18874	Fee-for-Service	1184611816	1184611816	1	1	ATKINSON, HENRI C MD	3/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	48088	41	Internal Medicine	0	In state provider	None	8420 S 8TH AVE	# 1	INGLEWOOD	CA	90305	1333	19	06037	33.96187764	-118.326548	Los Angeles County
18875	Fee-for-Service	1457845471	1457845471	1	1	AM HEALTHCARE INC	8/1/2018	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	700 S CENTRAL AVE	None	GLENDALE	CA	91204	2011	19	06037	34.13772	-118.2578335	Los Angeles County
18884	Fee-for-Service	1326400532	1326400532	1	1	ANAMAN, ZOE A MD MPH	7/18/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	162273	08	Family Practice	0	In state provider	None	220 E 13TH ST	None	MERCED	CA	95340	6242	24	06047	37.29309532	-120.4748791	Merced County
18898	Fee-for-Service	1053380832	1053380832	1	1	ALCOTT,SALLY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	0000	00	None	33.480864	-112.0795155	Maricopa County
18966	Fee-for-Service	1003958356	1003958356	1	1	ARARAT HOME OF LOS	5/20/1980	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ANGELES, INC	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
18996	Fee-for-Service	1295729648	1295729648	1	1	ARDILA, EDGAR A MD INC	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	54539	41	Internal Medicine	0	In state provider	None	4500 BROCKTON AVE	STE 301	RIVERSIDE	CA	92501	4028	33	06065	33.97785263	-117.3836152	Riverside County
19003	Fee-for-Service	1265774509	1265774509	1	1	ALEXANDRA FOX	2/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 W CLARENDON AVE	STE 142	PHOENIX	AZ	85013	3449	00	None	33.49179	-112.07844	Maricopa County
19004	Fee-for-Service	1194046193	1194046193	1	1	APPU, MERVEEN MD	8/7/2017	2084N0402X	NA	Neurology	026	PHYSICIANS	148984	79	Neurology-Child	0	In state provider	None	1524 MCHENRY AVE	STE 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
19033	Fee-for-Service	1720101769	1720101769	1	1	ARARAT HOME OF LA, INC	2/15/2006	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	15105 MISSION HILLS RD	None	MISSION HILLS	CA	91345	1103	19	06037	34.28226409	-118.4628068	Los Angeles County
19037	Fee-for-Service	1689951238	1689951238	1	1	ALAEDDINE, MOHAMAD MD	12/27/2022	208G00000X	NA	General Surgery	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
19040	Fee-for-Service	1083773741	1083773741	1	1	ASHLEY, MARK A MD	2/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77477	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
19053	Fee-for-Service	1265456768	1265456768	1	1	ALAMAR HEALTHCARE INC	8/20/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	58 WEST LOOP DR	None	CAMARILLO	CA	93010	2035	56	06111	34.23642208	-119.0416885	Ventura County
19072	Fee-for-Service	1639528847	1639528847	1	1	AMBER ENTERPRISES INC	2/21/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	328 E COMMERICAL RD	UNIT 102 & 103	SAN BERNARDINO	CA	92408	3708	36	06071	34.05586716	-117.2778981	San Bernardino County
19073	Fee-for-Service	1265658595	1265658595	2	3	APOLLOMED HOSPITALISTS A MED	10/27/2022	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ICAL CORPORATION	100 SOUTH RAYMOND AVENUE	None	ALHAMBRA	CA	91801	3166	19	06037	34.09027878	-118.1450083	Los Angeles County
19076	Fee-for-Service	1144893256	1144893256	1	1	AYK EYE GROUP INC	9/20/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	None	None	0	In state provider	None	3000 W OLYMPIC BLVD	201	LOS ANGELES	CA	90006	2588	19	06037	34.05260947	-118.3003335	Los Angeles County
19087	Fee-for-Service	1679927933	1679927933	1	1	ABADIR, MARY LMFT	7/24/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
19101	Fee-for-Service	1881811420	1881811420	1	1	AYALA, MARTIN LCSW	12/17/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
19117	Fee-for-Service	1679523682	1679523682	1	1	ALI, SUNEETHA MD	9/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	37417	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	741 S ORANGE AVE	None	WEST COVINA	CA	91790	2662	19	06037	34.07079634	-117.9445034	Los Angeles County
19159	Fee-for-Service	1073556627	1073556627	1	1	AZIZ, SEERAT MD	3/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51614	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
19171	Fee-for-Service	1295813061	1295813061	1	1	AMGOTT-KWAN GARRICK MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	68360	13	Neurology (M.D. only)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
19173	Fee-for-Service	1063421378	1063421378	1	1	ANDRIASCHUK, SOPHIE M MD	11/1/1999	207L00000X	NA	Other	026	PHYSICIANS	31973	05	Anesthesiology	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
19178	Fee-for-Service	1255489720	1255489720	1	1	AGARWAL, SANJAY K	6/14/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52018	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	STE 430	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
19248	Fee-for-Service	1548606254	1548606254	1	1	ANAEBERE, TIFFANY C MD	7/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134199	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
19253	Fee-for-Service	1215085006	1215085006	1	1	ABDOU, M SAMY MD	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70231	14	Neurological Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
19256	Fee-for-Service	1568825024	1568825024	1	1	ARSAN, CYBELE MD	8/30/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	167915	None	None	0	In state provider	None	1200 CLAY ST	None	OAKLAND	CA	94612	1400	01	06001	37.80422981	-122.2742222	Alameda County
19292	Fee-for-Service	1407175680	1407175680	1	1	AMERICAN STAR HOME	8/11/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1627 SHOREVIEW AVE	None	SAN MATEO	CA	94401	3033	41	06081	37.57302074	-122.3079054	San Mateo County
19312	Fee-for-Service	1720195753	1720195753	2	1	APRIA HEALTHCARE LLC	1/16/2018	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1994 ROCKEFELLER DR	None	CERES	CA	95307	9295	50	06099	37.60198638	-120.9725793	Stanislaus County
19321	Fee-for-Service	1720166366	1720166366	1	1	ADACHI, MITCHELL M MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	80647	22	Pathology (M.D. only)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
19328	Fee-for-Service	1699824557	1699824557	1	1	ALAMEDA COUNTY CCS	8/4/1993	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	BAY MTU	2001 BOCKMAN RD	None	SAN LORENZO	CA	94580	1903	01	06001	37.6716703	-122.1480506	Alameda County
19349	Fee-for-Service	1285829119	1285829119	1	1	ANDREW BRONSTEIN, MD PC	4/15/2023	163WM0705X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	10135 W TWAIN AVE	SUITE 100	LAS VEGAS	NV	89147	6720	00	None	36.12253856	-115.3134079	Clark County
19368	Fee-for-Service	1447288147	1447288147	1	1	ABRISHAMI, PAYAM MD	9/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86627	07	Dermatology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
19369	Fee-for-Service	1033110044	1033110044	1	1	ARORA, PANKAJ MD	11/12/2010	207R00000X	NA	Other	026	PHYSICIANS	54066	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
19405	Fee-for-Service	1821756578	1821756578	1	1	AMADASUN, FLORA O	12/16/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	7841 BONNY DOWNS WAY	None	ELK GROVE	CA	95758	6572	34	06067	38.421621	-121.411395	Sacramento County
19432	Fee-for-Service	1922131804	1922131804	1	1	ALAMEDA COUNTY MED CTR	7/1/1998	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	NEWARK HEALTH CENTER	6066 CIVIC TERRACE AVE	None	NEWARK	CA	94560	3746	01	06001	37.53623835	-122.0285012	Alameda County
19447	Fee-for-Service	1851345722	1851345722	1	1	AGEE, JAMES E MD	11/30/1984	208800000X	NA	Other	026	PHYSICIANS	46520	34	Urology and Urological Surgery	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
19448	Fee-for-Service	1073598371	1073598371	1	1	AYNEHCHI, SHAHRAD MD	9/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85401	34	Urology and Urological Surgery	0	In state provider	None	575 E HARDY ST	STE 215	INGLEWOOD	CA	90301	4041	19	06037	33.94909392	-118.3477665	Los Angeles County
19466	Fee-for-Service	1255489720	1255489720	1	1	AGARWAL, SANJAY K	6/14/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52018	67	Endocrinology	0	In state provider	STE 430	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
19478	Fee-for-Service	1720236953	1720236953	1	1	ABANOBI, KELECHI M MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123706	33	Thoracic Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
19496	Fee-for-Service	1073076881	1073076881	1	1	AGUSTIN, RICHIEL E CNP	1/15/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25272 MARGUERITE PKWY	None	MISSION VIEJO	CA	92692	2901	30	06059	33.59591616	-117.6586221	Orange County
19504	Fee-for-Service	1134732548	1134732548	1	1	ALI HUSSAINI, WASEEM W CRNA	4/15/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
19506	Fee-for-Service	1659337566	1659337566	1	1	ASHMAN, JONATHAN B. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 W CLARENDON AVE	STE 350	PHOENIX	AZ	85013	3497	00	None	33.49179	-112.07844	Maricopa County
19507	Fee-for-Service	1801579420	1801579420	1	1	AN, CINDY CNP	3/7/2024	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11100 WARNER AVE	STE 310	FOUNTAIN VALLEY	CA	92708	4009	30	06059	33.716291	-117.9355051	Orange County
19510	Fee-for-Service	1326544958	1326544958	1	1	ALMANZAR-RAMOS, HECTOR M MD	7/1/2021	208M00000X	NA	Other	026	PHYSICIANS	163577	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
19518	Fee-for-Service	1093934556	1093934556	1	1	ASSOCIATES IN GENERAL	9/1/1996	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	SURGERY A MEDICAL CORPOR	3610 LONG BEACH BLVD	SUITE 101	LONG BEACH	CA	90807	4012	19	06037	33.822396	-118.1893225	Los Angeles County
19521	Fee-for-Service	1659416873	1659416873	1	1	ASUNCION, GLORIA V MD	1/29/2008	207ZP0105X	NA	Other	026	PHYSICIANS	26105	22	Pathology (M.D. only)	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
19526	Fee-for-Service	1679100234	1679100234	1	1	ALLEN, ANDREA L	5/21/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1631 MILL STREAM DRIVE	None	CHINO HILLS	CA	91709	1780	36	06071	33.99992014	-117.7689125	San Bernardino County
19541	Fee-for-Service	1215085006	1215085006	1	1	ABDOU, M SAMY MD	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70231	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
19577	Fee-for-Service	1790522712	1790522712	1	1	ABT, ZACHARY AU	2/10/2025	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	960 E. GREEN ST	SUITE 208	PASADENA	CA	91106	2422	19	06037	34.14451994	-118.1301695	Los Angeles County
19595	Fee-for-Service	1033553383	1033553383	1	1	ARCHIE, MARK	10/23/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	137479	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
19616	Fee-for-Service	1235581604	1235581604	1	1	ASHHAB, ASHRAF MD	10/9/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	161402	10	Gastroenterology (M.D. only)	0	In state provider	None	328 S. FIRST ST	F	ALHAMBRA	CA	91801	3790	19	06037	34.09104553	-118.1252904	Los Angeles County
19627	Fee-for-Service	1285649897	1285649897	3	1	AMANITA RX, INC.	7/21/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1250 LA VENTA DR	STE 114	WESTLAKE VILLAGE	CA	91361	3702	56	06111	34.14827603	-118.8227637	Ventura County
19637	Fee-for-Service	1902267479	1902267479	1	9	ALTAMED HEALTH SERVICES	11/2/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1855 N FAIR OAKS AVENUE	SUITE 200	PASADENA	CA	91103	1620	19	06037	34.177806	-118.1507985	Los Angeles County
19651	Fee-for-Service	1952746174	1952746174	1	1	AMALU, PRISCILLA N NP	5/3/2021	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3501 S HARBOR BLVD	None	SANTA ANA	CA	92704	6919	30	06059	33.69981147	-117.9194272	Orange County
19692	Fee-for-Service	1821756578	1821756578	1	1	AMADASUN, FLORA O	12/16/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	7841 BONNY DOWNS WAY	None	ELK GROVE	CA	95758	6572	34	06067	38.421621	-121.411395	Sacramento County
19721	Fee-for-Service	1922131804	1922131804	1	1	ALAMEDA COUNTY MED CTR	7/1/1998	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	NEWARK HEALTH CENTER	6066 CIVIC TERRACE AVE	None	NEWARK	CA	94560	3746	01	06001	37.53623835	-122.0285012	Alameda County
19729	Fee-for-Service	1194911610	1194911610	1	1	ALMITY INTERNATIONAL	10/27/2008	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HOME HEALTH CARE INC	101-103 S SPRING STREET	None	CLAREMONT	CA	91711	4930	19	06037	34.09298422	-117.7166742	Los Angeles County
19740	Fee-for-Service	1023241833	1023241833	1	2	AMAX HOME HEALTH INC	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	27013 LANGSIDE AVE	UNIT M	CANYON COUNTRY	CA	91351	2557	19	06037	34.42101426	-118.4845699	Los Angeles County
19760	Fee-for-Service	1164530440	1164530440	1	1	AHLUWALIA, TREVINDER MD	10/31/1981	207R00000X	NA	Other	026	PHYSICIANS	38299	36	Psychiatry	0	In state provider	None	15982 QUANTICO RD	STE A	APPLE VALLEY	CA	92307	1382	36	06071	34.54150582	-117.2707656	San Bernardino County
19789	Fee-for-Service	1619047826	1619047826	3	1	ATAZAK INC	8/25/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2860 ARTESIA BOULEVARD	None	REDONDO BEACH	CA	90278	3421	19	06037	33.8727387	-118.3571296	Los Angeles County
19799	Fee-for-Service	1871063040	1871063040	1	1	ADVENTIST HEALTH CLEARLAKE	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	801 11TH ST	None	LAKEPORT	CA	95453	4100	17	06033	39.04898862	-122.9217691	Lake County
19813	Fee-for-Service	1679100234	1679100234	1	1	ALLEN, ANDREA L	5/21/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1631 MILL STREAM DRIVE	None	CHINO HILLS	CA	91709	1780	36	06071	33.99992014	-117.7689125	San Bernardino County
19834	Fee-for-Service	1699883157	1699883157	1	1	APODACA, LEONEL JR MD	8/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	66374	41	Internal Medicine	0	In state provider	None	1165 PHELPS AVE	STE 101	COALINGA	CA	93210	9665	10	06019	36.15155341	-120.3409732	Fresno County
19835	Fee-for-Service	1265510846	1265510846	1	1	ATMAR, JALAL A MD	12/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92324	08	Family Practice	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
19837	Fee-for-Service	1033670732	1033670732	1	1	AL BAGHDADI, MAHA MD	9/16/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	178879	45	Nephrology (Renal-Kidney)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
19843	Fee-for-Service	1295202943	1295202943	1	2	ANTHONY BENIGNO, PSYD., PSYC	4/12/2021	261QM0801X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10165 FOOTHILL BLVD	#3	RANCHO CUCAMONGA	CA	91730	0340	36	06071	34.10653497	-117.5834924	San Bernardino County
19849	Fee-for-Service	1801674999	1801674999	1	1	ADEII HEALTH INC	5/14/2024	261QM0855X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	None	1108 BISSELL AVE	None	RICHMOND	CA	94801	3135	07	06013	37.93404647	-122.3585886	Contra Costa County
19852	Fee-for-Service	1821091067	1821091067	1	1	ABACUS BUSINESS CORP GRP	7/1/1984	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	AMERICAN BIO-CLIN LABS	2730 N MAIN ST	None	LOS ANGELES	CA	90031	3321	19	06037	34.06598295	-118.2131144	Los Angeles County
19888	Fee-for-Service	1730352931	1730352931	1	1	AGARWAL, NINA DO	12/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11050	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1100 N PALM CANYON DRIVE	SUITE 212	PALM SPRINGS	CA	92262	4426	33	06065	33.838182	-116.546744	Riverside County
19889	Fee-for-Service	1285840298	1285840298	1	1	ALDRICH, AMY M DO	12/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10437	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1400 EAST CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
19894	Fee-for-Service	1073578332	1073578332	1	1	ALEXANDER, CAROLYN J MD	8/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85297	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8700 BEVERLY BLVD	STE 3611	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
19897	Fee-for-Service	1750571691	1750571691	1	1	AKERS-WHITE, LATANIA M MD	6/29/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166625	None	None	0	In state provider	None	333 W EL CAMINO REAL	STE 230	SUNNYVALE	CA	94087	1969	43	06085	37.36899556	-122.0358929	Santa Clara County
19908	Fee-for-Service	1073649455	1073649455	1	1	ALAKSON, REBECCA A MD	5/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155376	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
19927	Fee-for-Service	1902267479	1902267479	1	9	ALTAMED HEALTH SERVICES	11/2/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1855 N FAIR OAKS AVENUE	SUITE 200	PASADENA	CA	91103	1620	19	06037	34.177806	-118.1507985	Los Angeles County
19931	Fee-for-Service	1124337621	1124337621	1	1	ALFREIJAT, MAJD MD	5/3/2017	207R00000X	NA	Other	026	PHYSICIANS	144931	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
20063	Fee-for-Service	1093310369	1093310369	1	1	AAA JERUSALEM STAR INC	1/14/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5945 CAPISTRANO AVENUE	None	WOODLAND HILLS	CA	91367	3346	19	06037	34.17872207	-118.6168605	Los Angeles County
20075	Fee-for-Service	1033500780	1033500780	1	1	ANTHIS, ROBERT C	3/19/2015	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	8311 E FLORENCE AVE	None	DOWNEY	CA	94546	5306	19	06037	33.95103918	-118.1247373	Los Angeles County
20084	Fee-for-Service	1871063040	1871063040	1	1	ADVENTIST HEALTH CLEARLAKE	6/8/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	801 11TH ST	None	LAKEPORT	CA	95453	4100	17	06033	39.04898862	-122.9217691	Lake County
20099	Fee-for-Service	1548571789	1548571789	1	1	ANCHALA, PRAVEEN R MD	6/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117755	30	Radiology	0	In state provider	None	300 PASTEUR DR	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
20108	Fee-for-Service	1790131043	1790131043	1	1	ASNAASHARI, PAIYUAM DO	12/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15950	01	General Practice	0	In state provider	None	1201 ALHAMBRA BLVD	230	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
20127	Fee-for-Service	1730317355	1730317355	1	1	ASARE-BEDIAKO, SHEILA MD	10/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116985	40	Pediatrics	0	In state provider	None	8110 LAGUNA BLVD	None	ELK GROVE	CA	95758	7904	34	06067	38.421306	-121.408173	Sacramento County
20132	Fee-for-Service	1295202943	1295202943	1	2	ANTHONY BENIGNO, PSYD., PSYC	3/6/2024	261QM0801X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	10165 FOOTHILL BLVD	#3	RANCHO CUCAMONGA	CA	91730	0340	36	06071	34.10653497	-117.5834924	San Bernardino County
20213	Fee-for-Service	1154960235	1154960235	1	1	AUYOUNG, WENDY PT	10/14/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
20255	Fee-for-Service	1356850648	1356850648	1	1	ALGOS INC. A MEDICAL CORPORA	6/19/2018	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1900 ROYALTY DR	SUITE 120	POMONA	CA	91767	3032	19	06037	34.07754346	-117.7463466	Los Angeles County
20298	Fee-for-Service	1346470408	1346470408	1	1	ALSHAWABKEH, LAITH I MD	7/28/2017	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	150246	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
20318	Fee-for-Service	1184603706	1184603706	1	1	AFILAKA, ABOABA A MD	8/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131435	47	Miscellaneous	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
20319	Fee-for-Service	1033295449	1033295449	1	1	ASIAN NETWORK PHYSICAL	12/13/1994	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	THERAPY AND REHAB	821 HARRISON ST	None	OAKLAND	CA	94607	4422	01	06001	37.79922561	-122.2699797	Alameda County
20329	Fee-for-Service	1841202330	1841202330	1	1	ALLEN, ROBERT J MD	11/9/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	51378	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
20349	Fee-for-Service	1265803225	1265803225	1	1	ABREA, CRISJUN	7/10/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	465 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
20357	Fee-for-Service	1801829296	1801829296	1	1	AMPLA HEALTH	1/1/1998	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	MEDICAL & DENTAL	4941 OLIVEHURST AVE	None	OLIVEHURST	CA	95961	4225	58	06115	39.09746115	-121.5514942	Yuba County
20418	Fee-for-Service	1295202943	1295202943	1	2	ANTHONY BENIGNO, PSYD., PSYC	1/31/2024	261QM0801X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	10165 FOOTHILL BLVD	#3	RANCHO CUCAMONGA	CA	91730	0340	36	06071	34.10653497	-117.5834924	San Bernardino County
20427	Fee-for-Service	1952476780	1952476780	1	1	AURORA BREAST MRI	2/25/2008	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	ORANGE COUNTY LLC	101 THE CITY DRIVE SOUTH	BLDG 20	ORANGE	CA	92868	3217	30	06059	33.78674051	-117.8888713	Orange County
20447	Fee-for-Service	1659997625	1659997625	1	1	AGUIRRE-WONG, NEENAH C DPM	4/2/2025	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
20502	Fee-for-Service	1447887666	1447887666	1	1	ANG, KWAN-KEAT MD	5/25/2023	390200000X	NA	Other	026	PHYSICIANS	177850	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
20550	Fee-for-Service	1275979940	1275979940	1	1	ABOUTALIB, KAREEM O DO	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13702	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
20552	Fee-for-Service	1235676552	1235676552	1	1	ALTAIR HOSPICE CARE INC	9/29/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	12265 VENTURA BLVD	205	STUDIO CITY	CA	91604	2306	19	06037	34.14352345	-118.4008521	Los Angeles County
20586	Fee-for-Service	1619132693	1619132693	1	1	ADAIR, NICHOLE M DO	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9448	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
20607	Fee-for-Service	1578858585	1578858585	1	1	AM & BB IMAGING CENTER INC	3/30/2011	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	2407 MARSHALL AVE	None	IMPERIAL	CA	92251	9599	13	06025	32.82754165	-115.5688273	Imperial County
20616	Fee-for-Service	1265415376	1265415376	2	1	ALEMAN, JOHN C MD	9/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	40852	01	General Practice	0	In state provider	None	45 NIELSON ST	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7925859	Santa Cruz County
20645	Fee-for-Service	1801829296	1801829296	1	1	AMPLA HEALTH	9/1/1992	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MEDICAL & DENTAL	4941 OLIVEHURST AVE	None	OLIVEHURST	CA	95961	4225	58	06115	39.09746115	-121.5514942	Yuba County
20650	Fee-for-Service	1891395547	1891395547	1	1	ACCURO HOMES	5/22/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	13172 EARLY CRIMSON ST	None	EASTVALE	CA	92880	4609	33	06065	33.97594891	-117.5706636	Riverside County
20661	Fee-for-Service	1992869366	1992869366	1	1	ANDERSON, JAYME H	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
20710	Fee-for-Service	1295202943	1295202943	1	2	ANTHONY BENIGNO, PSYD., PSYC	2/26/2024	261QM0801X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	10165 FOOTHILL BLVD	#3	RANCHO CUCAMONGA	CA	91730	0340	36	06071	34.10653497	-117.5834924	San Bernardino County
20743	Fee-for-Service	1215160585	1215160585	1	2	ATTENTIVE EYE CARE OPTOMETRY	11/26/2018	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	, INC.	6850 LINCOLN AVE STE 204	None	BUENA PARK	CA	90620	4180	30	06059	33.8317925	-118.0136745	Orange County
20833	Fee-for-Service	1033431549	1033431549	1	1	ARONSON, ERICA R MD	11/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124252	07	Dermatology	0	In state provider	None	2290 SACRAMENTO ST	None	VALLEJO	CA	94590	2929	48	06095	38.12370851	-122.2637378	Solano County
20842	Fee-for-Service	1235676552	1235676552	1	1	ALTAIR HOSPICE CARE INC	9/29/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	12265 VENTURA BLVD	205	STUDIO CITY	CA	91604	2306	19	06037	34.14352345	-118.4008521	Los Angeles County
20874	Fee-for-Service	1376160796	1376160796	1	1	ALICASTRO, AUSTIN CNP	10/1/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
20913	Fee-for-Service	1760741045	1760741045	1	1	AGANGE, NEGIN MD	6/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136804	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06482757	-118.4443441	Los Angeles County
20932	Fee-for-Service	1801829296	1801829296	1	1	AMPLA HEALTH	3/25/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	MEDICAL & DENTAL	4941 OLIVEHURST AVE	None	OLIVEHURST	CA	95961	4225	58	06115	39.09746115	-121.5514942	Yuba County
20949	Fee-for-Service	1366195711	1366195711	1	1	ARCHWOOD HOME HEALTH CARE	3/14/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6912 OWENSMOUTH AVE	STE 209	CANOGA PARK	CA	91303	4259	19	06037	34.19599425	-118.6015033	Los Angeles County
20952	Fee-for-Service	1790177582	1790177582	1	1	ALTAMED HEALTH SERVICES	10/23/2018	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1900 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2725	19	06037	33.9891357	-118.2389609	Los Angeles County
20961	Fee-for-Service	1053709071	1053709071	1	1	ALIPOUR, MONA MD	8/10/2020	207LC0200X	NA	Other	026	PHYSICIANS	149540	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
20995	Fee-for-Service	1275879652	1275879652	1	1	ADONAI CONGREGATE LIVING INC	3/19/2014	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	10215 LASAINE AVENUE	None	NORTHRIDGE	CA	91325	1511	19	06037	34.25602056	-118.5122654	Los Angeles County
21027	Fee-for-Service	1285652651	1285652651	1	1	ADALBERTO GONZALEZ	2/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
21032	Fee-for-Service	1508018912	1508018912	1	1	ARELLANO, MONICA MFT	12/14/2016	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	31 20TH STREET	None	SAN DIEGO	CA	92102	3807	37	06073	32.705676	-117.1457815	San Diego County
21038	Fee-for-Service	1114003910	1114003910	1	1	AMORY, JOHN KENNETH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1959 NE PACIFIC ST	MS 359110 C/O UWP	SEATTLE	WA	98195	9110	00	None	47.65080692	-122.3081828	King County
21051	Fee-for-Service	1396712303	1396712303	1	1	ANGELES,JR HERMENEGILDO MD	7/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	66103	41	Internal Medicine	0	In state provider	None	1900 SULLIVAN AVENUE	STE 816	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
21109	Fee-for-Service	1023298536	1023298536	1	1	AWONUSI, OLUGBENGA D	8/22/2006	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	DYNAPROMPT MEDICAL DIST	44815 FIG AVE	STE 103	LANCASTER	CA	93534	3143	19	06037	34.69630244	-118.1431105	Los Angeles County
21112	Fee-for-Service	1346253689	1346253689	1	1	ALBERSTONE, CARY D. MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	76620	14	Neurological Surgery	0	In state provider	None	133 W SANTA CLARA ST	None	VENTURA	CA	93001	2543	56	06111	34.27954148	-119.302884	Ventura County
21120	Fee-for-Service	1720056880	1720056880	1	2	ASATO, THERESA T OD	9/3/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1031 WASHINGTON STREET	None	RED BLUFF	CA	96080	2746	52	06103	40.18004666	-122.2386525	Tehama County
21140	Fee-for-Service	1023431152	1023431152	1	1	AHMADZIA, AHMAD	11/25/2023	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	174775	None	None	0	In state provider	None	501 LIGHTHOUSE AVE	None	MONTEREY	CA	93940	1439	27	06053	36.61275747	-121.9010674	Monterey County
21163	Fee-for-Service	1952073207	1952073207	1	1	ANGEL LOVE HOSPICE SERVICES	5/30/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	100 WILLOW PLAZA	SUITE 100	VISALIA	CA	93291	6213	54	06107	36.33012504	-119.2922477	Tulare County
21170	Fee-for-Service	1558311886	1558311886	1	1	ADRIANO, AILEEN MARIE MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72939	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
21189	Fee-for-Service	1033783246	1033783246	1	1	ABDELNOR, CATHRIEN MD	10/8/2024	103TF0000X	NA	Mental Health Outpatient Services	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1505 SAINT ALPHONSUS WAY	None	ALAMO	CA	94507	1570	07	06013	37.85352058	-122.0351799	Contra Costa County
21194	Fee-for-Service	1447506779	1447506779	1	1	ADESHARA, PREETI V MD	11/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	133972	01	General Practice	0	In state provider	None	2071 COMPTON AVE	STE 102	CORONA	CA	92881	7279	33	06065	33.848487	-117.5361705	Riverside County
21223	Fee-for-Service	1801829296	1801829296	1	1	AMPLA HEALTH	9/1/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MEDICAL & DENTAL	4941 OLIVEHURST AVE	None	OLIVEHURST	CA	95961	4225	58	06115	39.09746115	-121.5514942	Yuba County
21234	Fee-for-Service	1073191102	1073191102	1	1	ARELLANO-ANDERSON, JACOB P M	9/24/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	192313	08	Family Practice	0	In state provider	D	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
21241	Fee-for-Service	1790177582	1790177582	1	1	ALTAMED HEALTH SERVICES	11/9/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1900 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2725	19	06037	33.9891357	-118.2389609	Los Angeles County
21265	Fee-for-Service	1215396213	1215396213	1	2	AKAY URGUN, DENIZ MD	12/13/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175321	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
21292	Fee-for-Service	1508942087	1508942087	1	1	ABC PHARMACY ENTERPRISES	10/2/1990	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	841 W VALLEY BLVD	STE 101	ALHAMBRA	CA	91803	3251	19	06037	34.07803221	-118.1327862	Los Angeles County
21298	Fee-for-Service	1376585042	1376585042	1	1	ABUDU, ASSIBI Z MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	32689	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
21310	Fee-for-Service	1912149527	1912149527	1	1	ANNE SLATER MD	1/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4800 SAND POINT WAY NE	None	SEATTLE	WA	98105	3901	00	None	47.662389	-122.281857	King County
21317	Fee-for-Service	1477569556	1477569556	1	1	ADAMS, TIMOTHY M MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	58675	05	Anesthesiology	0	In state provider	None	500 S MAIN ST	STE 1210	ORANGE	CA	92868	4556	30	06059	33.77991974	-117.8674745	Orange County
21326	Fee-for-Service	1043576317	1043576317	1	1	AUSTIN VOIGT MD	6/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2003 KOOTENAI HEALTH WAY	None	COEUR D ALENE	ID	83814	6051	00	None	47.695635	-116.792906	Kootenai County
21342	Fee-for-Service	1134305972	1134305972	2	1	A HOMECARE DEVICE INC	4/5/2024	332BP3500X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	5739 YORK BLVD	None	LOS ANGELES	CA	90042	2643	19	06037	34.1186668	-118.1924025	Los Angeles County
21363	Fee-for-Service	1841889961	1841889961	1	1	ASTERIOS TSIMPAS MD MSC MBA	12/9/2022	207T00000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	SOLUTIONS	26732 CROWN VALLEY PKWY	STE 541	MISSION VIEJO	CA	92691	6376	30	06059	33.56347704	-117.66546	Orange County
21371	Fee-for-Service	1053335406	1053335406	1	1	AURORA MEDICAL CORPORATION	1/3/2019	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	11245 LOWER AZUSA RD	None	EL MONTE	CA	91731	1553	19	06037	34.09163095	-118.0213554	Los Angeles County
21373	Fee-for-Service	1093957714	1093957714	1	1	ANGELA ALEXANDER MD	8/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	450 WILLIAMS WAY	None	MOAB	UT	84532	2185	00	None	38.57434043	-109.5593762	Grand County
21390	Fee-for-Service	1538187190	1538187190	1	1	AL-GHUSSAIN, EMAD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 W RIVER ST	None	OZARK	AR	72949	3023	00	None	35.485911	-93.8339775	Franklin County
21409	Fee-for-Service	1720185564	1720185564	2	1	ALL-LOR INC	4/28/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	728 FAIRPLEX DR	None	POMONA	CA	91768	1000	19	06037	34.0626567	-117.7874713	Los Angeles County
21427	Fee-for-Service	1962015941	1962015941	1	1	ADOC, JAMIE KATE M CNP	6/21/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2505 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2011	19	06037	34.03287856	-118.4748782	Los Angeles County
21431	Fee-for-Service	1902193246	1902193246	1	1	AFANASEVICH, VLADISLAV I MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127495	26	Psychiatry (child)	0	In state provider	None	10725 INTERNATIONAL DR	STE 208	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
21441	Fee-for-Service	1467513697	1467513697	1	1	ALEXAKOS, SARA PSYD	2/4/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9829 BLUE LARKSPUR LN	SUITE 2	MONTEREY	CA	93940	6535	27	06053	36.57109892	-121.8021077	Monterey County
21450	Fee-for-Service	1194899401	1194899401	1	1	ABDULLAH, RIZWANA MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90993	01	General Practice	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
21451	Fee-for-Service	1952073207	1952073207	1	1	ANGEL LOVE HOSPICE SERVICES	5/30/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	100 WILLOW PLAZA	SUITE 100	VISALIA	CA	93291	6213	54	06107	36.33012504	-119.2922477	Tulare County
21452	Fee-for-Service	1386058139	1386058139	1	1	APONTE GUZMAN, ERICK R MD	6/30/2021	207R00000X	NA	Other	026	PHYSICIANS	161077	None	None	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
21458	Fee-for-Service	1851440036	1851440036	1	1	AGATEP, MELVIN L MD	1/1/1996	207RN0300X	NA	Nephrology	026	PHYSICIANS	47785	41	Internal Medicine	0	In state provider	None	1245 WILSHIRE BLVD	STE 916	LOS ANGELES	CA	90017	4809	19	06037	34.05362775	-118.2661889	Los Angeles County
21470	Fee-for-Service	1629024989	1629024989	2	1	ALVIN V DAVIS	8/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5016 S US HIGHWAY 75	None	DENISON	TX	75020	4584	00	None	33.710211	-96.584958	Grayson County
21477	Fee-for-Service	1619374626	1619374626	1	1	ALYESH, TIFFANY CCC-SLP	12/27/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	16200 VENTURA BLVD	413	ENCINO	CA	91436	4636	19	06037	34.15659457	-118.485532	Los Angeles County
21484	Fee-for-Service	1780829952	1780829952	1	1	ALGOS INC., A MEDICAL CORPOR	5/24/2018	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	ATION	18040 SHERMAN WAY	SUITE 200	RESEDA	CA	91335	4631	19	06037	34.20103048	-118.526787	Los Angeles County
21491	Fee-for-Service	1518252188	1518252188	1	1	AHUJA, NAMRATA MD	7/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130041	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
21492	Fee-for-Service	1407000722	1407000722	1	1	ALLEN, MEGAN R PHD	9/8/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
21506	Fee-for-Service	1336172949	1336172949	1	1	ANTELOPE VALLEY NEPHROLOGY	1/27/1981	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL GROUP, INC	1759 W AVENUE J	STE 101	LANCASTER	CA	93534	2703	19	06037	34.68944351	-118.163124	Los Angeles County
21516	Fee-for-Service	1801279948	1801279948	1	1	AKBARY, SHAHRZAD DO	12/27/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	17098	None	None	0	In state provider	None	19950 RINALDI ST	SUITES 100 103 200	PORTER RANCH	CA	91326	4141	19	06037	34.27560199	-118.5696701	Los Angeles County
21526	Fee-for-Service	1790177582	1790177582	1	1	ALTAMED HEALTH SERVICES	11/9/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1900 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2725	19	06037	33.9891357	-118.2389609	Los Angeles County
21544	Fee-for-Service	1689609257	1689609257	1	1	ARROW VISION CENTER OPTOMETR	2/3/2006	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	Y	601 W ARROW HWY	None	GLENDORA	CA	91740	5411	19	06037	34.10614236	-117.8729115	Los Angeles County
21547	Fee-for-Service	1013294768	1013294768	1	1	ANDERSON, JOSHUA M MD	7/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125400	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
21568	Fee-for-Service	1205439700	1205439700	1	1	ASTRA HOSPICE CARE INC	12/1/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11350 VENTURA BLVD	STE 107	STUDIO CITY	CA	91604	3140	19	06037	34.14014506	-118.3774984	Los Angeles County
21570	Fee-for-Service	1073650339	1073650339	1	1	ALDOUS, JEANNETTE L MD	3/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101017	41	Internal Medicine	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5412	37	06073	33.03623896	-117.2837308	San Diego County
21580	Fee-for-Service	1962053785	1962053785	1	1	ACTIVATE CARE HOSPICE INC	7/2/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2904 THERESA DR	UNIT 104B	NEWBURY PARK	CA	91320	3149	56	06111	34.17901674	-118.9383417	Ventura County
21587	Fee-for-Service	1376585042	1376585042	1	1	ABUDU, ASSIBI Z MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	32689	41	Internal Medicine	0	In state provider	None	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
21599	Fee-for-Service	1104055458	1104055458	1	1	ALLEN COX FAMILY HOMES	9/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3831 N BRIX AVENUE	None	FRESNO	CA	93722	1132	10	06019	36.79130101	-119.8813729	Fresno County
21600	Fee-for-Service	1265677132	1265677132	1	1	ALEJANDRO CHAPA-RODRIGUEZ MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1003 WILLOW CREEK ROAD	None	PRESCOTT	AZ	86301	0000	00	None	34.558992	-112.481901	Yavapai County
21619	Fee-for-Service	1285635102	1285635102	1	1	ATTERBERRY, FRANCINE E	7/31/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	52558	40	Pediatrics	0	In state provider	None	1820 HAVEMEYER LN	None	REDONDO BEACH	CA	90278	4828	19	06037	33.8604717	-118.3791071	Los Angeles County
21620	Fee-for-Service	1467649418	1467649418	1	1	ARAYA, DAVID C MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	71579	41	Internal Medicine	0	In state provider	None	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	0000	26	06051	37.64575895	-118.9638914	Mono County
21643	Fee-for-Service	1174366850	1174366850	1	1	ALLIANCE FOR COMMUNITY EMPOW	4/8/2025	No Taxonomy Provided	NA	None	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	ERMENT, INC.	6925 CANOGA AVE	None	CANOGA PARK	CA	91303	2032	19	06037	34.196418	-118.597526	Los Angeles County
21654	Fee-for-Service	1194892018	1194892018	1	1	ABU-FADIL, SALIM F MD	2/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30048	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
21659	Fee-for-Service	1053335406	1053335406	1	1	AURORA MEDICAL CORPORATION	1/3/2019	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	11245 LOWER AZUSA RD	None	EL MONTE	CA	91731	1553	19	06037	34.09163095	-118.0213554	Los Angeles County
21709	Fee-for-Service	1699319103	1699319103	1	1	ANYAKPOR, NATHALIE NP	11/9/2023	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
21715	Fee-for-Service	1659137131	1659137131	1	1	ADAMSON, STYLER A DOULA	12/24/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
21717	Fee-for-Service	1265731905	1265731905	1	1	AZAR, DAN R MD	10/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	68563	01	General Practice	0	In state provider	None	22590 VOSS AVE	None	CUPERTINO	CA	95014	2627	43	06085	37.31779679	-122.069389	Santa Clara County
21718	Fee-for-Service	1902193246	1902193246	1	1	AFANASEVICH, VLADISLAV I MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127495	36	Psychiatry	0	In state provider	None	10725 INTERNATIONAL DR	STE 208	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
21723	Fee-for-Service	1851468722	1851468722	1	1	ANDREWS, MARTHA R MD	8/12/1988	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	42507	01	General Practice	0	In state provider	None	1615 W VERNON AVE	None	LOS ANGELES	CA	90062	1612	19	06037	34.00374952	-118.307358	Los Angeles County
21726	Fee-for-Service	1215949367	1215949367	2	1	AZIZZADEH, JONATHAN MD	4/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	52711	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1300 N VERMONT AVENUE	STE 304	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
21746	Fee-for-Service	1851440036	1851440036	1	1	AGATEP, MELVIN L MD	1/1/1996	207RN0300X	NA	Nephrology	026	PHYSICIANS	47785	45	Nephrology (Renal-Kidney)	0	In state provider	None	1245 WILSHIRE BLVD	STE 916	LOS ANGELES	CA	90017	4809	19	06037	34.05362775	-118.2661889	Los Angeles County
21771	Fee-for-Service	1780829952	1780829952	1	1	ALGOS INC., A MEDICAL CORPOR	5/24/2018	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	ATION	18040 SHERMAN WAY	SUITE 200	RESEDA	CA	91335	4631	19	06037	34.20103048	-118.526787	Los Angeles County
21783	Fee-for-Service	1700472149	1700472149	1	1	ARTEMIS HOSPICE AND	12/15/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE	15130 VENTURA BLVD	STE 208	SHERMAN OAKS	CA	91403	3372	19	06037	34.15320952	-118.4627115	Los Angeles County
21793	Fee-for-Service	1336172949	1336172949	1	1	ANTELOPE VALLEY NEPHROLOGY	1/27/1981	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	MEDICAL GROUP, INC	1759 W AVENUE J	STE 101	LANCASTER	CA	93534	2703	19	06037	34.68944351	-118.163124	Los Angeles County
21801	Fee-for-Service	1427289057	1427289057	1	1	AWAD, RAMY A MD INC	4/30/2010	208600000X	NA	General Surgery	026	PHYSICIANS	90487	02	General Surgery	0	In state provider	None	555 E TACHEVAH DRIVE	SUITE 1W-201	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
21803	Fee-for-Service	1982674701	1982674701	1	1	ANISH, DAVID S MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	51647	05	Anesthesiology	0	In state provider	None	815 POLLARD RD	None	LOS GATOS	CA	95032	1438	43	06085	37.26214754	-121.9701986	Santa Clara County
21834	Fee-for-Service	1487687844	1487687844	1	1	ADDEPALLI,RAJASEKHAR	6/14/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 E 149TH STREET	None	BRONX	NY	10451	5504	00	None	40.817538	-73.9240965	Bronx County
21840	Fee-for-Service	1881746006	1881746006	1	1	AUCH, WILLIAM R	8/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	59687	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
21857	Fee-for-Service	1699744599	1699744599	1	1	ASH, CANDACE D NP	2/3/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1352 COLUSA HWY	SUITE C	YUBA CITY	CA	95993	9147	51	06101	39.14177255	-121.635963	Sutter County
21858	Fee-for-Service	1205439700	1205439700	1	1	ASTRA HOSPICE CARE INC	12/1/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11350 VENTURA BLVD	STE 107	STUDIO CITY	CA	91604	3140	19	06037	34.14014506	-118.3774984	Los Angeles County
21870	Fee-for-Service	1962053785	1962053785	1	1	ACTIVATE CARE HOSPICE INC	7/2/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2904 THERESA DR	UNIT 104B	NEWBURY PARK	CA	91320	3149	56	06111	34.17901674	-118.9383417	Ventura County
21875	Fee-for-Service	1881999126	1881999126	1	1	ALCANTARA, ERNEST S CRNA	2/8/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
21906	Fee-for-Service	1285635102	1285635102	1	1	ATTERBERRY, FRANCINE E	6/1/2019	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	1820 HAVEMEYER LN	None	REDONDO BEACH	CA	90278	4828	19	06037	33.8604717	-118.3791071	Los Angeles County
21925	Fee-for-Service	1871136051	1871136051	1	1	ATIA, LILLIAN N LCSW	11/27/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
21946	Fee-for-Service	1346277514	1346277514	1	1	ALLSWEDE, MICHAEL P DO	11/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
21949	Fee-for-Service	1053335406	1053335406	1	1	AURORA MEDICAL CORPORATION	1/3/2019	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	11245 LOWER AZUSA RD	None	EL MONTE	CA	91731	1553	19	06037	34.09163095	-118.0213554	Los Angeles County
21974	Fee-for-Service	1265720510	1265720510	1	1	ANTONY, REUBEN MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	104795	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
21982	Fee-for-Service	1902479447	1902479447	1	1	ANAHEIM COMMUNITY HOSPITAL	2/3/2023	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	LLC	3350 W BALL ROAD	None	ANAHEIM	CA	92804	3710	30	06059	33.8172623	-118.0071207	Orange County
22038	Fee-for-Service	1265665913	1265665913	1	1	AMSTER, ERIC D MD	11/24/2020	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	117103	None	None	0	In state provider	None	860 WEST VALLEY PKWY	STE 150	ESCONDIDO	CA	92025	2534	37	06073	33.1175634	-117.0952973	San Diego County
22058	Fee-for-Service	1780829952	1780829952	1	1	ALGOS INC., A MEDICAL CORPOR	5/24/2018	103TB0200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ATION	18040 SHERMAN WAY	SUITE 200	RESEDA	CA	91335	4631	19	06037	34.20103048	-118.526787	Los Angeles County
22069	Fee-for-Service	1700472149	1700472149	1	1	ARTEMIS HOSPICE AND	12/15/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE	15130 VENTURA BLVD	STE 208	SHERMAN OAKS	CA	91403	3372	19	06037	34.15320952	-118.4627115	Los Angeles County
22072	Fee-for-Service	1144456674	1144456674	1	1	ADRIAN T HARVEY, D.O.	7/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
22100	Fee-for-Service	1548218308	1548218308	1	1	AFRIDI, BELAL S MD	8/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85128	08	Family Practice	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
22120	Fee-for-Service	1528442977	1528442977	1	1	ANDERSON, MEGAN NP	4/23/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 OLIVE AVE	STE 5	REDLANDS	CA	92373	5268	36	06071	34.05492419	-117.1784739	San Bernardino County
22147	Fee-for-Service	1942325832	1942325832	1	1	AMBE, CHENWI M MD	12/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	146144	02	General Surgery	0	In state provider	None	782 MEDICAL CENTER DR E	SUITE 101	CLOVIS	CA	93611	6890	10	06019	36.84379626	-119.6609117	Fresno County
22155	Fee-for-Service	1417960071	1417960071	1	1	ANTON, STEVEN L MD	10/22/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	42438	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2160 APPIAN WAY	STE 104	PINOLE	CA	94564	2524	07	06013	37.99585174	-122.3021549	Contra Costa County
22173	Fee-for-Service	1386318541	1386318541	1	1	AXIS ORTHOPEDIC INC.	11/17/2021	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	25 S RAYMOND AVE	203	ALHAMBRA	CA	91801	7144	19	06037	34.09042452	-118.1450725	Los Angeles County
22225	Fee-for-Service	1114147212	1114147212	1	1	ALVARADO, FRANK S MD	8/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	42153	08	Family Practice	0	In state provider	None	1235 W VINE ST	# 20	LODI	CA	95240	5109	39	06077	38.12279179	-121.2879362	San Joaquin County
22261	Fee-for-Service	1265720510	1265720510	1	1	ANTONY, REUBEN MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	104795	68	Hematology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
22271	Fee-for-Service	1902479447	1902479447	1	1	ANAHEIM COMMUNITY HOSPITAL	2/3/2023	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	LLC	3350 W BALL ROAD	None	ANAHEIM	CA	92804	3710	30	06059	33.8172623	-118.0071207	Orange County
22319	Fee-for-Service	1720156029	1720156029	1	1	ANAVIM, ARASH MD	7/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76186	30	Radiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
22322	Fee-for-Service	1154507952	1154507952	1	1	AQUINO, PAOLO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3901 BEAUBIEN ST	None	DETROIT	MI	48201	2119	00	None	42.35164453	-83.05377946	Wayne County
22339	Fee-for-Service	1003636564	1003636564	1	1	AT YOUR SERVICE TRANSPORTATI	10/17/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ON, INC.	2752 WANDA AVE	None	SIMI VALLEY	CA	93065	1519	56	06111	34.285239	-118.7488435	Ventura County
22342	Fee-for-Service	1477714665	1477714665	1	1	AMIN, NIRAV H MD	7/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133234	20	Orthopedic Surgery	0	In state provider	None	25455 BARTON RD	None	LOMA LINDA	CA	92354	3312	36	06071	34.04805253	-117.249534	San Bernardino County
22366	Fee-for-Service	1356446181	1356446181	1	1	ANDREWS, AUGUA A MD	7/31/1981	2084N0400X	NA	Neurology	026	PHYSICIANS	36604	13	Neurology (M.D. only)	0	In state provider	None	214 S LOCUST ST	None	INGLEWOOD	CA	90301	2304	19	06037	33.961194	-118.3503425	Los Angeles County
22396	Fee-for-Service	1477710234	1477710234	1	1	A LADY'S TOUCH, INC.	8/4/2022	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	612 D ST	None	SAN RAFAEL	CA	94901	3708	21	06041	37.97030652	-122.5324786	Marin County
22435	Fee-for-Service	1124015243	1124015243	1	1	ABDUL-NASSE ADJEI	3/29/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 DODSON AVE	STE 60	FORT SMITH	AR	72901	5182	00	None	35.371926	-94.4176275	Sebastian County
22492	Fee-for-Service	1275708760	1275708760	1	1	AHONI, BEVERLY L MD	5/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152938	40	Pediatrics	0	In state provider	None	8110 MANGO AVE	None	FONTANA	CA	92335	3603	36	06071	34.10549796	-117.4314604	San Bernardino County
22498	Fee-for-Service	1811212194	1811212194	1	1	APPLEGATE, NATALIE M LCSW	5/11/2020	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
22510	Fee-for-Service	1609022680	1609022680	1	2	ALINA HO OD A PROFESSIONAL C	11/23/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3150 E IMPERIAL HWY	UNIT A202-2	LYNWOOD	CA	90262	3223	19	06037	33.93024589	-118.2144381	Los Angeles County
22518	Fee-for-Service	1023109063	1023109063	1	1	ARONOWITZ, PAUL B	9/30/1990	207R00000X	NA	Other	026	PHYSICIANS	49152	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2800 BENEDICT DR	None	SAN LEANDRO	CA	94577	6840	01	06001	37.71593435	-122.131151	Alameda County
22533	Fee-for-Service	1932466125	1932466125	1	1	ARANEZ, JOSE LUIS MD	8/17/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	135164	10	Gastroenterology (M.D. only)	0	In state provider	None	3833 WORSHAM AVENUE	SUITE 300	LONG BEACH	CA	90808	1745	19	06037	33.828552	-118.1462755	Los Angeles County
22548	Fee-for-Service	1518320654	1518320654	1	1	ABEDI, SARAH MD	5/20/2021	207P00000X	NA	Other	026	PHYSICIANS	152454	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
22551	Fee-for-Service	1265720510	1265720510	1	1	ANTONY, REUBEN MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	104795	78	Neoplastic Diseases/Oncology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
22580	Fee-for-Service	1689671380	1689671380	1	1	ALEVIZOS, JOHN G DO	2/1/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	6108	08	Family Practice	0	In state provider	None	800 N TUSTIN AVE	STE A	SANTA ANA	CA	92705	3605	30	06059	33.752241	-117.8342255	Orange County
22601	Fee-for-Service	1326094822	1326094822	4	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	23072 ALICIA PKWY	None	MISSION VIEJO	CA	92692	1636	30	06059	33.62803407	-117.636481	Orange County
22672	Fee-for-Service	1952888695	1952888695	1	1	ADAMS, JENNIFER LMFT	3/20/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
22694	Fee-for-Service	1275527152	1275527152	1	1	ATIGA, ROLANDO A MD	6/12/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	78505	08	Family Practice	0	In state provider	None	25405 HANCOCK AVENUE	STE. 105	MURRIETA	CA	92562	5978	33	06065	33.5580833	-117.1850127	Riverside County
22699	Fee-for-Service	1174960819	1174960819	1	1	ALLARD, ROBYN LMFT	4/23/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 E SAN MARCOS BLVD	STE 400	SAN MARCOS	CA	92069	2986	37	06073	33.1409605	-117.162486	San Diego County
22736	Fee-for-Service	1669969044	1669969044	1	1	ANDERSON, AUSTIN S MD	12/3/2019	390200000X	NA	Other	026	PHYSICIANS	164427	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
22799	Fee-for-Service	1063792240	1063792240	1	1	AJMERA, ARCHANA J NP	4/7/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
22805	Fee-for-Service	1265670897	1265670897	1	1	AHN, GEUNG H MD	5/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99657	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
22862	Fee-for-Service	1942276324	1942276324	1	1	ANDERSON, BRUCE N MD INC	1/2/1979	2084P0800X	NA	Psychiatry	026	PHYSICIANS	21633	36	Psychiatry	0	In state provider	None	660 SANITARIUM RD	STE 302	DEER PARK	CA	94576	9714	28	06055	38.54206023	-122.47561	Napa County
22906	Fee-for-Service	1073704300	1073704300	1	1	ANTONGIORGI, ZARAH D MD	5/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102736	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	1778	19	06037	34.06373445	-118.443537	Los Angeles County
22907	Fee-for-Service	1134421704	1134421704	1	1	AYALA, KELLY L MD	6/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111573	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2071 EAST HERNDON	None	CLOVIS	CA	93611	6101	10	06019	36.8375685	-119.6781105	Fresno County
22912	Fee-for-Service	1609346691	1609346691	1	1	ALLEN, KENNETH J RCP	12/30/2018	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	97 SAN MARIN DR	None	NOVATO	CA	94945	1100	21	06041	38.12173729	-122.6048491	Marin County
22929	Fee-for-Service	1760740161	1760740161	1	1	ALLY, IMRAN R MD	8/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132361	01	General Practice	0	In state provider	None	1020 29TH STREET	580	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
22952	Fee-for-Service	1679656193	1679656193	1	1	ASUNCION, MERLYN M MD	11/25/2012	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	49850	41	Internal Medicine	0	In state provider	None	14624 SHERMAN WAY	STE 201	VAN NUYS	CA	91405	2287	19	06037	34.20078354	-118.450843	Los Angeles County
22975	Fee-for-Service	1922669985	1922669985	1	1	ASMAL, REBECCA A OT	5/26/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
23010	Fee-for-Service	1992861553	1992861553	2	2	AEGIS TREATMENT CENTERS, LLC	6/12/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	660 E LOS ANGELES AVE	B2	SIMI VALLEY	CA	93065	1873	56	06111	34.27162154	-118.7846685	Ventura County
23068	Fee-for-Service	1417246141	1417246141	1	1	AHADI, SAHAR MD	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142877	13	Neurology (M.D. only)	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
23091	Fee-for-Service	1780736199	1780736199	1	1	ADLER, JOHN R MD	10/7/1987	207T00000X	NA	General Surgery	026	PHYSICIANS	61466	02	General Surgery	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
23093	Fee-for-Service	1548600117	1548600117	1	1	AMORUSO, JULIE A NP	9/11/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
23098	Fee-for-Service	1447502885	1447502885	1	1	ANGELUS MEDICAL CLINIC MULTI	3/16/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SPECIALTY GROUP INC	3444 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1708	19	06037	34.02715078	-118.199595	Los Angeles County
23120	Fee-for-Service	1689049678	1689049678	1	1	ARCLIGHT HOSPICE INC	3/12/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	19562 VENTURA BLVD	STE 229	TARZANA	CA	91356	7126	19	06037	34.17276463	-118.5593281	Los Angeles County
23133	Fee-for-Service	1477608040	1477608040	1	1	APPLEGATE, JASON M CRNA	8/13/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
23134	Fee-for-Service	1942760293	1942760293	1	1	ADVENTIST HEALTH PHYSICIANS	6/25/2019	208800000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	None	2701 CHESTER AVE	102	BAKERSFIELD	CA	93301	2016	15	06029	35.384166	-119.0188765	Kern County
23141	Fee-for-Service	1154467009	1154467009	1	1	ADVENTIST HEALTH CALIF	2/27/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP INC	10 WOODLAND RD	None	ST HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
23147	Fee-for-Service	1285950030	1285950030	1	1	ARDILES, YONA R DO	6/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12024	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
23151	Fee-for-Service	1952693038	1952693038	1	1	ARORA, JASPREET MD	3/26/2018	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	138290	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
23163	Fee-for-Service	1780192476	1780192476	1	1	AROM, ARI LAC	10/26/2021	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	9201 WILSHIRE BLVD.	207	BEVERLY HILLS	CA	90210	5501	19	06037	34.06707891	-118.3924873	Los Angeles County
23179	Fee-for-Service	1154928646	1154928646	1	1	AL SHEIKH, AMANDA PT	10/28/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	215 S. HICKORY ST.	UNIT 112	ESCONDIDO	CA	92025	4359	37	06073	33.12335985	-117.0753842	San Diego County
23181	Fee-for-Service	1225141047	1225141047	1	1	AKIN, PAULA L MD	12/1/1998	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	6881	None	None	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
23192	Fee-for-Service	1346979028	1346979028	1	1	ALLEVIATE CARE-APPLE	6/1/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	VALLEY LLC	19167 US HIGHWAY 18	STE 6	APPLE VALLEY	CA	92307	2561	36	06071	34.53657841	-117.2457831	San Bernardino County
23200	Fee-for-Service	1376784413	1376784413	1	1	ARORA, RAJLEEN K OD	1/28/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1741 BROADWAY	None	OAKLAND	CA	94612	2105	01	06001	37.80728656	-122.2693708	Alameda County
23208	Fee-for-Service	1427173095	1427173095	1	1	APARICIO, CLARA I PSYD	6/27/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	595 E COLORADO BLVD STE	324	PASADENA	CA	91101	2021	19	06037	34.14588202	-118.1380722	Los Angeles County
23213	Fee-for-Service	1699273052	1699273052	1	1	AYALA, SEBASTIAN MD	12/16/2024	207L00000X	NA	Other	026	PHYSICIANS	188880	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
23221	Fee-for-Service	1801356746	1801356746	1	1	ARCHIBALD, HANNAH L MD	9/26/2022	390200000X	NA	Other	026	PHYSICIANS	179507	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
23224	Fee-for-Service	1811169113	1811169113	1	1	ALI, ZULFIQAR MD	5/23/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	160897	30	Radiology	0	In state provider	None	10101 RIVERSIDE DR	None	TOLUCA LAKE	CA	91602	2517	19	06037	34.15223753	-118.3508865	Los Angeles County
23265	Fee-for-Service	1962531590	1962531590	1	1	ALLERY & ASTHMA ASSOCIATES	1/1/1979	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	OF STA CLARA VALLEY	4050 MOORPARK AVE	None	SAN JOSE	CA	95117	1840	43	06085	37.31582054	-121.97493	Santa Clara County
23268	Fee-for-Service	1629059423	1629059423	1	1	ANDERSON, MIKE L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	MS 359110 C/O UWP	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
23276	Fee-for-Service	1770573834	1770573834	1	1	ALLEN C. WHITFORD, M.D.	5/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
23290	Fee-for-Service	1568721934	1568721934	1	1	ARLATA, TAMANTHA S MD	4/11/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	155040	40	Pediatrics	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
23299	Fee-for-Service	1992861553	1992861553	2	2	AEGIS TREATMENT CENTERS, LLC	6/12/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	660 E LOS ANGELES AVE	B2	SIMI VALLEY	CA	93065	1873	56	06111	34.27162154	-118.7846685	Ventura County
23305	Fee-for-Service	1043512619	1043512619	1	1	AGHIDEH, FARNAZ K MD	9/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114667	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
23315	Fee-for-Service	1891873782	1891873782	1	1	ARIOTO, WAYNE MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7452	05	Anesthesiology	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
23343	Fee-for-Service	1538354832	1538354832	1	1	ABARY, BRIAN M PSYD	3/2/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4929 WILSHIRE BLVD	STE 510	LOS ANGELES	CA	90010	3800	19	06037	34.0621435	-118.3380975	Los Angeles County
23348	Fee-for-Service	1598770471	1598770471	1	1	ALLISON CURTIS KINGSLEY MEOZ	3/9/2016	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	68	Hematology	1	Border provider	MICHAEL & SANCHEZ PC	2460 W HORIZON RIDGE PKW	None	HENDERSON	NV	89052	2648	00	None	36.00605292	-115.0935255	Clark County
23355	Fee-for-Service	1356097323	1356097323	1	1	ALERACARE MEDICAL GROUP OF C	11/6/2023	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ALIFORNIA	150 N ROBERTSON BLVD	206	BEVERLY HILLS	CA	90211	2142	19	06037	34.06812722	-118.3837146	Los Angeles County
23367	Fee-for-Service	1669430922	1669430922	1	1	ANSELMO, JULIE R MD	9/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86458	40	Pediatrics	0	In state provider	None	1235 OSOS ST	STE 100	SAN LUIS OBISPO	CA	93401	3619	40	06079	35.27979518	-120.6596361	San Luis Obispo County
23407	Fee-for-Service	1689049678	1689049678	1	1	ARCLIGHT HOSPICE INC	3/12/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	19562 VENTURA BLVD	STE 229	TARZANA	CA	91356	7126	19	06037	34.17276463	-118.5593281	Los Angeles County
23419	Fee-for-Service	1013448364	1013448364	1	1	ALDAAS, OMAR M	8/6/2024	208M00000X	NA	Other	026	PHYSICIANS	159272	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
23422	Fee-for-Service	1134263254	1134263254	1	1	ALHAMBRA HOSP MEDICAL	7/2/1998	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER D/P NF	100 S RAYMOND AVE	None	ALHAMBRA	CA	91801	3199	19	06037	34.09027878	-118.1450083	Los Angeles County
23431	Fee-for-Service	1437887395	1437887395	1	1	ANGELA M COLOMBO MD INC	11/10/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	20072 SW BIRCH ST	STE 190	NEWPORT BEACH	CA	92660	0799	30	06059	33.65980961	-117.874611	Orange County
23436	Fee-for-Service	1467919662	1467919662	1	1	ASARE, JENNIFER	2/12/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	22433 S VERMONT AVE	#420	TORRANCE	CA	90502	2583	19	06037	33.82217551	-118.2903627	Los Angeles County
23470	Fee-for-Service	1730797671	1730797671	1	1	ASTUTE CARE HOSPICE INC	8/18/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1110 S GLENDALE AVE	STE A	GLENDALE	CA	91205	5619	19	06037	34.13303677	-118.2520389	Los Angeles County
23475	Fee-for-Service	1962431544	1962431544	1	1	ALVIN MATHEW D.O.	3/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9225 N 3RD ST	STE 304	PHOENIX	AZ	85020	2466	00	None	33.57054	-112.0692465	Maricopa County
23480	Fee-for-Service	1346979028	1346979028	1	1	ALLEVIATE CARE-APPLE	6/1/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	VALLEY LLC	19167 US HIGHWAY 18	STE 6	APPLE VALLEY	CA	92307	2561	36	06071	34.53657841	-117.2457831	San Bernardino County
23490	Fee-for-Service	1871972885	1871972885	1	1	ANDERSON, LAURA C LPCC	10/18/2023	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
23491	Fee-for-Service	1861846834	1861846834	2	1	A & M SUPPLY INC	9/14/2020	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4875 EAGLE ROCK BLVD	None	LOS ANGELES	CA	90041	2632	19	06037	34.13464613	-118.2154983	Los Angeles County
23527	Fee-for-Service	1184607921	1184607921	1	1	ANDERSON, JOHN T MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	66242	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
23532	Fee-for-Service	1083099931	1083099931	1	1	ANGELS LIGHT HOSPICE	1/10/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10517 BURBANK BLVD	None	N HOLLYWOOD	CA	91601	0000	19	06037	34.17216449	-118.360188	Los Angeles County
23591	Fee-for-Service	1801015359	1801015359	1	1	ANGI, CATHY M LMFT	9/30/2016	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	768 TATA LN	None	SOUTH LAKE TAHOE	CA	96150	3816	09	06017	38.91711483	-120.0151184	El Dorado County
23602	Fee-for-Service	1568827210	1568827210	1	2	ALTURA CENTERS FOR HEALTH	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1186 E LELAND AVE	None	TULARE	CA	93274	7811	54	06107	36.23014473	-119.3277192	Tulare County
23619	Fee-for-Service	1083697809	1083697809	1	2	AIR EVAC EMS INC	7/10/2024	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	1601 W 11TH PL	STE B	BIG SPRING	TX	79720	4114	00	None	32.236515	-101.491605	Howard County
23620	Fee-for-Service	1992891329	1992891329	1	1	ASZTERBAUM, MICHELLE MD	12/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	81356	07	Dermatology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
23638	Fee-for-Service	1104238336	1104238336	1	1	ASHENBURG, NICHOLAS G MD	7/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155400	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
23641	Fee-for-Service	1356097323	1356097323	1	1	ALERACARE MEDICAL GROUP OF C	8/14/2024	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ALIFORNIA	150 N ROBERTSON BLVD	206	BEVERLY HILLS	CA	90211	2142	19	06037	34.06812722	-118.3837146	Los Angeles County
23644	Fee-for-Service	1598770471	1598770471	1	1	ALLISON CURTIS KINGSLEY MEOZ	3/9/2016	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	1	Border provider	MICHAEL & SANCHEZ PC	2460 W HORIZON RIDGE PKW	None	HENDERSON	NV	89052	2648	00	None	36.00605292	-115.0935255	Clark County
23677	Fee-for-Service	1003443862	1003443862	1	1	ADEBAYO, MOUJIDIN A MD	9/26/2023	207R00000X	NA	Other	026	PHYSICIANS	180488	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
23710	Fee-for-Service	1497165336	1497165336	1	1	AJIROTUTU, OLUYEMI A MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139603	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
23725	Fee-for-Service	1467919662	1467919662	1	1	ASARE, JENNIFER	2/12/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	22433 S VERMONT AVE	#420	TORRANCE	CA	90502	2583	19	06037	33.82217551	-118.2903627	Los Angeles County
23754	Fee-for-Service	1033861372	1033861372	1	1	ASSURED CARE VILLA INC	8/3/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	561 EAST 2ND AVENUE	None	LA HABRA	CA	90631	0820	30	06059	33.92991845	-117.939699	Orange County
23762	Fee-for-Service	1730797671	1730797671	1	1	ASTUTE CARE HOSPICE INC	8/18/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1110 S GLENDALE AVE	STE A	GLENDALE	CA	91205	5619	19	06037	34.13303677	-118.2520389	Los Angeles County
23767	Fee-for-Service	1184042699	1184042699	1	1	ANDERSON, BRIAN T MD	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139122	36	Psychiatry	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
23773	Fee-for-Service	1497128821	1497128821	1	1	ALVAREZ, PATRICIA L LMFT	2/20/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	245 E OLIVE AVE	SUITE 400	BURBANK	CA	91502	1214	19	06037	34.18145335	-118.3081834	Los Angeles County
23794	Fee-for-Service	1801024393	1801024393	1	1	AUSTIN, SHAUN M MD	12/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118229	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
23798	Fee-for-Service	1598770471	1598770471	1	3	ALLISON CURTIS KINGSLEY MEOZ	5/24/2016	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	1	Border provider	None	2020 SILVER CREEK ROAD	BLDG A SUITE 103	BULLHEAD CITY	AZ	86442	8476	00	None	35.113014	-114.570711	Mohave County
23805	Fee-for-Service	1639255854	1639255854	1	2	ARROWHEAD NEUROSURGICAL MEDI	5/8/2020	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	CAL GROUP, INC.	1080 N. INDIAN CANYON DR	SUITE 201	PALM SPRINGS	CA	92262	4869	33	06065	33.837354	-116.545572	Riverside County
23812	Fee-for-Service	1710587258	1710587258	1	1	ANMAR HOME HEALTH CARE INC	1/4/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	10200 SEPULVEDA BLVD	STE 112	MISSION HILLS	CA	91345	3325	19	06037	34.25572562	-118.4673156	Los Angeles County
23813	Fee-for-Service	1659756849	1659756849	1	1	ANGELO, JILLIAN MD	3/8/2019	208600000X	NA	General Surgery	026	PHYSICIANS	146626	02	General Surgery	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
23816	Fee-for-Service	1184607921	1184607921	1	1	ANDERSON, JOHN T MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	66242	02	General Surgery	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
23818	Fee-for-Service	1932242658	1932242658	1	1	AKOPOV, SERGEY E MD INC	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72794	36	Psychiatry	0	In state provider	None	501 S BUENA VISTA	STE 1	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
23821	Fee-for-Service	1083099931	1083099931	1	1	ANGELS LIGHT HOSPICE	1/10/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10517 BURBANK BLVD	None	N HOLLYWOOD	CA	91601	0000	19	06037	34.17216449	-118.360188	Los Angeles County
23860	Fee-for-Service	1518217330	1518217330	1	4	ARCH HEALTH PARTNERS	10/26/2015	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1955 CITRACADO PARKWAY	SUITE 301	ESCONDIDO	CA	92029	4113	37	06073	33.11301099	-117.1202081	San Diego County
23878	Fee-for-Service	1194831404	1194831404	1	1	ANGELO DE CLARO, ROMEO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	MS 359110 C/O UWP	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
23885	Fee-for-Service	1093311953	1093311953	1	1	AJD HOSPICE, INC	4/26/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	17037 CHATSWORTH ST	SUITE 106	GRANADA HILLS	CA	91344	5894	19	06037	34.26483049	-118.50372	Los Angeles County
23889	Fee-for-Service	1487650024	1487650024	1	1	ADVENTIST HEALTHCARE, INC	2/21/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	7600 CARROLL AVE	None	TAKOMA PARK	MD	21912	6367	00	None	38.985606	-77.001948	Montgomery County
23898	Fee-for-Service	1205511680	1205511680	1	1	ARIAS, KATHERINE OT	8/9/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	740 S PLACENTIA AVE	STE 100	PLACENTIA	CA	92870	6832	30	06059	33.86285731	-117.8822066	Orange County
23963	Fee-for-Service	1952461238	1952461238	1	1	AFFINATI, MARIO MD	3/1/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
24039	Fee-for-Service	1275535221	1275535221	1	1	AUGUST-SCHWARTZ, SUZANNE	6/30/2008	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	L RN	3081 TEAGARDEN ST	None	SAN LEANDRO	CA	94577	5720	01	06001	37.70519163	-122.1536391	Alameda County
24057	Fee-for-Service	1417962846	1417962846	2	1	ABELLON, CHRISTINA U	12/7/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12598 CENTRAL AVE	SUITE 102A	CHINO	CA	91710	3530	36	06071	34.02430506	-117.6894721	San Bernardino County
24069	Fee-for-Service	1205908365	1205908365	1	1	ALL EARS HEARING AIDS, INC	7/26/2019	332S00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	17822 BEACH BLVD	STE 166	HUNTINGTON BEACH	CA	92647	7165	30	06059	33.70331388	-117.9890471	Orange County
24070	Fee-for-Service	1275245649	1275245649	1	1	A HOME FOR MOM & DAD, INC.	10/18/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	44856 33RD STREET WEST	None	LANCASTER	CA	93536	8394	19	06037	34.69826759	-118.1909865	Los Angeles County
24072	Fee-for-Service	1003551615	1003551615	1	1	AFSANEH HAFTBARADARAN MOHAMM	9/1/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	None	None	0	In state provider	LISTS OF ORANGE COUNTY	25411 CABOT ROAD	105	LAGUNA HILLS	CA	92653	5520	30	06059	33.59224599	-117.6746001	Orange County
24087	Fee-for-Service	1598770471	1598770471	1	3	ALLISON CURTIS KINGSLEY MEOZ	5/24/2016	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	68	Hematology	1	Border provider	None	2020 SILVER CREEK ROAD	BLDG A SUITE 103	BULLHEAD CITY	AZ	86442	8476	00	None	35.113014	-114.570711	Mohave County
24088	Fee-for-Service	1952834608	1952834608	2	1	ADVANCE HEALTHCARE SERVICES	11/11/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1288 E LATHAM AVE	None	HEMET	CA	92543	4445	33	06065	33.7494633	-116.9588121	Riverside County
24101	Fee-for-Service	1932242658	1932242658	1	1	AKOPOV, SERGEY E MD INC	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72794	13	Neurology (M.D. only)	0	In state provider	None	501 S BUENA VISTA	STE 1	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
24114	Fee-for-Service	1689866998	1689866998	1	1	ALEXANDER, LAUREN A NP	2/9/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
24138	Fee-for-Service	1316252414	1316252414	1	1	AGARWAL, SANJAY PROFESSIONAL	3/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	104257	41	Internal Medicine	0	In state provider	MEDICAL CORPORATION	995 MONTAGUE EXPY	SUITE 218	MILPITAS	CA	95035	6885	43	06085	37.41431261	-121.8844434	Santa Clara County
24170	Fee-for-Service	1386725042	1386725042	1	1	ANGTUACO, TERESITA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM ST	None	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
24175	Fee-for-Service	1093311953	1093311953	1	1	AJD HOSPICE, INC	4/26/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	17037 CHATSWORTH ST	SUITE 106	GRANADA HILLS	CA	91344	5894	19	06037	34.26483049	-118.50372	Los Angeles County
24181	Fee-for-Service	1487650024	1487650024	1	1	ADVENTIST HEALTHCARE, INC	2/21/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	7600 CARROLL AVE	None	TAKOMA PARK	MD	21912	6367	00	None	38.985606	-77.001948	Montgomery County
24203	Fee-for-Service	1285081661	1285081661	1	1	ANVAR, ELHAAM MD	9/15/2023	207P00000X	NA	Other	026	PHYSICIANS	183333	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
24215	Fee-for-Service	1477817393	1477817393	1	1	ALBANIL GOMEZ, CARLOS	3/7/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1260 S. MAIN STREET	101	SALINAS	CA	93901	2292	27	06053	36.65656335	-121.6598928	Monterey County
24251	Fee-for-Service	1851479463	1851479463	1	1	ATKINSON, JOSEPH P MD	12/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91282	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
24266	Fee-for-Service	1639776958	1639776958	1	1	ADMIRABLE HOME HEALTH	6/13/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1535 W MERCED AVE	SUITE 304	WEST COVINA	CA	91790	3404	19	06037	34.06295577	-117.9482872	Los Angeles County
24298	Fee-for-Service	1053871251	1053871251	1	1	ALI, FARIKH MD	7/1/2023	207L00000X	NA	Other	026	PHYSICIANS	181942	None	None	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
24301	Fee-for-Service	1649639089	1649639089	1	1	ARUNAV	1/2/2018	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	631A S RANCHO SANTA FE	None	SAN MARCOS	CA	92078	3973	37	06073	33.13382678	-117.2065835	San Diego County
24311	Fee-for-Service	1376912618	1376912618	1	1	ANDERSON, SHANNON E MD	3/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135859	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
24355	Fee-for-Service	1194850321	1194850321	1	1	AKULA, VISHNU PRIYA S MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79023	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
24360	Fee-for-Service	1447806369	1447806369	1	1	AUGUSTIN, NIKKI J NP	9/26/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3161 L ST	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
24377	Fee-for-Service	1538270764	1538270764	2	1	ABT MEDICAL SUPPLY INC	11/14/2007	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4915 MERCURY ST	None	SAN DIEGO	CA	92111	1703	37	06073	32.83102258	-117.1488211	San Diego County
24389	Fee-for-Service	1457655771	1457655771	1	1	ADVANCED HEALTH CARE OF	4/13/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	BAKERSFIELD INC	4040 SAN DIMAS ST	SUITE A	BAKERSFIELD	CA	93301	1299	15	06029	35.396595	-119.0081515	Kern County
24409	Fee-for-Service	1245636562	1245636562	1	1	APOLINAR, ERIKE LMFT	12/28/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 S IMPERIAL AVE	STE 5	EL CENTRO	CA	92243	4242	13	06025	32.77882919	-115.5697116	Imperial County
24420	Fee-for-Service	1013270719	1013270719	1	1	AMAYA, SALLY LCSW	12/23/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3200 E GUASTI RD	STE 178B	ONTARIO	CA	91761	8660	36	06071	34.06518	-117.5822055	San Bernardino County
24427	Fee-for-Service	1316252414	1316252414	1	1	AGARWAL, SANJAY PROFESSIONAL	3/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	104257	29	Pulmonary Diseases (M.D. only)	0	In state provider	MEDICAL CORPORATION	995 MONTAGUE EXPY	SUITE 218	MILPITAS	CA	95035	6885	43	06085	37.41431261	-121.8844434	Santa Clara County
24446	Fee-for-Service	1740017813	1740017813	1	1	A1 DISCOUNT PHARMACY CORPORA	11/22/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	21777 VENTURA BLVD	SUITE 256	WOODLAND HILLS	CA	91364	1863	19	06037	34.16843944	-118.6021294	Los Angeles County
24453	Fee-for-Service	1528408671	1528408671	1	1	ARSLAN,ALBERT	6/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 E 149TH STREET	None	BRONX	NY	10451	5504	00	None	40.817538	-73.9240965	Bronx County
24464	Fee-for-Service	1538507710	1538507710	1	1	APOLLOMED CARE CLINIC A	11/1/2013	207R00000X	NA	Other	026	PHYSICIANS	69768	41	Internal Medicine	0	In state provider	PROFESSIONAL CORPORATION	9449 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1421	19	06037	34.24087386	-118.3954268	Los Angeles County
24475	Fee-for-Service	1811946999	1811946999	1	1	ASTONE, ERIC GLENN PT	8/5/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2960 E NEES AVE	108	FRESNO	CA	93720	6012	10	06019	36.85224946	-119.731689	Fresno County
24538	Fee-for-Service	1861619041	1861619041	1	1	ANGELA M KENNEDY NP	3/11/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS PL	None	SAINT LOUIS	MO	63110	1002	00	None	38.63728519	-90.26492064	St. Louis city
24539	Fee-for-Service	1851479463	1851479463	1	1	ATKINSON, JOSEPH P MD	12/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91282	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
24557	Fee-for-Service	1841510385	1841510385	1	2	AKINGBEMI, OLUMIDE M MD	12/3/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	112199	-	NOT APPLICABLE	0	In state provider	None	439 W COMPTON BOULEVARD	None	COMPTON	CA	90220	3008	19	06037	33.89596798	-118.2304609	Los Angeles County
24614	Fee-for-Service	1366598450	1366598450	1	1	ARGUELLES, MICHELLE E	5/16/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
24616	Fee-for-Service	1114363876	1114363876	1	1	AHMED, SAFI MD	8/26/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	135274	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
24644	Fee-for-Service	1083063382	1083063382	1	1	ALAM, OMAIR MD	12/9/2021	207RN0300X	NA	Nephrology	026	PHYSICIANS	161151	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
24667	Fee-for-Service	1710065503	1710065503	1	1	ABBOUD, PAUL-ANDRE C MD	9/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83212	66	Emergency Medicine (Urgent Care)	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
24723	Fee-for-Service	1659690337	1659690337	1	1	ABELA, OLIVER G MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	102 E LAKE MEAD PARKWAY	None	HENDERSON	NV	89015	5775	00	None	36.03815706	-114.9842287	Clark County
24789	Fee-for-Service	1346491651	1346491651	1	1	AMU, JAVIER MD	5/20/2009	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORPORATION	1093 11TH STREET	None	REEDLEY	CA	93654	2950	10	06019	36.60074456	-119.4445203	Fresno County
24803	Fee-for-Service	1912024910	1912024910	1	1	ARIBI, AHMED M MD	9/1/2010	207R00000X	NA	Other	026	PHYSICIANS	104041	41	Internal Medicine	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
24813	Fee-for-Service	1891877395	1891877395	1	1	AGENA, RYAN H MD	5/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9676	08	Family Practice	0	In state provider	None	3110 CHINO AVE	#150A	CHINO HILLS	CA	91709	1211	36	06071	34.01077341	-117.738406	San Bernardino County
24842	Fee-for-Service	1972681054	1972681054	1	1	ARSENAULT, LYNN M MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73805	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
24848	Fee-for-Service	1972063329	1972063329	1	1	AHUJA, ASHIM MD	7/29/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	181506	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
24878	Fee-for-Service	1790177582	1790177582	1	3	ALTAMED HEALTH SERVICES	6/1/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1542 E FLORENCE AVE	None	LOS ANGELES	CA	90001	2536	19	06037	33.97472354	-118.246122	Los Angeles County
24902	Fee-for-Service	1215110002	1215110002	1	1	AHMED, FARHANA MD	9/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105776	41	Internal Medicine	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
24907	Fee-for-Service	1316988785	1316988785	1	1	ALBANDER, HAMOUDI A MD	11/2/1981	174400000X	NA	Other	026	PHYSICIANS	30845	01	General Practice	0	In state provider	None	505 PARNASSUS AVE	# 997M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
24912	Fee-for-Service	1689935280	1689935280	1	1	ARANGO, ADRIAN LCSW	11/21/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1742 OREGON STREET	None	REDDING	CA	96001	1717	45	06089	40.5808265	-122.3932989	Shasta County
24922	Fee-for-Service	1124312434	1124312434	1	1	ADRAGNA, MELYNDA OT	11/6/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
24928	Fee-for-Service	1598957631	1598957631	1	1	ACCUPATH DIAGNOSTIC LAB	8/1/2008	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	410 W FALLBROOK	# 104	FRESNO	CA	93711	6191	10	06019	36.84938752	-119.7995445	Fresno County
24990	Fee-for-Service	1215985023	1215985023	1	1	ANESTHESIA CARE ASSOCIATES	5/29/1992	193400000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	MEDICAL	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
24993	Fee-for-Service	1851535132	1851535132	1	1	AGBO, CHIOMA A MD	8/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	24987	66	Emergency Medicine (Urgent Care)	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
24996	Fee-for-Service	1073950119	1073950119	1	1	AMIN, SARINA M MD	7/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150770	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO ST	None	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
25027	Fee-for-Service	1306954300	1306954300	1	1	ATIYA, WASEF Y MD	5/27/2014	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	32839	40	Pediatrics	0	In state provider	None	2573 W FLORIDA AVE	None	HEMET	CA	92545	4615	33	06065	33.74728402	-116.9986549	Riverside County
25035	Fee-for-Service	1104123264	1104123264	1	2	ADVENTIST HEALTH PHYSICIANS	2/22/2021	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	784 N LEMOORE AVE	None	LEMOORE	CA	93245	2329	16	06031	36.306675	-119.780783	Kings County
25048	Fee-for-Service	1437104783	1437104783	1	1	AVENT, MARC R DO	12/19/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	9174	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
25100	Fee-for-Service	1922548510	1922548510	1	1	A&G PHARMACY INC	10/19/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	129 S VERMONT AVE	None	LOS ANGELES	CA	90004	5904	19	06037	34.071858	-118.291708	Los Angeles County
25143	Fee-for-Service	1063718583	1063718583	1	1	ADVENTIST HEALTH PHYSICIANS	3/30/2011	261QM1300X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1524 W LACEY BLVD	None	HANFORD	CA	93230	5965	16	06031	36.32816338	-119.6690189	Kings County
25169	Fee-for-Service	1790177582	1790177582	1	3	ALTAMED HEALTH SERVICES	12/4/2023	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1542 E FLORENCE AVE	None	LOS ANGELES	CA	90001	2536	19	06037	33.97472354	-118.246122	Los Angeles County
25179	Fee-for-Service	1972853141	1972853141	1	1	AHN, JENNIFER K PSY	5/14/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
25203	Fee-for-Service	1700413002	1700413002	1	1	AGIL, JOHNATHAN E MD	7/7/2023	207P00000X	NA	Other	026	PHYSICIANS	183723	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
25241	Fee-for-Service	1528523669	1528523669	1	1	ARES HOME HEALTH INC	1/18/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14540 VICTORY BLVD	SUITE 212	VAN NUYS	CA	91411	4601	19	06037	34.1866315	-118.4501385	Los Angeles County
25246	Fee-for-Service	1033244348	1033244348	1	1	ANOOP MAHESHWARI M.D PROF. C	7/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	45841	None	None	0	In state provider	PROFESSIONAL CORPORATION	613 S HOWARD ST	None	CORONA	CA	92879	2254	33	06065	33.87429852	-117.5627049	Riverside County
25256	Fee-for-Service	1831144732	1831144732	1	1	AGHAMOHAMMADI, NEEMA DO	10/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	7859	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
25272	Fee-for-Service	1063728806	1063728806	1	1	ABSOLUTE COMPASSION LLC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6355 RIVERSIDE BLVD	SUITE T	SACRAMENTO	CA	95831	1143	34	06067	38.510703	-121.5400995	Sacramento County
25279	Fee-for-Service	1174579171	1174579171	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	298 E LIVE OAK AVE	None	ARCADIA	CA	91006	5629	19	06037	34.10834877	-118.0230654	Los Angeles County
25314	Fee-for-Service	1306954300	1306954300	1	1	ATIYA, WASEF Y MD	5/27/2014	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	32839	01	General Practice	0	In state provider	None	2573 W FLORIDA AVE	None	HEMET	CA	92545	4615	33	06065	33.74728402	-116.9986549	Riverside County
25318	Fee-for-Service	1952917635	1952917635	1	1	ALL INCLUSIVE MEDICAL SERVIC	3/17/2022	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5900 COYLE AVE	STE B	CARMICHAEL	CA	95608	0400	34	06067	38.6676	-121.3268445	Sacramento County
25323	Fee-for-Service	1225009202	1225009202	1	1	ARAI, VICTOR E OD	1/1/1979	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	960 E GREEN ST	268	PASADENA	CA	91106	2401	19	06037	34.14451994	-118.1301695	Los Angeles County
25338	Fee-for-Service	1548430671	1548430671	1	2	ADVANCE HOME CARE INC	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1903 N GLENOAKS BLVD	SUITE B	BURBANK	CA	91504	1903	19	06037	34.19634567	-118.3246279	Los Angeles County
25339	Fee-for-Service	1316104359	1316104359	1	1	ALLY, MARYANN T M MD	7/6/2017	208M00000X	NA	Other	026	PHYSICIANS	146011	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
25354	Fee-for-Service	1336266162	1336266162	1	1	ABRAHAMIANS, MELINE	5/17/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3436 N VERDUGO RD	STE 102	GLENDALE	CA	91208	1546	19	06037	34.20125581	-118.2276565	Los Angeles County
25395	Fee-for-Service	1619213212	1619213212	1	2	ANOVORX GROUP, LLC	3/14/2022	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	1710 N SHELBY OAKS DR,	STE 1	MEMPHIS	TN	38134	7403	00	None	35.171235	-89.8528095	Shelby County
25399	Fee-for-Service	1851705396	1851705396	1	1	ALSABBAK, HASSAN A H MD	8/7/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144328	41	Internal Medicine	0	In state provider	None	435 H STREET	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
25420	Fee-for-Service	1659365591	1659365591	1	1	ARLENE J EISENBERG MD	1/5/1987	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	COMMUNITY PATHOLOGY LAB	1074 S LA LUNA AVE	None	OJAI	CA	93023	3516	56	06111	34.4362072	-119.2893637	Ventura County
25429	Fee-for-Service	1376529701	1376529701	2	1	ANA PHARMACY CORPORATION	4/28/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ANA PHARMACY	10191 WESTMINSTER AVE	None	GARDEN GROVE	CA	92843	4752	30	06059	33.75964525	-117.9514029	Orange County
25435	Fee-for-Service	1609559145	1609559145	1	1	ARROYO, MICHELLE G PT	10/30/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	468 WINTON PKWY	None	LIVINGSTON	CA	95334	9809	24	06047	37.3865854	-120.7370705	Merced County
25443	Fee-for-Service	1861868721	1861868721	1	1	ALHL, LLC	11/1/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1334 SOUTH HAM LANE	None	LODI	CA	95242	3903	39	06077	38.11581694	-121.2881322	San Joaquin County
25454	Fee-for-Service	1790177582	1790177582	1	3	ALTAMED HEALTH SERVICES	6/1/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1542 E FLORENCE AVE	None	LOS ANGELES	CA	90001	2536	19	06037	33.97472354	-118.246122	Los Angeles County
25478	Fee-for-Service	1871858910	1871858910	1	1	AL-FAHAM, ZAID MD	9/2/2020	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	168815	39	Preventive (M.D. only)	0	In state provider	None	1760 CHICAGO AVE	STE J3	RIVERSIDE	CA	92507	2358	33	06065	33.995538	-117.348333	Riverside County
25487	Fee-for-Service	1336136548	1336136548	1	1	ABBAS, HUMAYUN MD	4/1/1999	207R00000X	NA	Other	026	PHYSICIANS	68455	41	Internal Medicine	0	In state provider	None	1541 FLORIDA AVE	STE 200	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
25518	Fee-for-Service	1366456170	1366456170	1	1	AOKI DIABETES RESEARCH	7/13/2012	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	INSTITUTE	1935 STOCKTON BLVD	None	SACRAMENTO	CA	95816	6637	34	06067	38.560203	-121.4624835	Sacramento County
25531	Fee-for-Service	1033244348	1033244348	1	2	ANOOP MAHESHWARI M.D PROF. C	2/3/2022	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ORP.	1157 W. GRAND BLVD	None	CORONA	CA	92882	4393	33	06065	33.86942637	-117.5690349	Riverside County
25545	Fee-for-Service	1164606380	1164606380	1	11	ABILITY PATHWAYS INC	7/13/2007	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ELM DIVISION	1894 ELM AVE	None	LOMA LINDA	CA	92354	1791	36	06071	34.06749348	-117.2468583	San Bernardino County
25557	Fee-for-Service	1063728806	1063728806	1	1	ABSOLUTE COMPASSION LLC	12/19/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6355 RIVERSIDE BLVD	SUITE T	SACRAMENTO	CA	95831	1143	34	06067	38.510703	-121.5400995	Sacramento County
25576	Fee-for-Service	1831115070	1831115070	1	1	AMPLA HEALTH	1/1/1998	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER	1000 SUTTER STREET	None	YUBA CITY	CA	95991	3459	51	06101	39.14436772	-121.6133922	Sutter County
25586	Fee-for-Service	1306976139	1306976139	1	1	AHUMADA, ANN M LMFT	6/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	906 G ST	None	SACRAMENTO	CA	95814	1800	34	06067	38.583468	-121.49289	Sacramento County
25626	Fee-for-Service	1215165287	1215165287	1	1	ANDREWS, CHRISTOPHER M MD	7/3/2018	207L00000X	NA	Other	026	PHYSICIANS	150445	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
25640	Fee-for-Service	1659476059	1659476059	1	1	AUBURN CARDIOLOGY	2/27/1997	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	MEDICAL ASSOC	3262 FORTUNE CT	None	AUBURN	CA	95602	7847	31	06061	38.943396	-121.101752	Placer County
25669	Fee-for-Service	1063490175	1063490175	1	1	ADNAN, HASAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4351 E. LOHMAN	SUITE 301	LAS CRUCES	NM	88011	0000	00	None	32.32353423	-106.726982	Doña Ana County
25674	Fee-for-Service	1972774123	1972774123	1	1	ATTALURI, VIKRAM MD	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124862	28	Proctology (colon and rectal)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
25680	Fee-for-Service	1174558043	1174558043	1	1	ABDOO, DENISE	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13123 E 16TH AVE	None	AURORA	CO	80045	0000	00	None	39.742164	-104.8350375	Adams County
25691	Fee-for-Service	1861978884	1861978884	1	1	ASANO, DAWN PT	8/9/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	582 S SUNNYVALE AVE	None	SUNNYVALE	CA	94086	6215	43	06085	37.36886669	-122.0316101	Santa Clara County
25703	Fee-for-Service	1053052522	1053052522	1	2	ALLMED OF LOS ANGELES INC	1/1/2025	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	7400 PACIFIC BLVD	SUITE A&B	HUNTINGTON PARK	CA	90255	5955	19	06037	33.97222445	-118.2252072	Los Angeles County
25741	Fee-for-Service	1376932228	1376932228	1	1	AULTMAN, AMARI CRNA	12/5/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
25781	Fee-for-Service	1093728776	1093728776	1	1	ATKINS, THOMAS N MD	3/16/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	41536	08	Family Practice	0	In state provider	None	2801 K ST	STE 520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
25784	Fee-for-Service	1750908257	1750908257	1	1	ALMASI, ANASHEH MD	8/17/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184880	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
25794	Fee-for-Service	1720240625	1720240625	1	1	ABELES, SHIRA R MD	7/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	103260	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
25809	Fee-for-Service	1780898304	1780898304	1	1	AAEN, GREGORY S MD	9/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90485	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
25817	Fee-for-Service	1871789354	1871789354	1	1	AHLBRAND, SCOTT M MD	12/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95711	05	Anesthesiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
25840	Fee-for-Service	1952749343	1952749343	1	1	ALANIS, DAVID LMFT	5/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
25864	Fee-for-Service	1831115070	1831115070	1	1	AMPLA HEALTH	1/1/1998	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER	1000 SUTTER STREET	None	YUBA CITY	CA	95991	3459	51	06101	39.14436772	-121.6133922	Sutter County
25867	Fee-for-Service	1699760751	1699760751	1	1	AMY LYNN LEE MD	1/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9225 N 3RD ST	STE 304	PHOENIX	AZ	85020	2466	00	None	33.57054	-112.0692465	Maricopa County
25876	Fee-for-Service	1184732091	1184732091	1	1	AMERICAN MEDICAL RESPONSE	4/1/1998	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	AMBULANCE SERVICE INC	616 FITCHE AVE	None	MOORPARK	CA	93021	2060	56	06111	34.28402053	-118.872882	Ventura County
25879	Fee-for-Service	1912176462	1912176462	1	1	ARORA, RUCHI MD	3/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114693	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
25883	Fee-for-Service	1225585789	1225585789	1	1	ALONZO, PHILIP B C	6/12/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
25890	Fee-for-Service	1740203595	1740203595	1	2	AHMAD, BORHAAN S MD	1/1/2005	208000000X	NA	Pediatric Primary Care	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	11175 CAMPUS ST COLEMAN	PAVILION RM A1121	LOMA LINDA	CA	92354	1700	36	06071	34.05060717	-117.2656018	San Bernardino County
25901	Fee-for-Service	1275868069	1275868069	1	1	AZZIZ, ANIA J MD	4/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107168	30	Radiology	0	In state provider	None	400 PANASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
25907	Fee-for-Service	1316332935	1316332935	1	1	ASHRAF, DAVIN C MD	3/18/2019	390200000X	NA	Other	026	PHYSICIANS	147244	18	Ophthalmology	0	In state provider	None	1001 POTRERO AVE	RM 4M31	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
25924	Fee-for-Service	1871641688	1871641688	1	1	ARMSTRONG, TIMOTHY P MD	4/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	56333	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
25968	Fee-for-Service	1619124864	1619124864	1	2	ATHALE, NINAD R MD	10/7/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	108914	-	NOT APPLICABLE	0	In state provider	None	2344 OLD SOMONA RD	None	NAPA	CA	94559	3708	28	06055	0	0	None
25986	Fee-for-Service	1073661807	1073661807	1	1	AKHAVAN, JAMSHEED MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	47734	40	Pediatrics	0	In state provider	None	22030 SHERMAN WAY	STE 101	CANOGA PARK	CA	91303	1844	19	06037	34.20099551	-118.6071615	Los Angeles County
25991	Fee-for-Service	1528742871	1528742871	1	1	ALICE THE DOULA, LLC	6/14/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	43	06085	0	0	None
26015	Fee-for-Service	1235392861	1235392861	1	1	ANTON, AMY P MD	10/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110557	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4651	34	06067	38.470392	-121.4223975	Sacramento County
26059	Fee-for-Service	1336584937	1336584937	1	1	ARZANIPOUR, GADI DO INC	7/1/2013	207L00000X	NA	Other	026	PHYSICIANS	12709	05	Anesthesiology	0	In state provider	None	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2481	19	06037	34.04925	-118.2177405	Los Angeles County
26084	Fee-for-Service	1356931083	1356931083	1	1	AWAKENED CONSULTING INC.	2/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1201 24TH STREET	SUITE B110 #350	BAKERSFIELD	CA	93301	2391	15	06029	35.38118267	-119.0155218	Kern County
26133	Fee-for-Service	1265468193	1265468193	1	1	ADLER, BETHANY A	1/22/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	12801 CROSSROADS PKWY S	None	CITY OF INDUSTRY	CA	91746	3402	19	06037	34.0289395	-118.024533	Los Angeles County
26143	Fee-for-Service	1720400427	1720400427	1	1	ADVENTIST HEALTH PHYSICIANS	2/6/2019	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	6 WOODLAND RD	STE 303	SAINT HELENA	CA	94574	9562	28	06055	38.54297115	-122.4754501	Napa County
26153	Fee-for-Service	1831115070	1831115070	1	1	AMPLA HEALTH	1/1/1998	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CENTER	1000 SUTTER STREET	None	YUBA CITY	CA	95991	3459	51	06101	39.14436772	-121.6133922	Sutter County
26164	Fee-for-Service	1003200957	1003200957	1	1	AGUIRRE, JASON R MD	10/14/2019	213EG0000X	NA	Other	026	PHYSICIANS	156653	01	General Practice	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28200485	-118.4030797	Los Angeles County
26181	Fee-for-Service	1871636381	1871636381	1	1	ACS ENTERPRISES LLC	5/4/2018	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1020 WEST EL NORTE PKWY	None	ESCONDIDO	CA	92026	3341	37	06073	33.1472414	-117.1075077	San Diego County
26217	Fee-for-Service	1083851992	1083851992	1	1	ALTAMED HEALTH SERVICES CORP	4/1/2009	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	GARDEN GROVE, HARBOR	12751 HARBOR BLVD	None	GARDEN GROVE	CA	92840	5800	30	06059	33.77746612	-117.9151381	Orange County
26237	Fee-for-Service	1174693352	1174693352	1	1	ADL-TABATABAI, NOUJAN MD	6/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101867	66	Emergency Medicine (Urgent Care)	0	In state provider	None	616 WITMER STREET	None	LOS ANGELES	CA	90017	2308	19	06037	34.0549933	-118.2658354	Los Angeles County
26275	Fee-for-Service	1073661807	1073661807	1	1	AKHAVAN, JAMSHEED MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	47734	01	General Practice	0	In state provider	None	22030 SHERMAN WAY	STE 101	CANOGA PARK	CA	91303	1844	19	06037	34.20099551	-118.6071615	Los Angeles County
26286	Fee-for-Service	1114517919	1114517919	1	1	ANTONE, STACY M CNP	5/12/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	33205 TEMECULA PKWY	None	TEMECULA	CA	92592	9142	33	06065	33.48600119	-117.0789409	Riverside County
26295	Fee-for-Service	1326351537	1326351537	1	1	AWKAR, NELLY MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137571	78	Neoplastic Diseases/Oncology	0	In state provider	None	11480 BROOKSHIRE AVE	STE 309	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
26310	Fee-for-Service	1720629389	1720629389	1	1	ALL INCLUSIVE HOSPICE CARE	6/18/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	6454 VAN NUYS BLVD	SUITE 5	VAN NUYS	CA	91401	1445	19	06037	34.187886	-118.448714	Los Angeles County
26338	Fee-for-Service	1578775045	1578775045	1	1	AZUSA DIALYSIS CENTER	3/5/2007	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	310-312 N AZUSA AVE	None	AZUSA	CA	91702	3439	19	06037	34.126803	-117.9075535	Los Angeles County
26394	Fee-for-Service	1033402847	1033402847	1	1	ALMOG, BRITA C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	116194	40	Pediatrics	0	In state provider	None	45104 10TH ST W	None	LANCASTER	CA	93534	2310	19	06037	34.702929	-118.1480935	Los Angeles County
26407	Fee-for-Service	1164606380	1164606380	1	9	ABILITY PATHWAYS INC	10/13/2007	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	COLOMA DIVISION	1895 S COLOMA ST	None	LOMA LINDA	CA	92354	1756	36	06071	34.06733553	-117.2497606	San Bernardino County
26421	Fee-for-Service	1255412870	1255412870	1	2	ANDRE, KATHERINE C	6/29/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	2	Out of state provider	None	300 EMORY OAK LANE	None	OXFORD	MS	38655	2895	00	None	34.362009	-89.46198	Lafayette County
26422	Fee-for-Service	1902162563	1902162563	1	1	AMOILS, MISHA MD	10/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	126426	04	Otology, Laryngology, Rhinology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
26441	Fee-for-Service	1831115070	1831115070	1	1	AMPLA HEALTH	12/11/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CENTER	1000 SUTTER STREET	None	YUBA CITY	CA	95991	3459	51	06101	39.14436772	-121.6133922	Sutter County
26471	Fee-for-Service	1497176705	1497176705	1	1	APIKYAN, LUSINE NP	12/1/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
26476	Fee-for-Service	1194831057	1194831057	1	1	AARON NOTESTINE	5/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 W IRONWOOD DR	STE 320	COEUR D ALENE	ID	83814	4485	00	None	47.69438484	-116.7931559	Kootenai County
26494	Fee-for-Service	1992879639	1992879639	2	1	ATG - REHAB SPECIALISTS, INC	12/26/2018	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1430 TULLY RD	SUITE 401	SAN JOSE	CA	95122	3058	43	06085	37.31710924	-121.8334186	Santa Clara County
26503	Fee-for-Service	1083851992	1083851992	1	1	ALTAMED HEALTH SERVICES CORP	4/1/2009	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	GARDEN GROVE, HARBOR	12751 HARBOR BLVD	None	GARDEN GROVE	CA	92840	5800	30	06059	33.77746612	-117.9151381	Orange County
26570	Fee-for-Service	1811130727	1811130727	1	1	ALTA EAST BAY PATHOLOGY	6/12/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	20103 LAKE CHABOT ROAD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
26574	Fee-for-Service	1437507688	1437507688	1	1	ATKINSON, GREGORY E MD	7/1/2020	207L00000X	NA	Other	026	PHYSICIANS	150684	05	Anesthesiology	0	In state provider	None	PUEBLO AT BATH STREETS	None	SANTA BARBARA	CA	93105	0000	42	06083	34.430526	-119.72196	Santa Barbara County
26583	Fee-for-Service	1326351537	1326351537	1	1	AWKAR, NELLY MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137571	68	Hematology	0	In state provider	None	11480 BROOKSHIRE AVE	STE 309	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
26598	Fee-for-Service	1720629389	1720629389	1	1	ALL INCLUSIVE HOSPICE CARE	6/18/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	6454 VAN NUYS BLVD	SUITE 5	VAN NUYS	CA	91401	1445	19	06037	34.187886	-118.448714	Los Angeles County
26617	Fee-for-Service	1073651550	1073651550	1	1	AVAKIAN, SARO MD	3/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95713	08	Family Practice	0	In state provider	None	610 N CENTRAL AVE	STE 204	GLENDALE	CA	91203	1408	19	06037	34.15531106	-118.2579125	Los Angeles County
26641	Fee-for-Service	1891240792	1891240792	2	1	ARTEMIS PHARMACY INC	6/5/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15725 E. WHITTIER BLVD	SUITE A	WHITTIER	CA	90603	2343	19	06037	33.94435533	-117.9931159	Los Angeles County
26659	Fee-for-Service	1619465689	1619465689	1	1	ABACOA MEDICAL SUPPLIES INC	9/26/2018	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	3100 NW BOCA RATON BLVD	SUITE 213	BOCA RATON	FL	33431	6658	00	None	26.37984867	-80.08471648	Palm Beach County
26662	Fee-for-Service	1760494843	1760494843	1	1	ABIERA, SALVADOR PT	9/30/2024	2251G0304X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1850 N RIVERSIDE AVE	240	RIALTO	CA	92376	8071	36	06071	34.132905	-117.3704675	San Bernardino County
26673	Fee-for-Service	1336969849	1336969849	1	1	ADDES, JOSHUA R PT	11/22/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	16573 VENTURA BLVD	5	ENCINO	CA	91436	2022	19	06037	34.1578643	-118.4944187	Los Angeles County
26675	Fee-for-Service	1851786826	1851786826	1	1	ANTONOVA, JULIE MD	10/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145863	08	Family Practice	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
26685	Fee-for-Service	1437262193	1437262193	1	1	ALVAREZ, MARTA E	8/20/1995	207P00000X	NA	Other	026	PHYSICIANS	80196	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	19	06037	33.83155851	-118.2920625	Los Angeles County
26689	Fee-for-Service	1205141504	1205141504	1	1	ACTIVE PLUS HOME HEALTH CARE	4/5/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	4766 PARK GRANANDA	SUITE 214	CALABASAS	CA	91302	1546	19	06037	34.15398634	-118.6423535	Los Angeles County
26723	Fee-for-Service	1184693319	1184693319	1	1	AKERS-HODSON, LISA A MD	6/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
26725	Fee-for-Service	1073896544	1073896544	1	1	ABOU RJAILI, GEORGES M MD FA	6/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140214	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4500 BROCKTON AVE	STE 203	RIVERSIDE	CA	92501	4006	33	06065	33.97785263	-117.3836152	Riverside County
26729	Fee-for-Service	1629274337	1629274337	1	1	AGHAI, MEHRDAD MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	83156	18	Ophthalmology	0	In state provider	CENTURY EYE CARE MED CTR	4477 W 118TH ST	STE 101	HAWTHORNE	CA	90250	2256	19	06037	33.92734752	-118.354221	Los Angeles County
26759	Fee-for-Service	1942879317	1942879317	1	1	ARELLANO, GENESIS LMFT	9/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4000 MAGNOLIA BLVD	A	BURBANK	CA	91505	2827	19	06037	34.16705225	-118.3493748	Los Angeles County
26770	Fee-for-Service	1235607482	1235607482	1	1	ARLINGTON PRESCRIPTION	12/20/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY INC	8990 GARFIELD STREET	STE 12	RIVERSIDE	CA	92503	3922	33	06065	33.92882844	-117.4396777	Riverside County
26781	Fee-for-Service	1821075987	1821075987	1	1	ATKINS,GUS G IV MD	7/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	65394	05	Anesthesiology	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
26782	Fee-for-Service	1093033276	1093033276	1	1	ANAM, SMITHA R MD	5/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113461	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
26788	Fee-for-Service	1821166331	1821166331	1	1	AGUIRRE, JOSE C MD	2/4/2020	207P00000X	NA	Other	026	PHYSICIANS	149057	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
26789	Fee-for-Service	1487072534	1487072534	1	1	ALSAMARAE, ARWA MD	8/13/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	162389	18	Ophthalmology	0	In state provider	None	1017 2ND ST	None	SANTA ROSA	CA	95404	6608	49	06097	38.442753	-122.7056805	Sonoma County
26792	Fee-for-Service	1083851992	1083851992	1	1	ALTAMED HEALTH SERVICES CORP	2/13/2014	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	GARDEN GROVE, HARBOR	12751 HARBOR BLVD	None	GARDEN GROVE	CA	92840	5800	30	06059	33.77746612	-117.9151381	Orange County
26793	Fee-for-Service	1508812520	1508812520	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3925 MISSION AVE	None	OCEANSIDE	CA	92058	7803	37	06073	33.22835922	-117.3243077	San Diego County
26811	Fee-for-Service	1821199563	1821199563	1	1	ARMSTRONG, RISHA F	5/4/2010	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1930 WILSHIRE BLVD	STE 904	LOS ANGELES	CA	90057	3619	19	06037	34.05720458	-118.2744084	Los Angeles County
26816	Fee-for-Service	1184622615	1184622615	1	1	ABRAMS, LAURIE A MD	6/27/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	89006	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
26819	Fee-for-Service	1821277252	1821277252	1	1	ABELSON, DEBORAH L MD	7/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105236	None	None	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
26857	Fee-for-Service	1811130727	1811130727	1	1	ALTA EAST BAY PATHOLOGY	6/12/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	20103 LAKE CHABOT ROAD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
26861	Fee-for-Service	1184194383	1184194383	1	1	ALAY, IVANNIA LCSW	12/3/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2068 ORANGE TREE LANE	216	REDLANDS	CA	92374	0109	36	06071	34.0679639	-117.2250148	San Bernardino County
26871	Fee-for-Service	1326351537	1326351537	1	1	AWKAR, NELLY MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137571	41	Internal Medicine	0	In state provider	None	11480 BROOKSHIRE AVE	STE 309	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
26898	Fee-for-Service	1104977602	1104977602	1	1	AYERS, JERRY D MD	8/5/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	42793	-	NOT APPLICABLE	0	In state provider	None	4141 PACIFIC HIGHWAY	None	SAN DIEGO	CA	92110	2030	37	06073	32.7444541	-117.1921543	San Diego County
26949	Fee-for-Service	1154747020	1154747020	1	9	ACN MEDICAL GROUP, INC	10/10/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	210 40TH STREET WAY	None	OAKLAND	CA	94611	5612	01	06001	37.82697949	-122.2550806	Alameda County
26970	Fee-for-Service	1083870497	1083870497	1	1	AZEEM, SYED S MD	5/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135229	14	Neurological Surgery	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
27013	Fee-for-Service	1588654123	1588654123	1	1	ASHIZAWA, JAMES H MD	1/31/1985	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	41984	08	Family Practice	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
27024	Fee-for-Service	1558745562	1558745562	1	1	ALAYAN, ALISA MD	8/13/2018	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	136967	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
27034	Fee-for-Service	1609185032	1609185032	1	1	AVTAR SINGH M.D.	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
27039	Fee-for-Service	1891421210	1891421210	1	1	AA OPTOMETRIC GROUP INC	4/29/2024	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3500 S BRISTOL ST	STE 202	SANTA ANA	CA	92704	7306	30	06059	33.70041	-117.885637	Orange County
27046	Fee-for-Service	1811356298	1811356298	1	1	ADVENTIST HEALTH PHYSICIANS	8/25/2020	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	2876 SYCAMORE DR	SUITE101	SIMI VALLEY	CA	93065	1530	56	06111	34.28795345	-118.7438659	Ventura County
27079	Fee-for-Service	1083851992	1083851992	1	1	ALTAMED HEALTH SERVICES CORP	4/1/2009	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	GARDEN GROVE, HARBOR	12751 HARBOR BLVD	None	GARDEN GROVE	CA	92840	5800	30	06059	33.77746612	-117.9151381	Orange County
27080	Fee-for-Service	1982100764	1982100764	1	1	ARORA, RANJEET SINGH MD	2/3/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174233	None	None	0	In state provider	None	400 E OAK ST	None	VISALIA	CA	93291	5034	54	06107	36.332253	-119.288691	Tulare County
27102	Fee-for-Service	1427657394	1427657394	1	1	AVEEVA HOSPICE-EAST	9/23/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3741 MERCED DR	STE L	RIVERSIDE	CA	92503	4956	33	06065	33.89494008	-117.4890821	Riverside County
27117	Fee-for-Service	1912617416	1912617416	1	1	ALL CONVENIENT CARE AP-NURSI	7/7/2023	261QU0200X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	NG CORP	8504 FIRESTONE BLVD STE	380	DOWNEY	CA	90241	4926	19	06037	33.93808746	-118.1295242	Los Angeles County
27124	Fee-for-Service	1982041174	1982041174	1	1	ALIAGA, LEONARDO MD	6/4/2021	207P00000X	NA	Other	026	PHYSICIANS	135330	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
27131	Fee-for-Service	1447246863	1447246863	1	1	AGUILAR, EDGAR C OD	8/18/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2151 ROSS AVE	None	EL CENTRO	CA	92243	3685	13	06025	32.78143941	-115.5799149	Imperial County
27173	Fee-for-Service	1528827755	1528827755	1	1	ANDERSEN, SHIRLEY A RCP	4/30/2024	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
27206	Fee-for-Service	1982668182	1982668182	1	1	ANTONS, KENNETH A MD	7/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84454	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
27214	Fee-for-Service	1861653990	1861653990	1	1	AMMIRATI, GUISEPPE MD	7/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97964	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
27225	Fee-for-Service	1033719943	1033719943	1	1	ANGELES HOSPICE CARE INC	10/3/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	659 N. ESCONDIDO BLVD.	None	ESCONDIDO	CA	92025	1701	37	06073	33.12726358	-117.0886654	San Diego County
27226	Fee-for-Service	1013259357	1013259357	1	1	ARORA, ARPIT MD	10/6/2021	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	173881	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
27249	Fee-for-Service	1740408384	1740408384	1	1	AARON TODD BENNER M.D.	3/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	DBA KEARNEY RAD PC	10 E 31ST ST	None	KEARNEY	NE	68847	2908	00	None	40.70647332	-99.08130081	Buffalo County
27267	Fee-for-Service	1477959096	1477959096	1	1	AHMED, SARAH F MD	6/28/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	139648	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
27295	Fee-for-Service	1487739835	1487739835	2	1	ALLA, HARITHA R MD	1/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54107	42	Nuclear Medicine	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
27296	Fee-for-Service	1457969032	1457969032	1	1	AUNG, HEAIN NP	12/6/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1080 N. INDIAN CANYON DR	SUITE 201	PALM SPRINGS	CA	92262	4869	33	06065	33.837354	-116.545572	Riverside County
27313	Fee-for-Service	1144088444	1144088444	1	1	ADVENTIST HEALTH PHYSICIANS	7/9/2024	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	959 LAS TABLAS RD	STE B3	TEMPLETON	CA	93465	9703	40	06079	35.55436153	-120.7148265	San Luis Obispo County
27351	Fee-for-Service	1730356072	1730356072	1	1	ALI-JONES, RASHAAN MD	8/6/2024	208600000X	NA	General Surgery	026	PHYSICIANS	103415	02	General Surgery	0	In state provider	None	2110 EL SEGUNDO BLVD	110	EL SEGUNDO	CA	90245	4548	19	06037	33.91624545	-118.390199	Los Angeles County
27366	Fee-for-Service	1083851992	1083851992	1	1	ALTAMED HEALTH SERVICES CORP	1/16/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	GARDEN GROVE, HARBOR	12751 HARBOR BLVD	None	GARDEN GROVE	CA	92840	5800	30	06059	33.77746612	-117.9151381	Orange County
27368	Fee-for-Service	1083134829	1083134829	1	1	ADEKUNBI, ADESHEWA MD	10/16/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	188409	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
27388	Fee-for-Service	1427657394	1427657394	1	1	AVEEVA HOSPICE-EAST	9/23/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3741 MERCED DR	STE L	RIVERSIDE	CA	92503	4956	33	06065	33.89494008	-117.4890821	Riverside County
27428	Fee-for-Service	1194913319	1194913319	1	1	AUBRY, ALYSIA R LMFT	2/22/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1307 W 6TH ST	212C	CORONA	CA	92882	1642	33	06065	33.87790309	-117.589666	Riverside County
27471	Fee-for-Service	1326534314	1326534314	1	1	ANDERSON, DIANE PHD	5/13/2024	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1470 MARIA LN STE 240	None	WALNUT CREEK	CA	94596	5399	07	06013	37.892501	-122.0566177	Contra Costa County
27494	Fee-for-Service	1982668182	1982668182	1	1	ANTONS, KENNETH A MD	7/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84454	41	Internal Medicine	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
27498	Fee-for-Service	1780728550	1780728550	1	1	AMBROSET, PHILIPPE P	10/1/1996	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	18913 SHERMAN WAY	None	RESEDA	CA	91335	2604	19	06037	34.20119548	-118.545399	Los Angeles County
27514	Fee-for-Service	1033719943	1033719943	1	1	ANGELES HOSPICE CARE INC	10/3/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	659 N. ESCONDIDO BLVD.	None	ESCONDIDO	CA	92025	1701	37	06073	33.12726358	-117.0886654	San Diego County
27517	Fee-for-Service	1306224050	1306224050	1	1	ALTHAUSER, SAMUEL R DO	3/31/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	15604	None	None	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
27526	Fee-for-Service	1891148847	1891148847	1	1	ARMSTRONG, ROBERT MD	8/10/2023	261QU0200X	NA	Other	026	PHYSICIANS	15772	None	None	0	In state provider	None	1450 TREAT BLVD	STE 160	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
27546	Fee-for-Service	1730151655	1730151655	1	1	AOKI, THOMAS T MD	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	16656	41	Internal Medicine	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
27581	Fee-for-Service	1588646368	1588646368	1	1	ASHFORD, ROY F MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	64893	20	Orthopedic Surgery	0	In state provider	None	1505 WILSON TER	STE 200	GLENDALE	CA	91206	4073	19	06037	34.14960934	-118.2313491	Los Angeles County
27584	Fee-for-Service	1487739835	1487739835	2	1	ALLA, HARITHA R MD	1/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54107	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
27601	Fee-for-Service	1093973281	1093973281	1	1	ANNEN, KYLE M DO	12/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	22	Pathology (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
27617	Fee-for-Service	1710329883	1710329883	1	1	AINECHI, SANAZ MD	1/22/2020	207ZP0102X	NA	Other	026	PHYSICIANS	139507	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	0992	19	06037	34.06324759	-118.2737045	Los Angeles County
27627	Fee-for-Service	1285771055	1285771055	1	1	ANGEL VIEW INC	5/6/1992	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	66635 GRANADA AVE	None	DESERT HOT SPRING	CA	92240	4659	33	06065	33.95503529	-116.4988208	Riverside County
27655	Fee-for-Service	1073661377	1073661377	1	1	ALAMEDA CO OFC OF EDU	11/1/1999	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	313 W WINTON AVE	None	HAYWARD	CA	94544	1136	01	06001	37.65785365	-122.0980184	Alameda County
27665	Fee-for-Service	1285382994	1285382994	1	1	AGABALIAN, ANI	3/20/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11245 E WASHINGTON BLVD	None	WHITTIER	CA	90606	3111	19	06037	33.97192651	-118.0711359	Los Angeles County
27689	Fee-for-Service	1013273036	1013273036	1	2	AVALLONE, MICHAEL A MD	8/8/2022	208800000X	NA	Other	026	PHYSICIANS	155941	None	None	0	In state provider	None	525 EAST PLAZA DR	STE 304	SANTA MARIA	CA	93465	9747	42	06083	34.9373822	-120.4296004	Santa Barbara County
27764	Fee-for-Service	1457451155	1457451155	1	1	ABCARIAN, PETER W MD	4/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	66737	30	Radiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
27787	Fee-for-Service	1659325256	1659325256	1	1	AMITAI, ALLON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
27791	Fee-for-Service	1558822023	1558822023	1	1	ARAB, JAHIR B	11/8/2019	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	14536 ROSCOE BLVD	SUITE 104	PANORAMA CITY	CA	91402	4103	19	06037	34.22150052	-118.450152	Los Angeles County
27823	Fee-for-Service	1356724074	1356724074	1	1	AFROZ, SANA MD	11/1/2023	207RR0500X	NA	Other	026	PHYSICIANS	191093	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
27826	Fee-for-Service	1689705873	1689705873	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1459 MAIN ST	None	RAMONA	CA	92065	2128	37	06073	33.03801505	-116.8758987	San Diego County
27830	Fee-for-Service	1689606741	1689606741	1	1	APAYDIN, AYTAC H MD	3/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	46632	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1115 LOS PALOS DR	STE A	SALINAS	CA	93901	3853	27	06053	36.65750452	-121.6453892	Monterey County
27835	Fee-for-Service	1134788771	1134788771	1	1	ARAMS, RYAN MD	6/15/2023	390200000X	NA	Other	026	PHYSICIANS	181142	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
27836	Fee-for-Service	1467804245	1467804245	1	1	ADVANCED SLEEP MEDICINE	7/3/2018	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	11500 W OLYMPIC BLVD	STE 555	LOS ANGELES	CA	90064	1524	19	06037	34.03617514	-118.4445122	Los Angeles County
27846	Fee-for-Service	1639510126	1639510126	1	1	AUSTIN, ROBIN	11/5/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	119191	-	NOT APPLICABLE	0	In state provider	None	440 POTRERO AVENUE	None	SAN FRANCISCO	CA	94110	1430	38	06075	37.76420358	-122.4074414	San Francisco County
27857	Fee-for-Service	1578022422	1578022422	1	1	ABBAS, FAKHAR MD	10/17/2024	207R00000X	NA	Other	026	PHYSICIANS	176623	41	Internal Medicine	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
27867	Fee-for-Service	1508574138	1508574138	1	1	APPACHAR, LAKSHMI R LCSW	12/15/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8775 AERO DRIVE	STE 238	SAN DIEGO	CA	92123	1756	37	06073	32.80965551	-117.1391563	San Diego County
27871	Fee-for-Service	1487739835	1487739835	2	1	ALLA, HARITHA R MD	1/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54107	41	Internal Medicine	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
27875	Fee-for-Service	1972614162	1972614162	1	1	AVEDISIAN-AGUILAR, JULIA S L	5/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
27878	Fee-for-Service	1629149869	1629149869	1	1	ARAKI, ALEX OD	7/1/1998	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
27886	Fee-for-Service	1518266014	1518266014	1	1	AMINIPOUR, SAHAR MD	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132742	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
27921	Fee-for-Service	1124029640	1124029640	1	1	ALTOR, SHEILA MD.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	LIBERTY EMG. PHYS.	2525 GLENN HENDREN DRIVE	None	LIBERTY	MO	64068	9625	00	None	39.278767	-94.42102759	Clay County
27941	Fee-for-Service	1073661377	1073661377	1	1	ALAMEDA CO OFC OF EDU	11/22/2024	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	313 W WINTON AVE	None	HAYWARD	CA	94544	1136	01	06001	37.65785365	-122.0980184	Alameda County
27965	Fee-for-Service	1629675384	1629675384	1	1	AN HOME HEALTH CARE, INC	10/21/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7220 WOODMAN AVE	STE 207A	VAN NUYS	CA	91405	2668	19	06037	34.20189	-118.431221	Los Angeles County
27978	Fee-for-Service	1386715365	1386715365	1	1	AZIZ, ASHRAF R MD	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	53567	68	Hematology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
28006	Fee-for-Service	1346398328	1346398328	1	1	ANAND, KANCHANA S MD	5/20/2004	207RH0003X	NA	Oncology	026	PHYSICIANS	76511	78	Neoplastic Diseases/Oncology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
28014	Fee-for-Service	1497937221	1497937221	1	1	ARC OF SAN DIEGO	2/3/1983	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1938 WASHINGTON ST	None	LEMON GROVE	CA	91945	4265	37	06073	32.72689054	-117.0243315	San Diego County
28028	Fee-for-Service	1629854583	1629854583	1	1	ARSULICH, LINA NP	10/12/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2400 EAST 4TH STREET	None	NATIONAL CITY	CA	91950	2026	37	06073	32.68637926	-117.0828839	San Diego County
28033	Fee-for-Service	1568544781	1568544781	1	1	ALDEN ENTERPRISES LLC	3/1/1966	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1240 S HOOVER ST	None	LOS ANGELES	CA	90006	3606	19	06037	34.04838072	-118.2841455	Los Angeles County
28072	Fee-for-Service	1538535612	1538535612	1	1	AHMAD, MALEEHA MD	10/12/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
28073	Fee-for-Service	1750452736	1750452736	1	1	AGUSTINES, LISA A MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	61033	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
28103	Fee-for-Service	1568081982	1568081982	1	1	AMIN, POOJA	10/31/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
28112	Fee-for-Service	1750477824	1750477824	1	1	ARGUDO, LORINDHA F MD	4/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	91347	41	Internal Medicine	0	In state provider	None	420 W ROWLAND ST	None	COVINA	CA	91723	2943	19	06037	34.078949	-117.8963031	Los Angeles County
28115	Fee-for-Service	1821230384	1821230384	1	1	ANDREW JOHN HOENE MD	3/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	707 SHERIDAN AVE	None	CODY	WY	82414	3409	00	None	44.52605901	-109.0732547	Park County
28119	Fee-for-Service	1689606741	1689606741	1	1	APAYDIN, AYTAC H MD	3/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	46632	34	Urology and Urological Surgery	0	In state provider	None	1115 LOS PALOS DR	STE A	SALINAS	CA	93901	3853	27	06053	36.65750452	-121.6453892	Monterey County
28150	Fee-for-Service	1275881187	1275881187	1	1	AUSTIN, JETAIME N LMFT	7/25/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
28154	Fee-for-Service	1841644895	1841644895	1	1	ABRAHAM, ANAND M MD	9/26/2022	207L00000X	NA	Other	026	PHYSICIANS	167768	None	None	0	In state provider	None	3701 J STREET	SUITE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
28164	Fee-for-Service	1760989834	1760989834	1	1	ANYANACHO, NGOZI NP	6/19/2020	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1809 W. REDLANDS BLVD	# 234	REDLANDS	CA	92373	8054	36	06071	34.06288379	-117.2156673	San Bernardino County
28167	Fee-for-Service	1912318445	1912318445	1	1	ALLIANCE NEURODIAGNOSTICS, L	6/28/2021	293D00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	2	Out of state provider	LC	4545 FULLER DR.	SUITE 100	IRVING	TX	92612	1001	00	None	32.86753258	-96.94853027	Dallas County
28177	Fee-for-Service	1346770567	1346770567	1	1	ALLERGY AND ASTHMA CONSULTAN	2/25/2019	207RA0201X	NA	Other	026	PHYSICIANS	None	03	Allergy	0	In state provider	TS PC	369 MAIN STREET	200	REDWOOD CITY	CA	94063	1759	41	06081	37.4908197	-122.2268446	San Mateo County
28205	Fee-for-Service	1144378126	1144378126	1	1	AGUIAR, JAMES A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34540	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
28220	Fee-for-Service	1396131983	1396131983	1	1	ARCOBELLO, JONATHAN T MD	11/2/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	170330	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
28268	Fee-for-Service	1336195833	1336195833	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2975 VAN BUREN BLVD	None	RIVERSIDE	CA	92503	5672	33	06065	33.9093344	-117.437395	Riverside County
28270	Fee-for-Service	1235456377	1235456377	1	1	ASAR, SABERA M MD	11/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138177	41	Internal Medicine	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
28273	Fee-for-Service	1902805245	1902805245	1	1	ALBERT EINSTEIN MED CTR	5/1/1999	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	5501 OLD YORK RD	None	PHILADELPHIA	PA	19141	3018	00	None	40.0374	-75.1435605	Philadelphia County
28277	Fee-for-Service	1710020805	1710020805	1	1	AMIN, JAYENDRA S MD	11/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	40490	01	General Practice	0	In state provider	None	13095 JAMBOREE RD	None	TUSTIN	CA	92782	9150	30	06059	33.73033216	-117.7875003	Orange County
28279	Fee-for-Service	1629566526	1629566526	1	1	AL JANDEEL, AWS	11/1/2022	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1680 E 120 ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
28323	Fee-for-Service	1720056880	1720056880	1	3	ASATO, THERESA T OD	1/3/2024	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1031 WASHINGTON ST	None	RED BLUFF	CA	96080	2746	52	06103	40.18004666	-122.2386525	Tehama County
28325	Fee-for-Service	1780880260	1780880260	1	1	ABYARI, PARINAZ MD	10/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108971	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
28368	Fee-for-Service	1568499606	1568499606	1	1	AHMAD, IMDAD MD	8/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	54170	41	Internal Medicine	0	In state provider	None	400 NORTH PEPPER AVENUE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
28386	Fee-for-Service	1366804106	1366804106	1	1	AL-KHAFAJI, JAAFAR F MD	2/19/2020	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
28429	Fee-for-Service	1831565100	1831565100	1	1	ADVENTIST HEALTH PHYSICIANS	7/10/2019	208600000X	NA	General Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	2750 SYCAMORE DR	#210	SIMI VALLEY	CA	93065	1502	56	06111	34.28529962	-118.7437672	Ventura County
28479	Fee-for-Service	1124587274	1124587274	1	1	ASADOURIAN, MIRO MD	6/3/2022	208M00000X	NA	Other	026	PHYSICIANS	176204	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
28508	Fee-for-Service	1396131983	1396131983	1	1	ARCOBELLO, JONATHAN T MD	11/2/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	170330	77	Infectious Disease	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
28523	Fee-for-Service	1225134885	1225134885	1	1	ALVAREZ-GALOOSIAN, FLORCITA	9/9/2009	207RN0300X	NA	Nephrology	026	PHYSICIANS	73006	41	Internal Medicine	0	In state provider	S MD	43830 10TH STREET WEST	None	LANCASTER	CA	93534	4826	19	06037	34.67913961	-118.1478725	Los Angeles County
28533	Fee-for-Service	1366109720	1366109720	1	1	APTITUDE CLINICAL LABORATORI	12/9/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	S	125 CREMONA DR	STE 100 & 220	GOLETA	CA	93117	3003	42	06083	34.43230069	-119.8567163	Santa Barbara County
28554	Fee-for-Service	1578955084	1578955084	1	3	ABOVE ALL CARE FACILITY LLC	6/1/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1022 OXFORD DR	None	PLACENTIA	CA	92870	4329	30	06059	33.88111351	-117.8645215	Orange County
28558	Fee-for-Service	1902805245	1902805245	1	1	ALBERT EINSTEIN MED CTR	5/1/1999	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	5501 OLD YORK RD	None	PHILADELPHIA	PA	19141	3018	00	None	40.0374	-75.1435605	Philadelphia County
28563	Fee-for-Service	1710020805	1710020805	1	1	AMIN, JAYENDRA S MD	11/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	40490	41	Internal Medicine	0	In state provider	None	13095 JAMBOREE RD	None	TUSTIN	CA	92782	9150	30	06059	33.73033216	-117.7875003	Orange County
28567	Fee-for-Service	1154963932	1154963932	1	1	AZ HOSPICE AND PALLIATIVE	8/11/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	6320 VAN NUYS BLVD	SUITE 402A	VAN NUYS	CA	91401	2617	19	06037	34.18545203	-118.4487091	Los Angeles County
28572	Fee-for-Service	1194223198	1194223198	1	1	ADVENTIST HEALTH PHYSICIANS	9/18/2019	207RI0011X	NA	Cardiology/Interventional Cardiology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	414 G ST	STE 210	MARYSVILLE	CA	95901	5669	58	06115	39.13913942	-121.5934649	Yuba County
28579	Fee-for-Service	1487252656	1487252656	1	1	ARREOLA, JIA NI L CRNA	5/28/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
28591	Fee-for-Service	1124210257	1124210257	1	1	ARANDA, YESSICA B LMFT	8/28/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CONSULTING SERVICES	3711 LONG BEACH BLVD	SUITE 5035	LONG BEACH	CA	90807	3315	19	06037	33.824583	-118.1893785	Los Angeles County
28612	Fee-for-Service	1194279901	1194279901	1	1	ASHMAN, ELLEN NP	7/13/2022	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
28646	Fee-for-Service	1457847154	1457847154	1	1	ALVAREZ ANTEZANA, ARTURO MD	8/17/2021	207R00000X	NA	Other	026	PHYSICIANS	173529	None	None	0	In state provider	None	1000 GREENLEY RD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
28662	Fee-for-Service	1902111339	1902111339	1	1	ASLAM, WASEEM MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124922	41	Internal Medicine	0	In state provider	None	3132 WEST MARCH LANE	STE 5	STOCKTON	CA	95219	2354	39	06077	37.9839146	-121.3516231	San Joaquin County
28664	Fee-for-Service	1477612109	1477612109	1	1	ALI, KASHIF MD	5/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88640	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
28666	Fee-for-Service	1548474570	1548474570	1	1	ARAIM, OMAR A MD	2/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97867	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	116 N AKERS ST	None	VISALIA	CA	93291	5121	54	06107	36.330588	-119.348748	Tulare County
28668	Fee-for-Service	1326074535	1326074535	1	1	AKOPIAN, GABRIEL MD	10/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	79817	None	None	0	In state provider	None	1560 E CHEVY CHASE DR	STE 430	GLENDALE	CA	91206	4197	19	06037	34.15290734	-118.2302295	Los Angeles County
28674	Fee-for-Service	1295200046	1295200046	1	1	AWATIN, MARYJANE CNP	7/16/2021	2278C0205X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
28677	Fee-for-Service	1306184452	1306184452	1	1	ARTHUR, AMESHIA S LCSW	2/22/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25 CADILLAC DR	#205	SACRAMENTO	CA	95825	8354	34	06067	38.574171	-121.4180055	Sacramento County
28711	Fee-for-Service	1508338260	1508338260	1	1	A NEW HOPE HOME HEALTH	4/13/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	12444 VICTORY BLVD	501	NORTH HOLLYWOOD	CA	91606	3113	19	06037	34.18663951	-118.4043555	Los Angeles County
28718	Fee-for-Service	1528286762	1528286762	2	1	ALLIANCE HEALTHCARE SERVICES	10/29/2018	261QR0208X	NA	Mammography Provider	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	INC	2500 MOWRY AVE	#170	FREMONT	CA	94538	1605	30	06059	37.555011	-121.9801005	Alameda County
28755	Fee-for-Service	1790179273	1790179273	1	1	ANGELI, LUCILA MD	10/10/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	155753	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
28785	Fee-for-Service	1568171668	1568171668	1	1	ADDAE MENSAH, MELISSA NP	8/24/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18672 FLORIDA ST	#100	HUNTINGTON BEACH	CA	92648	1917	30	06059	33.691185	-117.9910425	Orange County
28798	Fee-for-Service	1396131983	1396131983	1	1	ARCOBELLO, JONATHAN T MD	11/2/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	170330	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
28813	Fee-for-Service	1497788996	1497788996	1	1	ALICE CHAVEZ	3/12/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
28826	Fee-for-Service	1750399796	1750399796	1	1	ALLIANCE MEDICAL CENTER	3/1/1995	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	49	06097	38.62729851	-122.8637785	Sonoma County
28849	Fee-for-Service	1841264884	1841264884	1	1	AMY H LU MD	10/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 LOTHROP ST	None	PITTSBURGH	PA	15213	2536	00	None	40.44188737	-79.96079711	Allegheny County
28856	Fee-for-Service	1154963932	1154963932	1	1	AZ HOSPICE AND PALLIATIVE	8/11/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	6320 VAN NUYS BLVD	SUITE 402A	VAN NUYS	CA	91401	2617	19	06037	34.18545203	-118.4487091	Los Angeles County
28864	Fee-for-Service	1700516945	1700516945	1	1	ADVANCED NURSING THERAPEUTIC	8/24/2024	364SP0808X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	P	13323 W WASHINGTON BLVD	202	LOS ANGELES	CA	90066	5163	19	06037	33.99291637	-118.4429405	Los Angeles County
28868	Fee-for-Service	1215377445	1215377445	1	1	ARCINAS, CECILIA M CRNA	5/19/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
28886	Fee-for-Service	1609202415	1609202415	1	1	ACOSTA, MARGARITA NP	10/4/2018	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
28902	Fee-for-Service	1699714543	1699714543	1	1	AYAD, IHAB MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63734	05	Anesthesiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
28907	Fee-for-Service	1518484492	1518484492	1	1	A-1 HOME CARE AGENCY, INC	6/12/2019	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	2400 WEST COAST HWY	SUITE 5	NEWPORT BEACH	CA	92663	5127	30	06059	33.61911398	-117.9215784	Orange County
28912	Fee-for-Service	1972655108	1972655108	1	1	ACUNA, WALTER P MD	9/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87756	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
28955	Fee-for-Service	1548474570	1548474570	1	1	ARAIM, OMAR A MD	2/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97867	02	General Surgery	0	In state provider	None	116 N AKERS ST	None	VISALIA	CA	93291	5121	54	06107	36.330588	-119.348748	Tulare County
28958	Fee-for-Service	1184480436	1184480436	1	1	ANORVE, AMINADI S	3/5/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
28976	Fee-for-Service	1639293269	1639293269	1	1	ALPER, EUGENE MARC	8/1/2005	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1887 GREENFIELD AVE	#212	LOS ANGELES	CA	90025	4416	19	06037	34.04649917	-118.4394782	Los Angeles County
28983	Fee-for-Service	1750709580	1750709580	1	1	ALBRECHT, GUNNHILD A MD	1/9/2019	207R00000X	NA	Other	026	PHYSICIANS	140963	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
29014	Fee-for-Service	1902909294	1902909294	1	1	ARMAND, CLAUDINE L MD	1/6/2020	207R00000X	NA	Other	026	PHYSICIANS	65235	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
29015	Fee-for-Service	1215927579	1215927579	1	1	AJAY KUMAR SINGH MD	3/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	55 FRUIT ST	None	BOSTON	MA	02114	2621	00	None	42.363216	-71.0687745	Suffolk County
29016	Fee-for-Service	1477810836	1477810836	1	1	ANAND, NEHA MD	10/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136978	None	None	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
29018	Fee-for-Service	1134710080	1134710080	1	1	ARNOLD, CHELSIE J CRNA	7/7/2021	163W00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
29023	Fee-for-Service	1588641963	1588641963	1	1	AHN, JAMES S MD	2/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84344	None	None	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
29024	Fee-for-Service	1861711863	1861711863	1	3	AME MEDICAL GROUP, INC.	10/2/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	3625 MARTIN LUTHER KING	8	LYNWOOD	CA	90262	3509	19	06037	33.93044131	-118.2021564	Los Angeles County
29031	Fee-for-Service	1174974042	1174974042	1	1	ANDREW ERWTEMAN,M.D., INC	9/12/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	25150 HANCOCK AVE	# 200	MURRIETA	CA	92562	5987	33	06065	33.56635084	-117.1823956	Riverside County
29050	Fee-for-Service	1376660472	1376660472	1	1	ANDERSON, LEIGH R MD	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
29062	Fee-for-Service	1609350230	1609350230	1	1	ALLIANCE HEALTH SERVICES INC	2/9/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1421 EAST COOLEY DRIVE	SUITE 5	COLTON	CA	92324	3979	36	06071	34.05467952	-117.305163	San Bernardino County
29099	Fee-for-Service	1104332584	1104332584	1	1	A NEW HORIZON BILINGUAL FAMI	10/11/2018	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	LY THERAPY INC	325 W HOSPITALITY LN	STE 200	SAN BERNARDINO	CA	92374	2861	36	06071	34.0658995	-117.29034	San Bernardino County
29112	Fee-for-Service	1750399796	1750399796	1	1	ALLIANCE MEDICAL CENTER	3/1/1995	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	49	06097	38.62729851	-122.8637785	Sonoma County
29125	Fee-for-Service	1043440845	1043440845	1	1	AUNG, KHUN Z	7/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129813	None	None	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
29161	Fee-for-Service	1326048018	1326048018	2	1	ALTHAUS, SANDRA J	2/2/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	89080	None	None	0	In state provider	None	1065 BUCKS LAKE ROAD	None	QUINCY	CA	95971	9507	32	06063	39.93916024	-120.9619096	Plumas County
29191	Fee-for-Service	1760951263	1760951263	1	1	ALVARADO RADIOLOGY GROUP INC	2/1/2019	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PROFESSIONAL CORPORATION	6655 ALVARADO ROAD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
29202	Fee-for-Service	1457635740	1457635740	1	1	AGBOWO, JOSEPHINE MD	9/19/2012	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	118389	01	General Practice	0	In state provider	None	350 30TH ST	STE 100	OAKLAND	CA	94609	3424	01	06001	37.81892183	-122.2640154	Alameda County
29221	Fee-for-Service	1356438410	1356438410	1	1	ATWATER MEDICAL GROUP	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1775 3RD ST	None	ATWATER	CA	95301	3608	24	06047	37.35175935	-120.6061109	Merced County
29225	Fee-for-Service	MSS00032F	None	1	1	AREA 12 AGENCY	3/1/1999	No Taxonomy Provided	NA	None	074	MULTIPURPOSE SENIOR SERVICES PROGRAM	-	-	NOT APPLICABLE	0	In state provider	ON AGING	19074 STANDARD RD	STE A	SONORA	CA	95370	7542	55	06109	37.96978944	-120.3137898	Tuolumne County
29245	Fee-for-Service	1962603852	1962603852	1	1	ALFARO, ANDREA CRNA	6/8/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92111	2418	37	06073	32.79293009	-117.0952438	San Diego County
29318	Fee-for-Service	1861711863	1861711863	1	3	AME MEDICAL GROUP, INC.	10/2/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	3625 MARTIN LUTHER KING	8	LYNWOOD	CA	90262	3509	19	06037	33.93044131	-118.2021564	Los Angeles County
29335	Fee-for-Service	1922714088	1922714088	1	1	AVILA LOPEZ, MAGDALENA PT	12/5/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2755 BRISTOL ST.	STE 130	COSTA MESA	CA	92626	5985	30	06059	33.67368064	-117.889108	Orange County
29338	Fee-for-Service	1376660472	1376660472	1	1	ANDERSON, LEIGH R MD	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
29351	Fee-for-Service	1609350230	1609350230	1	1	ALLIANCE HEALTH SERVICES INC	2/9/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1421 EAST COOLEY DRIVE	SUITE 5	COLTON	CA	92324	3979	36	06071	34.05467952	-117.305163	San Bernardino County
29368	Fee-for-Service	1558894907	1558894907	1	1	AZEIZAT, THOMAS M MD	12/9/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159431	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
29384	Fee-for-Service	1104332584	1104332584	1	1	A NEW HORIZON BILINGUAL FAMI	9/9/2020	106H00000X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	LY THERAPY INC	325 W HOSPITALITY LN	STE 200	SAN BERNARDINO	CA	92374	2861	36	06071	34.0658995	-117.29034	San Bernardino County
29398	Fee-for-Service	1336387059	1336387059	1	1	ATAY-ROSENTHAL, SAADET MD	4/29/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	55747	None	None	0	In state provider	None	1180 POST ST	None	SAN FRANCISCO	CA	94109	5505	38	06075	37.78672984	-122.4209381	San Francisco County
29413	Fee-for-Service	1629030440	1629030440	1	1	AJLOUNY, MARY JANE J CNM	5/11/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
29415	Fee-for-Service	1588875207	1588875207	1	1	AJITPAL MANN	12/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	18701 N 67TH AVE	None	GLENDALE	AZ	85308	7100	00	None	33.655734	-112.201416	Maricopa County
29457	Fee-for-Service	1033635107	1033635107	1	1	ASSEFA, YOHANNES DO	8/18/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16760	None	None	0	In state provider	None	15111 WHITTIER BLVD	102	WHITTIER	CA	90603	2180	19	06037	33.94841455	-118.0049729	Los Angeles County
29480	Fee-for-Service	1972544872	1972544872	1	1	ACHARYA, NISHA MD	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86705	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
29490	Fee-for-Service	1457635740	1457635740	1	1	AGBOWO, JOSEPHINE MD	9/19/2012	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	118389	08	Family Practice	0	In state provider	None	350 30TH ST	STE 100	OAKLAND	CA	94609	3424	01	06001	37.81892183	-122.2640154	Alameda County
29495	Fee-for-Service	1518112762	1518112762	1	1	ARASHEBEN, ARMIN S MD	1/27/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	115108	08	Family Practice	0	In state provider	None	18607 VENTURA BLVD	102	TARZANA	CA	91356	4159	19	06037	34.16995274	-118.5388841	Los Angeles County
29509	Fee-for-Service	1356438410	1356438410	1	1	ATWATER MEDICAL GROUP	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1775 3RD ST	None	ATWATER	CA	95301	3608	24	06047	37.35175935	-120.6061109	Merced County
29517	Fee-for-Service	1467638064	1467638064	1	1	ADVANCED IMAGING CENTER	4/7/2008	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	INC	25842 TOURNAMENT RD	None	VALENCIA	CA	91355	2323	19	06037	34.39146805	-118.5621825	Los Angeles County
29518	Fee-for-Service	1295148633	1295148633	1	1	AHN, AUDREY DO	12/12/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	13320	40	Pediatrics	0	In state provider	None	8250 WOODMAN AVENUE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
29551	Fee-for-Service	1043717218	1043717218	1	1	ALVAREZ, PEDRO MD	1/17/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163467	None	None	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
29573	Fee-for-Service	1134492937	1134492937	1	1	ALTAMED HEALTH SERVICES CORP	6/29/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	EAST LA 1ST STREET	2219 E 1ST STREET	None	LOS ANGELES	CA	90033	3901	19	06037	34.04452444	-118.2114844	Los Angeles County
29583	Fee-for-Service	1477148047	1477148047	1	1	ALGOS INC., A MEDICAL CORPOR	1/22/2024	103TB0200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	11100 WARNER AVE	STE 310	FOUNTAIN VALLEY	CA	92708	4009	30	06059	33.716291	-117.9355051	Orange County
29588	Fee-for-Service	1437341500	1437341500	1	1	ARRATOONIAN, AILEEN PHD	10/18/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10470 FOOTHILL BLVD	SUITE 116	RANCHO CUCAMONGA	CA	91730	3754	36	06071	34.10659649	-117.576603	San Bernardino County
29598	Fee-for-Service	1861711863	1861711863	1	9	AME MEDICAL GROUP, INC.	4/25/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	401 BEVERLY BLVD	None	MONTEBELLO	CA	90640	3620	19	06037	34.01634247	-118.1020649	Los Angeles County
29606	Fee-for-Service	1639207350	1639207350	1	1	ABDEL-WAHAB, NANCY H MD	5/16/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	145175	None	None	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
29608	Fee-for-Service	1073769543	1073769543	1	2	ANX HOME HEALTHCARE	6/3/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	828 S BASCOM AVE	SUITE 240	SAN JOSE	CA	95128	2600	43	06085	37.31225204	-121.9317854	Santa Clara County
29630	Fee-for-Service	1063979110	1063979110	1	1	ADAMS, NATASHYA M NP	6/20/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
29674	Fee-for-Service	1104332584	1104332584	1	1	A NEW HORIZON BILINGUAL FAMI	6/15/2021	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	LY THERAPY INC	325 W HOSPITALITY LN	STE 200	SAN BERNARDINO	CA	92374	2861	36	06071	34.0658995	-117.29034	San Bernardino County
29689	Fee-for-Service	1700858248	1700858248	1	1	ANTHONY M VACA M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2400 S MINNESOTA AVE	STE 1	SIOUX FALLS	SD	57105	3761	00	None	43.523109	-96.7309155	Minnehaha County
29724	Fee-for-Service	1811211915	1811211915	1	1	ADVANCED SKILLED NURSING INC	1/1/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	975 N VIRGIL AVENUE	None	LOS ANGELES	CA	90029	2944	19	06037	34.08945481	-118.2869276	Los Angeles County
29786	Fee-for-Service	1518112762	1518112762	1	1	ARASHEBEN, ARMIN S MD	1/27/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	115108	38	Geriatrics	0	In state provider	None	18607 VENTURA BLVD	102	TARZANA	CA	91356	4159	19	06037	34.16995274	-118.5388841	Los Angeles County
29797	Fee-for-Service	1356438410	1356438410	1	1	ATWATER MEDICAL GROUP	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	1775 3RD ST	None	ATWATER	CA	95301	3608	24	06047	37.35175935	-120.6061109	Merced County
29829	Fee-for-Service	1962637215	1962637215	1	1	ALFAROFELIX, KATIA R MD	4/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129913	01	General Practice	0	In state provider	None	7140 INDIANA AVE	None	RIVERSIDE	CA	92504	4544	33	06065	33.93890182	-117.3977958	Riverside County
29835	Fee-for-Service	1982997342	1982997342	1	1	ALI, SYED U MD	2/1/2021	207R00000X	NA	Other	026	PHYSICIANS	161537	None	None	0	In state provider	None	185 E 7TH AVE	STE A	CHICO	CA	95926	3356	04	06007	39.74473059	-121.8488381	Butte County
29837	Fee-for-Service	1124066378	1124066378	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1268 MADERA RD	None	SIMI VALLEY	CA	93065	4002	56	06111	34.261767	-118.796193	Ventura County
29863	Fee-for-Service	1134492937	1134492937	1	1	ALTAMED HEALTH SERVICES CORP	6/29/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	EAST LA 1ST STREET	2219 E 1ST STREET	None	LOS ANGELES	CA	90033	3901	19	06037	34.04452444	-118.2114844	Los Angeles County
29869	Fee-for-Service	1477148047	1477148047	1	1	ALGOS INC., A MEDICAL CORPOR	10/8/2021	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	11100 WARNER AVE	STE 310	FOUNTAIN VALLEY	CA	92708	4009	30	06059	33.716291	-117.9355051	Orange County
29931	Fee-for-Service	1871733600	1871733600	1	1	ADVANCED ANESTHESIA SPECIALI	3/18/2022	207L00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	STS	7230 MEDICAL CENTER DR	SUITE 500-B	WEST HILLS	CA	91307	1907	19	06037	34.20172814	-118.6294322	Los Angeles County
29940	Fee-for-Service	1134632623	1134632623	1	2	ALEXANDRA, LAINE LCSW	6/1/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1111 E. TAHQUITZ CANYON	121	PALM SPRINGS	CA	92262	3701	33	06065	33.8230345	-116.5331835	Riverside County
29970	Fee-for-Service	1497766141	1497766141	1	1	ALMON, CHRISTINE M MD	3/1/2001	207L00000X	NA	Other	026	PHYSICIANS	65149	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
30009	Fee-for-Service	1134139561	1134139561	1	1	AOUKAR, PIERRE S MD	9/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115927	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
30042	Fee-for-Service	1477209237	1477209237	1	1	AOCL LLC	2/28/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	50 CONCORDIA LANE	None	OROVILLE	CA	95966	6300	04	06007	39.49624207	-121.5182906	Butte County
30071	Fee-for-Service	1518112762	1518112762	1	1	ARASHEBEN, ARMIN S MD	1/27/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	115108	40	Pediatrics	0	In state provider	None	18607 VENTURA BLVD	102	TARZANA	CA	91356	4159	19	06037	34.16995274	-118.5388841	Los Angeles County
30093	Fee-for-Service	1235266636	1235266636	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	74590 HIGHWAY 111	None	PALM DESERT	CA	92260	3804	33	06065	33.72143828	-116.3637999	Riverside County
30098	Fee-for-Service	1295963460	1295963460	1	1	ALHADDAD, FIRAS MD	1/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123243	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
30106	Fee-for-Service	1417052077	1417052077	1	1	ARMS,JOSEPH L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	345 N. SMITH AVENUE	None	ST PAUL	MN	55102	0000	00	None	44.94251219	-93.1074995	Ramsey County
30111	Fee-for-Service	1336202266	1336202266	1	1	ARABIAN, SARKIS DO	1/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9677	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
30126	Fee-for-Service	1144664053	1144664053	1	1	APEX HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	520 N MAIN ST	SUITE 250	SANTA ANA	CA	92701	4694	30	06059	33.749316	-117.868123	Orange County
30147	Fee-for-Service	1134492937	1134492937	1	1	ALTAMED HEALTH SERVICES CORP	6/29/2012	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	EAST LA 1ST STREET	2219 E 1ST STREET	None	LOS ANGELES	CA	90033	3901	19	06037	34.04452444	-118.2114844	Los Angeles County
30149	Fee-for-Service	1932207818	1932207818	1	1	ARTHRITIS CONSULTANT OF	1/9/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	NORTH COUNTY	2023 W VISTA WAY	STE H	VISTA	CA	92083	6030	37	06073	33.18569169	-117.2846332	San Diego County
30161	Fee-for-Service	1477148047	1477148047	1	1	ALGOS INC., A MEDICAL CORPOR	10/8/2021	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	11100 WARNER AVE	STE 310	FOUNTAIN VALLEY	CA	92708	4009	30	06059	33.716291	-117.9355051	Orange County
30172	Fee-for-Service	1376705905	1376705905	1	1	ALPHONSO, AFRON MD	1/28/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	114601	08	Family Practice	0	In state provider	None	8325 BRIMHALL RD	STE 100	BAKERSFIELD	CA	93312	2244	15	06029	35.36875951	-119.0959206	Kern County
30179	Fee-for-Service	1124446158	1124446158	1	1	ALAMEDA HEALTH SYSTEM	5/1/2014	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	None	501 S SHORE CENTER WEST	SUITE A-F	ALAMEDA	CA	94501	5759	01	06001	37.75884896	-122.2528366	Alameda County
30183	Fee-for-Service	1194028423	1194028423	1	1	ADVANCED SKIN CLINIC &	6/7/2011	193400000X	NA	Other	026	PHYSICIANS	None	07	Dermatology	0	In state provider	SURGERY PC	1310 SAN BERNARDINO RD	STE 207	UPLAND	CA	91786	4985	36	06071	34.10260261	-117.6332582	San Bernardino County
30223	Fee-for-Service	1801843917	1801843917	1	1	ANAHEIM MEMORIAL HOSP	4/12/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	EMER PHYS MEDICAL GROUP	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2881	30	06059	33.84718298	-117.933758	Orange County
30229	Fee-for-Service	1780117523	1780117523	1	1	AVEDISSIAN, HARI DO	7/13/2022	207L00000X	NA	Other	026	PHYSICIANS	18986	None	None	0	In state provider	None	3828 DELMAS TERRACE	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
30234	Fee-for-Service	1659072874	1659072874	1	1	ADVANCECARE WEST HOLLYWOOD I	4/21/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	NC	8700 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90069	4508	19	06037	34.08736437	-118.3800788	Los Angeles County
30244	Fee-for-Service	1588840763	1588840763	1	1	ALAMEDA COUNTY PUBLIC	1/1/2002	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	HEALTH DEPT	1000 BROADWAY	STE 500	OAKLAND	CA	94607	4033	01	06001	37.80185548	-122.2726866	Alameda County
30259	Fee-for-Service	1790443356	1790443356	1	1	AKAHIJI, BRETT PT	7/26/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
30324	Fee-for-Service	1306917430	1306917430	1	1	ARELLANO, ANDRES A MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	51229	01	General Practice	0	In state provider	None	1425 W H ST	STE 380	OAKDALE	CA	95361	3592	50	06099	37.75771796	-120.8627767	Stanislaus County
30332	Fee-for-Service	1225029630	1225029630	1	1	ANDERSEN PHYSICAL THERAPY IN	5/24/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	C	1917 COFFEE RD	None	MODESTO	CA	95355	2704	50	06099	37.67156536	-120.9757491	Stanislaus County
30344	Fee-for-Service	1265701494	1265701494	1	1	AGUILAR, MARIA MD	3/14/2024	207RI0008X	NA	Gastroenterology	026	PHYSICIANS	135984	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
30367	Fee-for-Service	1770723587	1770723587	1	1	ADAEZE ONUOHA MD	4/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 GEORGE DIETER DR	STE 110	EL PASO	TX	79936	7654	00	None	31.73376519	-106.3015492	El Paso County
30377	Fee-for-Service	1710671268	1710671268	1	1	ANA FAMILY PHARMACY	6/30/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	20469 SHERMAN WAY	None	WINNETKA	CA	91306	3109	19	06037	34.20115253	-118.5793589	Los Angeles County
30413	Fee-for-Service	1144664053	1144664053	1	1	APEX HOSPICE CARE INC	4/11/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	520 N MAIN ST	SUITE 250	SANTA ANA	CA	92701	4694	30	06059	33.749316	-117.868123	Orange County
30426	Fee-for-Service	1821386947	1821386947	1	1	ANSARI, SHORA M OD	4/5/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 LAGUNA ROAD	SUITE C	FULLERTON	CA	92835	3634	30	06059	33.89326085	-117.9300987	Orange County
30480	Fee-for-Service	1700862596	1700862596	1	2	ALAN DAVIDOFF M.D.	7/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	23900 KATY FWY	None	KATY	TX	77494	1323	00	None	29.78594112	-95.78613398	Harris County
30497	Fee-for-Service	1881682748	1881682748	1	1	ATALAY, MICHAEL KEMAL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	593 EDDY ST	None	PROVIDENCE	RI	02903	4923	00	None	41.81122992	-71.40713931	Providence County
30502	Fee-for-Service	1467431072	1467431072	1	1	ABEDI, SHAHLA MD	6/8/2005	207W00000X	NA	Ophthalmology	026	PHYSICIANS	30819	18	Ophthalmology	0	In state provider	None	15 MAREBLU	STE 260	ALISO VIEJO	CA	92656	3056	30	06059	33.5729913	-117.703431	Orange County
30576	Fee-for-Service	1598800310	1598800310	1	1	ADAMS, SHARON R	12/3/2007	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1340 LAKE BLVD	None	DAVIS	CA	95616	2619	57	06113	38.55491538	-121.7876886	Yolo County
30611	Fee-for-Service	1306917430	1306917430	1	1	ARELLANO, ANDRES A MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	51229	41	Internal Medicine	0	In state provider	None	1425 W H ST	STE 380	OAKDALE	CA	95361	3592	50	06099	37.75771796	-120.8627767	Stanislaus County
30635	Fee-for-Service	1891349361	1891349361	1	1	A PLUS HOSPICE LLC	8/21/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5006 SUNRISE BLVD	SUITE 202	FAIR OAKS	CA	95628	4940	34	06067	38.656899	-121.2718365	Sacramento County
30637	Fee-for-Service	1801988142	1801988142	1	1	ABALOS, ARTURO Z MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	29922	41	Internal Medicine	0	In state provider	None	1004 14TH AVE	None	DELANO	CA	93215	2246	15	06029	35.77449518	-119.2451571	Kern County
30648	Fee-for-Service	1881669018	1881669018	1	1	ALAFRIZ, MANUEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	222 W THOMAS RD	STE 102	PHOENIX	AZ	85013	4493	00	None	33.480558	-112.077027	Maricopa County
30668	Fee-for-Service	1427290683	1427290683	1	1	APPEL, KIMBERLY K LMFT	6/13/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4405 RIVERSIDE DR	205	BURBANK	CA	91505	4072	19	06037	34.15222929	-118.3480509	Los Angeles County
30674	Fee-for-Service	1699795146	1699795146	1	1	AHWAH, IAN S MD	11/30/1989	207P00000X	NA	Other	026	PHYSICIANS	68731	None	None	0	In state provider	None	2000 VALE RD	None	SAN PABLO	CA	94806	3808	07	06013	37.95393251	-122.3375029	Contra Costa County
30677	Fee-for-Service	1790768083	1790768083	1	1	ANAHEIM TERRACE CARE CTR	8/15/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	141 S KNOTT AVE	None	ANAHEIM	CA	92804	1406	30	06059	33.83033105	-118.0109775	Orange County
30689	Fee-for-Service	1366693954	1366693954	1	1	ARBABI, ZARSHID MD	2/26/2020	207R00000X	NA	Other	026	PHYSICIANS	103009	41	Internal Medicine	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
30694	Fee-for-Service	1598236333	1598236333	2	1	AMPARO SENIOR CARE INC	6/29/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1029 BOULDER PLACE	None	OCEANSIDE	CA	92057	1957	37	06073	33.2731103	-117.2949451	San Diego County
30697	Fee-for-Service	1417464793	1417464793	1	1	A VISION OF HEALTH	3/1/2020	251K00000X	NA	Other	102	DIABETES PREVENTION PROGRAM SUPPLIER	-	-	NOT APPLICABLE	0	In state provider	None	17723 CHATSWORTH ST.	None	GRANADA HILLS	CA	91344	5604	19	06037	34.26490982	-118.5207003	Los Angeles County
30704	Fee-for-Service	1093072514	1093072514	1	1	ARJOMANDI, HAMID MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146571	04	Otology, Laryngology, Rhinology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
30743	Fee-for-Service	1366451619	1366451619	1	1	AHMAD, NAILA B MD	6/10/2020	207RR0500X	NA	Other	026	PHYSICIANS	149820	83	Rheumatology	0	In state provider	None	29798 HAUN RD	SUITE 301	MENIFEE	CA	92586	6542	33	06065	33.68787713	-117.1748638	Riverside County
30761	Fee-for-Service	1518263003	1518263003	1	1	AMA PHARMACY, INC.	2/24/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	27453 HESPERIAN BLVD.	None	HAYWARD	CA	94545	4258	01	06001	37.63036131	-122.0964867	Alameda County
30770	Fee-for-Service	1780621615	1780621615	1	1	ALBERS, SHERI L DO	9/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	10148	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
30775	Fee-for-Service	1104267848	1104267848	1	1	ALAMEDA COUNTY MEDICAL	10/30/2013	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	13855 E 14TH STREET	None	SAN LEANDRO	CA	94578	2611	01	06001	37.712385	-122.143428	Alameda County
30784	Fee-for-Service	1952787749	1952787749	1	1	ALLEN, MONICA C PSYD	11/30/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
30826	Fee-for-Service	1982899704	1982899704	1	1	AMINI, MOHAMMAD R MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130497	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
30827	Fee-for-Service	1801273529	1801273529	1	1	AAA SOCAL HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4730 WOODMAN AVE	SUITE 302A	SHERMAN OAKS	CA	91423	2400	19	06037	34.156701	-118.4312045	Los Angeles County
30832	Fee-for-Service	1235767781	1235767781	1	1	AL JUBOORI, MOHAMMED G MD	8/11/2023	207R00000X	NA	Other	026	PHYSICIANS	186522	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
30839	Fee-for-Service	1528118346	1528118346	1	1	AKANDA, MAHFUJA I MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88719	08	Family Practice	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95616	6325	57	06113	38.5399459	-121.7284328	Yolo County
30851	Fee-for-Service	1568251296	1568251296	1	1	ARARAT BOARD AND CARE INC	4/1/2025	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6614 TEESDALE AVENUE	None	NORTH HOLLYWOOD	CA	91606	1210	19	06037	34.19082984	-118.4081181	Los Angeles County
30856	Fee-for-Service	1285821223	1285821223	1	1	ABRAMS, GEOFFREY D MD	10/11/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	105050	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
30859	Fee-for-Service	1407451149	1407451149	1	1	AGBOOLA, ELIZABETH O AU	10/25/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	100 MOODY DRIVE	None	THOUSAND OAKS	CA	91360	6077	56	06111	34.17732532	-118.8654117	Ventura County
30873	Fee-for-Service	1891728697	1891728697	1	2	AEROFLOW INC.	8/25/2020	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	65 BEALE RD	None	ARDEN	NC	28704	9213	00	None	35.464761	-82.5278985	Buncombe County
30880	Fee-for-Service	1356963417	1356963417	1	1	ATALLA MEDICAL GROUP	9/1/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	557 N. MACLAY AVE	None	SAN FERNANDO	CA	91340	2424	19	06037	34.28872206	-118.4339388	Los Angeles County
30891	Fee-for-Service	1326672205	1326672205	1	1	ALTAMED HEALTH SERVICES CORP	5/4/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5417 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4101	19	06037	34.01967692	-118.1536948	Los Angeles County
30912	Fee-for-Service	1578719092	1578719092	1	1	ADES, VERONICA MD	7/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107790	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
30913	Fee-for-Service	1295760395	1295760395	1	1	ARIMIE, RALUCA MD	3/1/2001	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	54502	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1701 CESAR CHAVEZ AVENUE	#307	LOS ANGELES	CA	90033	0000	19	06037	34.05112725	-118.2173921	Los Angeles County
30922	Fee-for-Service	1891349361	1891349361	1	1	A PLUS HOSPICE LLC	8/21/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5006 SUNRISE BLVD	SUITE 202	FAIR OAKS	CA	95628	4940	34	06067	38.656899	-121.2718365	Sacramento County
30937	Fee-for-Service	1407995111	1407995111	1	1	ALBERSTONE, CARY D MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	76620	14	Neurological Surgery	0	In state provider	A PROFESSIONAL CORP	1700 N ROSE AVE	STE 220	OXNARD	CA	93030	7640	56	06111	34.21746	-119.155545	Ventura County
30939	Fee-for-Service	1063890945	1063890945	1	1	ALVA, JAMES P MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153244	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
30946	Fee-for-Service	1700869815	1700869815	1	1	APELLANES, MARINA L MD	5/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86035	40	Pediatrics	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
30956	Fee-for-Service	1760136840	1760136840	1	1	AFFINITY HEALTHCARE VENTURA	7/4/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	310 S WELLS RD	SUITE 207A	VENTURA	CA	93004	1356	56	06111	34.29236867	-119.1585633	Ventura County
30958	Fee-for-Service	1760680227	1760680227	1	1	AKANNO, JONATHAN E MD	3/31/1995	207R00000X	NA	Other	026	PHYSICIANS	61907	01	General Practice	0	In state provider	None	6408 PACIFIC BLVD	None	HUNTINGTON PARK	CA	90255	4104	19	06037	33.981309	-118.2251735	Los Angeles County
30985	Fee-for-Service	1417399742	1417399742	1	1	AMANATKAR, HAMID REZA MD	12/12/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	155209	36	Psychiatry	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
31011	Fee-for-Service	1699796813	1699796813	1	1	ABRAMS, SHIRZAD A MD INC	5/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	30870	20	Orthopedic Surgery	0	In state provider	None	16311 VENTURA BLVD	SUITE 1150	ENCINO	CA	91436	4307	19	06037	34.15706864	-118.4885978	Los Angeles County
31019	Fee-for-Service	1629465802	1629465802	1	1	ABU ANZA, OMAR MD	7/15/2024	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
31020	Fee-for-Service	1568132967	1568132967	1	1	ATHENS, JACQUELINE NP	3/14/2024	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
31028	Fee-for-Service	1114345709	1114345709	1	1	ALEXANDER, CURTIS LMFT	6/5/2019	390200000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
31036	Fee-for-Service	1548451297	1548451297	1	1	ALI, EHSAN MD	4/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99416	41	Internal Medicine	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
31066	Fee-for-Service	1104267848	1104267848	1	1	ALAMEDA COUNTY MEDICAL	7/1/2016	No Taxonomy Provided	NA	None	060	COUNTY HOSPITAL INPATIENT	-	-	NOT APPLICABLE	0	In state provider	CENTER	13855 E 14TH STREET	None	SAN LEANDRO	CA	94578	2611	01	06001	37.712385	-122.143428	Alameda County
31079	Fee-for-Service	1598786113	1598786113	1	1	ALI, ALI A S MD	2/8/2015	207ZP0102X	NA	Other	026	PHYSICIANS	26102	22	Pathology (M.D. only)	0	In state provider	None	3350 W BALL RD	None	ANAHEIM	CA	92804	3710	30	06059	33.8172623	-118.0071207	Orange County
31080	Fee-for-Service	1306599097	1306599097	1	1	ABRAHAM, DAWIT MD	2/28/2025	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
31086	Fee-for-Service	1366157026	1366157026	1	1	ANTHEM HOSPICE PROVIDERS INC	3/2/2023	No Taxonomy Provided	NA	None	093	CARE COORDINATOR AGENCIES (CCA)	-	-	NOT APPLICABLE	0	In state provider	None	850 S VIA LATA	SUITE 118	COLTON	CA	92324	3985	36	06071	34.05627205	-117.3068803	San Bernardino County
31092	Fee-for-Service	1427465061	1427465061	1	2	ALMQUIST, TAYLOR LCSW	11/25/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	473 E CARNEGIE DRIVE	200	SAN BERNARDINO	CA	92408	4201	36	06071	34.0683677	-117.2746246	San Bernardino County
31114	Fee-for-Service	1801273529	1801273529	1	1	AAA SOCAL HOSPICE INC	5/17/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4730 WOODMAN AVE	SUITE 302A	SHERMAN OAKS	CA	91423	2400	19	06037	34.156701	-118.4312045	Los Angeles County
31140	Fee-for-Service	1366467888	1366467888	1	1	ACHIN, ROWENA E MD	12/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
31171	Fee-for-Service	1770041717	1770041717	1	1	ALALADE, SIMISOLA M MD	7/1/2023	207P00000X	NA	Other	026	PHYSICIANS	183192	None	None	0	In state provider	None	1401 S GRANDE AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
31182	Fee-for-Service	1528294915	1528294915	1	1	AKAN, DENIZHAN H MD	7/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106840	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
31189	Fee-for-Service	1033173307	1033173307	2	1	ABU-EID, CHERINE A MD	6/12/2006	207L00000X	NA	Other	026	PHYSICIANS	93701	05	Anesthesiology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
31197	Fee-for-Service	1447609847	1447609847	1	1	ANTOGNINI, TAD MD	4/20/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164212	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
31214	Fee-for-Service	1083131445	1083131445	1	1	ACEBO, SAMUEL A CRNA	4/13/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2767 OLIVE HIGHWAY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
31217	Fee-for-Service	1821261405	1821261405	1	1	ABOUTALEB, ALI MD	7/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97416	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
31232	Fee-for-Service	1154687705	1154687705	1	1	ANTHONY, KEISHA LMFT	2/19/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
31242	Fee-for-Service	1447237375	1447237375	1	1	AZZIZ, RICARDO MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	86581	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
31256	Fee-for-Service	1154379436	1154379436	1	1	ANESTHESIOLOGISTS MEDICAL	1/1/1979	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP OF SAN FRANCISCO	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
31263	Fee-for-Service	1134975501	1134975501	1	1	ANCHORED2HOPE CORP.	5/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 N MOUNTAIN AVE	SUITE 219	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
31314	Fee-for-Service	1730649229	1730649229	1	1	ANIS, BUSHRA MD	7/28/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	179317	None	None	0	In state provider	None	9675 BRIGHTON WAY	SUITE 100	BEVERLY HILLS	CA	90210	5132	19	06037	34.06763711	-118.4052901	Los Angeles County
31343	Fee-for-Service	1427015593	1427015593	1	1	AHN, KYU D MD	8/1/1983	207R00000X	NA	Other	026	PHYSICIANS	35299	41	Internal Medicine	0	In state provider	None	1900 ROYALTY DR	STE 205	POMONA	CA	91767	3038	19	06037	34.07754346	-117.7463466	Los Angeles County
31361	Fee-for-Service	1306015425	1306015425	1	2	ALTAMED HEALTH SERVICES CORP	2/8/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	15791 BUSHARD STREET	None	WESTMINSTER	CA	92683	7455	30	06059	33.73308	-117.9634075	Orange County
31363	Fee-for-Service	1780743633	1780743633	1	1	ALCALA, WILLIAM	4/28/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9280 STOCKTON BLVD	SUITE 116	ELK GROVE	CA	95758	8073	34	06067	38.420235	-121.394961	Sacramento County
31385	Fee-for-Service	1821102294	1821102294	1	1	AMATO, THOMAS F MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	30136	45	Nephrology (Renal-Kidney)	0	In state provider	None	1210 INDIANA CT	None	REDLANDS	CA	92374	2896	36	06071	34.06831113	-117.2057559	San Bernardino County
31396	Fee-for-Service	1225248537	1225248537	1	1	ALFREDO GARCIA MD AND	11/5/2003	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	LILIANA CACERES MD PTRS	363 E ALMOND AVE	SUITE 105	MADERA	CA	93637	5753	20	06039	36.94556502	-120.0531318	Madera County
31411	Fee-for-Service	1073908869	1073908869	1	1	ALSHAMMAA, ABDULLAH MD	7/9/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	2000 SUTTER PLACE	None	DAVIS	CA	95616	6201	57	06113	38.56289303	-121.7715238	Yolo County
31427	Fee-for-Service	1700948684	1700948684	1	1	AGUILAR, MICHAEL M MD	4/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	78496	02	General Surgery	0	In state provider	None	79 SCRIPPS DR	STE 202	SACRAMENTO	CA	95825	6208	34	06067	38.572911	-121.4105085	Sacramento County
31436	Fee-for-Service	1376772913	1376772913	1	1	AIR, MARY E MD	12/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132455	25	Physical Medicine and Rehabilitation	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
31457	Fee-for-Service	1346690096	1346690096	1	1	ASGHAR, ELISE B MD	5/18/2022	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	153661	None	None	0	In state provider	None	208 CONCOURSE BLVD	STE 1	SANTA ROSA	CA	95403	8120	49	06097	38.51255309	-122.7884839	Sonoma County
31469	Fee-for-Service	1700210242	1700210242	1	1	ABDALI, NAHID OD	2/20/2014	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MINOR HALL	None	BERKELEY	CA	94720	0001	01	06001	37.87133398	-122.2545466	Alameda County
31492	Fee-for-Service	1871728089	1871728089	1	1	AVOLON, ZOE A LMFT	9/24/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4500 GLEN HAVEN RD	None	SOQUEL	CA	95073	9450	44	06087	37.00249836	-121.9427104	Santa Cruz County
31502	Fee-for-Service	1588620835	1588620835	1	1	ALL CARE HOME HEALTH	4/2/2003	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	& HOSPICE	100 W BROADWAY	STE 810	GLENDALE	CA	91210	1227	19	06037	34.14643795	-118.2564824	Los Angeles County
31518	Fee-for-Service	1609391333	1609391333	1	1	ALCALA, VERONICA A	11/30/2017	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1150 ORANGEBURG AVE	None	MODESTO	CA	95350	4240	50	06099	37.66396236	-121.0095829	Stanislaus County
31530	Fee-for-Service	1689068215	1689068215	1	1	ALEX STUDEMEISTER MD INC A P	11/15/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	77	Infectious Disease	0	In state provider	None	105 N BASCOM AVE	SUITE 202	SAN JOSE	CA	95128	1811	43	06085	37.325853	-121.932068	Santa Clara County
31531	Fee-for-Service	1851895288	1851895288	1	1	ALBAREE, DINA DO	12/15/2021	207R00000X	NA	Other	026	PHYSICIANS	17654	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
31535	Fee-for-Service	1346827326	1346827326	1	1	ARTOUNIAN SAVARANI, ARSINEH	3/1/2024	207R00000X	NA	Other	026	PHYSICIANS	20961	41	Internal Medicine	0	In state provider	DO	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
31553	Fee-for-Service	1609589803	1609589803	1	1	ANDRUS, MEGAN OT	12/30/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4211 B VALLEY VIEW AVE	None	NORCO	CA	92860	3502	33	06065	33.943446	-117.5498725	Riverside County
31554	Fee-for-Service	1487290136	1487290136	1	1	ALL COMFORT HOSPICE INC	8/4/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	25201 AVENUE TIBBITTS	STE 202	VALENCIA	CA	91355	3433	19	06037	34.42872823	-118.5738422	Los Angeles County
31569	Fee-for-Service	1871671354	1871671354	1	1	AMENT, ALAN S MD	7/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87649	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	99 MONTECELLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
31607	Fee-for-Service	1669892857	1669892857	1	1	AKINFENWA, TEMITAYO A MD	4/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144135	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
31626	Fee-for-Service	1851430805	1851430805	3	1	ALTA VIEW HEALTH CARE LLC	10/20/2021	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2939 ALTA VIEW DR.	STE. L	SAN DIEGO	CA	92139	3394	37	06073	32.67602072	-117.0390778	San Diego County
31630	Fee-for-Service	1861755290	1861755290	1	1	ARUNACHALAM, DIVYA MD	10/3/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	127135	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
31641	Fee-for-Service	1760718670	1760718670	1	1	ALICAWAY, EDGARDO G MD PC	11/24/2009	2084N0400X	NA	Neurology	026	PHYSICIANS	50500	13	Neurology (M.D. only)	0	In state provider	None	1800 SULLIVAN AVE	STE 508	DALY CITY	CA	94015	2225	41	06081	37.68077723	-122.4728941	San Mateo County
31649	Fee-for-Service	1306015425	1306015425	1	2	ALTAMED HEALTH SERVICES CORP	2/8/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	15791 BUSHARD STREET	None	WESTMINSTER	CA	92683	7455	30	06059	33.73308	-117.9634075	Orange County
31672	Fee-for-Service	1821102294	1821102294	1	1	AMATO, THOMAS F MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	30136	41	Internal Medicine	0	In state provider	None	1210 INDIANA CT	None	REDLANDS	CA	92374	2896	36	06071	34.06831113	-117.2057559	San Bernardino County
31688	Fee-for-Service	1831226208	1831226208	1	1	ARNOW, BRUCE A PHD	8/31/1986	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	525 UNIVERSITY AVE	STE 400	PALO ALTO	CA	94301	1903	43	06085	37.44861996	-122.1589531	Santa Clara County
31715	Fee-for-Service	1700948684	1700948684	1	1	AGUILAR, MICHAEL M MD	4/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	78496	66	Emergency Medicine (Urgent Care)	0	In state provider	None	79 SCRIPPS DR	STE 202	SACRAMENTO	CA	95825	6208	34	06067	38.572911	-121.4105085	Sacramento County
31724	Fee-for-Service	1376592576	1376592576	1	1	ABRAHAM JACOB M.D.	1/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
31733	Fee-for-Service	1376567776	1376567776	1	1	ALI, MIR T MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	45889	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2400 S FLOWER ST	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
31792	Fee-for-Service	1588620835	1588620835	1	1	ALL CARE HOME HEALTH	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	& HOSPICE	100 W BROADWAY	STE 810	GLENDALE	CA	91210	1227	19	06037	34.14643795	-118.2564824	Los Angeles County
31815	Fee-for-Service	1306885520	1306885520	1	1	ANTONIO MARTINEZ M.D.	10/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	877 JEFFERSON AVE	None	MEMPHIS	TN	38103	2807	00	None	35.14259562	-90.03187321	Shelby County
31841	Fee-for-Service	1467483198	1467483198	1	1	ABU-ZAHRA, KHALIL W MD	9/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90796	30	Radiology	0	In state provider	None	FRESNO & R STREETS	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
31842	Fee-for-Service	1487290136	1487290136	1	1	ALL COMFORT HOSPICE INC	8/4/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	25201 AVENUE TIBBITTS	STE 202	VALENCIA	CA	91355	3433	19	06037	34.42872823	-118.5738422	Los Angeles County
31860	Fee-for-Service	1134769086	1134769086	1	1	ADVENTIST HEALTH PHYSICIANS	8/13/2020	207X00000X	NA	Orthopedic Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1235 W VINE ST	22	LODI	CA	95240	5144	39	06077	38.12279179	-121.2879362	San Joaquin County
31887	Fee-for-Service	1073918561	1073918561	1	1	AVILES, KATHIA S LMFT	10/17/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
31900	Fee-for-Service	1427735646	1427735646	1	1	AV INTENSIVIST GROUP INC	9/28/2023	207RC0200X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
31989	Fee-for-Service	1356600290	1356600290	1	1	ABRAHAM, BERIL V MD	7/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139777	05	Anesthesiology	0	In state provider	None	400 N PEPPER AVE	2ND FLOOR ANESTHESIA	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
31990	Fee-for-Service	1568540144	1568540144	1	1	ATHAVALE, NITIN S MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	81707	30	Radiology	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
32018	Fee-for-Service	1376567776	1376567776	1	1	ALI, MIR T MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	45889	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2400 S FLOWER ST	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
32039	Fee-for-Service	1780116186	1780116186	1	1	ABAYA, HAZEL B MD	5/24/2021	207R00000X	NA	Other	026	PHYSICIANS	169439	None	None	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
32050	Fee-for-Service	1194344721	1194344721	1	1	AU-YEUNG, ALVIN	9/27/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22665	08	Family Practice	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
32060	Fee-for-Service	1629522701	1629522701	1	1	AMARILLAS, ASHLEY N LMFT	4/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
32068	Fee-for-Service	1588050843	1588050843	1	1	ALIDINA, JASIM A MD	8/9/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	119 S LOCUST ST	STE B	VISALIA	CA	93291	6251	54	06107	36.329382	-119.2937355	Tulare County
32089	Fee-for-Service	1669526760	1669526760	1	1	ALTERMAN, DANNY PHD	10/23/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
32096	Fee-for-Service	1548219140	1548219140	1	1	AFRASIABI, SHIRIN MD	2/14/2024	207R00000X	NA	Other	026	PHYSICIANS	54306	None	None	0	In state provider	None	4950 BARRANCA PKWY	308	IRVINE	CA	92604	4671	30	06059	33.67620851	-117.7948348	Orange County
32130	Fee-for-Service	1679788723	1679788723	1	1	AZADI, MEHDI MD	10/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103058	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
32148	Fee-for-Service	1669564621	1669564621	1	1	ARZANI, SHEILA MD	5/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	79262	None	None	0	In state provider	None	2221 LINCOLN BLVD	STE 200	SANTA MONICA	CA	90405	1320	19	06037	34.00977424	-118.479803	Los Angeles County
32157	Fee-for-Service	1417614462	1417614462	1	1	ALBANO, LILIBETH M NP	11/3/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
32192	Fee-for-Service	1609019207	1609019207	1	1	ALLEWELT, HEATHER B MD	10/6/2020	2080P0207X	NA	Hematology	026	PHYSICIANS	170218	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
32194	Fee-for-Service	1831120070	1831120070	1	1	ARCIAGA, PEREGRINA L MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	72467	05	Anesthesiology	0	In state provider	None	12021 S WILMINGTON AVE	None	LOS ANGELES	CA	90059	3019	19	06037	33.922575	-118.2391785	Los Angeles
32198	Fee-for-Service	1205925484	1205925484	1	1	ASH, RIMA S MD	4/4/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	101286	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
32245	Fee-for-Service	1154502433	1154502433	1	1	AGREEN, SCOTT J LMFT	10/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1274 CENTER COURT DRIVE	SUITE 107	COVINA	CA	91724	3668	19	06037	34.07278979	-117.8637519	Los Angeles County
32274	Fee-for-Service	1710933718	1710933718	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	1	Border provider	None	5500 S 6TH ST	None	KLAMATH FALLS	OR	97603	5104	00	None	42.20643193	-121.7207085	Klamath County
32388	Fee-for-Service	1609817337	1609817337	1	1	ALPER, MARINA Y MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	53855	40	Pediatrics	0	In state provider	None	3528 E SHIELDS AVE	STE 101	FRESNO	CA	93726	6909	10	06019	36.7794507	-119.7655434	Fresno County
32389	Fee-for-Service	1225543424	1225543424	1	1	ALFARO, MARTIN LCSW	2/25/2025	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
32428	Fee-for-Service	1144284290	1144284290	1	1	AULD, RICHARD M MD	2/8/2015	174400000X	NA	Other	026	PHYSICIANS	35764	None	None	0	In state provider	None	1200 SONOMA AVE	STE 1	SANTA ROSA	CA	95405	6664	49	06097	38.440854	-122.6985165	Sonoma County
32429	Fee-for-Service	1174252852	1174252852	1	1	ALLEVIATE CARE INLAND VALLEY	6/1/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	LLC	3770 MYERS STREET	None	RIVERSIDE	CA	92503	4279	33	06065	33.91784703	-117.4498636	Riverside County
32442	Fee-for-Service	1205368826	1205368826	1	1	AZHIR, RAMIN MD	7/2/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	163697	40	Pediatrics	0	In state provider	None	726 MEDICAL CENTER DR E	STE 205	CLOVIS	CA	93611	6809	10	06019	36.84186593	-119.6624867	Fresno County
32478	Fee-for-Service	1801039615	1801039615	1	1	AVISE, JENNIFER A MD	5/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137711	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
32485	Fee-for-Service	1538395017	1538395017	1	2	ABRASS, ANDREW G MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89521	3861	00	None	39.52483792	-119.7968314	Washoe County
32487	Fee-for-Service	1245508159	1245508159	1	1	ADSUMILLI, JYOTHI MD	4/1/2018	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	143924	41	Internal Medicine	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1019	38	06075	37.7738933	-122.4544685	San Francisco County
32488	Fee-for-Service	1295202943	1295202943	1	3	ANTHONY BENIGNO, PSYD., PSYC	3/5/2024	163WM0705X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	16465 SIERRA LAKES PKWY	SUITE 140	FONTANA	CA	92336	1242	36	06071	34.13805177	-117.4457839	San Bernardino County
32490	Fee-for-Service	1124279393	1124279393	1	1	AQUATIC PHYSICAL THERAPY OF	3/15/2011	193400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	PALM DESERT INC	74399 HIGHWAY 111	None	PALM DESERT	CA	92260	1901	33	06065	33.72105633	-116.3666458	Riverside County
32515	Fee-for-Service	1750681656	1750681656	1	1	APPLEBY, EVELINA S MD	1/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121307	None	None	0	In state provider	None	2110 N BELLFLOWER AVENUE	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
32517	Fee-for-Service	1679611495	1679611495	1	1	AFONIN, FRANCES LMFT	9/16/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
32569	Fee-for-Service	1861606527	1861606527	1	1	AMY C ROMEY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
32583	Fee-for-Service	1336168418	1336168418	1	2	ANCONA-YOUNG, CORINNE DO	1/5/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	6337	08	Family Practice	0	In state provider	None	8881 FLETCHER PKWY	STE 205	LA MESA	CA	91942	3187	37	06073	32.78442148	-117.0073814	San Diego County
32591	Fee-for-Service	1154736429	1154736429	1	23	AVENAL COMMUNITY HEALTH CENT	5/5/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1000 SKYLINE BLVD	SUITE A	AVENAL	CA	93024	1850	16	06031	36.00790722	-120.1216067	Kings County
32614	Fee-for-Service	1710093000	1710093000	1	1	APPLEWHITE, LIAT MD	7/28/2022	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	179749	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
32639	Fee-for-Service	1659982130	1659982130	1	1	ANAYA WOMEN'S OB/GYN GROUP	12/30/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	None	18056 WIKA RD	B	APPLE VALLEY	CA	92307	2194	36	06071	34.54061851	-117.2701017	San Bernardino County
32656	Fee-for-Service	1467702647	1467702647	1	1	AMSHOFF, KERRY L CCC-SLP	8/22/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
32660	Fee-for-Service	1437108420	1437108420	1	1	AMY E LACROIX, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	988095 NEBRASKA MEDICAL	None	OMAHA	NE	68198	0000	00	None	0	0	None
32681	Fee-for-Service	1699096842	1699096842	2	2	ACARIAHEALTH PHARMACY 14 INC	3/17/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4151 COMMERCE	None	SACRAMENTO	CA	95834	9679	34	06067	38.646405	-121.523265	Sacramento County
32703	Fee-for-Service	1144859927	1144859927	1	1	ABEL, BRITTANY T MD	7/18/2023	207R00000X	NA	Other	026	PHYSICIANS	186867	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
32715	Fee-for-Service	1720136732	1720136732	1	1	ARMEDILLA, ANNA L MD	12/3/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	61034	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
32718	Fee-for-Service	1174252852	1174252852	1	1	ALLEVIATE CARE INLAND VALLEY	6/1/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	LLC	3770 MYERS STREET	None	RIVERSIDE	CA	92503	4279	33	06065	33.91784703	-117.4498636	Riverside County
32726	Fee-for-Service	1629656095	1629656095	1	1	ARASTEH, LIYAN	9/10/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4255 CAMPUS DR.	SUITE A110	IRVINE	CA	92612	8627	30	06059	33.64910596	-117.8394276	Orange County
32762	Fee-for-Service	1841663945	1841663945	1	1	AUSTIN, JENNIFER	3/18/2025	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8731 W PICO BLVD	None	LOS ANGELES	CA	90035	2205	19	06037	34.05456946	-118.3824636	Los Angeles County
32777	Fee-for-Service	1295202943	1295202943	1	3	ANTHONY BENIGNO, PSYD., PSYC	6/5/2024	163WM0705X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	16465 SIERRA LAKES PKWY	SUITE 140	FONTANA	CA	92336	1242	36	06071	34.13805177	-117.4457839	San Bernardino County
32782	Fee-for-Service	1437539129	1437539129	1	1	ALSHEBEEB, KUTAIBA T MD	11/7/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176173	None	None	0	In state provider	None	455 N ROXBURY DR	None	BEVERLY HILLS	CA	90210	5001	19	06037	34.06807822	-118.4069809	Los Angeles County
32808	Fee-for-Service	1194354837	1194354837	1	1	ATARI, EALLA MD	11/18/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	186680	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
32821	Fee-for-Service	1730551607	1730551607	1	1	ANSARI, ASHKON M MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138896	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
32830	Fee-for-Service	1043457005	1043457005	1	1	ARORA, TARANDEEP S MD	5/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137266	None	None	0	In state provider	None	525 WEST ACACIA STREET	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
32855	Fee-for-Service	1891952099	1891952099	1	1	AARON WYSE	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9003 E SHEA BLVD	None	SCOTTSDALE	AZ	85260	6709	00	None	33.580377	-111.88548	Maricopa County
32879	Fee-for-Service	1154736429	1154736429	1	23	AVENAL COMMUNITY HEALTH CENT	5/5/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1000 SKYLINE BLVD	SUITE A	AVENAL	CA	93024	1850	16	06031	36.00790722	-120.1216067	Kings County
32882	Fee-for-Service	1881666055	1881666055	1	1	AKINS, ROGER S DO	8/3/2020	2080P0006X	NA	Psychiatry	026	PHYSICIANS	18160	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
32885	Fee-for-Service	1316947864	1316947864	2	1	ACCENTCARE HOME HEALTH OF	1/12/2010	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	2295 GATEWAY OAKS	STE 125	SACRAMENTO	CA	95833	5888	34	06067	38.608479	-121.5130365	Sacramento County
32905	Fee-for-Service	1104582550	1104582550	1	1	AMERICAN STANDARD HOME	10/7/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH	7335 TOPANGA CANYON BLVD	STE 202	CANOGA PARK	CA	91303	3393	19	06037	34.20396	-118.6059855	Los Angeles County
32923	Fee-for-Service	1851709406	1851709406	1	1	ASHOK, NAGASAMUDRA S MD INC	2/3/2016	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1520 N MOUNTAIN AVE	BLDG F STE 128	ONTARIO	CA	91762	1132	36	06071	34.085925	-117.669564	San Bernardino County
32928	Fee-for-Service	1851498687	1851498687	1	1	ABRAHAM, REENI A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
32938	Fee-for-Service	1346481769	1346481769	1	1	ANGHELESCU, DAN S MD	4/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113305	30	Radiology	0	In state provider	None	1524 MCHENRY AVE	None	MODESTO	CA	95350	4566	50	06099	37.666233	-120.993933	Stanislaus County
33015	Fee-for-Service	1265963656	1265963656	1	1	ADAMS, CURTIS T MD	8/1/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	179314	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
33022	Fee-for-Service	1568814630	1568814630	1	1	APPLE PHARMACY INC	12/27/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	23141 MOULTON PKWY	STE 107	LAGUNA HILLS	CA	92653	1241	30	06059	33.62613379	-117.7305831	Orange County
33059	Fee-for-Service	1982990859	1982990859	1	1	ALTAMED HEALTH SREVICES CORP	12/14/2011	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3820 MARTIN LUTHER KING	JR BLVD	LYNWOOD	CA	90262	3625	19	06037	33.92760854	-118.1976943	Los Angeles County
33065	Fee-for-Service	1295202943	1295202943	1	3	ANTHONY BENIGNO, PSYD., PSYC	3/5/2024	163WM0705X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	16465 SIERRA LAKES PKWY	SUITE 140	FONTANA	CA	92336	1242	36	06071	34.13805177	-117.4457839	San Bernardino County
33107	Fee-for-Service	1427163393	1427163393	1	1	ABIEZZI, SALWAN S MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	61136	41	Internal Medicine	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
33111	Fee-for-Service	1780668798	1780668798	1	1	ABBOTT, KENT D MD	9/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
33126	Fee-for-Service	1336297795	1336297795	1	1	AHRAM, ABDULLAH A MD	5/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97522	40	Pediatrics	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
33144	Fee-for-Service	1215031216	1215031216	1	1	ACEVES, JOSE A MD	3/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	48529	08	Family Practice	0	In state provider	None	14609 WHITTIER BLVD	None	WHITTIER	CA	90605	1723	19	06037	33.95222875	-118.0132682	Los Angeles County
33146	Fee-for-Service	1396714184	1396714184	1	1	AKERMAN, ALLAN MD	12/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91309	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1310 W STEWART DR	STE 311	ORANGE	CA	92868	3838	30	06059	33.78236048	-117.8664975	Orange County
33175	Fee-for-Service	1487064127	1487064127	1	1	AZAD, ALI MD	7/18/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	141008	20	Orthopedic Surgery	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
33210	Fee-for-Service	1851709406	1851709406	1	1	ASHOK, NAGASAMUDRA S MD INC	2/3/2016	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1520 N MOUNTAIN AVE	BLDG F STE 128	ONTARIO	CA	91762	1132	36	06071	34.085925	-117.669564	San Bernardino County
33221	Fee-for-Service	1326486770	1326486770	1	1	ARONIN, RYAN MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140195	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
33232	Fee-for-Service	1639490121	1639490121	1	1	AURIGEMMA, KRISTEN D MD	10/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150939	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
33241	Fee-for-Service	1467475806	1467475806	1	1	ASPEN MEDICAL CLINIC INC	8/25/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2219	36	06071	34.5406159	-117.2658221	San Bernardino County
33242	Fee-for-Service	1124404207	1124404207	1	1	AKINTUNJI, KEHINDE T NP	10/31/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
33258	Fee-for-Service	1306228945	1306228945	1	1	AHLERING, HALEY L CRNA	1/29/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 N PEPPER AVE	ANESTHESIA DEPT, 2ND FLR	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
33269	Fee-for-Service	1689126278	1689126278	1	1	ANDERSON, GINA NP	7/5/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3701 J STREET	SUITE 109	SACRAMENTO	CA	95815	5542	34	06067	38.571237	-121.4566245	Sacramento County
33275	Fee-for-Service	1396176160	1396176160	1	1	ALAMEDA HEALTH SYSTEM	5/1/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2070 CLINTON AVENUE	None	ALAMEDA	CA	94501	4399	01	06001	37.76333626	-122.253868	Alameda County
33299	Fee-for-Service	1306877071	1306877071	1	1	ALAMGIR, SHAMSUDDIN MD	9/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89093	41	Internal Medicine	0	In state provider	None	1793 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.5941999	-122.3830625	San Mateo County
33321	Fee-for-Service	1942692439	1942692439	1	1	A.C. ADDERSON HEALTHCARE, IN	9/15/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	C.	1267 ENTERPRISE CT	None	CORONA	CA	92882	7126	33	06065	33.88429233	-117.5874457	Riverside County
33339	Fee-for-Service	1366635534	1366635534	1	1	ABU-QAOUD, MOHAMED S MD	8/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107737	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
33352	Fee-for-Service	1295202943	1295202943	1	3	ANTHONY BENIGNO, PSYD., PSYC	3/5/2024	163WM0705X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	16465 SIERRA LAKES PKWY	SUITE 140	FONTANA	CA	92336	1242	36	06071	34.13805177	-117.4457839	San Bernardino County
33391	Fee-for-Service	1114566551	1114566551	1	1	ANCHETA, TIFFANY H OT	4/25/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1251 E DYER RD	SUITE 150	SANTA ANA	CA	92705	5662	30	06059	33.70870351	-117.8551005	Orange County
33397	Fee-for-Service	1467638064	1467638064	1	2	ADVANCED IMAGING CENTER	4/7/2008	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	43731 N 15TH ST WEST	None	LANCASTER	CA	93534	4785	19	06037	34.67731742	-118.1564784	Los Angeles County
33402	Fee-for-Service	1679522270	1679522270	1	1	AZMY, KAMEL M MD	4/13/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	42474	40	Pediatrics	0	In state provider	None	1535 W MERCED AVE	STE 300	WEST COVINA	CA	91790	3404	19	06037	34.06295577	-117.9482872	Los Angeles County
33412	Fee-for-Service	1285999060	1285999060	1	1	ALGAZE-GONZALES, ISABEL M MD	7/11/2017	207PE0004X	NA	Other	026	PHYSICIANS	149317	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
33413	Fee-for-Service	1821289794	1821289794	1	1	ALGAZI, ALAIN P MD	6/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93703	68	Hematology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
33432	Fee-for-Service	1245558725	1245558725	1	1	ASUZUKI, RYO MD	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
33434	Fee-for-Service	1548410657	1548410657	1	1	ANGELOS, GEORGE C MD	8/16/2021	208600000X	NA	General Surgery	026	PHYSICIANS	167779	None	None	0	In state provider	None	2656 EDITH AVE	STE B	REDDING	CA	96001	3030	45	06089	40.57073094	-122.3974088	Shasta County
33459	Fee-for-Service	1265510820	1265510820	1	1	ALPERN, MARY J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39315	01	General Practice	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
33530	Fee-for-Service	1720460090	1720460090	1	1	ALLAN, ANNIE LAURIE DO	6/1/2023	208600000X	NA	General Surgery	026	PHYSICIANS	20459	None	None	0	In state provider	None	3630 E. IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
33559	Fee-for-Service	1598366601	1598366601	1	1	ANAIAH HOSPICE CARE INC	3/13/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5006 SUNRISE BLVD	STE 105	FAIR OAKS	CA	95628	4940	34	06067	38.656899	-121.2718365	Sacramento County
33584	Fee-for-Service	1902942543	1902942543	1	1	ASHLEY, WILLIAM E MD INC	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	33313	30	Radiology	0	In state provider	None	345 S HALCYON RD	None	ARROYO GRANDE	CA	93420	3896	40	06079	35.113419	-120.5915945	San Luis Obispo County
33596	Fee-for-Service	1043826811	1043826811	1	1	AVIVA HOSPICE INC	8/4/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	255 N D ST	STE 219	SAN BERNARDINO	CA	92401	1713	36	06071	34.1036709	-117.291874	San Bernardino County
33624	Fee-for-Service	1154401149	1154401149	1	1	ADDONIZIO, ORNELLA MD	4/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54305	36	Psychiatry	0	In state provider	None	1425 MONTGOMERY STREET	None	RED BLUFF	CA	96080	4605	52	06103	40.157883	-122.2250685	Tehama County
33636	Fee-for-Service	1437555422	1437555422	1	1	ADVENTIST HEALTH PHYSICIANS	2/6/2019	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	6 WOODLAND RD	STE 104	SAINT HELENA	CA	94574	9501	28	06055	38.54297115	-122.4754501	Napa County
33702	Fee-for-Service	1316955446	1316955446	1	1	AL-QURAINI, TALAL A MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	61433	41	Internal Medicine	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
33705	Fee-for-Service	1275523375	1275523375	1	1	AFFELDT, J0HN CHARLES MD	5/31/1986	207W00000X	NA	Ophthalmology	026	PHYSICIANS	38490	18	Ophthalmology	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
33709	Fee-for-Service	1821289794	1821289794	1	1	ALGAZI, ALAIN P MD	6/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	93703	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
33714	Fee-for-Service	1538356969	1538356969	1	1	ACKLAND, GARETH MD	1/11/2008	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
33722	Fee-for-Service	1245558725	1245558725	1	1	ASUZUKI, RYO MD	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
33725	Fee-for-Service	1295943132	1295943132	1	1	ABAID, LISA N MD	9/11/2008	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	104885	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	351 HOSPITAL RD	STE 507	NEWPORT BEACH	CA	92663	3500	30	06059	33.62579141	-117.9299554	Orange County
33749	Fee-for-Service	1407240831	1407240831	1	1	ASATRYAN, ALIS MD	9/13/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	164829	09	Gynecology (D.O. only)	0	In state provider	None	1941 JOHNSON AVE	STE 301	SAN LUIS OBISPO	CA	93401	4175	40	06079	35.27804785	-120.649711	San Luis Obispo County
33758	Fee-for-Service	1487688198	1487688198	1	1	ADAMS, SPENCER R MD	9/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86851	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	STE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
33801	Fee-for-Service	1932209905	1932209905	1	1	ALSTON, VICKIE CNMW	11/1/2001	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	37	06073	33.14066871	-117.156095	San Diego County
33806	Fee-for-Service	1154599546	1154599546	1	1	AYALON, ROY D MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102319	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4000 14TH ST	STE 401	RIVERSIDE	CA	92501	4010	33	06065	33.97771007	-117.3818381	Riverside County
33807	Fee-for-Service	1396143830	1396143830	1	1	APOLONIO, MARCOS M LCSW	4/18/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
33813	Fee-for-Service	1417150715	1417150715	1	1	AYAD, AMIRA N MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	105810	08	Family Practice	0	In state provider	None	655 S CENTRAL VALLEY HWY	None	SHAFTER	CA	93263	2790	15	06029	35.49504475	-119.264496	Kern County
33817	Fee-for-Service	1548034069	1548034069	1	1	ALVAREZ, FABIOLA AU	12/29/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	41	06081	37.48948529	-122.2232468	San Mateo County
33849	Fee-for-Service	1598366601	1598366601	1	1	ANAIAH HOSPICE CARE INC	3/13/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5006 SUNRISE BLVD	STE 105	FAIR OAKS	CA	95628	4940	34	06067	38.656899	-121.2718365	Sacramento County
33883	Fee-for-Service	1043826811	1043826811	1	1	AVIVA HOSPICE INC	8/4/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	255 N D ST	STE 219	SAN BERNARDINO	CA	92401	1713	36	06071	34.1036709	-117.291874	San Bernardino County
33902	Fee-for-Service	1184718454	1184718454	1	1	ALBERICO, MICHAEL A DPM	3/31/1990	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	4346 COGSWELL RD	None	EL MONTE	CA	91732	2016	19	06037	34.08075002	-118.0100117	Los Angeles County
33911	Fee-for-Service	1902492937	1902492937	1	1	ALLEVIATE HOSPICE CARE INC	11/18/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	13098 BORDEN AVE	None	SYLMAR	CA	91342	4211	19	06037	34.30818122	-118.4439655	Los Angeles County
33914	Fee-for-Service	1689856239	1689856239	1	1	ABBONA, PABLO J MD	3/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101673	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
33917	Fee-for-Service	1487257549	1487257549	1	1	AYVA HOME HEALTH SERVICES	5/18/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	20944 SHERMAN WAY	STE 209	CANOGA PARK	CA	91303	3642	19	06037	34.20095151	-118.5900435	Los Angeles County
33990	Fee-for-Service	1316955446	1316955446	1	1	AL-QURAINI, TALAL A MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	61433	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
34008	Fee-for-Service	1306837067	1306837067	1	1	ALDEN, ELIZABETH S PHD	3/1/1987	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	22 W MICHELTORENA ST	STE D	SANTA BARBARA	CA	93101	6523	42	06083	34.4255722	-119.7090178	Santa Barbara County
34013	Fee-for-Service	1295943132	1295943132	1	1	ABAID, LISA N MD	9/11/2008	207VX0201X	NA	Obstetrics & Gynecology	026	PHYSICIANS	104885	78	Neoplastic Diseases/Oncology	0	In state provider	None	351 HOSPITAL RD	STE 507	NEWPORT BEACH	CA	92663	3500	30	06059	33.62579141	-117.9299554	Orange County
34027	Fee-for-Service	1376868208	1376868208	1	1	ADAMS, KENNETH W II MD	8/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1409 E LAKE MEAD BLVD	None	N LAS VEGAS	NV	89030	7120	00	None	36.19579448	-115.1228925	Clark County
34038	Fee-for-Service	1407240831	1407240831	1	1	ASATRYAN, ALIS MD	9/13/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	164829	15	Obstetrics (D.O. only)	0	In state provider	None	1941 JOHNSON AVE	STE 301	SAN LUIS OBISPO	CA	93401	4175	40	06079	35.27804785	-120.649711	San Luis Obispo County
34041	Fee-for-Service	1154352755	1154352755	2	1	AMD HEALTH CARE SERVICES	12/1/2010	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	3911 LONG BEACH BLVD	SUITE B	LONG BEACH	CA	90807	2614	19	06037	33.829398	-118.1893795	Los Angeles County
34043	Fee-for-Service	1902004245	1902004245	1	1	ADACHI, NANCY Y	4/5/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
34054	Fee-for-Service	1023116563	1023116563	1	1	AGGARWAL, RESHMA G MD	3/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	77615	40	Pediatrics	0	In state provider	None	2600 REDONDO AVENUE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
34087	Fee-for-Service	1497375331	1497375331	1	1	ALTAMEEMI, LINA MD	9/3/2024	207R00000X	NA	Other	026	PHYSICIANS	192496	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
34090	Fee-for-Service	1093809329	1093809329	1	1	ALLSHOUSE, MICHAEL J DO	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	4992	40	Pediatrics	0	In state provider	None	3707 E SHIELDS AVE	None	FRESNO	CA	93726	7029	10	06019	36.77969052	-119.7632025	Fresno County
34108	Fee-for-Service	1972751915	1972751915	1	1	AYE, SAW W MD	2/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105329	41	Internal Medicine	0	In state provider	None	104 LYNCH CREEK WAY	STE 10	PETALUMA	CA	94954	2355	49	06097	38.25218808	-122.6339241	Sonoma County
34128	Fee-for-Service	1356971964	1356971964	1	1	ASTREA HOSPICE INC	3/1/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2701 E CHAPMAN AVE	STE 209	FULLERTON	CA	92831	3750	30	06059	33.87433652	-117.882207	Orange County
34155	Fee-for-Service	1790177582	1790177582	1	10	ALTAMED HEALTH SERVICES	11/2/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1595 N LAKE AVENUE	None	PASADENA	CA	91104	2307	19	06037	34.17333013	-118.1320829	Los Angeles County
34172	Fee-for-Service	1861627259	1861627259	1	1	ADRIAN D LAUGHLIN CPO	8/30/2010	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	591 E TENTH AVE	None	CHICO	CA	95926	2353	04	06007	39.75048145	-121.8450592	Butte County
34190	Fee-for-Service	1992836233	1992836233	1	1	ALVAREZ, ARMANDO MD	1/24/2022	261QU0200X	NA	Other	026	PHYSICIANS	63146	None	None	0	In state provider	None	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	15	06029	35.3687456	-119.1106561	Kern County
34200	Fee-for-Service	1902492937	1902492937	1	1	ALLEVIATE HOSPICE CARE INC	11/18/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	13098 BORDEN AVE	None	SYLMAR	CA	91342	4211	19	06037	34.30818122	-118.4439655	Los Angeles County
34202	Fee-for-Service	1982651568	1982651568	1	1	AMADOR EYE CARE ASSOCIATES	8/11/2014	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRY	10 BRYSON DR	None	SUTTER CREEK	CA	95685	4118	03	06005	38.38296339	-120.8055258	Amador County
34217	Fee-for-Service	1366590150	1366590150	1	1	ALBIN, MERLE A MD	2/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	41063	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
34221	Fee-for-Service	1326317983	1326317983	2	1	AMERICAN HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	120 S VICTORY BLVD	SUITE 205	BURBANK	CA	91502	2899	19	06037	34.17305012	-118.3162651	Los Angeles County
34269	Fee-for-Service	1073630596	1073630596	1	1	ADEPT HOME HEALTH SERVICES,	2/9/2015	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	818 N MOUNTAIN AVE	SUITE 120	UPLAND	CA	91786	4164	36	06071	34.10424442	-117.6701797	San Bernardino County
34308	Fee-for-Service	1407200553	1407200553	1	1	AL-KHOUJA, LUTFI T MD	9/24/2021	208600000X	NA	General Surgery	026	PHYSICIANS	151067	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
34346	Fee-for-Service	1194746826	1194746826	1	1	AB HARRIS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 WEST 8TH AVE	None	SPOKANE	WA	99205	0000	00	None	47.647989	-117.4112415	Spokane County
34359	Fee-for-Service	1417121286	1417121286	1	1	ALAN RAY TRUMBLY D.O.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2300 MARIE CURIEBLVD	None	GARLAND	TX	75042	5706	00	None	32.9186373	-96.66206625	Dallas County
34368	Fee-for-Service	1063443232	1063443232	1	1	ALGREN, DOUGLAS A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2310 HOLMES ST	STE 800	KANSAS CITY	MO	64108	2602	00	None	39.08432765	-94.57585309	Jackson County
34371	Fee-for-Service	1467656611	1467656611	1	1	ATILLO, QUEENIE A OT	9/10/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1680-D E ROSEVILLE PKWY	BLDG D, UNIT 110	ROSEVILLE	CA	95661	3988	31	06061	38.74724349	-121.2374438	Placer County
34379	Fee-for-Service	1093809329	1093809329	1	1	ALLSHOUSE, MICHAEL J DO	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	4992	02	General Surgery	0	In state provider	None	3707 E SHIELDS AVE	None	FRESNO	CA	93726	7029	10	06019	36.77969052	-119.7632025	Fresno County
34401	Fee-for-Service	1982844783	1982844783	1	1	ASPEY, BRAD S MD	7/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	112310	20	Orthopedic Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
34403	Fee-for-Service	1396985842	1396985842	1	1	AQUINO, GLEN A MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105808	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
34413	Fee-for-Service	1356971964	1356971964	1	1	ASTREA HOSPICE INC	3/1/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2701 E CHAPMAN AVE	STE 209	FULLERTON	CA	92831	3750	30	06059	33.87433652	-117.882207	Orange County
34439	Fee-for-Service	1255490918	1255490918	1	1	ACKERSON, BRADLEY K MD	4/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	51307	None	None	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
34441	Fee-for-Service	1942265954	1942265954	1	1	ALEXANDRA MARION MOLNAR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	None	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
34442	Fee-for-Service	1790177582	1790177582	1	10	ALTAMED HEALTH SERVICES	11/2/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1595 N LAKE AVENUE	None	PASADENA	CA	91104	2307	19	06037	34.17333013	-118.1320829	Los Angeles County
34462	Fee-for-Service	1083887202	1083887202	1	1	ADVANCED FAMILY PRACTICE	3/15/2011	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	73928	08	Family Practice	0	In state provider	SPECIALTY INC	4950 BARRANCA PKWY	STE 111	IRVINE	CA	92064	1719	30	06059	33.67620851	-117.7948348	Orange County
34469	Fee-for-Service	1073630588	1073630588	1	1	AGRAWAL, BELLA G MD	4/22/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	85202	01	General Practice	0	In state provider	None	1675 ALHAMBRA BLVD	STE B	SACRAMENTO	CA	95816	7047	34	06067	38.563983	-121.4679915	Sacramento County
34476	Fee-for-Service	1013067818	1013067818	1	1	ADAMS, SCOTT W MD	5/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87654	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
34483	Fee-for-Service	1174563779	1174563779	1	1	ANDREWS COUNTY HOSPITAL	4/3/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	720 HOSPITAL DR	None	ANDREWS	TX	79714	3617	00	None	32.33704061	-102.5459699	Andrews County
34485	Fee-for-Service	1104068519	1104068519	1	1	ANDERSON-DAM, JOHN L MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124191	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
34505	Fee-for-Service	1023895802	1023895802	1	1	ADRIANNE AVERBUKH A LICENSED	10/2/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CLINICAL SOCIAL WORKER	1714 IVAR AVE	SUITE D	LOS ANGELES	CA	90028	5124	19	06037	34.10240755	-118.3281352	Los Angeles County
34515	Fee-for-Service	1326317983	1326317983	2	1	AMERICAN HOSPICE INC	9/22/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	120 S VICTORY BLVD	SUITE 205	BURBANK	CA	91502	2899	19	06037	34.17305012	-118.3162651	Los Angeles County
34554	Fee-for-Service	1104971217	1104971217	1	1	ANTHONY, ODILIA F MD	10/8/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	108073	08	Family Practice	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
34555	Fee-for-Service	1841507506	1841507506	1	1	ASHOURI, JUDITH F MD	8/11/2011	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	109504	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
34574	Fee-for-Service	1205085347	1205085347	1	1	AYE, MYA M MD	12/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105373	41	Internal Medicine	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
34618	Fee-for-Service	1225593312	1225593312	1	1	ADVENTIST HEALTH PHYSICIANS	5/8/2019	207RP1001X	NA	Pulmonology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	232 HOSPITAL DR STE A	None	UKIAH	CA	95482	4562	23	06045	39.15171863	-123.2035462	Mendocino County
34639	Fee-for-Service	1376729483	1376729483	1	1	ACCENTCARE HOME HEALTH	12/1/2006	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA, INC	2934 E GARVEY AVE S	STE 210	WEST COVINA	CA	91791	2190	19	06037	34.07157499	-117.8836824	Los Angeles County
34663	Fee-for-Service	1144276650	1144276650	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	541 SOUTH REINO RD	None	NEWBURY PARK	CA	91320	4268	56	06111	34.16918591	-118.9558944	Ventura County
34669	Fee-for-Service	1609849991	1609849991	1	1	ALTMIN, STEPHEN MD	12/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11600 W 2ND AVE	None	LAKEWOOD	CO	80228	0000	00	None	39.71791454	-105.1292205	Jefferson County
34671	Fee-for-Service	1730147810	1730147810	1	1	ADAMS, JOYCE A MD	1/1/1988	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	64278	40	Pediatrics	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
34672	Fee-for-Service	1659701548	1659701548	1	1	ANGELINO HOSPICE CARE INC	1/28/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	444 IRVING DRIVE	SUITE 102	BURBANK	CA	91504	2400	19	06037	34.20035367	-118.3274018	Los Angeles County
34714	Fee-for-Service	1184887671	1184887671	1	1	ANDREW JAMES INGEMANSEN M.D.	11/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CNT	None	OMAHA	NE	68198	0001	00	None	0	0	None
34716	Fee-for-Service	1871549378	1871549378	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18579 BROOKHURST ST	None	FOUNTAIN VALLEY	CA	92708	6746	30	06059	33.69313539	-117.9542897	Orange County
34727	Fee-for-Service	1326126145	1326126145	1	1	AJAYI, FELIX N MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	85704	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
34741	Fee-for-Service	1528075017	1528075017	1	1	AGAH, RAVIN MD	9/1/1994	207R00000X	NA	Other	026	PHYSICIANS	79507	41	Internal Medicine	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
34758	Fee-for-Service	1669039327	1669039327	1	2	A MIND ABOVE, A PROFESSIONAL	12/26/2024	103TC0700X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1300 E SHAW AVE	SUITE 109	FRESNO	CA	93710	7903	10	06019	36.80872147	-119.765979	Fresno County
34763	Fee-for-Service	1447277090	1447277090	1	1	AGUILAR, NANCY E LMFT	12/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
34773	Fee-for-Service	1174563779	1174563779	1	1	ANDREWS COUNTY HOSPITAL	4/3/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	720 HOSPITAL DR	None	ANDREWS	TX	79714	3617	00	None	32.33704061	-102.5459699	Andrews County
34786	Fee-for-Service	1033999826	1033999826	1	1	ABREU, CLAUDIA NP	7/9/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
34803	Fee-for-Service	1174961981	1174961981	1	1	ANEES, MUHAMMAD A MD	11/11/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	146609	-	NOT APPLICABLE	0	In state provider	None	14140 BEACH BLVD	STE 120, 155, 200	WESTMINSTER	CA	92683	4453	30	06059	33.756966	-117.9894915	Orange County
34809	Fee-for-Service	1861711863	1861711863	1	8	AME MEDICAL GROUP, INC.	4/26/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	2621 S BRISTOL ST	105	SANTA ANA	CA	92704	5766	30	06059	33.711876	-117.885371	Orange County
34826	Fee-for-Service	1144885120	1144885120	1	1	AHMAD, SALMAN R MD	7/12/2022	390200000X	NA	Other	026	PHYSICIANS	178544	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
34828	Fee-for-Service	1861711863	1861711863	1	2	AME MEDICAL GROUP, INC.	8/9/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	11938 PARAMOUNT BLVD.	None	DOWNEY	CA	90242	2306	19	06037	33.93385032	-118.1444253	Los Angeles County
34846	Fee-for-Service	1235511478	1235511478	1	1	AJAGBE, TEMITOPE J MD	2/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151851	01	General Practice	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
34870	Fee-for-Service	1033830328	1033830328	1	1	ANDERSON, JANELLE	10/25/2022	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3303 CAROLYN CIR	None	OCEANSIDE	CA	92054	3842	37	06073	33.21479721	-117.3433037	San Diego County
34875	Fee-for-Service	1376654632	1376654632	1	1	ANTHONY, JEFFERY P DO	2/1/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	5400	08	Family Practice	0	In state provider	None	6719 ALVARADO RD	STE 200	SAN DIEGO	CA	92120	5256	37	06073	32.77684978	-117.055137	San Diego County
34952	Fee-for-Service	1720150576	1720150576	1	1	ASGHAR, AFSHAN MD	12/20/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	61656	09	Gynecology (D.O. only)	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
34958	Fee-for-Service	1659701548	1659701548	1	1	ANGELINO HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	444 IRVING DRIVE	SUITE 102	BURBANK	CA	91504	2400	19	06037	34.20035367	-118.3274018	Los Angeles County
34967	Fee-for-Service	1255637765	1255637765	1	1	ADVANCE SPECIALTY CARE LLC	9/24/2012	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3470 WILSHIRE BLVD	SUITE 600	LOS ANGELES	CA	90010	3917	19	06037	34.06172649	-118.299546	Los Angeles County
34987	Fee-for-Service	1972069763	1972069763	1	1	AMD ALTERNATIVE CARE	3/19/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SERVICES LLC	3939 MEADOWBROOK CIRCLE	None	PITTSBURGH	CA	94565	5539	07	06013	38.00144192	-121.8770307	Contra Costa County
35013	Fee-for-Service	1619934114	1619934114	1	1	AURORA CHARTER OAK	9/8/2000	283Q00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	LOS ANGELES, LLC	1161 E COVINA BLVD	None	COVINA	CA	91724	1523	19	06037	34.09946746	-117.8671905	Los Angeles County
35022	Fee-for-Service	1548528813	1548528813	1	1	AMANULLAH, FARHAN S MD	6/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146686	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
35031	Fee-for-Service	1528075017	1528075017	1	1	AGAH, RAVIN MD	9/1/1994	207R00000X	NA	Other	026	PHYSICIANS	79507	77	Infectious Disease	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
35046	Fee-for-Service	1669039327	1669039327	1	2	A MIND ABOVE, A PROFESSIONAL	10/14/2021	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1300 E SHAW AVE	SUITE 109	FRESNO	CA	93710	7903	10	06019	36.80872147	-119.765979	Fresno County
35055	Fee-for-Service	1356897680	1356897680	1	1	ALPAS, MEHMET D MD	6/28/2019	207R00000X	NA	Other	026	PHYSICIANS	162542	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	STE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
35070	Fee-for-Service	1477926830	1477926830	1	1	AUYEUNG, DARA S OD	6/15/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
35071	Fee-for-Service	1902267479	1902267479	1	3	ALTAMED HEALTH SERVICES	1/16/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	14906 PARAMOUNT BLVD	None	PARAMOUNT	CA	90723	3409	19	06037	33.8979564	-118.1600565	Los Angeles County
35075	Fee-for-Service	1417082694	1417082694	1	1	ALVAREZ, ALEJANDRA LMFT	3/19/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	450 BRAND	638	GLENDALE	CA	91203	2347	19	06037	34.152633	-118.254971	Los Angeles County
35077	Fee-for-Service	1902122419	1902122419	2	1	ACE 4Q, INC	10/27/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1126 S BRISTOL ST	None	SANTA ANA	CA	92704	3420	30	06059	33.73320995	-117.8852712	Orange County
35097	Fee-for-Service	1598741639	1598741639	1	1	ALLI, CYNTHIA R MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	69897	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
35147	Fee-for-Service	1629330253	1629330253	1	1	ALI, SABA F MD	4/6/2018	207ZH0000X	NA	Other	026	PHYSICIANS	137329	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
35157	Fee-for-Service	1033830328	1033830328	1	1	ANDERSON, JANELLE	10/25/2022	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3303 CAROLYN CIR	None	OCEANSIDE	CA	92054	3842	37	06073	33.21479721	-117.3433037	San Diego County
35164	Fee-for-Service	1922206796	1922206796	1	1	ADRIANA MANIKIAN	8/19/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 1ST AVE	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
35176	Fee-for-Service	1710255591	1710255591	1	1	AKHTAR, EHSAAN MD	6/17/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	133960	None	None	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
35190	Fee-for-Service	1902000193	1902000193	1	1	ALFONSO, ANA C	5/4/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
35211	Fee-for-Service	1790177582	1790177582	1	2	ALTAMED HEALTH SERVICES	12/4/2023	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6601 RUGBY AVE	STE 300	HUNTINGTON PARK	CA	90255	4046	19	06037	33.979113	-118.2265595	Los Angeles County
35223	Fee-for-Service	1861638660	1861638660	1	1	ALIM, AWONI A MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	53982	30	Radiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
35250	Fee-for-Service	1922691773	1922691773	1	1	ADVENTIST HEALTH PHYSICIANS	8/4/2021	208VP0000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	810 RICHLAND RD	None	YUBA CITY	CA	95991	6200	51	06101	39.1181022	-121.6228659	Sutter County
35255	Fee-for-Service	1801837539	1801837539	1	1	ALBANY MEMORIAL HOSP	10/14/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	600 NORTHERN BLVD	None	ALBANY	NY	12204	1004	00	None	42.674175	-73.7486865	Albany County
35259	Fee-for-Service	1477664159	1477664159	1	1	AGDASSI, HALEH N MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	62998	25	Physical Medicine and Rehabilitation	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
35301	Fee-for-Service	1619934114	1619934114	1	1	AURORA CHARTER OAK	9/8/2000	283Q00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	LOS ANGELES, LLC	1161 E COVINA BLVD	None	COVINA	CA	91724	1523	19	06037	34.09946746	-117.8671905	Los Angeles County
35318	Fee-for-Service	1528075017	1528075017	1	1	AGAH, RAVIN MD	9/1/1994	207R00000X	NA	Other	026	PHYSICIANS	79507	01	General Practice	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
35323	Fee-for-Service	1881997872	1881997872	1	1	ADAPA, SREEDHAR R MD	5/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123534	None	None	0	In state provider	None	568 E HERNDON AVE	SUITE 201	FRESNO	CA	93720	2989	10	06019	36.83752653	-119.7776433	Fresno County
35334	Fee-for-Service	1669039327	1669039327	1	2	A MIND ABOVE, A PROFESSIONAL	10/14/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1300 E SHAW AVE	SUITE 109	FRESNO	CA	93710	7903	10	06019	36.80872147	-119.765979	Fresno County
35345	Fee-for-Service	1255397709	1255397709	1	1	ALFAFARA, RICARDO C MD	6/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1648 HWY 95	None	BULLHEAD CITY	AZ	86442	7906	00	None	35.125227	-114.578037	Mohave County
35353	Fee-for-Service	1902018666	1902018666	1	1	ALLY, MAZER R MD	11/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146924	10	Gastroenterology (M.D. only)	0	In state provider	None	28078 BAXTER RD	STE 530	MURRIETA	CA	92563	1405	33	06065	33.615	-117.1670265	Riverside County
35360	Fee-for-Service	1902267479	1902267479	1	3	ALTAMED HEALTH SERVICES	1/16/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	14906 PARAMOUNT BLVD	None	PARAMOUNT	CA	90723	3409	19	06037	33.8979564	-118.1600565	Los Angeles County
35365	Fee-for-Service	1134207749	1134207749	1	1	ARANA, SONIA MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	69609	41	Internal Medicine	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
35405	Fee-for-Service	1275850448	1275850448	1	1	ADRIAN LYNN DANIEL	6/10/2010	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2851 BEDFORD LN	SUITE 165	CHINO HILLS	CA	91709	3558	36	06071	34.00780958	-117.7422412	San Bernardino County
35465	Fee-for-Service	1598776270	1598776270	1	1	AHMED, MOHAMED S MD	6/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	1648 HWY 95	None	BULLHEAD CITY	AZ	86442	7906	00	None	35.125227	-114.578037	Mohave County
35469	Fee-for-Service	1497166573	1497166573	1	1	AHMED, WASEEM	9/5/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
35479	Fee-for-Service	1720045412	1720045412	1	1	ANGLE, NIREN MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78968	02	General Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
35482	Fee-for-Service	1871853614	1871853614	1	1	ANSARI PIRSARAEI, PEDRAM MD	6/14/2023	207R00000X	NA	Other	026	PHYSICIANS	132457	None	None	0	In state provider	None	30492 GATEWAY PLACE	SUITE 110	RANCHO MISSION VI	CA	92694	1862	30	06059	33.52139226	-117.6168345	Orange County
35487	Fee-for-Service	1003180019	1003180019	1	1	A-QUEST HEALTH CARE INC	12/4/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6560 VAN BUREN BLVD	SUITE H	RIVERSIDE	CA	92503	1542	33	06065	33.949953	-117.4540065	Riverside County
35495	Fee-for-Service	1780909093	1780909093	1	1	AILISHEVA, REBECCA T LMFT	11/20/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
35499	Fee-for-Service	1790177582	1790177582	1	2	ALTAMED HEALTH SERVICES	6/1/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6601 RUGBY AVE	STE 300	HUNTINGTON PARK	CA	90255	4046	19	06037	33.979113	-118.2265595	Los Angeles County
35542	Fee-for-Service	1801837539	1801837539	1	1	ALBANY MEMORIAL HOSP	10/14/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	600 NORTHERN BLVD	None	ALBANY	NY	12204	1004	00	None	42.674175	-73.7486865	Albany County
35560	Fee-for-Service	1447847108	1447847108	1	1	ANNA HAMRELL LCSW INC	2/24/2021	251S00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5776 LINDERO CANYON RD	STE D-297	WESTLAKE VILLAGE	CA	91362	6428	19	06037	34.15518137	-118.7952839	Los Angeles County
35569	Fee-for-Service	1790932200	1790932200	1	1	ARDEN, DEBORAH MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115990	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
35585	Fee-for-Service	1356775878	1356775878	1	1	ALTAMED HEALTH SERVICES CORP	12/16/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	6336 PASSONS BLVD	None	PICO RIVERA	CA	90660	3355	19	06037	33.98515856	-118.0862644	Los Angeles County
35588	Fee-for-Service	1619934114	1619934114	1	1	AURORA CHARTER OAK	9/8/2000	283Q00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	LOS ANGELES, LLC	1161 E COVINA BLVD	None	COVINA	CA	91724	1523	19	06037	34.09946746	-117.8671905	Los Angeles County
35594	Fee-for-Service	1558774349	1558774349	1	1	ATHIAS, STACEY LMFT	7/28/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2400 WASHINGTON AVE	STE 401	REDDING	CA	96001	2827	45	06089	40.577499	-122.371478	Shasta County
35622	Fee-for-Service	1669039327	1669039327	1	2	A MIND ABOVE, A PROFESSIONAL	10/19/2022	103TC0700X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1300 E SHAW AVE	SUITE 109	FRESNO	CA	93710	7903	10	06019	36.80872147	-119.765979	Fresno County
35636	Fee-for-Service	1255397709	1255397709	1	1	ALFAFARA, RICARDO C MD	6/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	1648 HWY 95	None	BULLHEAD CITY	AZ	86442	7906	00	None	35.125227	-114.578037	Mohave County
35641	Fee-for-Service	1306574231	1306574231	1	1	AVT TRANSIT CORP	8/26/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	43740 TIBER ST	None	HEMET	CA	92544	9192	33	06065	33.76179583	-116.8981584	Riverside County
35647	Fee-for-Service	1902267479	1902267479	1	3	ALTAMED HEALTH SERVICES	11/22/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	14906 PARAMOUNT BLVD	None	PARAMOUNT	CA	90723	3409	19	06037	33.8979564	-118.1600565	Los Angeles County
35656	Fee-for-Service	1134207749	1134207749	1	1	ARANA, SONIA MD	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	69609	01	General Practice	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
35666	Fee-for-Service	1932758596	1932758596	1	1	ALLEN, SAMANTHA M CNP	11/18/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1401 SPANOS COURT	SUITE 108	MODESTO	CA	95355	2812	50	06099	37.66975543	-120.9724048	Stanislaus County
35733	Fee-for-Service	1841626587	1841626587	1	1	ADVENTIST HEALTH CLEARLAKE	7/21/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	9430 LAKE STREET	SUITE C	LOWER LAKE	CA	95457	8600	17	06033	38.91493279	-122.6088084	Lake County
35751	Fee-for-Service	1851986038	1851986038	1	1	APF HOSPICE INC	6/22/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	818 N MOUNTAIN AVE	SUITE 105	UPLAND	CA	91786	4164	36	06071	34.10424442	-117.6701797	San Bernardino County
35755	Fee-for-Service	1598776270	1598776270	1	1	AHMED, MOHAMED S MD	6/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1648 HWY 95	None	BULLHEAD CITY	AZ	86442	7906	00	None	35.125227	-114.578037	Mohave County
35769	Fee-for-Service	1205984143	1205984143	1	1	ADIELE, FELICIA N CNM	11/1/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	110 N LA BREA AVENUE	None	INGLEWOOD	CA	90301	1708	19	06037	33.96345848	-118.3533454	Los Angeles County
35772	Fee-for-Service	1932668092	1932668092	1	1	AKA, CHELSEA A MD	10/14/2022	207R00000X	NA	Other	026	PHYSICIANS	179969	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
35779	Fee-for-Service	1255594685	1255594685	1	1	APELIAN, RAMI G MD	10/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104259	13	Neurology (M.D. only)	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
35780	Fee-for-Service	1164083812	1164083812	1	1	ACEVES, BRENDA I NP	6/9/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
35784	Fee-for-Service	1194239053	1194239053	1	1	AMY BLEAK	7/16/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	962 SAGE DR	None	CEDAR CITY	UT	84720	1885	00	None	37.66055637	-113.0809841	Iron County
35786	Fee-for-Service	1790177582	1790177582	1	2	ALTAMED HEALTH SERVICES	6/1/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6601 RUGBY AVE	STE 300	HUNTINGTON PARK	CA	90255	4046	19	06037	33.979113	-118.2265595	Los Angeles County
35796	Fee-for-Service	1821101742	1821101742	1	1	ALLEN, EVAN D MD	9/22/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	88720	None	None	0	In state provider	None	210 W SAN BERNARDINO RD	None	COVINA	CA	91723	1515	19	06037	34.088004	-117.893475	Los Angeles County
35801	Fee-for-Service	1134124548	1134124548	1	2	AGARWAL, VANDANA MD	1/14/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	41760	None	None	0	In state provider	None	1909 ROYALTY DR	None	POMONA	CA	91767	3020	19	06037	34.07772664	-117.746308	Los Angeles County
35803	Fee-for-Service	1013613041	1013613041	1	1	ADVANCED HAND THERAPY AND RE	4/12/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	HABILITATION OC, INC.	27601 FORBES RD	STE 54	LAGUNA NIGUEL	CA	92677	1242	30	06059	33.56194338	-117.6758402	Orange County
35832	Fee-for-Service	1396792073	1396792073	1	1	ADAM H JUVILER	6/27/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	217 W CATALDO AVE	None	SPOKANE	WA	99201	2217	00	None	47.665782	-117.4152105	Spokane County
35844	Fee-for-Service	1861711863	1861711863	1	10	AME MEDICAL GROUP, INC.	5/16/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	29525 CANWOOD ST	200	AGOURA HILLS	CA	91301	4233	19	06037	34.14724223	-118.7675471	Los Angeles County
35854	Fee-for-Service	1982193090	1982193090	1	1	ADLAKHA, JASJIT MD	2/17/2022	207P00000X	NA	Other	026	PHYSICIANS	173895	None	None	0	In state provider	None	2050 VIBORG RD	None	SOLVANG	CA	93463	2220	42	06083	34.60246267	-120.1261332	Santa Barbara County
35859	Fee-for-Service	1023544517	1023544517	1	1	ANDREATTA, ROBERTA MD	10/23/2024	207L00000X	NA	Other	026	PHYSICIANS	171986	05	Anesthesiology	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
35872	Fee-for-Service	1356775878	1356775878	1	1	ALTAMED HEALTH SERVICES CORP	12/16/2013	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	6336 PASSONS BLVD	None	PICO RIVERA	CA	90660	3355	19	06037	33.98515856	-118.0862644	Los Angeles County
35877	Fee-for-Service	1629059639	1629059639	1	1	AHMED, SYED I MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	87102	20	Orthopedic Surgery	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
35888	Fee-for-Service	1205161155	1205161155	1	1	ALMEIDA, URSULA LMFT	8/6/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1910 S COURT ST	None	VISALIA	CA	93277	5426	54	06107	36.313605	-119.2914765	Tulare County
35893	Fee-for-Service	1205041746	1205041746	1	1	ALTAMED HEALTH SVS CORP	4/15/1997	261QA0600X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	ALTAMED RUGBY PLAZA ADHC	6330 RUGBY AVE	STE 200	HUNTINGTON PARK	CA	90255	6938	19	06037	33.98277323	-118.2265373	Los Angeles County
35912	Fee-for-Service	1669039327	1669039327	1	2	A MIND ABOVE, A PROFESSIONAL	10/14/2021	103TC0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1300 E SHAW AVE	SUITE 109	FRESNO	CA	93710	7903	10	06019	36.80872147	-119.765979	Fresno County
35922	Fee-for-Service	1891324521	1891324521	1	1	ABDELMALAK, JOSEPH DPM	8/7/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	903 W, SEVENTH ST	None	OXNARD	CA	93030	6755	56	06111	34.19516303	-119.1889271	Ventura County
35935	Fee-for-Service	1902267479	1902267479	1	3	ALTAMED HEALTH SERVICES	5/9/2023	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	14906 PARAMOUNT BLVD	None	PARAMOUNT	CA	90723	3409	19	06037	33.8979564	-118.1600565	Los Angeles County
35963	Fee-for-Service	1801867643	1801867643	1	1	ASH CUSHING HOSPITAL LLC	2/10/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1027 EAST CHERRY ST	None	CUSHING	OK	74023	4101	00	None	35.97893826	-96.75757688	Payne County
35996	Fee-for-Service	1710581574	1710581574	1	1	AHMADI, ALEXIS CCC-SLP	4/19/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
36020	Fee-for-Service	1841626587	1841626587	1	1	ADVENTIST HEALTH CLEARLAKE	7/21/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	9430 LAKE STREET	SUITE C	LOWER LAKE	CA	95457	8600	17	06033	38.91493279	-122.6088084	Lake County
36037	Fee-for-Service	1851986038	1851986038	1	1	APF HOSPICE INC	6/22/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	818 N MOUNTAIN AVE	SUITE 105	UPLAND	CA	91786	4164	36	06071	34.10424442	-117.6701797	San Bernardino County
36041	Fee-for-Service	1396061958	1396061958	1	1	ALI, MUJTABA M MD	5/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129464	None	None	0	In state provider	None	1702 ESPLANDE	None	CHICO	CA	95926	3315	04	06007	39.74458257	-121.8503103	Butte County
36102	Fee-for-Service	1003834094	1003834094	1	1	ABRAMOWITZ, SHARONE A MD	12/1/1995	2084P0800X	NA	Psychiatry	026	PHYSICIANS	52348	36	Psychiatry	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
36103	Fee-for-Service	1770679805	1770679805	1	1	ALI, MUHAMMAD MD	7/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	71039	30	Radiology	0	In state provider	None	624 S CENTRAL AVE	None	GLENDALE	CA	91204	2009	19	06037	34.13847846	-118.2578377	Los Angeles County
36131	Fee-for-Service	1962460220	1962460220	1	1	ANDERSON, MARY E MD	8/17/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	186222	None	None	0	In state provider	None	880 E TUOLOMNE RD	STE 103	TURLOCK	CA	95382	1550	50	06099	37.51459247	-120.837519	Stanislaus County
36133	Fee-for-Service	1427150978	1427150978	2	1	ANGELS ON EARTH HOME HEALTH	8/18/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	4959 PALO VERDE ST	SUITE 201A	MONTCLAIR	CA	91763	2339	36	06071	34.08129954	-117.6966135	San Bernardino County
36145	Fee-for-Service	1912058728	1912058728	1	1	A CENTER FOR VISIONCARE	5/26/1993	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	SURGICAL & MEDICAL GROUP	2031 W ALAMEDA AVE	SUITE 300	BURBANK	CA	91506	2932	19	06037	34.15972797	-118.3237055	Los Angeles County
36177	Fee-for-Service	1457410060	1457410060	1	1	ABDEL-MALEK, ALEXAN MD	8/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36729	36	Psychiatry	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
36182	Fee-for-Service	1205041746	1205041746	1	1	ALTAMED HEALTH SVS CORP	4/15/1997	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ALTAMED RUGBY PLAZA ADHC	6330 RUGBY AVE	STE 200	HUNTINGTON PARK	CA	90255	6938	19	06037	33.98277323	-118.2265373	Los Angeles County
36187	Fee-for-Service	1710091806	1710091806	1	1	ANDERSON, NANCY J MD	1/1/1982	207N00000X	NA	Dermatology	026	PHYSICIANS	34769	07	Dermatology	0	In state provider	None	2580 SR MARY COLUMBA DR	None	RED BLUFF	CA	96084	3450	52	06103	40.14842672	-122.2180085	Tehama County
36199	Fee-for-Service	1669039327	1669039327	1	2	A MIND ABOVE, A PROFESSIONAL	6/3/2024	103TC0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1300 E SHAW AVE	SUITE 109	FRESNO	CA	93710	7903	10	06019	36.80872147	-119.765979	Fresno County
36205	Fee-for-Service	1265033856	1265033856	1	1	AKSHAR KRUPA INC	11/13/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	25620 BARTON RD	None	LOMA LINDA	CA	92354	3110	36	06071	34.0485153	-117.246114	San Bernardino County
36224	Fee-for-Service	1295175636	1295175636	1	1	ANA WAY TRANSPORTATION INC	7/22/2013	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	417 ARDEN AVE	STE 112D	GLENDALE	CA	91203	4045	19	06037	34.15847866	-118.2621835	Los Angeles County
36250	Fee-for-Service	1548444250	1548444250	1	1	ANAND, SUSHIL P MD FAAP	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110593	None	None	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
36254	Fee-for-Service	1801867643	1801867643	1	1	ASH CUSHING HOSPITAL LLC	2/10/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1027 EAST CHERRY ST	None	CUSHING	OK	74023	4101	00	None	35.97893826	-96.75757688	Payne County
36281	Fee-for-Service	1356543169	1356543169	1	1	ANWER,FAIZ MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
36290	Fee-for-Service	1790149425	1790149425	1	1	ASHAK, DANI MD	4/9/2018	390200000X	NA	Other	026	PHYSICIANS	151432	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
36311	Fee-for-Service	1013651173	1013651173	1	1	AKUA BEHAVIORAL HEALTH, INC	10/2/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	9121 FOLSOM BLVD	SUITE C & G	SACRAMENTO	CA	95826	2473	34	06067	38.559906	-121.3624125	Sacramento County
36324	Fee-for-Service	1275720377	1275720377	1	1	AHMC SAN GABRIEL VALLEY	12/22/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER LP	438 W LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
36333	Fee-for-Service	1104842152	1104842152	1	1	AYERS, ROBERT M MD	8/13/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	86714	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	501 N BRIDGE ST	None	VISALIA	CA	93291	5014	54	06107	36.334107	-119.289186	Tulare County
36336	Fee-for-Service	1821558222	1821558222	1	1	ASHFAQ, ADEEL MD	8/7/2024	208600000X	NA	General Surgery	026	PHYSICIANS	182099	02	General Surgery	0	In state provider	None	365 HAWTHORNE AVE	STE 101-102	OAKLAND	CA	94609	3107	01	06001	37.82079728	-122.2633226	Alameda County
36347	Fee-for-Service	1235230566	1235230566	1	1	ANOSHIRAVANI, ARASH MD	8/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76006	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
36361	Fee-for-Service	1992156335	1992156335	1	1	ALFONSO, MA C M	11/21/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE ROAD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
36362	Fee-for-Service	1982437869	1982437869	1	1	AGUAYO, WENDY	8/27/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
36364	Fee-for-Service	1144268665	1144268665	1	1	ALLSUP, KAREN M MD	5/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78503	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
36374	Fee-for-Service	1750709929	1750709929	1	1	ANDERSON, MOLLY E MD	6/12/2017	390200000X	NA	Other	026	PHYSICIANS	148884	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
36398	Fee-for-Service	1972698074	1972698074	1	1	AWCS MEDICAL INC	12/24/1999	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1392 W OLIVE AVE	STE D	PORTERVILLE	CA	93257	3070	54	06107	36.06592203	-119.046969	Tulare County
36402	Fee-for-Service	1952545550	1952545550	1	1	ALLEN, JUSTIN R MD	6/21/2023	207P00000X	NA	Other	026	PHYSICIANS	159741	None	None	0	In state provider	None	3700 E SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.8601747	-118.148313	Los Angeles County
36433	Fee-for-Service	1912058728	1912058728	1	1	A CENTER FOR VISIONCARE	4/1/1996	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	SURGICAL & MEDICAL GROUP	2031 W ALAMEDA AVE	SUITE 300	BURBANK	CA	91506	2932	19	06037	34.15972797	-118.3237055	Los Angeles County
36440	Fee-for-Service	1043411879	1043411879	1	1	ASKARI, KAMRAN S MD	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105583	07	Dermatology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
36443	Fee-for-Service	1386893055	1386893055	1	1	ANAOKAR, JORDAN M	5/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111066	None	None	0	In state provider	None	21840 S NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
36444	Fee-for-Service	1538876552	1538876552	1	1	ADEBISI, ADEDAYO NP	2/15/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1207 E FLORIDA AVE	None	HEMET	CA	92543	4513	33	06065	33.74753552	-116.9593245	Riverside County
36486	Fee-for-Service	1528265345	1528265345	1	1	AINGARAN, MYTHILI MD	11/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120906	40	Pediatrics	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
36491	Fee-for-Service	1518958313	1518958313	1	1	AMARA, DOMINIC P MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	76226	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	181 ANDRIEUX ST	STE 108	SONOMA	CA	95476	6920	49	06097	38.28809911	-122.4613026	Sonoma County
36499	Fee-for-Service	1619507050	1619507050	1	1	AVILES, RONLEY A NP	8/3/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
36505	Fee-for-Service	1174040414	1174040414	1	1	ADVENTIST HEALTH PHYSICIANS	12/11/2017	193200000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	4909 CENTENNIAL PLAZA WA	None	BAKERFSFIELD	CA	93312	2011	15	06029	35.40410521	-119.0932287	Kern County
36524	Fee-for-Service	1659616183	1659616183	1	1	ALBINI, GERALDINE EUNICE R C	5/18/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	NP	2514 BERRYESSA RD	None	SAN JOSE	CA	95132	2947	43	06085	37.38738217	-121.8595232	Santa Clara County
36550	Fee-for-Service	1487942009	1487942009	1	1	AZAD, KAMRAN J MD	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128991	24	Plastic Surgery	0	In state provider	None	95 SCRIPPS DRIVE	None	SACRAMENTO	CA	95825	6320	34	06067	38.571831	-121.409604	Sacramento County
36552	Fee-for-Service	1427579960	1427579960	1	3	AIR EVAC EMS, INC.	11/8/2023	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	159 MEDICAL DR	None	PEARSALL	TX	78061	6604	00	None	28.89729384	-99.11711477	Frio County
36555	Fee-for-Service	1790177582	1790177582	1	11	ALTAMED HEALTH SERVICES	11/2/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMTTENT CLINIC	10408 VACCO STREET	SUITE A	SOUTH EL MONTE	CA	91733	3328	19	06037	34.04727908	-118.0442754	Los Angeles County
36557	Fee-for-Service	1679954408	1679954408	1	1	APPLIED PALLIATIVE AND	10/19/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE SERVICES INC	2865 SUNRISE BLVD	SUITE 103	RANCHO CORDOVA	CA	95742	6104	34	06067	38.599254	-121.264812	Sacramento County
36576	Fee-for-Service	1427494061	1427494061	1	1	AULAKH, BOBBY MD	11/5/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	139510	83	Rheumatology	0	In state provider	None	1335 BUENAVENTURA BLVD	100	REDDING	CA	96001	0000	45	06089	40.58222519	-122.4261823	Shasta County
36595	Fee-for-Service	1518907864	1518907864	2	1	ABBOTT, DANIEL L MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	22988	02	General Surgery	0	In state provider	None	10250 ARTESIA BLVD	None	BELLFLOWER	CA	90706	6720	19	06037	33.8728535	-118.1154555	Los Angeles County
36609	Fee-for-Service	1275720377	1275720377	1	1	AHMC SAN GABRIEL VALLEY	12/22/2007	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER LP	438 W LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
36610	Fee-for-Service	1417977315	1417977315	1	1	ABRAMSON, PAUL D MD	8/8/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76111	66	Emergency Medicine (Urgent Care)	0	In state provider	None	199 E WEBSTER ST	None	COLUSA	CA	95932	2954	06	06011	39.20737704	-122.0004043	Colusa County
36613	Fee-for-Service	1154476588	1154476588	1	1	ALY, AL S MD	10/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	41700	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
36657	Fee-for-Service	1487012407	1487012407	1	1	ASHBY, KRISTEN B MD	8/29/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	179287	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
36681	Fee-for-Service	1447262126	1447262126	1	1	ANDREWS, JOHN B MD	10/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82762	41	Internal Medicine	0	In state provider	None	5901 W OLYMPIC BLVD	STE 204	LOS ANGELES	CA	90036	4663	19	06037	34.05764121	-118.3603115	Los Angeles County
36693	Fee-for-Service	1689655789	1689655789	1	1	ANTONIETTE VANDERPOL	8/27/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	404 W GLYNN DR	None	PARKSTON	SD	57366	9606	00	None	43.39887786	-97.99022854	Hutchinson County
36704	Fee-for-Service	1972670008	1972670008	1	2	AA HEARING AIDS CENTER	11/20/2018	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	24191 PASEO DE VALENCIA	STE C	LAGUNA WOODS	CA	92637	3167	30	06059	33.61151014	-117.7130721	Orange County
36706	Fee-for-Service	1740228170	1740228170	1	1	ARGUINCHONA, HENRY L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	104 W 5TH, SUITE 400W	None	SPOKANE	WA	99204	0000	00	None	47.651625	-117.4141485	Spokane County
36732	Fee-for-Service	1326175274	1326175274	1	1	ACEVEDO, ROSA LEE LMFT	1/25/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
36733	Fee-for-Service	1245279512	1245279512	1	1	ANDERSON, THOMAS R MD	11/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84211	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
36738	Fee-for-Service	1376653360	1376653360	1	1	ARAKAKI, DWIGHT C MD	11/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95662	66	Emergency Medicine (Urgent Care)	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
36772	Fee-for-Service	1528265345	1528265345	1	1	AINGARAN, MYTHILI MD	11/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120906	77	Infectious Disease	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
36784	Fee-for-Service	1679659114	1679659114	1	1	ASSOCIATED PATHOLOGY	2/1/2001	291U00000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	MEDICAL GROUP	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
36790	Fee-for-Service	1750728358	1750728358	1	1	AHUJA, NEHA MD	1/29/2020	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	161224	10	Gastroenterology (M.D. only)	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
36805	Fee-for-Service	1538206297	1538206297	1	2	ADDICTION RESEARCH AND TREAT	10/11/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3103 E CARTWRIGHT AVE	None	FRESNO	CA	93725	9385	10	06019	36.67617437	-119.7344474	Fresno County
36826	Fee-for-Service	1356366926	1356366926	1	1	ABBER, JASON C MD	6/30/1986	208800000X	NA	Other	026	PHYSICIANS	48322	34	Urology and Urological Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
36843	Fee-for-Service	1679954408	1679954408	1	1	APPLIED PALLIATIVE AND	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE SERVICES INC	2865 SUNRISE BLVD	SUITE 103	RANCHO CORDOVA	CA	95742	6104	34	06067	38.599254	-121.264812	Sacramento County
36844	Fee-for-Service	1790177582	1790177582	1	11	ALTAMED HEALTH SERVICES	11/2/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMTTENT CLINIC	10408 VACCO STREET	SUITE A	SOUTH EL MONTE	CA	91733	3328	19	06037	34.04727908	-118.0442754	Los Angeles County
36849	Fee-for-Service	1336148543	1336148543	1	1	ADASHEK & WILKES LLP	3/13/2007	207VM0101X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	5761 S FORT APACHE RD	None	LAS VEGAS	NV	89148	5506	00	None	36.083673	-115.299972	Clark County
36897	Fee-for-Service	1417977315	1417977315	1	1	ABRAMSON, PAUL D MD	8/8/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76111	08	Family Practice	0	In state provider	None	199 E WEBSTER ST	None	COLUSA	CA	95932	2954	06	06011	39.20737704	-122.0004043	Colusa County
36910	Fee-for-Service	1720241904	1720241904	1	1	AUNG, YE K MD	3/9/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114010	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
36927	Fee-for-Service	1710246160	1710246160	1	1	AZIMI, AYSUN DO	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13331	40	Pediatrics	0	In state provider	None	262 EUCLID AVE	STE 220	SAN DIEGO	CA	92114	3629	37	06073	32.70710149	-117.0851288	San Diego County
36948	Fee-for-Service	1215287768	1215287768	1	1	ALTAMIRANO, ELIASAR	6/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4201 W CHAPMAN AVENUE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
36953	Fee-for-Service	1326010273	1326010273	1	1	ALAMANCE REGIONAL MEDICAL	2/22/2012	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	1240 HUFFMAN MILL RD	None	BURLINGTON	NC	27215	8700	00	None	36.061353	-79.5024225	Alamance County
36968	Fee-for-Service	1043054257	1043054257	1	1	ALG PHARMACY INC	7/15/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	924 W ALAMEDA AVE	None	BURBANK	CA	91506	2802	19	06037	34.16343486	-118.3124189	Los Angeles County
36990	Fee-for-Service	1427004977	1427004977	1	1	ASHTIANI, RAMIN B MD	6/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77527	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	700 N TUSTIN AVE	None	SANTA ANA	CA	92705	3602	30	06059	33.75128487	-117.834205	Orange County
37007	Fee-for-Service	1316993967	1316993967	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1260 E ONTARIO AVE	None	CORONA	CA	92881	3600	33	06065	33.84755918	-117.5418146	Riverside County
37008	Fee-for-Service	1528144219	1528144219	1	1	ACOSTA, LOUIS MD	10/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25772	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1711 W TEMPLE ST	None	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
37045	Fee-for-Service	1033542683	1033542683	1	1	AHN, LORIEN S MD	3/18/2025	207R00000X	NA	Other	026	PHYSICIANS	159674	41	Internal Medicine	0	In state provider	None	2336 SANTA MONICA BLVD	301, 304	SANTA MONICA	CA	90404	2067	19	06037	34.03136627	-118.4766854	Los Angeles County
37049	Fee-for-Service	1134284912	1134284912	1	1	APPLE, ROBIN F PH.D	3/31/1994	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
37066	Fee-for-Service	1417307125	1417307125	1	1	ALCOHOL-DRUG CARE SERVICES	4/19/2018	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC	2413 2ND STREET	None	EUREKA	CA	95501	0811	12	06023	40.80634452	-124.1456445	Humboldt County
37125	Fee-for-Service	1386705713	1386705713	1	1	ASKINS, HOWARD L MD INC	2/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	71909	36	Psychiatry	0	In state provider	None	960 E GREEN ST	STE 202	PASADENA	CA	91106	2401	19	06037	34.14451994	-118.1301695	Los Angeles County
37129	Fee-for-Service	1528087632	1528087632	1	1	ALBERTINI, JOHN J MD	6/24/1999	208800000X	NA	Other	026	PHYSICIANS	85282	34	Urology and Urological Surgery	0	In state provider	None	2576 RENFREW ST	None	EUREKA	CA	95501	3345	12	06023	40.78539559	-124.1387085	Humboldt County
37139	Fee-for-Service	1558599985	1558599985	1	1	ABUBAKER, FIRAS MD INC	6/2/2014	193400000X	NA	Other	026	PHYSICIANS	101953	66	Emergency Medicine (Urgent Care)	0	In state provider	None	31700 TEMECULA PKWY	None	CORONA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
37146	Fee-for-Service	1396500542	1396500542	1	1	ALI, AMEKA CD	4/22/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	01	06001	0	0	None
37158	Fee-for-Service	1992149165	1992149165	1	1	AHMAD, SANIYA MD	8/6/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
37187	Fee-for-Service	1912248378	1912248378	1	1	ADVENTIST HEALTH PHYSICIANS	6/17/2013	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	2750 SYCAMORE DRIVE	STE 202	SIMI VALLEY	CA	93065	1502	56	06111	34.28529962	-118.7437672	Ventura County
37212	Fee-for-Service	1922286954	1922286954	1	1	AKHTARI, MOJTABA MD	5/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129758	78	Neoplastic Diseases/Oncology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
37244	Fee-for-Service	1326010273	1326010273	1	1	ALAMANCE REGIONAL MEDICAL	1/1/2003	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	1240 HUFFMAN MILL RD	None	BURLINGTON	NC	27215	8700	00	None	36.061353	-79.5024225	Alamance County
37245	Fee-for-Service	1114934866	1114934866	1	1	AJUDIA, KETAN P MD	10/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	78074	41	Internal Medicine	0	In state provider	PLACERVILLE INTERNAL MED	1095 MARSHALL WAY	None	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
37246	Fee-for-Service	1104189828	1104189828	1	1	AWERBUCK, MATTHEW J MD	12/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131930	41	Internal Medicine	0	In state provider	None	1401 GARCES HWY	None	DELANO	CA	93215	1448	15	06029	35.76144847	-119.238912	Kern County
37265	Fee-for-Service	1215202403	1215202403	1	1	ARMONTROUT, JAMES A MD	2/1/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	138817	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
37277	Fee-for-Service	1427004977	1427004977	1	1	ASHTIANI, RAMIN B MD	6/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77527	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	700 N TUSTIN AVE	None	SANTA ANA	CA	92705	3602	30	06059	33.75128487	-117.834205	Orange County
37292	Fee-for-Service	1770097909	1770097909	1	1	ASESOR, CARMEN J NP	3/17/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	711 EAST ROSECRANS AVE	None	COMPTON	CA	90221	2143	19	06037	33.9035073	-118.2158303	Los Angeles County
37298	Fee-for-Service	1821093394	1821093394	1	1	ARCILLA, ANGELO C MD	4/30/1994	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48557	01	General Practice	0	In state provider	None	1800 SULLIVAN AVE	RM 101	DALY CITY	CA	94015	2227	41	06081	37.68077723	-122.4728941	San Mateo County
37322	Fee-for-Service	1306224456	1306224456	1	1	ABRAHAM, NATHAN J MD	6/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155286	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	STE 1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
37338	Fee-for-Service	1689627028	1689627028	1	1	ANAYA, CARLOS A MD	7/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90268	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
37360	Fee-for-Service	1083347967	1083347967	1	1	ALSULAIMANI, SARA MD	4/16/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	192452	14	Neurological Surgery	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
37365	Fee-for-Service	1699884718	1699884718	1	1	APRIA HEALTHCARE LLC	5/1/1997	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3636 N LAUGHLIN RD	STE 190	SANTA ROSA	CA	95403	1068	49	06097	38.5086306	-122.8002545	Sonoma County
37371	Fee-for-Service	1457898447	1457898447	1	1	AJOC, JOSE G MD	11/27/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	162174	08	Family Practice	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
37374	Fee-for-Service	1285003368	1285003368	1	1	ALEXANDER, SUSAN J LMFT	8/10/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	74361 HWY III	STE 3	PALM DESERT	CA	92260	4125	33	06065	0	0	None
37403	Fee-for-Service	1306817721	1306817721	1	1	ANNE L GALLION MD	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMBELL AVE	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
37425	Fee-for-Service	1558599985	1558599985	1	1	ABUBAKER, FIRAS MD INC	6/2/2014	193400000X	NA	Other	026	PHYSICIANS	101953	77	Infectious Disease	0	In state provider	None	31700 TEMECULA PKWY	None	CORONA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
37434	Fee-for-Service	1225529886	1225529886	1	1	ARMOOGAM, AMANDA LCSW	8/12/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
37461	Fee-for-Service	1043227747	1043227747	1	1	AL-NASER,RAED A MD	8/29/2006	207RP1001X	NA	Pulmonology	026	PHYSICIANS	71932	41	Internal Medicine	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
37464	Fee-for-Service	1932600954	1932600954	1	1	ALDERBROOK, INC	11/14/2019	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2540 W AVENUE K	None	LANCASTER	CA	93536	5323	19	06037	34.67490464	-118.1762855	Los Angeles County
37478	Fee-for-Service	1073975900	1073975900	1	1	ALLIANCE HEALTH SERVICES INC	9/29/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1421 E COOLEY DR	SUITE 4	COLTON	CA	92324	3979	36	06071	34.05467952	-117.305163	San Bernardino County
37499	Fee-for-Service	1477790657	1477790657	1	1	AL SHAER, ADNAN MOHAMMAD MD	2/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106200	None	None	0	In state provider	None	3551 Q STREET	STE 100	BAKERSFIELD	CA	93301	1658	15	06029	35.392059	-119.010556	Kern County
37501	Fee-for-Service	1922286954	1922286954	1	1	AKHTARI, MOJTABA MD	5/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129758	41	Internal Medicine	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
37513	Fee-for-Service	1447338538	1447338538	1	1	ANDERSON, ROBERT A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35474	01	General Practice	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
37526	Fee-for-Service	1093277139	1093277139	1	1	ANDRING, NICHOLAS MD	8/1/2024	390200000X	NA	Other	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
37577	Fee-for-Service	1861568784	1861568784	4	1	AMBRY GENETICS CORPORATION	3/10/2025	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	7 ARGONAUT	None	ALISO VIEJO	CA	92656	1423	30	06059	33.59362592	-117.7261513	Orange County
37594	Fee-for-Service	1437676160	1437676160	1	1	AGUSTIN III, ALFREDO J	10/26/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3950 BRISTLEWOOD WAY	None	SACRAMENTO	CA	95823	6241	34	06067	38.482326	-121.4628885	Sacramento County
37600	Fee-for-Service	1689105801	1689105801	1	1	ADAMS, SPENCER MD	8/25/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	174514	None	None	0	In state provider	None	7075 N SHARON AVE	None	FRESNO	CA	93720	3329	10	06019	36.83882737	-119.7590708	Fresno County
37618	Fee-for-Service	1780946012	1780946012	1	1	AGBUYA-FLORES, MELODY OD	3/22/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
37623	Fee-for-Service	1336464254	1336464254	1	1	AL-HAKIM, SARAH M MD	7/15/2021	207L00000X	NA	Other	026	PHYSICIANS	121744	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
37666	Fee-for-Service	1821485392	1821485392	1	1	ASNAKE, BETELEHEM MD	1/23/2020	390200000X	NA	Other	026	PHYSICIANS	148601	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
37675	Fee-for-Service	1235227018	1235227018	1	1	AGUSTIN, MARIA L MD	9/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98556	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
37707	Fee-for-Service	1013165406	1013165406	1	1	AU, SCOTT C MD	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108075	25	Physical Medicine and Rehabilitation	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
37739	Fee-for-Service	1689964991	1689964991	1	1	ANDERSON, SHEA DOROTHY LCSW	6/22/2011	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
37745	Fee-for-Service	1144578212	1144578212	1	1	AVILA, ADRIANA	6/23/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
37752	Fee-for-Service	1043227747	1043227747	1	1	AL-NASER,RAED A MD	8/29/2006	207RP1001X	NA	Pulmonology	026	PHYSICIANS	71932	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
37766	Fee-for-Service	1598520405	1598520405	1	1	ARTIN, KARINE	12/16/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
37792	Fee-for-Service	1497814834	1497814834	1	1	AUNG, DIANA MD	5/3/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78991	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
37795	Fee-for-Service	1922286954	1922286954	1	1	AKHTARI, MOJTABA MD	5/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129758	68	Hematology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
37797	Fee-for-Service	1154736429	1154736429	1	21	AVENAL COMMUNITY HEALTH CENT	4/13/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	569 WEST PUTNAM AVE	None	PORTERVILLE	CA	93257	3260	54	06107	36.06957307	-119.0296992	Tulare County
37809	Fee-for-Service	1124525324	1124525324	1	1	AU, TIFFANY J MD	9/20/2022	2279E0002X	NA	Other	026	PHYSICIANS	163975	None	None	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
37810	Fee-for-Service	1225029630	1225029630	1	2	ANDERSEN PHYSICAL THERAPY IN	5/24/2019	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	C	1917 COFFEE RD	None	MODESTO	CA	95355	2704	50	06099	37.67156536	-120.9757491	Stanislaus County
37839	Fee-for-Service	1023026234	1023026234	1	1	ALKHAIRY, M TAHIR M.D	2/8/2015	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	None	None	2	Out of state provider	None	250 E DUNLAP AVE	None	PHOENIX	AZ	85020	2825	00	None	33.568947	-112.0712985	Maricopa County
37870	Fee-for-Service	1275561805	1275561805	1	1	AHMED, SALEHA MD	2/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	65549	41	Internal Medicine	0	In state provider	None	2505 WEST HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.02139448	-121.347738	San Joaquin County
37872	Fee-for-Service	1255573119	1255573119	1	1	ALWAN M D INC	8/31/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1310 SAN BERNARDINO RD	STE 205	UPLAND	CA	91786	4985	36	06071	34.10260261	-117.6332582	San Bernardino County
37879	Fee-for-Service	1437676160	1437676160	1	1	AGUSTIN III, ALFREDO J	10/26/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3950 BRISTLEWOOD WAY	None	SACRAMENTO	CA	95823	6241	34	06067	38.482326	-121.4628885	Sacramento County
37883	Fee-for-Service	1578765236	1578765236	1	1	ARORA, VASUDHA N MD	9/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104919	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
37905	Fee-for-Service	1295168193	1295168193	1	1	ANTHEM HOSPICE PROVIDERS INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	850 VIA LATA	SUITE 118	COLTON	CA	92324	3985	36	06071	34.05627205	-117.3068803	San Bernardino County
37924	Fee-for-Service	1386283984	1386283984	1	1	APTUS PACEM, LLC	1/14/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5035 ECHO ST	None	LOS ANGELES	CA	90042	3915	19	06037	34.10444061	-118.2003302	Los Angeles County
37939	Fee-for-Service	1295043024	1295043024	1	1	ANTONYANTS, ALINA LCSW	1/4/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
37942	Fee-for-Service	1740548866	1740548866	1	1	AHUJA, BRIAN MD	4/20/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	141897	13	Neurology (M.D. only)	0	In state provider	None	200 JOSE FIGUERES AVE	SUITE 475	SAN JOSE	CA	95116	1500	43	06085	37.36122014	-121.8505998	Santa Clara County
37961	Fee-for-Service	1689652893	1689652893	1	1	ADAMS, CARLTON Z MD	11/6/2019	2086S0129X	NA	General Surgery	026	PHYSICIANS	68221	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	6555 COYLE AVE	SUITE 190	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
37982	Fee-for-Service	1780927731	1780927731	1	1	ASCENDIO HEALTH SYSTEMS INC	4/11/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1035 S MILIKEN AVE	STE I	ONTARIO	CA	91761	7862	36	06071	34.053669	-117.5576535	San Bernardino County
38003	Fee-for-Service	1780147082	1780147082	1	1	ACTIVE MOBILITY INC	5/26/2020	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	23735 JACKSON AVE	None	MURRIETA	CA	92562	2099	33	06065	33.58523589	-117.2190194	Riverside County
38019	Fee-for-Service	1265849749	1265849749	1	1	AHN, BRIAN K DO	9/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14427	01	General Practice	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
38025	Fee-for-Service	1306836994	1306836994	1	1	ALCANTARA, MELODIA NP	10/18/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
38026	Fee-for-Service	1144659608	1144659608	1	1	ALYSSA M GALUSHA MD	1/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
38048	Fee-for-Service	1780090332	1780090332	1	1	ADVENTIST HEALTH PHYSICIANS	2/1/2019	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	125 MALL DR	STE 211A	HANFORD	CA	93230	5794	16	06031	36.3246477	-119.6685218	Kings County
38059	Fee-for-Service	1568570380	1568570380	2	1	APRIA HEALTHCARE LLC	1/20/2020	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	141 BERNOULLI CIR	None	OXNARD	CA	93030	8011	56	06111	34.20254972	-119.1503688	Ventura County
38083	Fee-for-Service	1346861671	1346861671	1	1	ASUNTO, JOEL MD	9/4/2024	208M00000X	NA	Other	026	PHYSICIANS	190777	41	Internal Medicine	0	In state provider	None	372 W CYPRESS AVE	None	REEDLEY	CA	95654	2199	10	06019	36.60784193	-119.4520057	Fresno County
38087	Fee-for-Service	1154736429	1154736429	1	21	AVENAL COMMUNITY HEALTH CENT	4/13/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	569 WEST PUTNAM AVE	None	PORTERVILLE	CA	93257	3260	54	06107	36.06957307	-119.0296992	Tulare County
38101	Fee-for-Service	1205152139	1205152139	1	1	ADETOLA, ADEGBENGA A MD INC	3/17/2010	207R00000X	NA	Other	026	PHYSICIANS	55507	41	Internal Medicine	0	In state provider	None	3737 MARTIN LUTHER KING	#400	LYNWOOD	CA	90262	2684	19	06037	33.92872742	-118.2006921	Los Angeles County
38106	Fee-for-Service	1336379668	1336379668	1	1	ACTON, THOMAS P DO	1/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	11559	01	General Practice	0	In state provider	None	8110 LAGUNA BLVD	None	ELK GROVE	CA	95758	7904	34	06067	38.421306	-121.408173	Sacramento County
38115	Fee-for-Service	1215430632	1215430632	1	1	ASHER, CHARMAINE M LCSW	8/18/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	100672	-	NOT APPLICABLE	0	In state provider	None	1207 EAST FRUIT STREET	A, B, B2, B3, C, D, E, F	SANTA ANA	CA	92701	4206	30	06059	33.75238847	-117.8539245	Orange County
38133	Fee-for-Service	1891786729	1891786729	1	1	ALNABELSI,MOHAMAD K MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61138	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	STE K208	RANCHO MIRAGE	CA	92270	7048	33	06065	33.763572	-116.4056895	Riverside County
38182	Fee-for-Service	1467410464	1467410464	1	1	ALLEN T JACOBS MD	5/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2776 CLEVELAND AVE	None	FORT MYERS	FL	33901	5864	00	None	26.628237	-81.873945	Lee County
38194	Fee-for-Service	1295168193	1295168193	1	1	ANTHEM HOSPICE PROVIDERS INC	3/24/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	850 VIA LATA	SUITE 118	COLTON	CA	92324	3985	36	06071	34.05627205	-117.3068803	San Bernardino County
38195	Fee-for-Service	1265705677	1265705677	1	1	ARAKOZIE, ZULAIKHA MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123738	41	Internal Medicine	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
38217	Fee-for-Service	1063410280	1063410280	1	1	AHMED, NAYEEMA MD	8/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87847	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	517 N MAIN ST	None	SANTA ANA	CA	92701	4686	30	06059	33.74951945	-117.8675809	Orange County
38221	Fee-for-Service	1699031450	1699031450	1	1	ABUSAMRAH SALAIMEH, ABDALLAH	8/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136229	41	Internal Medicine	0	In state provider	MD	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
38248	Fee-for-Service	1831260728	1831260728	1	1	ABREW-RIVERA, MONICA D	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	64891	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
38265	Fee-for-Service	1780927731	1780927731	1	1	ASCENDIO HEALTH SYSTEMS INC	4/11/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1035 S MILIKEN AVE	STE I	ONTARIO	CA	91761	7862	36	06071	34.053669	-117.5576535	San Bernardino County
38345	Fee-for-Service	1811123318	1811123318	1	1	AARON J KAUER M.D.	4/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
38359	Fee-for-Service	1326232794	1326232794	1	1	AMESS, WILLIAM T MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101329	41	Internal Medicine	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
38379	Fee-for-Service	1982915344	1982915344	1	1	AUFDERHEIDE, ADAM C MD	5/4/2017	207W00000X	NA	Ophthalmology	026	PHYSICIANS	148715	18	Ophthalmology	0	In state provider	None	110 CHESTNUT ST	None	MOUNT SHASTA	CA	96067	2209	47	06093	41.31295849	-122.3110503	Siskiyou County
38398	Fee-for-Service	1255593612	1255593612	1	1	ABBADESSA, BENJAMIN	7/30/2018	208C00000X	NA	General Surgery	026	PHYSICIANS	153729	28	Proctology (colon and rectal)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
38418	Fee-for-Service	1891786729	1891786729	1	1	ALNABELSI,MOHAMAD K MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61138	01	General Practice	0	In state provider	None	39000 BOB HOPE DR	STE K208	RANCHO MIRAGE	CA	92270	7048	33	06065	33.763572	-116.4056895	Riverside County
38420	Fee-for-Service	1932434107	1932434107	1	1	APARO, MIWA T OT	10/23/2009	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	15454 GALE AVE	STE F	HACIENDA HEIGHTS	CA	91745	1500	19	06037	34.01293546	-117.9699259	Los Angeles County
38456	Fee-for-Service	1457744708	1457744708	1	2	ABARE, MARCE MD	6/21/2024	207R00000X	NA	Other	086	MEDICAL DIRECTORS	144590	-	NOT APPLICABLE	0	In state provider	None	3600 GLEN CANYON RD	2	SCOTTS VALLEY	CA	95066	4916	44	06087	37.04102106	-122.0230491	Santa Cruz County
38469	Fee-for-Service	1609003193	1609003193	1	1	AMEZQUITA, ALBERTO LMFT	12/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
38481	Fee-for-Service	1831550615	1831550615	1	1	ALL SAINTS HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	415 E HARVARD ST	SUITE 102	GLENDALE	CA	91205	1045	19	06037	34.14448348	-118.250604	Los Angeles County
38486	Fee-for-Service	1932467354	1932467354	1	1	ALPERN, ADRIANNE N PHD	8/8/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
38502	Fee-for-Service	1528344686	1528344686	1	1	ANGELES MEDICAL CLINIC, INC.	12/19/2018	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	204 E PICO BLVD	None	LOS ANGELES	CA	90015	2508	19	06037	34.0355835	-118.2591226	Los Angeles County
38505	Fee-for-Service	1245324698	1245324698	1	1	ANTON, CHRISTOPHER G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
38509	Fee-for-Service	1851430805	1851430805	3	2	ALTA VIEW HEALTH CARE LLC	4/2/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	296 H ST	STE. 103	CHULA VISTA	CA	91910	4779	37	06073	32.63445985	-117.0769184	San Diego County
38541	Fee-for-Service	1689674889	1689674889	2	1	ANTON CORP	4/8/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1031 E VISTA WY	None	VISTA	CA	92084	4606	37	06073	33.21306401	-117.2286162	San Diego County
38546	Fee-for-Service	1982617551	1982617551	1	1	ARSHAM, FREDERIC J MD	1/1/1996	261Q00000X	NA	Other	026	PHYSICIANS	29610	01	General Practice	0	In state provider	None	1834 MAIN ST	None	RAMONA	CA	92065	2522	37	06073	33.03447536	-116.8814758	San Diego County
38559	Fee-for-Service	1093365470	1093365470	1	1	ABLE HANDS HOME HEALTH	3/1/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES LLC	12001 VENTURA PLACE	STE 202	STUDIO CITY	CA	91604	2626	19	06037	34.14394491	-118.393247	Los Angeles County
38570	Fee-for-Service	1780862136	1780862136	1	1	ADAMS, JILL LCSW	12/16/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
38601	Fee-for-Service	1710922513	1710922513	1	1	ABABA, MICHELLE D MD	10/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93142	08	Family Practice	0	In state provider	None	824 E CARSON ST	STE 104	CARSON	CA	90745	2262	19	06037	33.83159904	-118.2605506	Los Angeles County
38604	Fee-for-Service	1205903101	1205903101	1	1	ACORD, MICHAEL P MD	9/30/1993	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	31936	25	Physical Medicine and Rehabilitation	0	In state provider	None	25825 S VERMONT ST	None	HARBOR CITY	CA	90710	0000	19	06037	33.7892965	-118.2937327	Los Angeles County
38620	Fee-for-Service	1164680336	1164680336	1	1	AGGARWAL, NUPUR	8/15/2023	208M00000X	NA	Other	026	PHYSICIANS	161088	None	None	0	In state provider	None	23625 WR HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
38623	Fee-for-Service	1619921806	1619921806	1	1	AKRAM, MOHAMMED S MD	1/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	52438	01	General Practice	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
38624	Fee-for-Service	1750375846	1750375846	1	1	AVALON CARE CENTER-NEWMAN	12/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	709 N ST	None	NEWMAN	CA	95360	1162	50	06099	37.32235142	-121.0238941	Stanislaus County
38655	Fee-for-Service	1255386256	1255386256	1	1	ARISTEIGUIETA, CESAR MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71829	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
38664	Fee-for-Service	1588865489	1588865489	1	1	AOKI, MELANIE F PHD	6/21/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
38690	Fee-for-Service	1780628487	1780628487	1	1	ASHLEY, ROBERT D MD	2/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	66332	None	None	0	In state provider	None	1920 COLORADO BLVD	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
38707	Fee-for-Service	1891786729	1891786729	1	1	ALNABELSI,MOHAMAD K MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61138	67	Endocrinology	0	In state provider	None	39000 BOB HOPE DR	STE K208	RANCHO MIRAGE	CA	92270	7048	33	06065	33.763572	-116.4056895	Riverside County
38730	Fee-for-Service	1700247657	1700247657	1	1	ALI, AHMED S MD	12/8/2020	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
38770	Fee-for-Service	1831550615	1831550615	1	1	ALL SAINTS HOSPICE CARE INC	12/11/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	415 E HARVARD ST	SUITE 102	GLENDALE	CA	91205	1045	19	06037	34.14448348	-118.250604	Los Angeles County
38788	Fee-for-Service	1396928727	1396928727	1	1	ALLELUIA	5/9/1995	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	PEARL GATES HOME	2256 STERLING AVE	None	SANGER	CA	93657	2033	10	06019	36.71519886	-119.5687193	Fresno County
38789	Fee-for-Service	1528344686	1528344686	1	1	ANGELES MEDICAL CLINIC, INC.	1/25/2016	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	104717	None	None	0	In state provider	None	204 E PICO BLVD	None	LOS ANGELES	CA	90015	2508	19	06037	34.0355835	-118.2591226	Los Angeles County
38804	Fee-for-Service	1033594023	1033594023	1	1	ARANA, AMANDA N LMFT	8/21/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3200 GUASTI RD	STE 100	ONTARIO	CA	91761	3707	36	06071	34.06518	-117.5822055	San Bernardino County
38833	Fee-for-Service	1982617551	1982617551	1	1	ARSHAM, FREDERIC J MD	1/1/1996	261Q00000X	NA	Other	026	PHYSICIANS	29610	08	Family Practice	0	In state provider	None	1834 MAIN ST	None	RAMONA	CA	92065	2522	37	06073	33.03447536	-116.8814758	San Diego County
38896	Fee-for-Service	1801230172	1801230172	1	1	ALAVA, IBRAHIM MD	7/10/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	-	04	Otology, Laryngology, Rhinology	2	Out of state provider	None	6410 FANNIN STREET	SUITE 1500	HOUSTON	TX	77030	5306	00	None	29.71419639	-95.39755562	Harris County
38905	Fee-for-Service	1295904787	1295904787	1	1	ANDERSON, THOMAS A MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	102757	05	Anesthesiology	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
38941	Fee-for-Service	1023766722	1023766722	1	1	ALL HEALTH GROUP OF	5/2/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	COMPANIES	5466 W WILSON ST	None	BANNING	CA	92220	3212	33	06065	33.93263147	-116.9365095	Riverside County
38950	Fee-for-Service	1073074977	1073074977	1	1	AGHIGHI, MARYAM MD	7/15/2024	207ZP0102X	NA	Other	026	PHYSICIANS	181908	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1165 MONTGOMERY DRIVE	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
38959	Fee-for-Service	1407112188	1407112188	1	1	ADROUNY, MELISSA K MD	4/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129928	33	Thoracic Surgery	0	In state provider	None	2907 CHANTICLEER AVE	None	SANTA CRUZ	CA	95065	1815	44	06087	36.98793933	-121.9782322	Santa Cruz County
38962	Fee-for-Service	1245681485	1245681485	1	1	ALBA, VANESSA C	12/30/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	OTHERAPY SERVICES	9017 RESEDA BLVD STE 204	None	NORTHRIDGE	CA	91324	3985	19	06037	34.234155	-118.5360975	Los Angeles County
38968	Fee-for-Service	1467539122	1467539122	1	1	AZADEH, HOOSHANG MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	24681	None	None	0	In state provider	None	18251 ROSCOE BLVD	STE 203	NORTHRIDGE	CA	91325	4255	19	06037	34.22081017	-118.5314078	Los Angeles County
38971	Fee-for-Service	1386042794	1386042794	1	1	AGHEL, AZADEH MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	127369	22	Pathology (M.D. only)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
38974	Fee-for-Service	1447854161	1447854161	1	1	ADEYEMI, LIHLE LMFT	3/17/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	505 NORTH TUSTIN AVENUE	SUITE 265	SANTA ANA	CA	78611	3112	30	06059	33.74962094	-117.8341227	Orange County
38977	Fee-for-Service	1851637466	1851637466	1	1	AGUILAR, CARMEN LCSW	2/24/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	34	06067	38.570553	-121.481325	Sacramento County
39010	Fee-for-Service	1265960215	1265960215	1	3	ANESTHESIOLOGY SPECIALISTS O	6/4/2020	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	F CALIFORNIA	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	33	06065	33.5580705	-117.1835458	Riverside County
39053	Fee-for-Service	1952419970	1952419970	1	1	ARANETA, TOMAS TAN JR MD	11/25/1985	207R00000X	NA	Other	026	PHYSICIANS	42288	41	Internal Medicine	0	In state provider	None	26960 CHERRY HILLS BLVD	STE B	SUN CITY	CA	92586	2512	33	06065	33.71084821	-117.1899782	Riverside County
39075	Fee-for-Service	1063742161	1063742161	1	1	AFSHAR, ARMIN R MD	7/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121391	18	Ophthalmology	0	In state provider	None	1635 DIVISADERO STREET	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
39077	Fee-for-Service	1528344686	1528344686	1	1	ANGELES MEDICAL CLINIC, INC.	12/19/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	204 E PICO BLVD	None	LOS ANGELES	CA	90015	2508	19	06037	34.0355835	-118.2591226	Los Angeles County
39078	Fee-for-Service	1902461072	1902461072	1	1	ASAO, SHUNEI MD	10/23/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
39107	Fee-for-Service	1194873067	1194873067	1	1	AGATEP, ANGELI O MD	2/16/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	62294	01	General Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
39119	Fee-for-Service	1285898163	1285898163	1	1	ALEXANDER, LAUREN A MD	1/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132072	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
39138	Fee-for-Service	1174533343	1174533343	1	1	ARLINGTON MEMORIAL HOSP	3/11/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	800 W RANDOL MILL RD	None	ARLINGTON	TX	76012	2504	00	None	32.75010897	-97.11582719	Tarrant County
39159	Fee-for-Service	1750657995	1750657995	1	1	ADAMS, JOSEPH D LAC	9/10/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
39192	Fee-for-Service	1407357635	1407357635	1	1	AIKINS, SADIE K CCC-SLP	1/3/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
39202	Fee-for-Service	1821398058	1821398058	1	1	AUBIN, PAUL A DC	9/30/2022	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
39215	Fee-for-Service	1386902583	1386902583	1	1	AWAD, PAMELA LMFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	89451	-	NOT APPLICABLE	0	In state provider	None	43520 DIVISION STREET	None	LANCASTER	CA	93535	4089	19	06037	34.673445	-118.130143	Los Angeles County
39243	Fee-for-Service	1497833248	1497833248	1	1	ABDULLAH, RABIATU MD	1/29/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75566	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
39247	Fee-for-Service	1154523371	1154523371	1	1	ALATTAR, MAY MD	2/7/2025	207RE0101X	NA	Endocrinology	026	PHYSICIANS	179801	67	Endocrinology	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
39273	Fee-for-Service	1578668067	1578668067	1	1	ACHARYA & SHARMA MED GP	10/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1240 E CHAPMAN AVE	None	ORANGE	CA	92866	2217	30	06059	33.78781349	-117.840303	Orange County
39284	Fee-for-Service	1235145962	1235145962	1	1	ANDREWS, BARBARA G NP	1/6/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
39287	Fee-for-Service	1770990772	1770990772	1	1	ANNICCHIARICO, ANTHONY LPCC	8/20/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
39331	Fee-for-Service	1861719668	1861719668	1	1	ADVANCED CARDIO SERVICES	8/25/2011	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2544 CAMPBELL PLACE	STE 275	CARLSBAD	CA	92009	1768	37	06073	33.12870934	-117.2633227	San Diego County
39379	Fee-for-Service	1790243616	1790243616	1	1	AMERICANO HOME HEALTH CARE	7/8/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	10012 COMMERCE AVE	STE D	TUJUNGA	CA	91042	2304	19	06037	34.25058808	-118.2886057	Los Angeles County
39384	Fee-for-Service	1629211065	1629211065	1	1	AU, JOHN D MD	5/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129460	18	Ophthalmology	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
39424	Fee-for-Service	1720625510	1720625510	1	1	ATTAIE HEALTHCARE INC	2/15/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4133 MOHR AVE	SUITE A	PLEASANTON	CA	94566	4750	01	06001	37.68195698	-121.8737212	Alameda County
39430	Fee-for-Service	1174533343	1174533343	1	1	ARLINGTON MEMORIAL HOSP	3/11/2007	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	800 W RANDOL MILL RD	None	ARLINGTON	TX	76012	2504	00	None	32.75010897	-97.11582719	Tarrant County
39437	Fee-for-Service	1437564135	1437564135	1	1	ABTAHI, SEYED MAHDI MD	7/18/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	161415	30	Radiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
39447	Fee-for-Service	1427465061	1427465061	1	1	ALMQUIST, TAYLOR LCSW	6/17/2019	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92563	7906	30	06059	33.62516256	-117.7353393	Orange County
39471	Fee-for-Service	1194110163	1194110163	1	1	AL-SALEH, ALI M MD DO	10/25/2018	207R00000X	NA	Other	026	PHYSICIANS	143365	41	Internal Medicine	0	In state provider	None	751 S WEIR CANYON RD	SUITE 167	ANAHEIM	CA	92808	1692	30	06059	33.86181251	-117.7376332	Orange County
39482	Fee-for-Service	1174882385	1174882385	1	1	ALANZALON, RYAN E MD FAAP	7/25/2014	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	127373	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
39507	Fee-for-Service	1174056246	1174056246	1	1	AHMAD, KINZA T MD	7/1/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	172219	None	None	0	In state provider	None	11370 ANDERSON ST	STE 1800	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
39543	Fee-for-Service	1528146206	1528146206	1	1	ARROYO, GILBERT S MD	12/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	80282	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
39550	Fee-for-Service	1871503557	1871503557	1	1	A. DE LA PENA, MD A MED	10/30/1991	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC.	2446 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	3041	19	06037	34.01449625	-118.1287912	Los Angeles County
39568	Fee-for-Service	1225456643	1225456643	1	1	AJAYI, ANTONETTE A MD	11/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137868	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
39579	Fee-for-Service	1619906690	1619906690	1	1	A C I SYSTEMS INC	11/26/1996	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	10847 BURBANK BLVD	None	NORTH HOLLYWOOD	CA	91601	2521	19	06037	34.17218745	-118.3675365	Los Angeles County
39594	Fee-for-Service	1699481523	1699481523	1	1	ABELLANA, HEATHER J	2/10/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
39630	Fee-for-Service	1356397350	1356397350	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	20261 HIGHWAY 18	None	APPLE VALLEY	CA	92307	2953	36	06071	34.52556433	-117.2198711	San Bernardino County
39637	Fee-for-Service	1558682880	1558682880	1	1	AMADOR, ELLA C MD	10/26/2018	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	131984	39	Preventive (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
39646	Fee-for-Service	1184856122	1184856122	1	1	ACEVEDO, DANIEL C MD	3/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107668	20	Orthopedic Surgery	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
39654	Fee-for-Service	1427336338	1427336338	1	1	ADVANCED SLEEP MEDICINE SRVS	7/3/2018	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	81833 DR CARREON BLVD	SUITE 4	INDIO	CA	92201	5590	33	06065	33.70737252	-116.2365255	Riverside County
39665	Fee-for-Service	1689108425	1689108425	1	1	AHMAD, ASHRAF F MD	6/10/2021	390200000X	NA	Other	026	PHYSICIANS	172184	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
39681	Fee-for-Service	1114037942	1114037942	2	1	AFP DRUGSTORE INC	4/29/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15863 KASOTA RD	STE C	APPLE VALLEY	CA	92308	4507	36	06071	34.53957208	-117.2667471	San Bernardino County
39704	Fee-for-Service	1730292541	1730292541	1	1	ADVANCED RETINA	4/29/2020	207W00000X	NA	Ophthalmology	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES MEDICAL GROUP	17750 SHERMAN WAY	SUITE 100	RESEDA	CA	91335	8331	19	06037	34.2009025	-118.520343	Los Angeles County
39708	Fee-for-Service	1902165178	1902165178	1	1	AL SAD, SONDOS A MD	2/23/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	175577	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
39709	Fee-for-Service	1770517385	1770517385	1	1	AL-SALTI, MUSBAH MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	41145	02	General Surgery	0	In state provider	None	4629 WHITNEY AVE	STE 2	SACRAMENTO	CA	95821	4111	34	06067	38.62841967	-121.3563671	Sacramento County
39714	Fee-for-Service	1720625510	1720625510	1	1	ATTAIE HEALTHCARE INC	2/15/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4133 MOHR AVE	SUITE A	PLEASANTON	CA	94566	4750	01	06001	37.68195698	-121.8737212	Alameda County
39721	Fee-for-Service	1740558451	1740558451	1	1	ABUTIN, FATIMA F MD	2/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120709	01	General Practice	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
39726	Fee-for-Service	1477100378	1477100378	1	1	ADVANCED CARE ORTHOPEDICS	10/14/2020	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4067 TWEEDY BLVD	None	SOUTH GATE	CA	90280	6146	19	06037	33.94365993	-118.2004884	Los Angeles County
39763	Fee-for-Service	1679894315	1679894315	1	1	ARCE, MICHAEL W MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137865	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2175 ROSALINE AVENUE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
39821	Fee-for-Service	1386644029	1386644029	1	1	ASHLAND COMMUNITY HOSP	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	280 MAPLE ST	None	ASHLAND	OR	97520	1552	00	None	42.20644248	-122.724936	Jackson County
39828	Fee-for-Service	1508894114	1508894114	1	1	ACCESS DIABETIC SUPPLY	9/18/2001	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	AOM HEALTHCARE SOLUTIONS	2101 NW 33RD ST	STE 2000	POMPANO BEACH	FL	33069	5906	00	None	26.27185641	-80.15366234	Broward County
39829	Fee-for-Service	1649402678	1649402678	1	1	AVOIAN, TIGRAN MD	9/15/2009	207PE0004X	NA	Other	026	PHYSICIANS	109124	20	Orthopedic Surgery	0	In state provider	None	2400 S FLOWER ST	None	LOS ANGELES	CA	90007	2629	19	06037	34.02861627	-118.273964	Los Angeles County
39837	Fee-for-Service	1871503557	1871503557	1	1	A. DE LA PENA, MD A MED	10/23/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	GROUP, INC.	2446 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	3041	19	06037	34.01449625	-118.1287912	Los Angeles County
39885	Fee-for-Service	1639309347	1639309347	1	1	AHMADI, ESHWA B MD	1/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108070	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
39893	Fee-for-Service	1245207174	1245207174	1	1	ASADUZZAMAN, MOHAMMED MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66840	05	Anesthesiology	0	In state provider	None	9212 MIRA ESTE CT	STE 204	SAN DIEGO	CA	92126	6337	37	06073	32.88927901	-117.1482338	San Diego County
39924	Fee-for-Service	1942200142	1942200142	1	1	ANDERSON BROS FLORIN SQ	7/23/1979	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	INC	2374 FLORIN RD	None	SACRAMENTO	CA	95822	4403	34	06067	38.4956427	-121.4833568	Sacramento County
39925	Fee-for-Service	1396355467	1396355467	1	1	ALPHA & OMEGA FAMILY COUNSEL	11/10/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ING, INC.	400 MOBIL AVE	D29	CAMARILLO	CA	93010	6338	56	06111	34.22111093	-119.0429505	Ventura County
39929	Fee-for-Service	1669642658	1669642658	1	1	ASHIDA, ELLYN R MD	1/1/1982	207K00000X	NA	Other	026	PHYSICIANS	40034	03	Allergy	0	In state provider	None	16660 PARAMOUNT BLVD	STE 308	PARAMOUNT	CA	90723	5470	19	06037	33.882723	-118.1599535	Los Angeles County
39948	Fee-for-Service	1225586100	1225586100	1	1	ANDERSON, ANDREA R PT	7/30/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	34	06067	38.56554	-121.4664615	Sacramento County
39991	Fee-for-Service	1730292541	1730292541	1	1	ADVANCED RETINA	4/4/2006	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES MEDICAL GROUP	17750 SHERMAN WAY	SUITE 100	RESEDA	CA	91335	8331	19	06037	34.2009025	-118.520343	Los Angeles County
39994	Fee-for-Service	1265415087	1265415087	1	1	AIR EVAC EMS INC	5/5/2023	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	115 HCR 4282	None	HILLSBORO	TX	76645	4115	00	None	32.02476418	-97.08367632	Hill County
39996	Fee-for-Service	1770517385	1770517385	1	1	AL-SALTI, MUSBAH MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	41145	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4629 WHITNEY AVE	STE 2	SACRAMENTO	CA	95821	4111	34	06067	38.62841967	-121.3563671	Sacramento County
40012	Fee-for-Service	1912116989	1912116989	1	1	AUBERT, HOWARD A MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143438	01	General Practice	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94354395	-117.394926	Riverside County
40020	Fee-for-Service	1750605481	1750605481	1	1	ANJUM, JALEEL MD	6/25/2019	208M00000X	NA	Other	026	PHYSICIANS	151254	08	Family Practice	0	In state provider	None	435 H ST	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
40022	Fee-for-Service	1588083646	1588083646	1	1	ARCHIE, MEENA M MD	8/1/2019	2086S0129X	NA	General Surgery	026	PHYSICIANS	142383	None	None	0	In state provider	None	1140 W LA VETA AVE	STE 850	ORANGE	CA	92868	4218	30	06059	33.7802984	-117.8651669	Orange County
40059	Fee-for-Service	1366678294	1366678294	2	1	ASHLI HEALTHCARE INC	5/10/2017	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2201 ZEUS CT	None	BAKERSFIELD	CA	93308	6867	15	06029	35.43250123	-119.067763	Kern County
40071	Fee-for-Service	1255496600	1255496600	2	2	AEGIS TREATMENT CENTERS, LLC	6/11/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1450 N LAKE AVENUE	150	PASADENA	CA	91104	2387	19	06037	34.17087521	-118.132138	Los Angeles County
40072	Fee-for-Service	1215442405	1215442405	1	1	AZENKOT, TALI MD	6/10/2022	207R00000X	NA	Other	026	PHYSICIANS	176737	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
40081	Fee-for-Service	1497763528	1497763528	1	1	ALAIDANDREW CORP	3/29/2006	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1205 8TH ST	None	BAKERSFIELD	CA	93304	2123	15	06029	35.36456051	-119.015658	Kern County
40084	Fee-for-Service	1477639193	1477639193	1	1	AU, ALVIN Y MD	6/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	45911	10	Gastroenterology (M.D. only)	0	In state provider	None	1360 BAILEY ST	None	HANFORD	CA	93230	5921	16	06031	36.3273344	-119.665596	Kings County
40087	Fee-for-Service	1659030070	1659030070	1	1	AMERI-CAB	6/15/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2461 E ORANGETHORPE AVE	225	FULLERTON	CA	92831	5302	30	06059	33.85968746	-117.886599	Orange County
40091	Fee-for-Service	1386815199	1386815199	1	1	ANDRES, RENCHELL J MD	10/20/2008	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
40092	Fee-for-Service	1912393281	1912393281	1	1	ANAND, KAPIL MD	7/21/2023	207R00000X	NA	Other	026	PHYSICIANS	177794	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
40107	Fee-for-Service	1386644029	1386644029	1	1	ASHLAND COMMUNITY HOSP	12/1/1977	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	None	280 MAPLE ST	None	ASHLAND	OR	97520	1552	00	None	42.20644248	-122.724936	Jackson County
40131	Fee-for-Service	1336469790	1336469790	1	4	ALEXANDER REYZELMAN D P M IN	2/17/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1580 VALENCIA STREET	109	SAN FRANCISCO	CA	94110	4420	38	06075	37.74746923	-122.4202583	San Francisco County
40138	Fee-for-Service	1871073510	1871073510	1	1	AVELAR, CINDY	1/17/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
40162	Fee-for-Service	1144379413	1144379413	1	1	ARISHIN, JOHN A DC	8/27/2008	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	7275 E SOUTHGATE DRIVE	STE 204	SACRAMENTO	CA	95823	2628	34	06067	38.493576	-121.436559	Sacramento County
40183	Fee-for-Service	1790918019	1790918019	1	1	ALMARZOUKI, HASHEM S MD	8/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111024	18	Ophthalmology	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
40184	Fee-for-Service	1851976260	1851976260	1	1	ALI, SOHRAB NAUSHAD MD	9/14/2021	208800000X	NA	Other	026	PHYSICIANS	174798	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
40189	Fee-for-Service	1922116664	1922116664	1	1	AGAJANIAN, RICHY MD	2/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	70830	78	Neoplastic Diseases/Oncology	0	In state provider	None	11480 BROOKSHIRE AVE	STE 309	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
40191	Fee-for-Service	1619275443	1619275443	1	1	ATLIS, MERA M PHD	6/15/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	800 SERENO DRIVE	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
40200	Fee-for-Service	1609954478	1609954478	1	1	ALKORAISHI, AHMED S H MD	3/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	61654	02	General Surgery	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
40208	Fee-for-Service	1396804027	1396804027	1	1	ASH, SANDRA C	6/9/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	14011 PARK AVE	None	VICTORVILLE	CA	92392	2413	36	06071	34.505647	-117.3265457	San Bernardino County
40222	Fee-for-Service	1700212891	1700212891	1	2	AM/PM MEDICAL TRANSPORTATION	11/23/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	7005 N. MILBURN AVE	SUITE 102	FRESNO	CA	93722	7982	10	06019	36.83744262	-119.8791265	Fresno County
40223	Fee-for-Service	1013169986	1013169986	1	1	ARAMBULO, MARIA MD	9/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112913	None	None	0	In state provider	None	2828 FRESNO ST	STE 203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
40313	Fee-for-Service	1063701753	1063701753	1	1	AGARWAL, SHUCHI MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135690	01	General Practice	0	In state provider	None	601 VAN NESS AVE	None	SAN FRANCISCO	CA	94102	3200	38	06075	37.78149353	-122.4206703	San Francisco County
40318	Fee-for-Service	1053458885	1053458885	1	2	ADDICTION RESEARCH AND TREAT	12/16/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	433 TURK STREET	None	SAN FRANCISCO	CA	94102	3329	38	06075	37.78247225	-122.4163506	San Francisco County
40321	Fee-for-Service	1417332057	1417332057	1	1	ADVANCE SPECIALTY CARE SOUTH	9/19/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	12437 LEWIS STREET	SUITE 201	GARDEN GROVE	CA	92840	4652	30	06059	33.78204	-117.8974875	Orange County
40355	Fee-for-Service	1164606380	1164606380	1	10	ABILITY PATHWAYS INC	6/21/2007	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LILAC DIVISION	1886 S LILAC CT	None	LOMA LINDA	CA	92354	1759	36	06071	34.0672515	-117.2517034	San Bernardino County
40359	Fee-for-Service	1952406522	1952406522	1	1	AYARS, KRISTI L	4/10/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9 WILLIAMSBURG LANE	None	CHICO	CA	95926	2225	04	06007	39.75249362	-121.8554242	Butte County
40361	Fee-for-Service	1255496600	1255496600	2	2	AEGIS TREATMENT CENTERS, LLC	6/11/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1450 N LAKE AVENUE	150	PASADENA	CA	91104	2387	19	06037	34.17087521	-118.132138	Los Angeles County
40372	Fee-for-Service	1477639193	1477639193	1	1	AU, ALVIN Y MD	6/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	45911	41	Internal Medicine	0	In state provider	None	1360 BAILEY ST	None	HANFORD	CA	93230	5921	16	06031	36.3273344	-119.665596	Kings County
40378	Fee-for-Service	1740613652	1740613652	1	1	AMANCHA, ALEXANDRA E	11/8/2013	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	711 W CAMINO REAL	ROOM 202	ARCADIA	CA	91007	9326	19	06037	34.12214338	-118.0557376	Los Angeles County
40402	Fee-for-Service	1902954860	1902954860	1	1	ANGUIANO, HECTOR E MD	8/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	56389	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
40413	Fee-for-Service	1437424447	1437424447	1	1	ATWAL-KHANNA, SANJEEVAN CNP	3/1/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1707 EYE ST	100	BAKERSFIELD	CA	93301	5208	15	06029	35.37461686	-119.020062	Kern County
40435	Fee-for-Service	1801988902	1801988902	1	1	ANGELIKA B KRAUS, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	714 W PINE ST	None	NEWPORT	WA	99156	9046	00	None	48.1820733	-117.0490023	Pend Oreille County
40444	Fee-for-Service	1952942955	1952942955	1	1	ANDERSON, LAUREN L NP	6/1/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
40445	Fee-for-Service	1659630044	1659630044	1	1	ANDRADE, JACOB MD	7/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130911	30	Radiology	0	In state provider	None	1069 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65855557	-121.6450018	Monterey County
40447	Fee-for-Service	1770180382	1770180382	1	1	ANTELOPE VALLEY INPATIENT PE	11/1/2020	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	DIATRIC ASSOCIATES, INC	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
40460	Fee-for-Service	1306007463	1306007463	1	1	ARCONE, RAFAEL J MD	1/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123026	None	None	0	In state provider	None	9939 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	33	06065	33.91571158	-117.4549231	Riverside County
40477	Fee-for-Service	1922116664	1922116664	1	1	AGAJANIAN, RICHY MD	2/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	70830	68	Hematology	0	In state provider	None	11480 BROOKSHIRE AVE	STE 309	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
40480	Fee-for-Service	1720726433	1720726433	1	1	ALL EARS HEARING AID CENTER	6/28/2022	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2231 J ST	STE 105	SACRAMENTO	CA	95816	4760	34	06067	38.575908	-121.476033	Sacramento County
40500	Fee-for-Service	1013963909	1013963909	1	1	AUGUSTYN,MARK A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2116 CRAIG ROAD	None	EAU CLAIRE	WI	54701	0000	00	None	44.79642	-91.5191165	Eau Claire County
40519	Fee-for-Service	1649505124	1649505124	1	1	AGBIM, UCHENNA A MD	5/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114482	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
40526	Fee-for-Service	1194247635	1194247635	1	1	ALLARD-PHILLIPS, EMILY A MD	6/24/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	10 CONGRESS ST	505	PASADENA	CA	91105	3042	19	06037	34.13396893	-118.1528162	Los Angeles County
40536	Fee-for-Service	1992371074	1992371074	1	1	ANDREW J THOMAS MD INC	6/25/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	None	None	0	In state provider	ND ENT	123 MARGARET LN	STE C1	GRASS VALLEY	CA	95945	5268	29	06057	39.22839146	-121.0455763	Nevada County
40539	Fee-for-Service	1942488796	1942488796	1	1	ANOTHER CHOICE ANOTHER	1/30/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	CHANCE	4000 PINNELL STREET	None	SACRAMENTO	CA	95838	2907	34	06067	38.6400543	-121.4198266	Sacramento County
40552	Fee-for-Service	1952911703	1952911703	1	1	AK CARE HOSPICE	10/9/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	303 N GLENOAKS BLVD	STE 212	BURBANK	CA	91502	1116	19	06037	34.18486122	-118.308553	Los Angeles County
40602	Fee-for-Service	1063701753	1063701753	1	1	AGARWAL, SHUCHI MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135690	25	Physical Medicine and Rehabilitation	0	In state provider	None	601 VAN NESS AVE	None	SAN FRANCISCO	CA	94102	3200	38	06075	37.78149353	-122.4206703	San Francisco County
40618	Fee-for-Service	1497372650	1497372650	1	1	ARCADIA UNIFIED SCHOOL	1/1/2021	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	150 SOUTH THIRD AVENUE	None	ARCADIA	CA	91006	3703	19	06037	34.13828995	-118.0235548	Los Angeles County
40661	Fee-for-Service	1386887255	1386887255	1	1	ALLWELL MEDICAL SERVICES INC	8/31/2012	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	110 SOUTH LA BREA AVE	STE 280	INGLEWOOD	CA	90301	8770	19	06037	33.962778	-118.353343	Los Angeles County
40663	Fee-for-Service	1962638312	1962638312	1	1	ALEX J. MESSINA M D INC	3/19/2019	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2021 SANTA MONICA BLVD	SUITE 101 E	SANTA MONICA	CA	90404	2208	19	06037	34.02922048	-118.4793681	Los Angeles County
40689	Fee-for-Service	1902954860	1902954860	1	1	ANGUIANO, HECTOR E MD	8/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	56389	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
40702	Fee-for-Service	1720570682	1720570682	1	1	AMAYA, STEPHANIE I MD	4/24/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	180601	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
40744	Fee-for-Service	1710421359	1710421359	1	1	ANDRE, GLADYS LCSW	10/23/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
40749	Fee-for-Service	1518217330	1518217330	1	3	ARCH HEALTH PARTNERS	10/4/2013	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	1955 CITRACADO PKWY	STE 200	ESCONDIDO	CA	92029	4113	37	06073	33.11301099	-117.1202081	San Diego County
40778	Fee-for-Service	1982131397	1982131397	1	1	AHMED, HANNAH S MD	4/19/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	173132	None	None	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
40803	Fee-for-Service	1881665180	1881665180	1	1	AMMED DIRECT, LLC	1/7/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	AMMED DIRECT, LLC	5720 CROSSINGS BLVD	SUITE A	ANTIOCH	TN	37013	3144	00	None	36.04025985	-86.64612607	Davidson County
40813	Fee-for-Service	1194247635	1194247635	1	1	ALLARD-PHILLIPS, EMILY A MD	6/24/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	09	Gynecology (D.O. only)	0	In state provider	None	10 CONGRESS ST	505	PASADENA	CA	91105	3042	19	06037	34.13396893	-118.1528162	Los Angeles County
40819	Fee-for-Service	1063851939	1063851939	1	1	ANDERSON, ERIC K PHD	4/2/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
40824	Fee-for-Service	1467661330	1467661330	1	1	ABLENET INC	11/9/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3111 CAMINO DEL RIO N	400	SAN DIEGO	CA	92108	5720	37	06073	32.77510996	-117.1277427	San Diego County
40839	Fee-for-Service	1952911703	1952911703	1	1	AK CARE HOSPICE	10/9/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	303 N GLENOAKS BLVD	STE 212	BURBANK	CA	91502	1116	19	06037	34.18486122	-118.308553	Los Angeles County
40865	Fee-for-Service	1316095375	1316095375	1	1	AURANG, KAMRAN MD	5/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85435	20	Orthopedic Surgery	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
40877	Fee-for-Service	1467862201	1467862201	1	1	ANGEL OF JOY HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4702 BROOKS ST	None	MONTCLAIR	CA	91763	4723	36	06071	34.0615587	-117.7022415	San Bernardino County
40886	Fee-for-Service	1356195184	1356195184	1	1	ALLIANT MENTAL HEALTH, INC	2/7/2025	2084P0800X	NA	Psychiatry	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	100 N BARRANCA ST	STE 708	WEST COVINA	CA	91791	1647	19	06037	34.073073	-117.8812535	Los Angeles County
40905	Fee-for-Service	1639724941	1639724941	1	1	ABOUTORABIAN, NEGIN A OD	10/10/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	125 E GONZALEZ RD	None	OXNARD	CA	93036	8259	56	06111	34.21917544	-119.1759418	Ventura County
40917	Fee-for-Service	1215381975	1215381975	1	1	AGU, CINDY O DO	8/17/2022	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	20083	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
40923	Fee-for-Service	1457386294	1457386294	1	1	ARAIN, MOHAMMAD A MD	10/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	32711	02	General Surgery	0	In state provider	None	1019 W YOSEMITE AVE	None	MADERA	CA	93637	4584	20	06039	36.95438006	-120.0709254	Madera County
40924	Fee-for-Service	1366682767	1366682767	1	1	ANSOLABEHERE, BERNADETTE MD	8/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103954	08	Family Practice	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
40953	Fee-for-Service	1558438416	1558438416	1	1	AKA, PAUL K MD	1/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	60759	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
40959	Fee-for-Service	1164606380	1164606380	1	8	ABILITY PATHWAYS INC	6/1/2007	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1291 LOMA SOLA AVE	None	UPLAND	CA	91786	2846	36	06071	34.1105156	-117.6280077	San Bernardino County
40964	Fee-for-Service	1669449823	1669449823	1	1	AU YEUNG, KAM L R MD	5/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142071	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
40967	Fee-for-Service	1922099332	1922099332	1	1	ALSAFFAR, NAZAR R MD	12/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42029	30	Radiology	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
40985	Fee-for-Service	1235593567	1235593567	1	2	AJAY PATEL, MD A PROFESSIONA	8/17/2021	163WP0000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	L MEDICAL CORPORATION	10441 LAKEWOOD BLVD	E	DOWNEY	CA	90241	2744	19	06037	33.94358034	-118.1193714	Los Angeles County
41036	Fee-for-Service	1518217330	1518217330	1	3	ARCH HEALTH PARTNERS	10/4/2013	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	46	Hand Surgery	0	In state provider	None	1955 CITRACADO PKWY	STE 200	ESCONDIDO	CA	92029	4113	37	06073	33.11301099	-117.1202081	San Diego County
41079	Fee-for-Service	1104327881	1104327881	1	1	ALLEN, RACHEL W NP	1/9/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
41088	Fee-for-Service	1669632154	1669632154	1	1	AZMA, AZIN MD	10/13/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	-	None	None	1	Border provider	None	2020 WELLNESS WAY	#300	LAS VEGAS	NV	89106	4145	00	None	36.16163146	-115.1686755	Clark County
41089	Fee-for-Service	1518301100	1518301100	1	1	AGRAWAL, ASHISH MD	6/11/2018	390200000X	NA	Other	026	PHYSICIANS	133999	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
41124	Fee-for-Service	1851641880	1851641880	1	1	ARCH HEALTH PARTNERS	10/19/2012	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	15611 POMERADO RD	STE 580	POWAY	CA	92064	2438	37	06073	32.99706	-117.05544	San Diego County
41157	Fee-for-Service	1790090280	1790090280	1	1	AVS PHARMACY INC	6/9/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	511 1/2 E BROADWAY BLVD	None	GLENDALE	CA	91205	1110	19	06037	34.14635866	-118.2495127	Los Angeles County
41162	Fee-for-Service	1245309962	1245309962	2	1	ASPIRE RX INC	2/14/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1215 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4697	19	06037	34.01110985	-118.113546	Los Angeles County
41163	Fee-for-Service	1467862201	1467862201	1	1	ANGEL OF JOY HOSPICE INC	1/14/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4702 BROOKS ST	None	MONTCLAIR	CA	91763	4723	36	06071	34.0615587	-117.7022415	San Bernardino County
41200	Fee-for-Service	1750841920	1750841920	1	1	ABKIAN, ERIC G MD	6/6/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
41206	Fee-for-Service	1902479447	1902479447	1	2	ANAHEIM COMMUNITY HOSPITAL	9/9/2022	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	LLC	3350 W BALL ROAD	None	ANAHEIM	CA	92804	3710	30	06059	33.8172623	-118.0071207	Orange County
41212	Fee-for-Service	1265601561	1265601561	1	1	ALAKOR HEALTHCARE LLC	6/1/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	323 S HELIOTROPE AVENUE	None	MONROVIA	CA	91016	2914	19	06037	34.14874597	-117.9922068	Los Angeles County
41214	Fee-for-Service	1457744708	1457744708	1	1	ABARE, MARCE E MD	10/23/2019	207R00000X	NA	Other	026	PHYSICIANS	144590	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
41238	Fee-for-Service	1013401074	1013401074	1	1	ADEPT HOSPICE CARE	2/2/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	9267 HAVEN AVE	SUITE 275	RANCHO CUCAMONGA	CA	91730	5423	36	06071	34.08526599	-117.575627	San Bernardino County
41243	Fee-for-Service	1982148920	1982148920	1	1	ANDERSON, ERICA L LMFT	2/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2150 N 1ST ST	650	SAN JOSE	CA	95131	2031	43	06085	37.37699728	-121.9208292	Santa Clara County
41253	Fee-for-Service	1205408515	1205408515	1	2	AKHIMIEN, ANNE MD	10/10/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183521	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
41283	Fee-for-Service	1245301159	1245301159	1	1	ABCAR, ANTOINE C MD	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67366	45	Nephrology (Renal-Kidney)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
41297	Fee-for-Service	1063646594	1063646594	1	1	ADVANCED SURGERY INSTITUTE	11/10/2010	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	1739 4TH ST	None	SANTA ROSA	CA	95404	3601	49	06097	38.449278	-122.698755	Sonoma County
41346	Fee-for-Service	1740599638	1740599638	1	1	ALLBRIGHT, JACE A	5/16/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
41355	Fee-for-Service	1750810941	1750810941	1	1	AGUILAR, RUBY A LCSW	2/27/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
41367	Fee-for-Service	1477786598	1477786598	1	1	AHMAD, FAWAZ MD	9/19/2019	207RC0200X	NA	Other	026	PHYSICIANS	148385	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
41390	Fee-for-Service	1700933587	1700933587	1	1	ARBEGAST, KATHERINE C OD	2/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1955 COWELL BLVD	None	DAVIS	CA	95618	6325	57	06113	38.5399459	-121.7284328	Yolo County
41396	Fee-for-Service	1124653126	1124653126	1	2	AU HOMES INC	11/4/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8422 SAN MARINO DR	None	BUENA PARK	CA	90620	3013	30	06059	33.84056198	-118.0239687	Orange County
41422	Fee-for-Service	1912290669	1912290669	1	1	ADVANCED URGENT CARE	5/13/2013	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OF BEVERLY HILLS INC	242 S ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	2811	19	06037	34.06370697	-118.3835693	Los Angeles County
41492	Fee-for-Service	1700035946	1700035946	1	1	ADAM M. ROTUNDA, M.D., A PRO	4/2/2021	207ND0101X	NA	Dermatology	026	PHYSICIANS	None	None	None	0	In state provider	FESSIONAL CORPORATION	1100 QUAIL ST	SUITE 102	NEWPORT BEACH	CA	92660	2701	30	06059	33.65958081	-117.8666188	Orange County
41500	Fee-for-Service	1265601561	1265601561	1	1	ALAKOR HEALTHCARE LLC	6/1/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	323 S HELIOTROPE AVENUE	None	MONROVIA	CA	91016	2914	19	06037	34.14874597	-117.9922068	Los Angeles County
41509	Fee-for-Service	1407175847	1407175847	1	1	AFFORDABLE VISION CENTER INC	7/8/2010	193400000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	906 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3311	19	06037	34.28155934	-118.4402648	Los Angeles County
41526	Fee-for-Service	1275185373	1275185373	1	1	ARUTYUNYAN KAZARIAN O.D. COR	7/30/2019	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	17310 VENTURA BLVD	None	ENCINO	CA	91316	3904	19	06037	34.16093637	-118.5106255	Los Angeles County
41530	Fee-for-Service	1013401074	1013401074	1	1	ADEPT HOSPICE CARE	2/2/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	9267 HAVEN AVE	SUITE 275	RANCHO CUCAMONGA	CA	91730	5423	36	06071	34.08526599	-117.575627	San Bernardino County
41539	Fee-for-Service	1639153513	1639153513	1	1	ARNOTT, TYRON P MD	11/1/1995	207R00000X	NA	Other	026	PHYSICIANS	83189	41	Internal Medicine	0	In state provider	None	11879 KEMPER RD	STE 15	AUBURN	CA	95603	9021	31	06061	38.93136899	-121.0916266	Placer County
41543	Fee-for-Service	1790722718	1790722718	1	1	ALI, TAREQ A MD	3/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51048	01	General Practice	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
41554	Fee-for-Service	1639227507	1639227507	1	1	ANDIA, ANA MARIA	8/30/1993	2084P0800X	NA	Psychiatry	026	PHYSICIANS	42186	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
41555	Fee-for-Service	1043474513	1043474513	1	1	AMIRKHANIAN-NAMAGERDY, SEBO	6/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100190	None	None	0	In state provider	None	3630 EAST EMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
41557	Fee-for-Service	1366984445	1366984445	1	1	ANGEL RAYS HOSPICE INC	5/14/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10324 BALBOA BLVD	STE #203B	GRANADA HILLS	CA	91344	7349	19	06037	34.258293	-118.5022935	Los Angeles County
41568	Fee-for-Service	1245573708	1245573708	1	1	ARIELI, ROBERT P MD	9/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137227	41	Internal Medicine	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 100	LOS ANGELES	CA	90033	2488	19	06037	34.05112725	-118.2173921	Los Angeles County
41623	Fee-for-Service	1043396716	1043396716	1	1	AUGUSTO,RAMOS G MD	3/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1700 E SAUNDERS	None	LAREDO	TX	78041	5401	00	None	27.532971	-99.478116	Webb County
41642	Fee-for-Service	1104029990	1104029990	1	1	ARSANJANI, REZA MD	8/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116223	41	Internal Medicine	0	In state provider	None	400 NORTH PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
41655	Fee-for-Service	1306831912	1306831912	2	1	ATIGA, JON J MD	3/5/2020	2080A0000X	NA	Pediatric Primary Care	026	PHYSICIANS	43702	40	Pediatrics	0	In state provider	None	25405 HANCOCK AVE.	STE. 108	MURRIETA	CA	92563	5978	33	06065	33.5580833	-117.1850127	Riverside County
41696	Fee-for-Service	1376316125	1376316125	1	1	AR & KA TRANSPORTATION	3/12/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	11490 BURBANK BLVD	STE 4G	NORTH HOLLYWOOD	CA	91601	2332	19	06037	34.17212154	-118.3819905	Los Angeles County
41716	Fee-for-Service	1902267479	1902267479	1	7	ALTAMED HEALTH SERVICES	5/8/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	4066 JOHNNIE COCHRAN	VISTA	LOS ANGELES	CA	90019	6025	19	06037	34.04256029	-118.326277	Los Angeles County
41717	Fee-for-Service	1265708697	1265708697	1	1	AKBAR, ADNAN MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
41725	Fee-for-Service	1922411214	1922411214	1	1	ABRAM, CASSANDRA R OD	8/28/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	991 E MONTE VISTA AVE	None	TURLOCK	CA	95382	0636	50	06099	37.52188647	-120.83769	Stanislaus County
41740	Fee-for-Service	1962825737	1962825737	1	1	ADVENTIST HEALTH FACILITY	5/25/2017	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	13942 DOMINICAN AVE	None	MORENO VALLEY	CA	92555	2566	33	06065	33.918138	-117.2026315	Riverside County
41743	Fee-for-Service	1326292806	1326292806	1	1	AFUWAPE, HAKEEM A DO	6/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13257	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
41774	Fee-for-Service	1174279681	1174279681	1	1	ALMOND VIEW CARE CENTER LLC	3/1/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1224 E STREET	None	WILLIAMS	CA	95987	5187	06	06011	39.15249817	-122.1567386	Colusa County
41796	Fee-for-Service	1912926676	1912926676	1	1	AGGARWAL, SHITAL MD	7/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	86334	41	Internal Medicine	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
41810	Fee-for-Service	1811663727	1811663727	1	1	AMENTA, ALYSON PT	12/1/2023	2251N0400X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5255 EL CAMINO REAL	SUITE C	ATASCADERO	CA	93422	3351	40	06079	35.49280107	-120.6762923	San Luis Obispo County
41831	Fee-for-Service	1487744215	1487744215	1	1	ARAKAKI, BRANDON E	8/13/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
41842	Fee-for-Service	1639227507	1639227507	1	1	ANDIA, ANA MARIA	8/30/1993	2084P0800X	NA	Psychiatry	026	PHYSICIANS	42186	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
41845	Fee-for-Service	1366984445	1366984445	1	1	ANGEL RAYS HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10324 BALBOA BLVD	STE #203B	GRANADA HILLS	CA	91344	7349	19	06037	34.258293	-118.5022935	Los Angeles County
41847	Fee-for-Service	1356626402	1356626402	1	1	AL-JIBOURY, HALA A MD	11/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123602	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
41913	Fee-for-Service	1285280297	1285280297	1	1	ACOSTA, ALICIA M LCSW	2/22/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
41920	Fee-for-Service	1114527843	1114527843	1	1	ALL SMILES HOME HEALTH BEST	5/12/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE, INC	14545 VICTORY BLVD	STE 503B	VAN NUYS	CA	91411	4143	19	06037	34.18668846	-118.450152	Los Angeles County
41933	Fee-for-Service	1003022534	1003022534	1	1	ANDERSON, DIANE H LCSW	7/26/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	STE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
41982	Fee-for-Service	1073706628	1073706628	1	1	AGUIRRE, JON	1/31/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	740 S PLACENTIA AVE	STE 100	PLACENTIA	CA	92870	6832	30	06059	33.86285731	-117.8822066	Orange County
41989	Fee-for-Service	1730647991	1730647991	1	1	AGUDAH, VICTORIA CNP	6/23/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
42000	Fee-for-Service	1902267479	1902267479	1	7	ALTAMED HEALTH SERVICES	5/8/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	4066 JOHNNIE COCHRAN	VISTA	LOS ANGELES	CA	90019	6025	19	06037	34.04256029	-118.326277	Los Angeles County
42015	Fee-for-Service	1790105559	1790105559	1	1	ALTURA CENTERS FOR HEALTH	11/4/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	600 N CHERRY ST	None	TULARE	CA	93274	2978	54	06107	36.21679761	-119.3375929	Tulare County
42026	Fee-for-Service	1013002716	1013002716	1	1	AGATEP-BERBANO, MELBA MD	9/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	53064	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	73 W MARCH LN	STE A	STOCKTON	CA	95207	5726	39	06077	37.99550203	-121.3068758	San Joaquin County
42080	Fee-for-Service	1801383294	1801383294	1	1	ALLEN, ANTOINETTE A MD	6/22/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	178899	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
42095	Fee-for-Service	1245993161	1245993161	1	1	ABELLA, ROXANNE NP	6/7/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11822 FLORAL DR	None	WHITTIER	CA	90601	2900	19	06037	33.99172377	-118.0495187	Los Angeles County
42120	Fee-for-Service	1912977463	1912977463	1	1	ARFAA, KAIVON MD	10/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55686	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
42134	Fee-for-Service	1346297579	1346297579	1	1	ALTENEDER, HEIDI C	4/1/2002	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1911 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5605	19	06037	34.03097999	-118.4838241	Los Angeles County
42153	Fee-for-Service	1326700287	1326700287	1	1	ANGELIDAKIS, AUSTIN N NP	11/19/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
42155	Fee-for-Service	1124550850	1124550850	1	1	ACTION FAMILY COUNSELING -	8/21/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	K RTC	407 HELEN WAY / 9301 OPA	None	BAKERSFIELD	CA	93307	6112	15	06029	35.27085113	-119.0086666	Kern County
42226	Fee-for-Service	1467867523	1467867523	1	1	AMAVI HOME HEALTH AND	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE CARE SERVICES IN	131 SAND CREEK ROAD	UNIT K	BRENTWOOD	CA	94513	7302	07	06013	37.94676716	-121.6989995	Contra Costa County
42238	Fee-for-Service	1982663795	1982663795	1	1	AHN, EDWARD S MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	40196	None	None	0	In state provider	None	4620 BEVERLY BLVD	None	LOS ANGELES	CA	90004	3102	19	06037	34.07622211	-118.3099548	Los Angeles County
42254	Fee-for-Service	1588087738	1588087738	1	1	ABBASI, SEEMA	10/29/2020	207R00000X	NA	Other	026	PHYSICIANS	148582	41	Internal Medicine	0	In state provider	None	2505 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.02139448	-121.347738	San Joaquin County
42276	Fee-for-Service	1033808209	1033808209	1	1	ANJS RX	8/24/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4347 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	3727	19	06037	34.15024111	-118.4488694	Los Angeles County
42289	Fee-for-Service	1992951115	1992951115	1	1	ANANTHASAYANAN, ASHOK K MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128657	41	Internal Medicine	0	In state provider	None	1100 N PALM CANYON DR	STE 211	PALM SPRINGS	CA	92262	4426	33	06065	33.838182	-116.546744	Riverside County
42299	Fee-for-Service	1609133578	1609133578	1	1	AL RABADI, LEINA S MD	8/2/2019	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	153810	10	Gastroenterology (M.D. only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
42305	Fee-for-Service	1790105559	1790105559	1	1	ALTURA CENTERS FOR HEALTH	2/21/2019	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	600 N CHERRY ST	None	TULARE	CA	93274	2978	54	06107	36.21679761	-119.3375929	Tulare County
42389	Fee-for-Service	1154736429	1154736429	1	3	AVENAL COMMUNITY HEALTH CENT	12/2/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	781 SEQUOIA AVENUE	SUITE 1	LINDSAY	CA	93247	1422	54	06107	36.21240571	-119.0961081	Tulare County
42409	Fee-for-Service	1689022824	1689022824	1	1	ABDELKADER, MARIAM A MD	11/7/2022	207RC0200X	NA	Other	026	PHYSICIANS	182753	None	None	0	In state provider	None	2335 E KASHIAN LANE	SUITE 260	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
42440	Fee-for-Service	1265543268	1265543268	1	1	ADVANCED BUSINESS	8/17/2005	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ENTERPRISE, INC	515 N AZUSA AVE	None	COVINA	CA	91722	3502	19	06037	34.0895921	-117.9079487	Los Angeles County
42444	Fee-for-Service	1417119256	1417119256	1	1	ANTONIO, ERICA S MFT	5/2/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	80062	-	NOT APPLICABLE	0	In state provider	None	615 B STREET	SUITE 1A	SAN RAFAEL	CA	94901	3884	21	06041	37.9699095	-122.5300109	Marin County
42452	Fee-for-Service	1518275726	1518275726	1	1	ANGELL, HEATHER D MD	7/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118738	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
42460	Fee-for-Service	1740628460	1740628460	1	1	ASSURANCE HEALTH PARTNERS	3/5/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	2255 WATT AVE	SUITE 20	SACRAMENTO	CA	95825	0508	34	06067	38.604789	-121.38399	Sacramento County
42467	Fee-for-Service	1013746163	1013746163	1	1	ALTAMED DENTAL GROUP	1/17/2025	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	3601 W SUNFLOWER AVE	ROOMS 243-244,252 & 254	SANTA ANA	CA	92704	7916	30	06059	33.69568151	-117.918072	Orange County
42475	Fee-for-Service	1982786034	1982786034	2	1	ASADINIK, SAHAR D LP	8/29/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1101 CALIFORNIA AVE	STE 100	CORONA	CA	92881	6472	33	06065	33.86171794	-117.5440764	Riverside County
42499	Fee-for-Service	1447230412	1447230412	1	1	ALARCON, AUGUSTO C MD	5/1/1995	174400000X	NA	Other	026	PHYSICIANS	82193	None	None	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
42508	Fee-for-Service	1730306218	1730306218	1	1	ALONZO, LEOPOLDO J MD	7/1/1995	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	79776	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7111 WINNETKA AVE	None	CANOGA PARK	CA	91306	3646	19	06037	34.199739	-118.5710185	Los Angeles County
42516	Fee-for-Service	1467867523	1467867523	1	1	AMAVI HOME HEALTH AND	9/19/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE CARE SERVICES IN	131 SAND CREEK ROAD	UNIT K	BRENTWOOD	CA	94513	7302	07	06013	37.94676716	-121.6989995	Contra Costa County
42547	Fee-for-Service	1750974788	1750974788	1	1	ASTER HOME HEALTH, INC	6/28/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	RESOURCES	5236 COLODNY DRIVE	STE 205	AGOURA HILLS	CA	91301	4913	19	06037	34.14403336	-118.742661	Los Angeles County
42549	Fee-for-Service	1295173607	1295173607	1	1	AGGABAO, MARY ANN M PT	12/9/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
42571	Fee-for-Service	1801183678	1801183678	1	1	ALSUP, CARL A MD	6/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146112	66	Emergency Medicine (Urgent Care)	0	In state provider	None	155 GLASSON WAY	None	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
42574	Fee-for-Service	1023672367	1023672367	1	1	APEX MULTISPECIALTY MEDICAL	10/8/2024	104100000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	GROUP, INC	600 S SAN VICENTE BLVD	STE 101	LOS ANGELES	CA	90048	4653	19	06037	34.06576461	-118.3728518	Los Angeles County
42576	Fee-for-Service	1992951115	1992951115	1	1	ANANTHASAYANAN, ASHOK K MD	9/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128657	45	Nephrology (Renal-Kidney)	0	In state provider	None	1100 N PALM CANYON DR	STE 211	PALM SPRINGS	CA	92262	4426	33	06065	33.838182	-116.546744	Riverside County
42588	Fee-for-Service	1609133578	1609133578	1	1	AL RABADI, LEINA S MD	8/2/2019	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	153810	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
42590	Fee-for-Service	1790105559	1790105559	1	1	ALTURA CENTERS FOR HEALTH	11/4/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	600 N CHERRY ST	None	TULARE	CA	93274	2978	54	06107	36.21679761	-119.3375929	Tulare County
42621	Fee-for-Service	1518093178	1518093178	1	1	ABRAMS, ARTHUR J MD INC	9/20/2007	207N00000X	NA	Dermatology	026	PHYSICIANS	13460	07	Dermatology	0	In state provider	None	763 ALTOS OAKS DR	STE 4	LOS ALTOS	CA	94024	5400	43	06085	37.35937984	-122.0938858	Santa Clara County
42646	Fee-for-Service	1245727783	1245727783	1	1	AVICENNA HOME HEALTH INC	11/5/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	17915 VENTURA BLVD	STE 222	ENCINO	CA	91316	3618	19	06037	34.16385429	-118.522817	Los Angeles County
42676	Fee-for-Service	1154736429	1154736429	1	3	AVENAL COMMUNITY HEALTH CENT	12/2/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	781 SEQUOIA AVENUE	SUITE 1	LINDSAY	CA	93247	1422	54	06107	36.21240571	-119.0961081	Tulare County
42729	Fee-for-Service	1780034579	1780034579	1	1	ARCAM HOME HEALTH CARE	7/15/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	25115 AVE STANFORD	SUITE A211	VALENCIA	CA	91355	1290	19	06037	34.43652793	-118.5753255	Los Angeles County
42741	Fee-for-Service	1003202409	1003202409	1	1	ALMUKHTAR, RAWAA MD	12/9/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	161035	07	Dermatology	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
42754	Fee-for-Service	1396087300	1396087300	1	1	ALL ABOUT LOVING CARE INC.	8/11/2015	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	6060 W MANCHESTER AVE	SUITE 113	LOS ANGELES	CA	90045	4266	19	06037	33.95976851	-118.390734	Los Angeles County
42808	Fee-for-Service	1497917025	1497917025	1	1	AGUERO, KAREN A LMFT	6/4/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15455 SAN FERNANDO MISSO	#300	MISSION HILLS	CA	91345	1353	19	06037	34.27194157	-118.469079	Los Angeles County
42860	Fee-for-Service	1023672367	1023672367	1	1	APEX MULTISPECIALTY MEDICAL	10/8/2024	104100000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	600 S SAN VICENTE BLVD	STE 101	LOS ANGELES	CA	90048	4653	19	06037	34.06576461	-118.3728518	Los Angeles County
42880	Fee-for-Service	1033544507	1033544507	1	1	ALHADI, FATIN PSYD	4/2/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2830 I ST	UNIT 202	SACRAMENTO	CA	95816	4311	34	06067	38.574423	-121.467717	Sacramento County
42911	Fee-for-Service	1396812202	1396812202	1	1	ABRAMSON, MARK D MD	8/31/1982	207R00000X	NA	Other	026	PHYSICIANS	50909	41	Internal Medicine	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
42924	Fee-for-Service	1710639869	1710639869	1	1	ANDERSON, JESSICA LCSW	7/15/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4241 JUTLAND DR	320	SAN DIEGO	CA	92117	3663	37	06073	32.82458459	-117.2275063	San Diego County
42938	Fee-for-Service	1295895241	1295895241	1	1	ALEJANDRIA, MA ESTELA A LMFT	9/21/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3694 HILLBORN RD	STE 150	FAIRFIELD	CA	94534	1784	48	06095	38.29483631	-122.0362992	Solano County
42953	Fee-for-Service	1437226370	1437226370	1	1	AQUINO, ROXANNE L MD	10/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84349	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
42994	Fee-for-Service	1952916777	1952916777	1	1	ALLIANCE HEARING AIDS	8/6/2021	332S00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	802 14TH ST	N	MODESTO	CA	95354	1029	50	06099	37.64172216	-120.9944627	Stanislaus County
42997	Fee-for-Service	1750657763	1750657763	1	1	ANGELICA LLANA SILERIO	6/2/2012	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	30760 VIEW RIDGE LN	None	MENIFEE	CA	92584	7015	33	06065	33.67399969	-117.1531536	Riverside County
42998	Fee-for-Service	1063493625	1063493625	1	1	ABELE, JOHN S MD	4/30/1987	207ZC0500X	NA	Other	026	PHYSICIANS	28999	22	Pathology (M.D. only)	0	In state provider	None	3301 C ST	STE 103C	SACRAMENTO	CA	95816	3363	34	06067	38.579877	-121.456143	Sacramento County
43061	Fee-for-Service	1073769543	1073769543	1	1	ANX HOME HEALTHCARE	10/8/2009	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1633 BAYSHORE HIGHWAY	SUITE 234	BURLINGAME	CA	94010	1588	41	06081	37.6001836	-122.3685107	San Mateo County
43070	Fee-for-Service	1336596568	1336596568	1	1	ARANDI, NAVID R MD	7/29/2019	207P00000X	NA	Other	026	PHYSICIANS	155964	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
43103	Fee-for-Service	1114032620	1114032620	1	1	ANDERS, ALPHA J MD	9/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52224	08	Family Practice	0	In state provider	None	2811 H ST	None	BAKERSFIELD	CA	93301	1913	15	06029	35.38526604	-119.021172	Kern County
43109	Fee-for-Service	1932292604	1932292604	1	1	AMERICAN MEDICAL RESPONSE OF	1/19/2016	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	SOUTHERN CALIFORNIA	5257 N VINCENT AVE	None	IRWINDALE	CA	91706	5418	19	06037	34.10838	-117.925387	Los Angeles County
43141	Fee-for-Service	1215337993	1215337993	1	1	ALLRED, MARK D CRNA	6/13/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
43147	Fee-for-Service	1023672367	1023672367	1	1	APEX MULTISPECIALTY MEDICAL	10/8/2024	104100000X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC	600 S SAN VICENTE BLVD	STE 101	LOS ANGELES	CA	90048	4653	19	06037	34.06576461	-118.3728518	Los Angeles County
43155	Fee-for-Service	1104583228	1104583228	1	1	ABSOLUTE QUALITY CARE HOME	1/13/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	INC	10731 COLOMA STREET	None	LOMA LINDA	CA	92354	2301	36	06071	34.05896025	-117.2498283	San Bernardino County
43194	Fee-for-Service	1003519778	1003519778	1	1	ANIMASHAUN, HABIBAT AJOKE	6/7/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	10034 ETON AVENUE	None	CHATSWORTH	CA	91311	3033	19	06037	34.25275641	-118.5950682	Los Angeles County
43196	Fee-for-Service	1215430632	1215430632	1	2	ASHER, CHARMAINE M LCSW	4/26/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
43214	Fee-for-Service	1689710337	1689710337	1	1	ARELLANO, DARVA L CRNA	2/14/2007	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
43241	Fee-for-Service	1437226370	1437226370	1	1	AQUINO, ROXANNE L MD	10/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84349	67	Endocrinology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
43260	Fee-for-Service	1487876116	1487876116	1	1	ALAMEDA CO HLTH DEPT LAB	3/11/1987	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	499 5TH ST	# 403	OAKLAND	CA	94607	3835	01	06001	37.79844518	-122.2758999	Alameda County
43284	Fee-for-Service	1750657763	1750657763	1	1	ANGELICA LLANA SILERIO	6/2/2012	164W00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	30760 VIEW RIDGE LN	None	MENIFEE	CA	92584	7015	33	06065	33.67399969	-117.1531536	Riverside County
43291	Fee-for-Service	1275967143	1275967143	1	1	ALSHUWAYKH, OMAR S H MD	2/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139572	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVENUE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
43303	Fee-for-Service	1467464677	1467464677	1	1	AMINI, FARIBA	8/13/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
43345	Fee-for-Service	1497890677	1497890677	1	1	ANGEL NICULESCU	8/31/1994	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2478 WARREN LN	None	WALNUT CREEK	CA	94597	3036	07	06013	37.91639767	-122.0745577	Contra Costa County
43353	Fee-for-Service	1063041986	1063041986	1	1	ALKAITIS, MATTHEW S MD	7/16/2023	207R00000X	NA	Other	026	PHYSICIANS	185534	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
43380	Fee-for-Service	1740367390	1740367390	3	1	ABC MEDIHEALTH INC	3/9/2015	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	425 S BASCOM AVE	None	SAN JOSE	CA	95128	2210	43	06085	37.32120285	-121.9319803	Santa Clara County
43391	Fee-for-Service	1114032620	1114032620	1	1	ANDERS, ALPHA J MD	9/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52224	41	Internal Medicine	0	In state provider	None	2811 H ST	None	BAKERSFIELD	CA	93301	1913	15	06029	35.38526604	-119.021172	Kern County
43405	Fee-for-Service	1275543258	1275543258	1	1	ASCHER, RALPH MD	7/30/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	8109	01	General Practice	0	In state provider	None	2201 MISSION AVENUE	None	NORTHRIDGE	CA	91324	0000	19	06037	0	0	None
43438	Fee-for-Service	1104974914	1104974914	1	1	AZIZI, FARAMARZ MD	9/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38309	22	Pathology (M.D. only)	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
43443	Fee-for-Service	1851055305	1851055305	1	1	AAA MEDICAL CORP	12/16/2022	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
43483	Fee-for-Service	1003519778	1003519778	1	1	ANIMASHAUN, HABIBAT AJOKE	6/7/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	10034 ETON AVENUE	None	CHATSWORTH	CA	91311	3033	19	06037	34.25275641	-118.5950682	Los Angeles County
43486	Fee-for-Service	1487325106	1487325106	1	1	ACUPROGROUP INC	6/20/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	INIC	1437 BEVERLY BLVD	None	MONTEBELLO	CA	90640	4154	19	06037	34.01887585	-118.1141726	Los Angeles County
43494	Fee-for-Service	1992030951	1992030951	1	1	AARONSON, KATHRYN M F NP	5/11/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
43497	Fee-for-Service	1326326596	1326326596	1	1	ASQUEL ARIAS, DELIA LMFT	6/9/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2873 MISSION ST.	3	SAN FRANCISCO	CA	94110	2623	38	06075	37.75143095	-122.4183678	San Francisco County
43500	Fee-for-Service	1154736429	1154736429	1	9	AVENAL COMMUNITY HEALTH CENT	9/19/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	329 W 8TH STREET	SUITE 103	HANFORD	CA	93230	4533	16	06031	36.32698307	-119.6503466	Kings County
43535	Fee-for-Service	1790918696	1790918696	1	1	ALDANA, DANIEL H MD	11/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	80094	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
43545	Fee-for-Service	1780399758	1780399758	1	1	ADVANCECARE SAN FRANCISCO IN	3/2/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2301 MARKET ST	None	SAN FRANCISCO	CA	94114	1690	38	06075	37.76379051	-122.4335111	San Francisco County
43574	Fee-for-Service	1508931056	1508931056	1	1	AYESHA, HAG MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
43585	Fee-for-Service	1699782722	1699782722	1	1	AEGIS SCIENCES CORPORATION	2/6/2017	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	530 GREAT CIRCLE RD	None	NASHVILLE	TN	37228	1309	00	None	36.19676075	-86.80863434	Davidson County
43608	Fee-for-Service	1144605429	1144605429	1	1	ABAUNZA, YAMILET LCSW	5/11/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
43673	Fee-for-Service	1578604211	1578604211	1	1	ALAMEDA FAMILY PHYS MED	2/28/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	GRP	2433 CENTRAL AVE	STE A	ALAMEDA	CA	94501	4564	01	06001	37.76358675	-122.2413153	Alameda County
43677	Fee-for-Service	1366853194	1366853194	1	1	ARREAZA, HECTOR J MD	8/30/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144976	None	None	0	In state provider	None	7800 NILES ST	None	BAKERSFIELD	CA	93306	4922	15	06029	35.37628052	-118.9179	Kern County
43681	Fee-for-Service	1114032620	1114032620	1	1	ANDERS, ALPHA J MD	9/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52224	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2811 H ST	None	BAKERSFIELD	CA	93301	1913	15	06029	35.38526604	-119.021172	Kern County
43684	Fee-for-Service	1841616851	1841616851	1	1	ALAS-SEGURA, MONIKA C MD	3/1/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	128535	40	Pediatrics	0	In state provider	None	1200 NORTH STATE STREET	None	LOS ANGELES	CA	90033	1083	19	06037	34.05855992	-118.209755	Los Angeles County
43701	Fee-for-Service	1477816783	1477816783	1	1	ALWAN, RIHAM MD	6/25/2019	207PP0204X	NA	Other	026	PHYSICIANS	162754	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
43706	Fee-for-Service	1205909603	1205909603	1	1	AGBAYANI, ROMEO C MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	81045	84	Surgery-Head and Neck	0	In state provider	None	1000 S ELISEO DR	STE 103	GREENBRAE	CA	94904	2150	21	06041	37.94348559	-122.5335273	Marin County
43707	Fee-for-Service	1285633529	1285633529	1	1	ASHMAN, EDWARD S MD	3/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	20	Orthopedic Surgery	1	Border provider	None	2650 N TENAYA WAY	STE 301	LAS VEGAS	NV	89128	1112	00	None	36.20804839	-115.2501292	Clark County
43733	Fee-for-Service	1003806233	1003806233	1	1	ANDERSEN, BRENDA J OD	10/28/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6945 EL CAJON BLVD	None	SAN DIEGO	CA	92115	1754	37	06073	32.76862715	-117.048093	San Diego County
43739	Fee-for-Service	1013443746	1013443746	1	1	AZADIAN, MOOSA MD	7/1/2020	2278C0205X	NA	Other	026	PHYSICIANS	163046	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
43751	Fee-for-Service	1427448497	1427448497	1	1	ARNOLD, ALLISON N	4/7/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
43762	Fee-for-Service	1972701324	1972701324	1	1	ABBASI, SALEHA MD	10/13/2009	2084P0800X	NA	Psychiatry	026	PHYSICIANS	106565	26	Psychiatry (child)	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
43769	Fee-for-Service	1770635450	1770635450	1	1	ALLEN-SPEES FAMILY HOME	4/17/1996	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	524 W ROBERTS AVE	None	FRESNO	CA	93704	1832	10	06019	36.82016447	-119.8021545	Fresno County
43781	Fee-for-Service	1720492721	1720492721	1	1	ACHARYA, HEMANG A MD	5/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139314	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 WESTWOOD PLAZA	SUITE 1517	LOS ANGELES	CA	90095	7402	19	06037	34.06633051	-118.4452686	Los Angeles County
43788	Fee-for-Service	1154736429	1154736429	1	9	AVENAL COMMUNITY HEALTH CENT	9/19/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	329 W 8TH STREET	SUITE 103	HANFORD	CA	93230	4533	16	06031	36.32698307	-119.6503466	Kings County
43791	Fee-for-Service	1003944984	1003944984	1	1	AMIAL-COTA, YADIRA	12/29/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1702 E BULLARD AVE	SUITE 102	FRESNO	CA	93710	5800	10	06019	36.82318447	-119.7563985	Fresno County
43862	Fee-for-Service	1700066933	1700066933	1	1	ATWAN, NAWAL L MD	6/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101396	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
43864	Fee-for-Service	1245441757	1245441757	1	1	ALVAREZ-HERNANDEZ, BLANCA	1/22/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	5100 N 6TH STREET	SUITE 104	FRESNO	CA	93710	7506	10	06019	36.810666	-119.763204	Fresno County
43870	Fee-for-Service	1659789527	1659789527	1	1	ALVARADO, JHONELL R MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149544	41	Internal Medicine	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
43897	Fee-for-Service	1851924286	1851924286	1	1	A CARING LIFE HOME HEALTH	10/15/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	35 E 10TH ST	STE H	TRACY	CA	95376	4083	39	06077	37.73854032	-121.4249153	San Joaquin County
43908	Fee-for-Service	1245995828	1245995828	1	1	ANLEY, MICHELLE LCSW	1/14/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
43918	Fee-for-Service	1548530769	1548530769	1	1	ANNABELLE NASCIMENTO	1/12/2012	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2236 N SHAFFER ST	None	ORANGE	CA	92865	3409	30	06059	33.825258	-117.8490775	Orange County
43968	Fee-for-Service	1821423898	1821423898	1	1	ABHADHAN, TASFIA LMFT	12/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
43969	Fee-for-Service	1578626925	1578626925	1	1	ATTIA, FADIA R MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	45954	41	Internal Medicine	0	In state provider	None	770 MAGNOLIA AVE	STE 2J	CORONA	CA	92879	3122	33	06065	33.85936872	-117.5534605	Riverside County
43976	Fee-for-Service	1992813406	1992813406	1	1	AMIRIKIA, KATHRYN C MD	11/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86919	02	General Surgery	0	In state provider	None	50 S SAN MATEO DR	None	SAN MATEO	CA	94401	3857	41	06081	37.56634141	-122.3261145	San Mateo County
44004	Fee-for-Service	1902267479	1902267479	1	10	ALTAMED HEALTH SERVICES	11/2/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	3703 PECK ROAD	SUITE A-C	EL MONTE	CA	91731	3543	19	06037	34.07312516	-118.0237229	Los Angeles County
44050	Fee-for-Service	1972701324	1972701324	1	1	ABBASI, SALEHA MD	10/13/2009	2084P0800X	NA	Psychiatry	026	PHYSICIANS	106565	36	Psychiatry	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
44098	Fee-for-Service	1780222968	1780222968	1	1	ARCH HEALTH PARTNERS	2/20/2020	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2385 S MELROSE DR	None	VISTA	CA	92081	8788	37	06073	33.14409946	-117.2417711	San Diego County
44101	Fee-for-Service	1831127869	1831127869	1	1	AGUILAR, NORMA MD	4/1/2019	364SP0809X	NA	Other	026	PHYSICIANS	37060	36	Psychiatry	0	In state provider	None	7840 IMPERIAL HWY	B	DOWNEY	CA	90242	3457	19	06037	33.92542657	-118.1549366	Los Angeles County
44104	Fee-for-Service	1851600548	1851600548	1	1	ARMIN, SEAN MD INC	7/20/2011	207T00000X	NA	General Surgery	026	PHYSICIANS	88304	14	Neurological Surgery	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
44116	Fee-for-Service	1225387616	1225387616	1	1	AVENAL COMMUNITY HEALTH	1/25/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CENTER	1000 SKYLINE BLVD	None	AVENAL	CA	93204	1850	16	06031	36.00790722	-120.1216067	Kings County
44173	Fee-for-Service	1750586012	1750586012	1	1	ALAMIN, HIBA MD	10/18/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	185615	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
44205	Fee-for-Service	1548530769	1548530769	1	1	ANNABELLE NASCIMENTO	1/12/2012	164X00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2236 N SHAFFER ST	None	ORANGE	CA	92865	3409	30	06059	33.825258	-117.8490775	Orange County
44217	Fee-for-Service	1396739421	1396739421	1	1	AMERICAN NURSING MANAGEMENT	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CONSULTING INC	2105 BEVERLY BLVD	SUITE 205	LOS ANGELES	CA	90057	2268	19	06037	34.06682861	-118.2706286	Los Angeles County
44220	Fee-for-Service	1114376332	1114376332	1	1	ASSADSANGABI, REZA MD	8/1/2019	2085N0700X	NA	MRI Provider	026	PHYSICIANS	163187	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
44232	Fee-for-Service	1447950936	1447950936	1	1	ARANDA, CLAUDIA NP	8/15/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
44233	Fee-for-Service	1073956231	1073956231	1	1	ADAMS, ZACHARY A MD	2/17/2020	207QS1201X	NA	Adult Primary Care	026	PHYSICIANS	167567	08	Family Practice	0	In state provider	None	1665 DOMINICAN WAY	STE 222A	SANTA CRUZ	CA	95065	1515	44	06087	36.99032886	-121.9811968	Santa Cruz County
44262	Fee-for-Service	1336696376	1336696376	1	1	AEGIS HOSPICE CARE	2/14/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4959 PALO VERDE ST	STE 206C-4	MONTCLAIR	CA	91763	2341	36	06071	34.08129954	-117.6966135	San Bernardino County
44268	Fee-for-Service	1063468437	1063468437	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	720 3RD AVE	None	CHULA VISTA	CA	91910	5804	37	06073	32.62680922	-117.0742561	San Diego County
44297	Fee-for-Service	1902267479	1902267479	1	10	ALTAMED HEALTH SERVICES	11/2/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	3703 PECK ROAD	SUITE A-C	EL MONTE	CA	91731	3543	19	06037	34.07312516	-118.0237229	Los Angeles County
44312	Fee-for-Service	1881627743	1881627743	2	1	ALVAREZ, PAMELA L MD	11/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	98180	13	Neurology (M.D. only)	0	In state provider	None	24910 LAS BRISAS RD	STE 115	MURRIETA	CA	92562	4035	33	06065	33.57522424	-117.1828078	Riverside County
44313	Fee-for-Service	1629809439	1629809439	1	1	ALONZO, CHERYL A DOULA	4/2/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	56	06111	0	0	None
44317	Fee-for-Service	1518092147	1518092147	1	1	AZEM, DANIELLE J D PHD	9/28/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
44323	Fee-for-Service	1962601302	1962601302	1	1	ANCHOR ORTHOTICS & PROSTHETI	2/7/2008	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	CS, INC.	1828 TRIBUTE RD	G	SACRAMENTO	CA	95815	4310	34	06067	38.599416	-121.4428905	Sacramento County
44329	Fee-for-Service	1427615426	1427615426	1	1	ARTYMOWICZ, ANNA MD	7/24/2023	207R00000X	NA	Other	026	PHYSICIANS	186277	None	None	0	In state provider	None	215 CHINA GRADE LOOP	None	BAKERSFIELD	CA	93308	1707	15	06029	35.4265209	-119.0190909	Kern County
44330	Fee-for-Service	1235150079	1235150079	1	1	ASHLEY, BLAKE A MD	3/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	72881	02	General Surgery	0	In state provider	None	24411 HEALTH CENTER DR	SUITE 350	LAGUNA HILLS	CA	92653	3687	30	06059	33.6087201	-117.7076948	Orange County
44343	Fee-for-Service	1871541144	1871541144	1	1	ANESTHESIA MEDICAL GROUP	11/4/1993	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	OF SANTA CRUZ	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
44359	Fee-for-Service	1477181238	1477181238	1	1	AKTER, ROUSHON A MD	11/3/2023	207R00000X	NA	Other	026	PHYSICIANS	191695	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
44387	Fee-for-Service	1639159619	1639159619	1	1	ASSOCIATED OB-GYN SPECIA	4/27/2009	193400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	LISTS OF SANTA BARBARA	2329 OAK PARK LN	None	SANTA BARBARA	CA	93105	4280	42	06083	34.4291325	-119.7252464	Santa Barbara County
44403	Fee-for-Service	1225387616	1225387616	1	1	AVENAL COMMUNITY HEALTH	9/20/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER	1000 SKYLINE BLVD	None	AVENAL	CA	93204	1850	16	06031	36.00790722	-120.1216067	Kings County
44404	Fee-for-Service	1033267059	1033267059	1	1	ALMALEH, ELY R OD	2/11/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
44425	Fee-for-Service	1083881122	1083881122	1	1	AMIRI-DAVANI, NOOSHA C MD	7/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107386	None	None	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91773	3219	19	06037	34.20289797	-118.6294006	Los Angeles County
44454	Fee-for-Service	1871350652	1871350652	1	1	ALFORQUE, CARISSA	6/27/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
44478	Fee-for-Service	1871811091	1871811091	1	1	AMERI, MARYAM D MD	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125553	22	Pathology (M.D. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
44497	Fee-for-Service	1578521050	1578521050	1	1	ANAND, ARUN MD	3/28/1988	207L00000X	NA	Other	026	PHYSICIANS	44609	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
44504	Fee-for-Service	1487670824	1487670824	1	1	ARMBRUSTER, TODD DO	10/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10022	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
44525	Fee-for-Service	1417992694	1417992694	1	1	ADLER, JULIA E MD	7/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99847	36	Psychiatry	0	In state provider	None	2340 CLAY ST	7TH FL	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
44539	Fee-for-Service	1477105914	1477105914	1	1	ABALANCE MARRIAGE AND FAMILY	9/15/2020	251T00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	NSELING	2101 GEER RD	304	TURLOCK	CA	95382	1142	50	06099	37.512324	-120.8489985	Stanislaus County
44549	Fee-for-Service	1336696376	1336696376	1	1	AEGIS HOSPICE CARE	2/14/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4959 PALO VERDE ST	STE 206C-4	MONTCLAIR	CA	91763	2341	36	06071	34.08129954	-117.6966135	San Bernardino County
44567	Fee-for-Service	1083934665	1083934665	1	1	AGARWAL, PRIYANKA MD	5/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121790	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
44591	Fee-for-Service	1114957941	1114957941	1	1	ALLEYNE, ROBIN A MD	5/7/2021	207R00000X	NA	Other	026	PHYSICIANS	51874	None	None	0	In state provider	None	11050 S ATLANTIC AVE	None	LYNWOOD	CA	90262	3068	19	06037	33.92855145	-118.1843492	Los Angeles County
44617	Fee-for-Service	1043642952	1043642952	1	1	ACCORD HOSPICE AND	11/20/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	2934 E GARVEY AVE S	STE 212	WEST COVINA	CA	91797	2178	19	06037	34.07157499	-117.8836824	Los Angeles County
44638	Fee-for-Service	1235596826	1235596826	1	1	ABSOLUTE HOSPICE CARE INC	5/5/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3944 MURPHY CANYON RD	STE C100	SAN DIEGO	CA	92123	4414	37	06073	32.81699026	-117.1170431	San Diego County
44693	Fee-for-Service	1225387616	1225387616	1	1	AVENAL COMMUNITY HEALTH	9/20/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER	1000 SKYLINE BLVD	None	AVENAL	CA	93204	1850	16	06031	36.00790722	-120.1216067	Kings County
44704	Fee-for-Service	1598129264	1598129264	1	1	ALLEN, TIERNEY J MD	9/17/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	150683	08	Family Practice	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
44717	Fee-for-Service	1346498151	1346498151	1	1	ABBOTT, MICHAEL PSYD	7/10/2020	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
44728	Fee-for-Service	1467606053	1467606053	1	1	ALLAMEHZADEH, REZA MD	7/13/2010	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	102735	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
44751	Fee-for-Service	1265658595	1265658595	2	1	APOLLOMED HOSPITALISTS A MED	10/27/2022	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ICAL CORPORATION	438 WEST LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
44759	Fee-for-Service	1639638463	1639638463	1	1	AHSAN, SHANGIDA MD	7/19/2022	207R00000X	NA	Other	026	PHYSICIANS	178016	None	None	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
44773	Fee-for-Service	1356662381	1356662381	1	1	ARAYA, MELEY R OD	4/11/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	425 W BONITA AVE	STE 110B	SAN DIMAS	CA	91773	2541	19	06037	34.10669347	-117.814932	Los Angeles County
44786	Fee-for-Service	1578521050	1578521050	1	1	ANAND, ARUN MD	3/28/1988	207L00000X	NA	Other	026	PHYSICIANS	44609	05	Anesthesiology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
44787	Fee-for-Service	1811336258	1811336258	1	1	ADVENTIST HEALTH PHYSICIANS	2/6/2019	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1460 N CAMINO ALTO	STE 111	VALLEJO	CA	94589	2567	48	06095	38.13262019	-122.2386804	Solano County
44826	Fee-for-Service	1477105914	1477105914	1	1	ABALANCE MARRIAGE AND FAMILY	4/10/2020	251T00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	NSELING	2101 GEER RD	304	TURLOCK	CA	95382	1142	50	06099	37.512324	-120.8489985	Stanislaus County
44840	Fee-for-Service	1407402845	1407402845	1	1	ASHLEY N HAWKES	6/3/2020	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	625 9TH AVE	STE 210	LONGVIEW	WA	98632	2465	00	None	46.12378087	-122.9340848	Cowlitz County
44867	Fee-for-Service	1437196250	1437196250	1	1	ALANES, YVONNE A MD	7/17/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	30117	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4081 E OLYMPIC BLVD	None	LOS ANGELES	CA	90023	3330	19	06037	34.01891346	-118.186614	Los Angeles County
44877	Fee-for-Service	1255068722	1255068722	1	1	ACOSTA, ANGELA OT	8/15/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2262 N. 1ST ST	None	SAN JOSE	CA	95131	2022	43	06085	37.37772646	-121.921374	Santa Clara County
44906	Fee-for-Service	1043642952	1043642952	1	1	ACCORD HOSPICE AND	11/20/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	2934 E GARVEY AVE S	STE 212	WEST COVINA	CA	91797	2178	19	06037	34.07157499	-117.8836824	Los Angeles County
44925	Fee-for-Service	1235596826	1235596826	1	1	ABSOLUTE HOSPICE CARE INC	5/5/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3944 MURPHY CANYON RD	STE C100	SAN DIEGO	CA	92123	4414	37	06073	32.81699026	-117.1170431	San Diego County
44933	Fee-for-Service	1316236078	1316236078	1	1	AZARBAL, FARNAZ MD	11/27/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	122468	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
44938	Fee-for-Service	1720368764	1720368764	1	1	ABELLERA, GUIDO D MD APC	8/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	None	None	0	In state provider	None	123 S COMMERCE ST	STE D	STOCKTON	CA	95202	2837	39	06077	37.95105947	-121.2920715	San Joaquin County
44957	Fee-for-Service	1669009874	1669009874	1	1	ANSARI, NEHA MD	11/17/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	190648	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
44980	Fee-for-Service	1225387616	1225387616	1	1	AVENAL COMMUNITY HEALTH	10/15/2015	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CENTER	1000 SKYLINE BLVD	None	AVENAL	CA	93204	1850	16	06031	36.00790722	-120.1216067	Kings County
44987	Fee-for-Service	1932417714	1932417714	1	1	ARVANITIDIS, ALEXI N LMFT	4/16/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	100700	-	NOT APPLICABLE	0	In state provider	None	333 GELLERT	STE 206	DALY CITY	CA	94015	2621	41	06081	37.66672018	-122.4685948	San Mateo County
44990	Fee-for-Service	1740718881	1740718881	1	1	ASUZU, DAVID T MD	5/8/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
44991	Fee-for-Service	1104185206	1104185206	1	1	AHMAD-NABI, MARIA M MD	9/10/2018	2080P0207X	NA	Hematology	026	PHYSICIANS	135853	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
45042	Fee-for-Service	1619744075	1619744075	1	1	ALIADOS HEALTH	10/21/2024	251B00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	1310 REDWOOD WAY	STE 135	PETALUMA	CA	94954	6514	49	06097	38.27573107	-122.6657677	Sonoma County
45083	Fee-for-Service	1851667661	1851667661	1	2	ASLIAN, AZITA	2/5/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	118227	None	None	0	In state provider	None	435 H STREET	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
45087	Fee-for-Service	1295827939	1295827939	1	1	ANDREEFF, KATHERINE M MD	6/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81633	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
45155	Fee-for-Service	1437196250	1437196250	1	1	ALANES, YVONNE A MD	7/17/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	30117	01	General Practice	0	In state provider	None	4081 E OLYMPIC BLVD	None	LOS ANGELES	CA	90023	3330	19	06037	34.01891346	-118.186614	Los Angeles County
45170	Fee-for-Service	1669934626	1669934626	1	1	ACCEPT FAMILY COUNSELING INC	8/9/2019	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	10918 HESPERIA RD	STE B	HESPERIA	CA	92345	2151	36	06071	34.44933232	-117.2964082	San Bernardino County
45198	Fee-for-Service	1437545738	1437545738	1	1	ALAEE, SPENCER R MD	4/10/2023	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
45268	Fee-for-Service	1629351572	1629351572	1	1	ALARID, CARLOS J PSYD	3/22/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
45291	Fee-for-Service	1114948239	1114948239	1	1	ARROWHEAD MOBILE HEALTHCARE	9/16/2010	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 E MILLS	None	SHOW LOW	AZ	85901	5916	00	None	34.248429	-110.03139	Navajo County
45308	Fee-for-Service	1457766107	1457766107	1	1	ABBOTT, COREY M NP	6/22/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
45320	Fee-for-Service	1326386764	1326386764	1	1	AWALE, SAPNA	4/19/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
45355	Fee-for-Service	1366755811	1366755811	1	1	ALJASSEM, ANNAS	11/29/2022	2081H0002X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	182336	None	None	0	In state provider	None	104 E OLIVE AVE	STE 100	REDLANDS	CA	92373	5255	36	06071	34.0540723	-117.1800104	San Bernardino County
45369	Fee-for-Service	1144547456	1144547456	1	1	ALBA, DIANA L MD	4/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126283	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
45379	Fee-for-Service	1376554824	1376554824	1	1	ALLERGY IMMUNOLOGY AND	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASTHMA MED GRP INC	4628 GEORGETOWN PL	None	STOCKTON	CA	95207	6204	39	06077	37.9893781	-121.313486	San Joaquin County
45385	Fee-for-Service	1093246944	1093246944	1	1	AURAN, RICHARD L MD	9/27/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	176023	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
45404	Fee-for-Service	1922068311	1922068311	2	1	ADSIT, WILLIAM S MD	4/30/1995	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	57564	20	Orthopedic Surgery	0	In state provider	None	301 UNIVERISITY AVE	None	SAN DIEGO	CA	92103	3008	37	06073	32.74824655	-117.162423	San Diego County
45429	Fee-for-Service	1720692130	1720692130	1	1	AUTEN, OLGA CNP	7/3/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11103 VENICE BLVD	None	LOS ANGELES	CA	90034	6914	19	06037	34.01379685	-118.4159354	Los Angeles County
45436	Fee-for-Service	1194168450	1194168450	1	1	AKRAM, ALI R MD	8/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132086	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
45443	Fee-for-Service	1992799928	1992799928	1	1	ANNEX HEALTHCARE PRVDRS	4/24/2003	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	22041 CLARENDON ST	SUITE 200	WOODLAND	CA	91367	6305	19	06037	34.16969086	-118.6073492	Los Angeles County
45452	Fee-for-Service	1225786981	1225786981	1	1	AHDOOT, SARA OD	10/18/2023	390200000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	13124 PHILADELPHIA ST	None	WHITTIER	CA	90601	4301	19	06037	33.97907349	-118.035333	Los Angeles County
45461	Fee-for-Service	1669934626	1669934626	1	1	ACCEPT FAMILY COUNSELING INC	5/13/2019	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	10918 HESPERIA RD	STE B	HESPERIA	CA	92345	2151	36	06071	34.44933232	-117.2964082	San Bernardino County
45470	Fee-for-Service	1801897368	1801897368	1	1	AXMINSTER MEDICAL GROUP	12/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INC	8540 S SEPULVEDA BLVD	STE 818	LOS ANGELES	CA	90045	3808	19	06037	33.96022076	-118.3961982	Los Angeles County
45480	Fee-for-Service	1811728405	1811728405	1	1	ADVANCED & NEURO-INTERVENTIO	2/6/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	27	Psychiatry Neurology (D.O. only)	0	In state provider	NAL PSYCHIATRY INC	3300 FRANKLIN ST	None	ANDERSON	CA	96007	3279	45	06089	40.44810344	-122.3109375	Shasta County
45520	Fee-for-Service	1992787808	1992787808	1	1	ALFORD, AMANDA B MD	7/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	842 E MAIN STREET	None	MEDFORD	OR	97504	7155	00	None	42.32787853	-122.863311	Jackson County
45551	Fee-for-Service	1588337265	1588337265	1	1	ACQUAYE, EYIZAH	12/7/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
45573	Fee-for-Service	1467785246	1467785246	1	1	AGARWAL, AMBIKA MD	5/29/2024	261QR0200X	NA	Mammography/MRI Provider	026	PHYSICIANS	123378	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
45580	Fee-for-Service	1912354002	1912354002	1	1	ASCHERMAN, ALLEN LMFT	3/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3 GOVERNORS LN	A	CHICO	CA	95926	5503	04	06007	39.75542195	-121.8587226	Butte County
45591	Fee-for-Service	1649465402	1649465402	1	2	AFFINITY HEALTH CARE	10/15/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PROVIDERS INC	1551 COLORADO BLVD	STE 203	LOS ANGELES	CA	90041	1496	19	06037	34.13955172	-118.2000149	Los Angeles County
45601	Fee-for-Service	1487689410	1487689410	1	1	ANTON, PETER A MD	1/30/1997	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	56998	10	Gastroenterology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
45616	Fee-for-Service	1538651815	1538651815	2	1	ARBELAEZ, DANIELA MD	10/10/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	171837	15	Obstetrics (D.O. only)	0	In state provider	None	220 S PALISADE DR	STE 203	SANTA MARIA	CA	93454	8903	42	06083	34.95143521	-120.412098	Santa Barbara County
45642	Fee-for-Service	1396774089	1396774089	1	1	ABBRUZZESE JR. SALVATORE DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3-3420 KUHIO HIGHWAY	STE B	LIHUE	HI	96766	1098	00	None	21.98560043	-159.3663628	Kauai County
45670	Fee-for-Service	1396959060	1396959060	1	1	ALTAMED MEDICAL GROUP-	2/8/2022	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	5427 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4101	19	06037	34.01966132	-118.1536008	Los Angeles County
45690	Fee-for-Service	1396018925	1396018925	1	1	ANGUIANO CERVANTES, ELIZABET	1/10/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	H LMFT	28494 WESTINGHOUSE PL	SUITE 213	VALENCIA	CA	91355	0930	19	06037	34.44221561	-118.5989564	Los Angeles County
45742	Fee-for-Service	1306047196	1306047196	1	1	ALAMEDA COUNTY MED CTR	7/1/1998	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	WINTON WELLNESS CENTER	24100 AMADOR ST	None	HAYWARD	CA	94544	1273	01	06001	37.65846116	-122.0943585	Alameda County
45766	Fee-for-Service	1790739951	1790739951	1	1	ANNE MARIE KOSTER NP	2/13/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9850 ST LUKES DR	None	NAMPA	ID	83687	7912	00	None	43.618383	-116.5904145	Canyon County
45769	Fee-for-Service	1811728405	1811728405	1	1	ADVANCED & NEURO-INTERVENTIO	2/6/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	NAL PSYCHIATRY INC	3300 FRANKLIN ST	None	ANDERSON	CA	96007	3279	45	06089	40.44810344	-122.3109375	Shasta County
45770	Fee-for-Service	1548915887	1548915887	1	1	ALPHA RECOVERY CENTER INC	11/22/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	7316 W AVENUE D8	None	LANCASTER	CA	93536	8815	19	06037	34.76924231	-118.2625396	Los Angeles County
45774	Fee-for-Service	1639931157	1639931157	1	1	AH CARE RX INC	6/28/2024	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5315 LAUREL CANYON BLVD	STE 104	VALLEY VILLAGE	CA	91607	4915	19	06037	34.16713798	-118.3965446	Los Angeles County
45776	Fee-for-Service	1801373352	1801373352	1	1	ANTELOPE VALLEY LUNG & SLEEP	7/16/2019	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INSTITUTE, INC	1331 W AVENUE J	SUITE 101	LANCASTER	CA	93534	2942	19	06037	34.68946152	-118.155699	Los Angeles County
45787	Fee-for-Service	1538402565	1538402565	1	1	AGRAWAL, VAIBHAV MD	8/20/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	168278	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
45793	Fee-for-Service	1427106376	1427106376	1	1	ARORA, HARIPAL S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33961	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
45804	Fee-for-Service	1144608860	1144608860	1	1	AULAKH, GAGANDEEP DO	4/22/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15145	08	Family Practice	0	In state provider	None	2071 EAST HERNDON	None	CLOVIS	CA	93611	6001	10	06019	36.8375685	-119.6781105	Fresno County
45829	Fee-for-Service	1922182682	1922182682	1	1	AJANG, MAHMOUD MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	37717	36	Psychiatry	0	In state provider	None	23000 CRENSHAW BLVD	STE 203	TORRANCE	CA	90505	3052	19	06037	33.816762	-118.328024	Los Angeles County
45857	Fee-for-Service	1770179939	1770179939	1	1	ASAY HOME HEALTH INC	5/31/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7041 OWENSMOUTH AVE	SUITE 105-A	CANOGA PARK	CA	91303	2057	19	06037	34.1985716	-118.6015863	Los Angeles County
45874	Fee-for-Service	1659026615	1659026615	1	1	ARCHWAY RECOVERY SERVICES IN	3/23/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	C	717 MISSOURI ST	SUITE B	FAIRFIELD	CA	94533	6252	48	06095	38.24809951	-122.042511	Solano County
45883	Fee-for-Service	1427466911	1427466911	1	1	ADEMA, JILLEAN L LMFT	4/7/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	116618	-	NOT APPLICABLE	0	In state provider	None	401 S. STREET	None	SACRAMENTO	CA	95811	6919	34	06067	38.572677	-121.5050805	Sacramento County
45937	Fee-for-Service	1356704878	1356704878	1	1	AMARASEKERA, SOHANI MD	4/29/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	622 ABBOTT STREET	None	SALINAS	CA	93901	4315	27	06053	36.66170619	-121.6412319	Monterey County
45939	Fee-for-Service	1699720706	1699720706	1	1	AMINOVA, ALLA MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63469	40	Pediatrics	0	In state provider	None	1723 W BALL RD	None	ANAHEIM	CA	92804	5502	30	06059	33.8193	-117.942588	Orange County
45940	Fee-for-Service	1639984313	1639984313	1	1	APOSTOL, FRIEDA	4/9/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9065 HAVEN AVE	STE 110	RANCHO CUCAMONGA	CA	91730	5429	36	06071	34.089012	-117.5756625	San Bernardino County
45946	Fee-for-Service	1225009319	1225009319	1	1	ALLEN, MELISSA B NP	7/31/2007	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2351 E 29TH ST	None	OAKLAND	CA	94606	3511	01	06001	37.79523294	-122.2252157	Alameda County
45952	Fee-for-Service	1275160962	1275160962	1	1	ARENDASH, JEFFREY MD	7/18/2024	390200000X	NA	Other	026	PHYSICIANS	189188	05	Anesthesiology	0	In state provider	None	PUEBLO AT BATH STREETS	None	SANTA BARBARA	CA	93105	0000	42	06083	34.430526	-119.72196	Santa Barbara County
45959	Fee-for-Service	1396959060	1396959060	1	1	ALTAMED MEDICAL GROUP-	4/28/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	5427 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4101	19	06037	34.01966132	-118.1536008	Los Angeles County
45992	Fee-for-Service	1306454236	1306454236	1	1	ADVANCED GLOBAL HEALTHCARE	12/30/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	1800 BROADVIEW DR	SUITE 250	GLENDALE	CA	91208	1259	19	06037	34.20411072	-118.2273733	Los Angeles County
45997	Fee-for-Service	1346770047	1346770047	1	1	ALADI, STANLEY MD	11/15/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
46048	Fee-for-Service	1902267479	1902267479	1	5	ALTAMED HEALTH SERVICES	3/22/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4100 FIRESTONE BLVD	None	SOUTH GATE	CA	90280	3218	19	06037	33.95329871	-118.1976115	Los Angeles County
46084	Fee-for-Service	1306890017	1306890017	1	1	ADDUCI, ALEXANDER J MD	9/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79458	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
46109	Fee-for-Service	1205049038	1205049038	1	1	ASSER, SETH MD	4/17/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	46444	40	Pediatrics	0	In state provider	None	8001 FROST ST	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
46117	Fee-for-Service	1598770471	1598770471	1	2	ALLISON CURTIS KINGSLEY MEOZ	5/24/2016	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	68	Hematology	1	Border provider	None	701 SHADOW LANE	STE 300	LAS VEGAS	NV	89106	4133	00	None	36.162333	-115.1654035	Clark County
46162	Fee-for-Service	1184902579	1184902579	1	1	ANBALAGAN, EMAYA MD	8/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127293	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
46194	Fee-for-Service	1437186061	1437186061	1	1	AMOL JAGDISH SHAH M.D.	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	401 15TH AVE SE	None	PUYALLUP	WA	98372	3715	00	None	47.17745153	-122.2900155	Pierce County
46197	Fee-for-Service	1043262454	1043262454	1	1	ALB, LARRY A MD	12/18/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	63332	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
46225	Fee-for-Service	1699720706	1699720706	1	1	AMINOVA, ALLA MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63469	08	Family Practice	0	In state provider	None	1723 W BALL RD	None	ANAHEIM	CA	92804	5502	30	06059	33.8193	-117.942588	Orange County
46245	Fee-for-Service	1396959060	1396959060	1	1	ALTAMED MEDICAL GROUP-	8/1/1991	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	5427 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4101	19	06037	34.01966132	-118.1536008	Los Angeles County
46246	Fee-for-Service	1649226952	1649226952	2	1	ANDERSON REGIONAL MEDICAL CE	6/13/2018	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NTER	2124 14TH ST	None	MERIDIAN	MS	39301	4040	00	None	32.372811	-88.699527	Lauderdale County
46258	Fee-for-Service	1295127256	1295127256	1	1	AMLIFE HOME HEALTH SERVICES	10/22/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	800 CHARCOT AVE	SUITE 106	SAN JOSE	CA	95131	2211	43	06085	37.38625759	-121.9076666	Santa Clara County
46268	Fee-for-Service	1821584137	1821584137	1	1	ARSALA, ERIN M	6/13/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1320 STANDIFORD AVE	STE 5	MODESTO	CA	95350	0726	50	06099	37.68934252	-121.0140405	Stanislaus County
46294	Fee-for-Service	1720287311	1720287311	1	1	ARNETT, K KIMBERLEY	2/8/2015	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	ARNETT, K KIMBERLEY	3700 KATELLA AVE	STE 202	LOS ALAMITOS	CA	90720	3100	30	06059	33.80299714	-118.0681431	Orange County
46329	Fee-for-Service	1407808637	1407808637	1	1	ALMENDRAL, DANTE F MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80668	18	Ophthalmology	0	In state provider	None	1201 LONG BEACH BLVD	None	LONG BEACH	CA	90813	3224	19	06037	33.781626	-118.1894975	Los Angeles County
46331	Fee-for-Service	1609577279	1609577279	1	1	ASSIST TRANSPORT	10/20/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2245 OLSON DR	None	LODI	CA	95242	4797	39	06077	38.10158548	-121.302234	San Joaquin County
46337	Fee-for-Service	1902267479	1902267479	1	5	ALTAMED HEALTH SERVICES	3/22/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	4100 FIRESTONE BLVD	None	SOUTH GATE	CA	90280	3218	19	06037	33.95329871	-118.1976115	Los Angeles County
46346	Fee-for-Service	1124669544	1124669544	1	1	ALGOS INC., A MEDICAL CORPOR	9/23/2020	163WP0000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	26357 MCBEAN PKWY	SUITE 210	SANTA CLARITA	CA	91355	4497	19	06037	34.41257644	-118.5597683	Los Angeles County
46350	Fee-for-Service	1801381702	1801381702	1	1	ARGYRIS, DIMITRIOS LMFT	12/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
46355	Fee-for-Service	1831623354	1831623354	1	1	AGUILAR, KATHLEEN M MD	11/13/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	169534	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
46367	Fee-for-Service	1669635660	1669635660	1	1	ARCADIA MED SUPPLY INC	2/18/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ARCADIA MED SUPPLY INC	616 EAST LIVE OAK AVE	None	ARCADIA	CA	91006	5700	19	06037	34.10912912	-118.0174782	Los Angeles County
46394	Fee-for-Service	1861570418	1861570418	1	1	ATANASSOVA, PETIA B MD	4/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84772	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
46405	Fee-for-Service	1598770471	1598770471	1	2	ALLISON CURTIS KINGSLEY MEOZ	5/24/2016	207RH0003X	NA	Oncology	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	1	Border provider	None	701 SHADOW LANE	STE 300	LAS VEGAS	NV	89106	4133	00	None	36.162333	-115.1654035	Clark County
46412	Fee-for-Service	1558677286	1558677286	1	1	ALTERNATIVE HEALTH CARE LLC	10/4/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14752 BEACH BLVD	SUITE 101	LA MIRADA	CA	90638	4255	19	06037	33.89702826	-117.986616	Los Angeles County
46423	Fee-for-Service	1194702159	1194702159	1	1	ARABIA, FRANCISCO A MD	1/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55501	33	Thoracic Surgery	0	In state provider	None	2901 SILLECT AVE	None	BAKERSFIELD	CA	93308	6371	15	06029	35.38611256	-119.0393796	Kern County
46428	Fee-for-Service	1487849345	1487849345	1	1	ANAYA, EUFEMIO LMFT	8/19/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
46448	Fee-for-Service	1598936106	1598936106	1	1	ABOU-HARB, MUHAMMAD	10/19/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
46454	Fee-for-Service	1669039327	1669039327	1	1	A MIND ABOVE, A PROFESSIONAL	8/9/2021	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	334 SHAW AVE	SUITE 100	CLOVIS	CA	93612	3839	10	06019	36.80839352	-119.7049776	Fresno County
46481	Fee-for-Service	1871883082	1871883082	1	1	AGUILAR, STEVEN M MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122694	36	Psychiatry	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
46509	Fee-for-Service	1114283520	1114283520	1	1	AARON, NEAL J DO	11/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14948	66	Emergency Medicine (Urgent Care)	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
46534	Fee-for-Service	1396959060	1396959060	1	1	ALTAMED MEDICAL GROUP-	8/1/1991	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	5427 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4101	19	06037	34.01966132	-118.1536008	Los Angeles County
46535	Fee-for-Service	1649226952	1649226952	2	1	ANDERSON REGIONAL MEDICAL CE	6/13/2018	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	NTER	2124 14TH ST	None	MERIDIAN	MS	39301	4040	00	None	32.372811	-88.699527	Lauderdale County
46560	Fee-for-Service	1003840596	1003840596	1	1	ANDERSON, EDWARD T MD	2/9/1987	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	24095	06	Cardiovascular Disease (M.D. only)	0	In state provider	CARDIOVASCULAR MED INC	770 WELCH RD	STE 100	PALO ALTO	CA	94304	1505	43	06085	37.43748087	-122.1759625	Santa Clara County
46594	Fee-for-Service	1285477224	1285477224	1	1	AMORMINO, MAX PT	9/25/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
46596	Fee-for-Service	1316205834	1316205834	1	1	ARETZ, DANIELLE H DO	1/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	11741	40	Pediatrics	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
46616	Fee-for-Service	1407808637	1407808637	1	1	ALMENDRAL, DANTE F MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80668	41	Internal Medicine	0	In state provider	None	1201 LONG BEACH BLVD	None	LONG BEACH	CA	90813	3224	19	06037	33.781626	-118.1894975	Los Angeles County
46631	Fee-for-Service	1124669544	1124669544	1	1	ALGOS INC., A MEDICAL CORPOR	10/11/2021	163WP0000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	26357 MCBEAN PKWY	SUITE 210	SANTA CLARITA	CA	91355	4497	19	06037	34.41257644	-118.5597683	Los Angeles County
46742	Fee-for-Service	1669039327	1669039327	1	1	A MIND ABOVE, A PROFESSIONAL	6/3/2024	103TC0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	334 SHAW AVE	SUITE 100	CLOVIS	CA	93612	3839	10	06019	36.80839352	-119.7049776	Fresno County
46757	Fee-for-Service	1316593916	1316593916	1	1	ASTILLA, JANICE MARIE NP	9/2/2021	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
46768	Fee-for-Service	1124482450	1124482450	1	1	AU, ADRIAN MD	3/27/2023	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	152096	None	None	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
46805	Fee-for-Service	1497529689	1497529689	1	1	ACT MEDICAL TRANSPORTATION I	2/2/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1309 MARIA AVE	None	SPRING VALLEY	CA	91977	4428	37	06073	32.71777426	-116.9942253	San Diego County
46860	Fee-for-Service	1346245669	1346245669	1	1	ADAME, MARK JOSEPH MD	1/31/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48014	08	Family Practice	0	In state provider	None	1332 NATIVIDAD RD	STE C	SALINAS	CA	93906	3133	27	06053	36.69909137	-121.635247	Monterey County
46865	Fee-for-Service	1669810123	1669810123	1	1	ABIDALI, MOUSTAPHA DO	10/30/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	16993	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	255 E BONITA AVE	None	POMONA	CA	91767	1923	19	06037	34.097913	-117.7474635	Los Angeles County
46868	Fee-for-Service	1427410547	1427410547	1	1	ALI, ALIZA DO	10/17/2024	207R00000X	NA	Other	026	PHYSICIANS	18087	41	Internal Medicine	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
46888	Fee-for-Service	1053712828	1053712828	1	1	ALKHAYER, NISREEN AU	8/31/2015	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
46889	Fee-for-Service	1376842864	1376842864	1	1	AMAN, TIFFANY H MD	7/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128438	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
46921	Fee-for-Service	1497848832	1497848832	3	2	ALTO PHARMACY, LLC	8/1/2022	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 TENNESSEE STREET	UNIT 2	SAN FRANCISCO	CA	94107	3421	38	06075	37.75382711	-122.3888813	San Francisco County
46926	Fee-for-Service	1154990513	1154990513	1	1	AMIT GUPTA MD, INC	6/8/2022	208800000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	414 N CAMDEN DR	STE 650	BEVERLY HILLS	CA	90210	4513	19	06037	34.06880486	-118.4042308	Los Angeles County
46942	Fee-for-Service	1538784749	1538784749	1	1	A&H HOSPICE CARE INC	9/22/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	333 S CENTRAL AVE	STE 100	GLENDALE	CA	91204	4751	19	06037	34.14182246	-118.257882	Los Angeles County
47030	Fee-for-Service	1669039327	1669039327	1	1	A MIND ABOVE, A PROFESSIONAL	4/4/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	334 SHAW AVE	SUITE 100	CLOVIS	CA	93612	3839	10	06019	36.80839352	-119.7049776	Fresno County
47037	Fee-for-Service	1447566781	1447566781	1	1	ABANOBI, CHIZOMAM M NP	10/17/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
47056	Fee-for-Service	1548475213	1548475213	1	1	AHMADPOUR, NASROLLAH MD	7/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105326	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	77 CADILLAC DR	STE 210	SACRAMENTO	CA	95825	5480	34	06067	38.572551	-121.4181585	Sacramento County
47063	Fee-for-Service	1063781557	1063781557	1	1	AQUINO, LISA L MD	1/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	106067	07	Dermatology	0	In state provider	None	990 PACIFIC STREET	None	SAN LUIS OBISPO	CA	93401	6309	40	06079	35.27942504	-120.6598668	San Luis Obispo County
47072	Fee-for-Service	1396744884	1396744884	1	1	ALBERTO, TIBURCIO P MD	2/8/2015	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	25336	02	General Surgery	0	In state provider	None	20930 S BONITA ST	STE W	CARSON	CA	90746	3683	19	06037	33.83978813	-118.2592106	Los Angeles County
47085	Fee-for-Service	1497395354	1497395354	1	1	ADVENTIST HEALTH PHYSICIANS	5/12/2020	208600000X	NA	General Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	432 LEXINGTON ST	A	DELANO	CA	93215	3697	15	06029	35.762706	-119.2407725	Kern County
47092	Fee-for-Service	1518408798	1518408798	1	1	ATENCIO, ADRIENNE MD	6/14/2020	390200000X	NA	Other	026	PHYSICIANS	157472	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
47101	Fee-for-Service	1255890729	1255890729	1	1	AMR TRANSPORTATION INC	10/2/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	977 LILLIES WAY	None	BEAUMONT	CA	92223	0001	33	06065	33.93551863	-116.9609016	Riverside County
47129	Fee-for-Service	1891841938	1891841938	1	1	ANDERS, MALVIN D	3/27/2008	207W00000X	NA	Ophthalmology	026	PHYSICIANS	29436	01	General Practice	0	In state provider	None	931 BUENA VISTA STREET	SUITE 204	DUARTE	CA	91010	1713	19	06037	34.141635	-117.9775755	Los Angeles County
47167	Fee-for-Service	1790416113	1790416113	1	1	ALONTE, JESSICA PT	6/21/2022	208100000X	NA	Physical Medicine and Rehabilitation	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1350 BURTON DRIVE	STE 260	VACAVILLE	CA	95687	3545	48	06095	38.36416107	-121.9552032	Solano County
47178	Fee-for-Service	1376842864	1376842864	1	1	AMAN, TIFFANY H MD	7/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128438	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
47213	Fee-for-Service	1538784749	1538784749	1	1	A&H HOSPICE CARE INC	9/22/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	333 S CENTRAL AVE	STE 100	GLENDALE	CA	91204	4751	19	06037	34.14182246	-118.257882	Los Angeles County
47214	Fee-for-Service	1104247097	1104247097	1	1	ARROYO, GABRIEL A LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
47218	Fee-for-Service	1215464276	1215464276	1	1	AKHMEROV, AKBARSHAKH MD	9/22/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	147516	33	Thoracic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
47258	Fee-for-Service	1538278270	1538278270	1	1	AZURIN, ELEANOR MD INC	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66742	08	Family Practice	0	In state provider	None	3045 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5837	19	06037	33.97305955	-118.2139451	Los Angeles County
47259	Fee-for-Service	1841278124	1841278124	1	1	ABRAMSON, BRUCE OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1017 2ND ST	None	SANTA ROSA	CA	95404	6608	49	06097	38.442753	-122.7056805	Sonoma County
47269	Fee-for-Service	1598920951	1598920951	1	1	AL HADDAD, OMAR MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145621	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
47320	Fee-for-Service	1669039327	1669039327	1	1	A MIND ABOVE, A PROFESSIONAL	4/4/2020	103TC0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	334 SHAW AVE	SUITE 100	CLOVIS	CA	93612	3839	10	06019	36.80839352	-119.7049776	Fresno County
47323	Fee-for-Service	1649257361	1649257361	1	1	ALLERGY & ASTHMA MEDICAL	1/1/1987	174400000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	GROUP & RESEARCH CENTER	5776 RUFFIN RD	None	SAN DIEGO	CA	92123	1013	37	06073	32.83931384	-117.1274102	San Diego County
47334	Fee-for-Service	1205000890	1205000890	1	1	AKHONDI, ANDRE B MD	3/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111933	41	Internal Medicine	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
47338	Fee-for-Service	1174680805	1174680805	1	1	ALLEN, DIAN E LMFT	12/15/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T, LPCC	526 TENNESSEE ST	None	VALLEJO	CA	94590	4431	48	06095	38.11000218	-122.253832	Solano County
47355	Fee-for-Service	1730293630	1730293630	1	1	ADVANCED GASTROENTEROLOG	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDL ASSOC	1205 GARCES HWY	STE 101	DELANO	CA	93215	3657	15	06029	35.76144147	-119.2400687	Kern County
47373	Fee-for-Service	1366713513	1366713513	1	1	ABBASI, SADEEA Q MD	8/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	123851	41	Internal Medicine	0	In state provider	None	2001 SANTA MONICA BLVD	STE 560W	SANTA MONICA	CA	90404	2182	19	06037	34.02891163	-118.4797466	Los Angeles County
47399	Fee-for-Service	1033681127	1033681127	1	1	AILIFE DIAGNOSTICS, INC.	3/6/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	1920 COUNTRY PLACE PARKW	SUITE 100	PEARLAND	TX	77584	2282	00	None	29.57698443	-95.38394698	Brazoria County
47402	Fee-for-Service	1598261166	1598261166	1	1	ARMSTRONG, ALLISON NP	4/17/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
47416	Fee-for-Service	1891841938	1891841938	1	1	ANDERS, MALVIN D	3/27/2008	207W00000X	NA	Ophthalmology	026	PHYSICIANS	29436	18	Ophthalmology	0	In state provider	None	931 BUENA VISTA STREET	SUITE 204	DUARTE	CA	91010	1713	19	06037	34.141635	-117.9775755	Los Angeles County
47450	Fee-for-Service	1649688037	1649688037	1	1	ALECTO HEALTHCARE SERVICES	5/12/2015	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	FAIRMONT	1325 LOCUST AVE	None	FAIRMONT	WV	26554	1435	00	None	39.482451	-80.165466	Marion County
47472	Fee-for-Service	1235113218	1235113218	1	1	ANANDA, AJAY K MD	3/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81098	14	Neurological Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
47479	Fee-for-Service	1447458310	1447458310	1	1	AGARWAL, SANJAY J MD	6/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55624	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
47502	Fee-for-Service	1568510394	1568510394	1	1	AZAR, ZAVIN Z MD	12/31/1995	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	60698	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
47507	Fee-for-Service	1417900028	1417900028	1	1	AR MOBILITY	2/11/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	AR MOBILITY	16601 GOTHARD ST	STE M	HUNTINGTON BEACH	CA	92647	4479	30	06059	33.7214788	-118.0001671	Orange County
47508	Fee-for-Service	1356748487	1356748487	1	1	ATLANTIS HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1775 E LINCOLN AVE	SUITE 203A	ANAHEIM	CA	92805	8903	30	06059	33.84026684	-117.8924704	Orange County
47511	Fee-for-Service	1720641079	1720641079	1	1	AHMED, AMBAREEN Z DO	3/8/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20162	None	None	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
47515	Fee-for-Service	1659340339	1659340339	1	1	AZIZ, HANY S MD	6/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89185	41	Internal Medicine	0	In state provider	None	3805 SAN DIMAS STREET	SUITE B	BAKERSFIELD	CA	93301	5725	15	06029	35.39508529	-119.0082516	Kern County
47527	Fee-for-Service	1538278270	1538278270	1	2	AZURIN, ELEANOR MD INC	5/15/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	3045 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	6302	19	06037	33.97305955	-118.2139451	Los Angeles County
47544	Fee-for-Service	1023435450	1023435450	1	1	AMBA, SAMRIDHI MD	6/24/2022	207RC0200X	NA	Other	026	PHYSICIANS	142588	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
47606	Fee-for-Service	1669039327	1669039327	1	1	A MIND ABOVE, A PROFESSIONAL	10/19/2022	103TC0700X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	334 SHAW AVE	SUITE 100	CLOVIS	CA	93612	3839	10	06019	36.80839352	-119.7049776	Fresno County
47607	Fee-for-Service	1396047429	1396047429	1	1	ALFILER, ADALAIDA C MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114636	41	Internal Medicine	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
47619	Fee-for-Service	1205000890	1205000890	1	1	AKHONDI, ANDRE B MD	3/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111933	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
47641	Fee-for-Service	1730293630	1730293630	1	1	ADVANCED GASTROENTEROLOG	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	MEDL ASSOC	1205 GARCES HWY	STE 101	DELANO	CA	93215	3657	15	06029	35.76144147	-119.2400687	Kern County
47656	Fee-for-Service	1154747020	1154747020	1	2	ACN MEDICAL GROUP, INC	10/10/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	751 SAN PEDRO TERRACE RD	None	PACIFICA	CA	94044	4101	41	06081	37.58922864	-122.5018256	San Mateo County
47662	Fee-for-Service	1366713513	1366713513	1	1	ABBASI, SADEEA Q MD	8/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	123851	10	Gastroenterology (M.D. only)	0	In state provider	None	2001 SANTA MONICA BLVD	STE 560W	SANTA MONICA	CA	90404	2182	19	06037	34.02891163	-118.4797466	Los Angeles County
47669	Fee-for-Service	1811064736	1811064736	1	1	ATKINSON, LINDA M MD	1/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79466	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
47673	Fee-for-Service	1982794509	1982794509	1	1	ANTOMMARIA,ARMAND MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	None	SALT LAKE CITY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
47675	Fee-for-Service	1700886496	1700886496	1	1	ANDREE, STEVEN R MD	8/31/1995	207P00000X	NA	Other	026	PHYSICIANS	62077	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2550 SR MARY COLUMBA DR	None	TEHAMA	CA	96080	0000	52	06103	40.14847323	-122.2180997	Tehama
47679	Fee-for-Service	1730388174	1730388174	1	1	ANDERSON, KAYE S LCSW	9/1/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
47702	Fee-for-Service	1780782979	1780782979	1	1	ALONZO, RONALIE B MD	8/23/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	76400	05	Anesthesiology	0	In state provider	None	1421 OAKDALE RD	None	MODESTO	CA	95355	3359	50	06099	37.664802	-120.9576055	Stanislaus County
47724	Fee-for-Service	1053846584	1053846584	1	1	ANDINO, JUAN J MD	5/11/2022	208800000X	NA	Other	026	PHYSICIANS	177912	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
47732	Fee-for-Service	1356407332	1356407332	1	1	ALAMEDA SURGERY CENTER LP	1/22/2011	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2601 W ALAMEDA AVE	SUITE 312	BURBANK	CA	91505	4812	19	06037	34.15783817	-118.3293969	Los Angeles County
47737	Fee-for-Service	1649688037	1649688037	1	1	ALECTO HEALTHCARE SERVICES	5/12/2015	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	FAIRMONT	1325 LOCUST AVE	None	FAIRMONT	WV	26554	1435	00	None	39.482451	-80.165466	Marion County
47750	Fee-for-Service	1407494735	1407494735	1	1	ADEGBITE, ADEKUNLE S CNP	9/30/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
47751	Fee-for-Service	1992780688	1992780688	1	1	ADAMANY, RONALD N MD	11/30/1995	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	54976	10	Gastroenterology (M.D. only)	0	In state provider	None	24411 HEALTH CENTER DR	STE 550	LAGUNA HILLS	CA	92653	3687	30	06059	33.6087201	-117.7076948	Orange County
47790	Fee-for-Service	1720007495	1720007495	1	1	ANDREWS, JANNA Z MD	9/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83272	78	Neoplastic Diseases/Oncology	0	In state provider	None	2466 1ST AVE	STE B	SAN DIEGO	CA	92101	1408	37	06073	32.731137	-117.1639695	San Diego County
47795	Fee-for-Service	1356748487	1356748487	1	1	ATLANTIS HOSPICE INC	7/3/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1775 E LINCOLN AVE	SUITE 203A	ANAHEIM	CA	92805	8903	30	06059	33.84026684	-117.8924704	Orange County
47808	Fee-for-Service	1619194222	1619194222	1	1	AIJIAN, CHRISTINE A LMFT	6/26/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
47880	Fee-for-Service	1700403086	1700403086	1	1	AMPM HOSPICE INC	8/23/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14542 VENTURA BLVD	STE 202	SHERMAN OAKS	CA	91403	5520	19	06037	34.15111125	-118.4500521	Los Angeles County
47891	Fee-for-Service	1639464431	1639464431	1	1	AMOUSSOU, DELA	7/6/2017	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
47908	Fee-for-Service	1124725163	1124725163	1	1	ARMIJO, ANTHONY OD	3/13/2024	156FX1800X	NA	Other	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	14210 PALM DR	A2	DESERT HOT SPRING	CA	92240	6873	33	06065	33.94544616	-116.5011825	Riverside County
47938	Fee-for-Service	1780746479	1780746479	2	2	AEGIS TREATMENT CENTERS, LLC	5/15/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1018 21ST STREET	None	BAKERSFIELD	CA	93301	4709	15	06029	35.37813217	-119.0132767	Kern County
47942	Fee-for-Service	1649344235	1649344235	1	1	ARROYO, ROLANDO MD	5/14/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	68562	09	Gynecology (D.O. only)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
47967	Fee-for-Service	1528261500	1528261500	1	1	ANGAN, ANITHA MD	9/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94004	None	None	0	In state provider	None	2557 MOWRY AVE	STE 12	FREMONT	CA	94538	1614	01	06001	37.55561575	-121.9826617	Alameda County
47994	Fee-for-Service	1851109094	1851109094	1	1	AMY RAY DOULA LLC	12/19/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	07	06013	0	0	None
48003	Fee-for-Service	1750869244	1750869244	1	1	ACCESS ONE HOME CARE SERVICE	9/18/2020	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	27125 SIERRA HWY	SUITE 325H	SANTA CLARITA	CA	91351	1001	19	06037	34.4082627	-118.4611389	Los Angeles County
48059	Fee-for-Service	1164993473	1164993473	1	1	ABITONA, RHONALD G NP	1/2/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
48068	Fee-for-Service	1669550380	1669550380	1	1	ANDOLINA, KARYL L MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71484	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
48075	Fee-for-Service	1912289703	1912289703	1	1	ADLER, EDNA C LCSW	10/15/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1491 CEDARWOOD LN STE A	None	PLEASANTON	CA	94566	6126	01	06001	37.6718281	-121.8748788	Alameda County
48079	Fee-for-Service	1114224326	1114224326	1	1	AUYEUNG, SHERMAN	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
48082	Fee-for-Service	1285777854	1285777854	1	1	ASHER-GALLOWAY, KERIN D	1/26/2015	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	4900 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5814	19	06037	34.0981225	-118.2965085	Los Angeles County
48092	Fee-for-Service	1205895505	1205895505	2	1	ARJONA, JOSE L MD	10/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	88721	30	Radiology	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
48100	Fee-for-Service	1629038542	1629038542	1	1	ABAWI, JABER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1106 N BEELINE HWY	None	PAYSON	AZ	85541	3714	00	None	34.25517	-111.322809	Gila County
48125	Fee-for-Service	1013441229	1013441229	1	1	ABRAHA, TEKLEHAIMANOT S NP	6/12/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
48155	Fee-for-Service	1740612282	1740612282	1	1	ARIAS, JOE L LCSW	12/15/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3600 LIME ST	BUILDING 2/SUITE 103	RIVERSIDE	CA	92501	2971	33	06065	33.98276147	-117.3693188	Riverside County
48168	Fee-for-Service	1700403086	1700403086	1	1	AMPM HOSPICE INC	8/23/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14542 VENTURA BLVD	STE 202	SHERMAN OAKS	CA	91403	5520	19	06037	34.15111125	-118.4500521	Los Angeles County
48169	Fee-for-Service	1598116139	1598116139	1	1	AGONAFER, EDDEN LP	2/13/2025	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
48184	Fee-for-Service	1851167282	1851167282	1	1	ABRAMS-MISBEEK, LISA LMFT	3/10/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41593 WINCHESTER RD	215	TEMECULA	CA	92590	4860	33	06065	33.52030169	-117.1659061	Riverside County
48189	Fee-for-Service	1396728903	1396728903	1	1	AKHTAR, ROOMANA MD	10/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102264	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
48198	Fee-for-Service	1073096160	1073096160	1	1	A SYDNEY WILLIAMS AND ASSOCI	12/18/2018	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IATES INC	101 S SAN MATEO DR	STE 306	SAN MATEO	CA	94401	3844	41	06081	37.56590481	-122.325549	San Mateo County
48228	Fee-for-Service	1649344235	1649344235	1	1	ARROYO, ROLANDO MD	5/14/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	68562	05	Anesthesiology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
48229	Fee-for-Service	1780746479	1780746479	2	2	AEGIS TREATMENT CENTERS, LLC	5/15/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1018 21ST STREET	None	BAKERSFIELD	CA	93301	4709	15	06029	35.37813217	-119.0132767	Kern County
48244	Fee-for-Service	1427298199	1427298199	1	1	AMIRYAR, MAIHAN MD	3/24/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	106592	08	Family Practice	0	In state provider	None	1301 PINOLE VALLEY ROAD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
48259	Fee-for-Service	1386980233	1386980233	1	1	ARAUJO, ANTONIO CRNA	4/9/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
48268	Fee-for-Service	1588664916	1588664916	1	1	ANDERSON, JONATHAN P MD	10/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	73601	08	Family Practice	0	In state provider	None	2720 N HARBOR BLVD	None	FULLERTON	CA	92835	2609	30	06059	33.90126238	-117.9292154	Orange County
48286	Fee-for-Service	1205102472	1205102472	1	1	ARROYO, ANNA J MD	5/16/2019	207RA0201X	NA	Other	026	PHYSICIANS	126642	03	Allergy	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
48292	Fee-for-Service	1144339953	1144339953	1	1	ADVANCED WOMENS HEALTHCARE	8/5/2005	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	A MEDICAL CORPORATION	7355 CHURCH ST	STE F	YUCCA VALLEY	CA	92284	3273	36	06071	34.119666	-116.436541	San Bernardino County
48299	Fee-for-Service	1427889195	1427889195	1	1	ADOBE PH CA MEDICAL GROUP, P	4/1/2025	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	.C.	135 SOUTH STATE COLLEGE	#228	BREA	CA	92821	5823	30	06059	33.92036053	-117.8829421	Orange County
48318	Fee-for-Service	1871538637	1871538637	1	1	AGUILERA-LEDESMA, L MD	7/1/2000	207R00000X	NA	Other	026	PHYSICIANS	64724	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27212 CALAROGA AVE	None	HAYWARD	CA	94545	4339	01	06001	37.63229023	-122.0896425	Alameda County
48337	Fee-for-Service	1124226469	1124226469	1	1	ANCHETA, KEITH M	4/5/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
48340	Fee-for-Service	1659589588	1659589588	1	1	AVITEA, LORENA LCSW	3/6/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8080 LA MESA BLVD	STE 104	LA MESA	CA	91942	0361	37	06073	32.76348513	-117.0227291	San Diego County
48377	Fee-for-Service	1639238215	1639238215	1	1	ARORA, SAMEER MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70748	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
48413	Fee-for-Service	1396238671	1396238671	1	1	ARAKAKI, CHRISTINA OD	1/2/2019	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 LAGUNA RD	SUITE C	FULLERTON	CA	92835	3634	30	06059	33.89326085	-117.9300987	Orange County
48426	Fee-for-Service	1588619464	1588619464	1	1	ALIM, MUHAMMAD A MD	12/21/2021	207RP1001X	NA	Pulmonology	026	PHYSICIANS	54260	None	None	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
48462	Fee-for-Service	1902267479	1902267479	1	11	ALTAMED HEALTH SERVICES	9/30/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	3351 FIRESTONE BLVD	None	SOUTH GATE	CA	90280	2937	19	06037	33.95467597	-118.2098272	Los Angeles County
48473	Fee-for-Service	1558535740	1558535740	1	1	AXELROD, FREDERICK A MD	2/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	60047	22	Pathology (M.D. only)	0	In state provider	None	1150 N INDIAN CANYON DRI	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
48474	Fee-for-Service	1144588260	1144588260	1	1	ALLEN, ANTHONY T MD	2/4/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	162640	13	Neurology (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
48540	Fee-for-Service	1558328054	1558328054	1	1	ASSOCIATED ANESTHESIOLOGISTS	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	MEDICAL GROUP APC	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
48550	Fee-for-Service	1942696323	1942696323	1	1	AUJLA, GURPREET K MD	5/18/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	150505	36	Psychiatry	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
48557	Fee-for-Service	1891735676	1891735676	1	1	AMBO, STANLEY G MD	12/1/2003	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	77814	01	General Practice	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
48585	Fee-for-Service	1427889195	1427889195	1	1	ADOBE PH CA MEDICAL GROUP, P	4/1/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	.C.	135 SOUTH STATE COLLEGE	#228	BREA	CA	92821	5823	30	06059	33.92036053	-117.8829421	Orange County
48627	Fee-for-Service	1376548271	1376548271	1	1	ASSOCIATED REGIONAL AND	4/4/1986	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	1	Border provider	UNIVERSITY PATHOLOGISTS	500 CHIPETA WAY	None	SALT LAKE CTY	UT	84108	1221	00	None	40.758707	-111.8239633	Salt Lake County
48643	Fee-for-Service	1194588392	1194588392	1	3	ACUTE CARE ASSOCIATES OF CAL	3/1/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	IFORNIA PC	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
48680	Fee-for-Service	1699591610	1699591610	1	1	ALLIANCE HEALTH RCFE, INC.	1/15/2025	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	23601 CANZONET ST	None	WOODLAND HILLS	CA	91367	5845	19	06037	34.1651977	-118.6402715	Los Angeles County
48700	Fee-for-Service	1326478074	1326478074	1	1	ANDERSEN, CODY KIT MD	2/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15531	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1000 GREENLEY ROAD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
48725	Fee-for-Service	1841685435	1841685435	1	1	ASLAM, JUNAID MD	5/31/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	176003	None	None	0	In state provider	None	1306 MARICOPA HIGHWAY	None	OJAI	CA	93023	3131	56	06111	34.44229705	-119.2645703	Ventura County
48742	Fee-for-Service	1154455178	1154455178	1	1	ABBASS, KHURRAM MD	6/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129410	83	Rheumatology	0	In state provider	None	3273 CLAREMONT WAY	STE 209	NAPA	CA	94558	3329	28	06055	38.32062499	-122.3012501	Napa County
48749	Fee-for-Service	1902267479	1902267479	1	11	ALTAMED HEALTH SERVICES	9/30/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	3351 FIRESTONE BLVD	None	SOUTH GATE	CA	90280	2937	19	06037	33.95467597	-118.2098272	Los Angeles County
48763	Fee-for-Service	1508488362	1508488362	1	1	AGM RX INC	7/1/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12043 RIVERSIDE DR.	None	VALLEY VILLAGE	CA	91607	3744	19	06037	34.15764451	-118.3959855	Los Angeles County
48768	Fee-for-Service	1881924389	1881924389	1	1	ARCH HEALTH PARTNERS	4/8/2011	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	211 13TH ST	None	RAMONA	CA	92065	2711	37	06073	33.04020023	-116.8739786	San Diego County
48789	Fee-for-Service	1720831720	1720831720	1	1	ADVENTIST HEALTH PHYSICIANS	8/7/2024	2085R0001X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	2985 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28953746	-118.7439291	Ventura County
48801	Fee-for-Service	1023663671	1023663671	1	1	ALTEMA, DEREK MD	4/22/2024	207P00000X	NA	Other	026	PHYSICIANS	186940	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 WESTWOOD PLAZA	STE 1517	LOS ANGELES	CA	90095	7402	19	06037	34.06633051	-118.4452686	Los Angeles County
48821	Fee-for-Service	1518034495	1518034495	1	1	ABOUZEID, YOUSSEF M MD	11/30/1985	204D00000X	NA	Other	026	PHYSICIANS	43032	01	General Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
48824	Fee-for-Service	1588776918	1588776918	1	1	ADAPA, INDIRA D MD	6/13/2011	2084P0804X	NA	Psychiatry	026	PHYSICIANS	86927	36	Psychiatry	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
48840	Fee-for-Service	1588661672	1588661672	1	1	AMERICUS & SUMTER COUNTY	10/23/2006	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	100 WHEATLEY DR	None	AMERICUS	GA	31709	3788	00	None	32.06249335	-84.2205776	Sumter County
48846	Fee-for-Service	1891735676	1891735676	1	1	AMBO, STANLEY G MD	12/1/2003	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	77814	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
48848	Fee-for-Service	1669512760	1669512760	1	1	ARDAKANI, NAVID A MD	4/1/2010	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	70188	None	None	0	In state provider	None	400 CHANNING AVE	None	PALO ALTO	CA	94301	2801	43	06085	37.44420406	-122.1551287	Santa Clara County
48860	Fee-for-Service	1063555696	1063555696	1	1	ALPERT, RICKI A MD	10/4/2013	207L00000X	NA	Other	026	PHYSICIANS	44725	05	Anesthesiology	0	In state provider	None	10121 PINE AVE	None	TRUCKEE	CA	96161	1835	29	06057	39.3245308	-120.2013097	Nevada County
48864	Fee-for-Service	1245713767	1245713767	1	1	AKARAPHANTH, MONICA OT	11/8/2022	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
48866	Fee-for-Service	1861562019	1861562019	1	1	AMERICAN HEALTH SERVICES LLC	11/6/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2720 E PALMDALE BLVD	SUITES 129, 130, 131	PALMDALE	CA	93550	4930	19	06037	34.58012347	-118.0800855	Los Angeles County
48889	Fee-for-Service	1437537412	1437537412	1	1	ALEXANIAN, SERGE MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111292	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3076	19	06037	34.06373445	-118.443537	Los Angeles County
48896	Fee-for-Service	1841720604	1841720604	1	1	AZIZ, SALLI MD	1/11/2021	208M00000X	NA	Other	026	PHYSICIANS	169811	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
48928	Fee-for-Service	1184777237	1184777237	1	1	ALFARERO, GUILLERMA LVN	8/1/2005	164X00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	6281 N MALSBURY AVE	None	FRESNO	CA	93711	0957	10	06019	36.8278565	-119.8539633	Fresno County
48931	Fee-for-Service	1194588392	1194588392	1	3	ACUTE CARE ASSOCIATES OF CAL	3/1/2024	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	IFORNIA PC	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
48985	Fee-for-Service	1063902104	1063902104	1	1	ANDERSON, JARRED R DO	7/15/2022	207P00000X	NA	Other	026	PHYSICIANS	19349	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
48995	Fee-for-Service	1477609808	1477609808	1	1	AGUILERA, ADOLFO MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69022	08	Family Practice	0	In state provider	None	26520 CACTUS AVE	# B2018	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
49029	Fee-for-Service	1154455178	1154455178	1	1	ABBASS, KHURRAM MD	6/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129410	41	Internal Medicine	0	In state provider	None	3273 CLAREMONT WAY	STE 209	NAPA	CA	94558	3329	28	06055	38.32062499	-122.3012501	Napa County
49061	Fee-for-Service	1699779504	1699779504	2	1	AGMMM PHARMACY INC	1/11/2013	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5735 ATLANTIC AVE	None	LONG BEACH	CA	90805	4712	19	06037	33.859908	-118.185069	Los Angeles County
49076	Fee-for-Service	1316359086	1316359086	1	1	ALVAREZ, MARFELIA LMFT	1/6/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
49096	Fee-for-Service	1750876017	1750876017	1	1	AMIN, NIKKEE MD	11/15/2023	2084N0402X	NA	Neurology	026	PHYSICIANS	165862	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
49105	Fee-for-Service	1760659882	1760659882	1	1	AWSARE, SWATI B MD	4/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	78534	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
49126	Fee-for-Service	1326269515	1326269515	1	1	AGRAWAL, BRAJESH K MD	7/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130604	13	Neurology (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
49128	Fee-for-Service	1588661672	1588661672	1	1	AMERICUS & SUMTER COUNTY	10/23/2006	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	100 WHEATLEY DR	None	AMERICUS	GA	31709	3788	00	None	32.06249335	-84.2205776	Sumter County
49135	Fee-for-Service	1114023058	1114023058	1	2	AMSTER, MICHAEL A MD	11/15/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	81550	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
49157	Fee-for-Service	1083147755	1083147755	1	1	ALSAATI, FARAH MD	9/8/2021	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	171104	None	None	0	In state provider	None	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
49170	Fee-for-Service	1386826287	1386826287	1	1	ALMEIDA, CRISTINA M MD	10/5/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	95032	08	Family Practice	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
49184	Fee-for-Service	1285089920	1285089920	1	1	ALICEA, SIGRID M LMFT	4/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
49214	Fee-for-Service	1184777237	1184777237	1	1	ALFARERO, GUILLERMA LVN	3/3/2003	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	6281 N MALSBURY AVE	None	FRESNO	CA	93711	0957	10	06019	36.8278565	-119.8539633	Fresno County
49224	Fee-for-Service	1093769242	1093769242	3	1	ALPHA AIR DME INC	7/17/2020	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	26341 JEFFERSON AVE.	E	MURRIETA	CA	95262	6974	33	06065	33.53475568	-117.1791945	Riverside County
49282	Fee-for-Service	1962430447	1962430447	1	1	ANNA STEELE M.D.	12/16/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 EXEMPLA CIR	None	LAFAYETTE	CO	80026	3370	00	None	39.97232464	-105.086171	Boulder County
49287	Fee-for-Service	1154736429	1154736429	1	13	AVENAL COMMUNITY HEALTH CENT	5/22/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	271 N L STREET	None	DINUBA	CA	93618	2107	54	06107	36.54248431	-119.3921496	Tulare County
49292	Fee-for-Service	1104328384	1104328384	1	1	ALDAVOODI, SHAHLA NP	8/24/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
49358	Fee-for-Service	1518194612	1518194612	1	1	ASIF, FOUZIA MD	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118392	01	General Practice	0	In state provider	None	2720 N HARBOR BLVD	None	FULLERTON	CA	92835	2609	30	06059	33.90126238	-117.9292154	Orange County
49365	Fee-for-Service	1346829744	1346829744	1	1	AMIN, MILAN MD	6/26/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	191759	40	Pediatrics	0	In state provider	None	8910 VILLA LA JOLLA DR	STE 110	LA JOLLA	CA	92037	1701	37	06073	32.87058261	-117.2338797	San Diego County
49373	Fee-for-Service	1528139433	1528139433	1	1	ALEX, NEIL S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	21389	26	Psychiatry (child)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
49390	Fee-for-Service	1124180815	1124180815	2	2	AEGIS TREATMENT CENTERS, LLC	5/15/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1019 JEFFERSON STREET	None	DELANO	CA	93215	2238	15	06029	35.76992766	-119.2445457	Kern County
49400	Fee-for-Service	1295803302	1295803302	1	1	ADVANCED MEDICAL IMAGING	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	59482	30	Radiology	0	In state provider	None	6297 N FRESNO ST	None	FRESNO	CA	93710	5209	10	06019	36.828144	-119.7814165	Fresno County
49416	Fee-for-Service	1861711863	1861711863	1	7	AME MEDICAL GROUP, INC.	2/3/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	15141 WHITTIER BLVD	120	WHITTIER	CA	90603	2145	19	06037	33.94810044	-118.0039419	Los Angeles County
49422	Fee-for-Service	1528344884	1528344884	1	1	ARMSTRONG, STACEY LMFT	10/6/2023	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
49432	Fee-for-Service	1639279417	1639279417	1	1	AZAD, ARMAGHAN MD	7/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96508	66	Emergency Medicine (Urgent Care)	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
49440	Fee-for-Service	1336297266	1336297266	1	1	ALAGOZ, TURGUT MD	12/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	69671	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
49523	Fee-for-Service	1699970053	1699970053	1	1	ARROYO, SILVIA J DPM	5/19/2010	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
49548	Fee-for-Service	1013161306	1013161306	1	1	ABRAHAM, SUNIL J MD	3/12/2019	207R00000X	NA	Other	026	PHYSICIANS	109069	08	Family Practice	0	In state provider	None	18522 US HIGHWAY 18 STE	None	APPLE VALLEY	CA	92307	2321	36	06071	34.53944358	-117.2599885	San Bernardino County
49552	Fee-for-Service	1588026488	1588026488	1	1	ALURU, VIJAY MD	6/20/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
49577	Fee-for-Service	1154736429	1154736429	1	13	AVENAL COMMUNITY HEALTH CENT	5/22/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	271 N L STREET	None	DINUBA	CA	93618	2107	54	06107	36.54248431	-119.3921496	Tulare County
49597	Fee-for-Service	1730315359	1730315359	1	1	AKROUSH, ALVERA A MD	11/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116256	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
49610	Fee-for-Service	1194932285	1194932285	1	1	ARSENE, HEDVIGA C MD	8/27/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	101285	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
49613	Fee-for-Service	1942512256	1942512256	1	1	ASHOK, MALA MD	10/19/2004	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	85579	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8120 TIMBERLAKE WAY	None	SACRAMENTO	CA	95823	5412	34	06067	38.461023	-121.41414	Sacramento County
49628	Fee-for-Service	1669093357	1669093357	1	1	ADVENTIST HEALTH PHYSICIANS	1/11/2021	207V00000X	NA	Obstetrics & Gynecology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1505 WILSON TER	300	GLENDALE	CA	91206	4073	19	06037	34.14960934	-118.2313491	Los Angeles County
49643	Fee-for-Service	1982021564	1982021564	1	1	ASPIRA LABS INC	8/30/2016	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	12117 BEE CAVES RD	BLDG 3 SUITE 100	AUSTIN	TX	78738	7873	00	None	30.30776872	-97.92854955	Travis County
49653	Fee-for-Service	1316177215	1316177215	1	1	ASHRAF, SANA A MD	10/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115228	40	Pediatrics	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
49666	Fee-for-Service	1750339727	1750339727	1	1	AHMED, MAHAMED G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 NE 139TH ST	None	VANCOUVER	WA	98686	2742	00	None	45.720117	-122.647986	Clark County
49679	Fee-for-Service	1124180815	1124180815	2	2	AEGIS TREATMENT CENTERS, LLC	5/15/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1019 JEFFERSON STREET	None	DELANO	CA	93215	2238	15	06029	35.76992766	-119.2445457	Kern County
49683	Fee-for-Service	1336662576	1336662576	1	1	ABAD, JAY RAYMOND NP	5/20/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
49727	Fee-for-Service	1467672485	1467672485	1	1	ALHATEM, FADI MD	12/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	159408	01	General Practice	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
49741	Fee-for-Service	1295248110	1295248110	1	1	ABREKOV, TEHILA T NP	1/19/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
49781	Fee-for-Service	1982987095	1982987095	1	1	APEX PEDIATRICS INC	2/10/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	399 E HIGHLAND AVE	SUITE 329	SAN BERNARDINO	CA	92404	3861	36	06071	34.1358627	-117.2757898	San Bernardino County
49803	Fee-for-Service	1992918916	1992918916	1	1	AL AMMARY, FAWAZ S MD	10/24/2022	208M00000X	NA	Other	026	PHYSICIANS	99785	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
49808	Fee-for-Service	1013382373	1013382373	1	1	ANUKAM, JOAN N NP	11/2/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
49813	Fee-for-Service	1467423772	1467423772	1	1	ACOSTA, JUAN M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1920 E CAMBRIDGE AVE	STE #201	PHOENIX	AZ	85006	0000	00	None	33.4775733	-112.040141	Maricopa County
49837	Fee-for-Service	1588026488	1588026488	1	1	ALURU, VIJAY MD	6/20/2024	208M00000X	NA	Other	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
49838	Fee-for-Service	1477736965	1477736965	1	1	ARPAJIRAKUL, NEARY MD	1/4/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	101018	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	3191	07	06013	38.00771973	-122.1331484	Contra Costa County
49849	Fee-for-Service	1801828900	1801828900	3	1	A1 MEDICAL EQUIPMENT	12/24/2018	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	& SUPPLY INC	314 E HILLCREST BLVD	None	INGLEWOOD	CA	90301	2431	19	06037	33.95973995	-118.3510077	Los Angeles County
49864	Fee-for-Service	1154736429	1154736429	1	13	AVENAL COMMUNITY HEALTH CENT	6/8/2022	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	271 N L STREET	None	DINUBA	CA	93618	2107	54	06107	36.54248431	-119.3921496	Tulare County
49888	Fee-for-Service	1902241177	1902241177	1	1	AVPT INC	10/15/2013	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	18095 HIGHWAY 18	SUITE C	APPLE VALLEY	CA	92307	2189	36	06071	34.54025876	-117.2693057	San Bernardino County
49891	Fee-for-Service	1861474157	1861474157	1	1	AYENI, OSITA N	6/1/2005	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	CYNNIES MED SUP HM EQ CO	4401 ATLANTIC AVE	STE 200	LONG BEACH	CA	90807	2264	19	06037	33.836976	-118.185096	Los Angeles County
49901	Fee-for-Service	1003906496	1003906496	1	1	AMPLE GROUP HOLDING, INC	2/8/2007	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	COMFORT MEDICAL SVCS INC	339 E MISSION BLVD	None	POMONA	CA	91766	1848	19	06037	34.05521207	-117.7474136	Los Angeles County
49919	Fee-for-Service	1306564091	1306564091	1	1	AMARO, BRYAN NP	1/23/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3930 4TH AVE	STE 300	SAN DIEGO	CA	92103	3119	37	06073	32.74892723	-117.1616459	San Diego County
49951	Fee-for-Service	1043492879	1043492879	1	1	ARC OF SAN DIEGO	2/3/1983	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2244 MEADOW LARK DR	None	SAN DIEGO	CA	92123	3312	37	06073	32.78412882	-117.1545435	San Diego County
49954	Fee-for-Service	1255047312	1255047312	1	1	AGUILAVASQUEZ, CHARLEEN	11/1/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	27120 EUCALYPTUS AVENUE	SUITE F	MORENO VALLEY	CA	92555	4543	33	06065	33.93551714	-117.1876083	Riverside County
49961	Fee-for-Service	1942762174	1942762174	1	1	A PLUS DURABLE MEDICAL EQUIP	9/15/2020	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	9829 CARMENITA RD	A	WHITTIER	CA	90605	3269	19	06037	33.9479708	-118.0466386	Los Angeles County
49965	Fee-for-Service	1083130553	1083130553	1	1	ADVANCED ANESTHESIA SPECIALI	2/15/2024	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	STS, A MEDICAL CORPORATI	4500 TRADE CENTER DR	SUITE A	BAKERSFIELD	CA	93311	8716	15	06029	35.31410008	-119.1313466	Kern County
49994	Fee-for-Service	1205854247	1205854247	1	1	AHADIAN, FARSHAD M MD	12/11/2002	207L00000X	NA	Other	026	PHYSICIANS	77732	05	Anesthesiology	0	In state provider	None	400 E MAIN ST	STE 200	STOCKTON	CA	95202	3000	39	06077	37.95344497	-121.2852303	San Joaquin County
49999	Fee-for-Service	1205035425	1205035425	1	2	ADDICTION RESEARCH AND TREAT	10/21/2021	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1124 INTERNATIONAL BOULE	None	OAKLAND	CA	94606	4331	01	06001	37.79106984	-122.2484928	Alameda County
50001	Fee-for-Service	1770979288	1770979288	1	1	ANDRE, MARK MD	12/8/2018	207R00000X	NA	Other	026	PHYSICIANS	149223	41	Internal Medicine	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
50010	Fee-for-Service	1225186273	1225186273	1	1	APPA, SURI N MD	12/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79261	18	Ophthalmology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
50015	Fee-for-Service	1588615207	1588615207	1	1	ADLER-BRESSLER, SUSAN J	12/1/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	56108	08	Family Practice	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2268	07	06013	37.98417931	-122.0361585	Contra Costa County
50026	Fee-for-Service	1265658595	1265658595	2	2	APOLLOMED HOSPITALISTS A MED	10/27/2022	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ICAL CORPORATION	900 SOUTH ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	4716	19	06037	34.049623	-118.1388014	Los Angeles County
50031	Fee-for-Service	1871832253	1871832253	1	1	AL-ASADY, NOOR DO	5/18/2020	207R00000X	NA	Other	026	PHYSICIANS	14791	41	Internal Medicine	0	In state provider	None	1400 E PALOMAR ST	None	CHULA VISTA	CA	91931	1800	37	06073	32.62382113	-116.9960539	San Diego County
50063	Fee-for-Service	1790941797	1790941797	1	1	ACHARYA, PATRICIA T MD	4/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133852	30	Radiology	0	In state provider	None	11370 ANDERSON ST	SUITE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
50070	Fee-for-Service	1700064557	1700064557	1	1	ANOTHER CHOICE ANOTHER	1/30/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	CHANCE	2710 KILGORE ROAD	ROOM 3	RANCHO CORDOVA	CA	95670	6104	34	06067	38.601603	-121.275702	Sacramento County
50098	Fee-for-Service	1922728278	1922728278	1	1	ALAMEDA ORTHOPEDIC FOOTCARE	2/16/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	CENTER	18271 MCDURMOTT ST.	SUITE F	IRVINE	CA	92614	9261	30	06059	33.68845084	-117.8669142	Orange County
50123	Fee-for-Service	1699038836	1699038836	1	1	ADT LLC	9/16/2021	No Taxonomy Provided	NA	None	068	HCBC BENEFIT PROVIDER	-	-	NOT APPLICABLE	2	Out of state provider	None	32100 US HIGHWAY 19 N	None	PALM HARBOR	FL	34684	3709	00	None	28.063827	-82.73901698	Pinellas County
50125	Fee-for-Service	1336845478	1336845478	1	1	AIKO, DARIUS ROSA	2/23/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	15850 LOS ALTOS DR	None	HACIENDA HEIGHTS	CA	91745	5310	19	06037	33.98631504	-117.9686788	Los Angeles County
50126	Fee-for-Service	1679656193	1679656193	1	2	ASUNCION, MERLYN M MD	4/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	49850	None	None	0	In state provider	None	14555 HAMLIN ST	STE 108	VAN NUYS	CA	91411	1617	19	06037	34.18872722	-118.4506359	Los Angeles County
50163	Fee-for-Service	1043313927	1043313927	1	1	ALSBERGAS, MELISSA J CRNA	6/18/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
50169	Fee-for-Service	1659493625	1659493625	1	1	AL-HAKEEM, SULTAN A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	41587	08	Family Practice	0	In state provider	None	2740 S BRISTOL ST	STE 214	SANTA ANA	CA	92704	6233	30	06059	33.70999696	-117.8854626	Orange County
50180	Fee-for-Service	1639607294	1639607294	1	1	ALI, SAIYED MD	4/26/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	165663	None	None	0	In state provider	None	3300 E SOUTH ST	STE 308	LONG BEACH	CA	90805	4598	19	06037	33.86018093	-118.1537163	Los Angeles County
50281	Fee-for-Service	1134290067	1134290067	1	1	ALGOZINE, CARRIE A DO	6/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8504	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
50283	Fee-for-Service	1548779952	1548779952	1	1	ARUTYUNYAN, VAHE OD	2/12/2018	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	477 E COLORADO BLVD	None	PASADENA	CA	91101	2024	19	06037	34.14587948	-118.140561	Los Angeles County
50290	Fee-for-Service	1205035425	1205035425	1	2	ADDICTION RESEARCH AND TREAT	10/21/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1124 INTERNATIONAL BOULE	None	OAKLAND	CA	94606	4331	01	06001	37.79106984	-122.2484928	Alameda County
50333	Fee-for-Service	1356902597	1356902597	1	1	ACKER, SHANNON LMFT	3/24/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2030 E 4TH ST	C-232	SANTA ANA	CA	92705	3940	30	06059	33.74808045	-117.8378273	Orange County
50351	Fee-for-Service	1013035443	1013035443	1	1	ALCALDE, BRIAN R OD	10/8/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	251 W BENCAMP STREET	STE A	SAN GABRIEL	CA	91776	3798	19	06037	34.07852743	-118.1028748	Los Angeles County
50371	Fee-for-Service	1427491539	1427491539	1	1	AULAKH, PUNEET K MD	10/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144271	41	Internal Medicine	0	In state provider	None	901 NEVIN AVENUE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
50380	Fee-for-Service	1649254467	1649254467	1	1	AVDALOVIC, MARK V MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63508	41	Internal Medicine	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
50399	Fee-for-Service	1215511134	1215511134	1	1	AGGARWAL, MEGHA MD	10/31/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
50412	Fee-for-Service	1336845478	1336845478	1	1	AIKO, DARIUS ROSA	2/23/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	15850 LOS ALTOS DR	None	HACIENDA HEIGHTS	CA	91745	5310	19	06037	33.98631504	-117.9686788	Los Angeles County
50459	Fee-for-Service	1659493625	1659493625	1	1	AL-HAKEEM, SULTAN A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	41587	38	Geriatrics	0	In state provider	None	2740 S BRISTOL ST	STE 214	SANTA ANA	CA	92704	6233	30	06059	33.70999696	-117.8854626	Orange County
50507	Fee-for-Service	1396704698	1396704698	1	1	AKUTHOTA, PRAVEEN MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137976	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
50533	Fee-for-Service	1427713247	1427713247	1	2	AYALASOMAYAJULA, FRANCES A	7/11/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
50595	Fee-for-Service	1881015584	1881015584	1	1	ACE ENDOSCOPY & SURGERY CENT	11/27/2019	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	ER	2006 N. RIVERSIDE AVENUE	SUITE C	RIALTO	CA	92377	4697	36	06071	34.13670866	-117.3704994	San Bernardino County
50615	Fee-for-Service	1083298079	1083298079	1	1	ANOCHILI, VIVIAN MD	8/2/2024	390200000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
50656	Fee-for-Service	1841753787	1841753787	1	1	ABDELMALEK, KEROLOS N MD	7/18/2022	207R00000X	NA	Other	026	PHYSICIANS	177996	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
50666	Fee-for-Service	1700077112	1700077112	1	1	ACHA, ADALID MD	12/1/2003	174400000X	NA	Other	026	PHYSICIANS	31088	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	886 GOOSE LAKE CT	None	SAN JOSE	CA	95123	2464	43	06085	37.24310286	-121.8667092	Santa Clara County
50681	Fee-for-Service	1245205996	1245205996	1	1	ABELLO, RICHARD R MD	1/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	50909	30	Radiology	0	In state provider	None	10666 N TORREY PINES RD	None	SAN DIEGO	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
50689	Fee-for-Service	1790074243	1790074243	1	1	AKASHEH, ASHKAN MD	10/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123270	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
50715	Fee-for-Service	1790161628	1790161628	1	1	ANDERSON LOGHRY, KRISTEN DO	5/20/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15261	08	Family Practice	0	In state provider	None	451 W GONZALES RD	STE 230	OXNARD	CA	93036	0719	56	06111	34.21921445	-119.1816945	Ventura County
50726	Fee-for-Service	1891136487	1891136487	1	1	AFSHAR, SAM DO	10/28/2019	207L00000X	NA	Other	026	PHYSICIANS	16747	05	Anesthesiology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
50738	Fee-for-Service	1689029746	1689029746	1	1	ABELES, RUTH MD	6/10/2020	207R00000X	NA	Other	026	PHYSICIANS	167594	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
50740	Fee-for-Service	1861837221	1861837221	1	1	AMATYA, SUBHA L MD	1/23/2023	207R00000X	NA	Other	026	PHYSICIANS	150777	None	None	0	In state provider	None	17762 BEACH BLVD.	220	HUNTINGTON BEACH	CA	92647	6860	30	06059	33.70404013	-117.9890603	Orange County
50745	Fee-for-Service	1447425178	1447425178	1	1	AMATO, ERIN B MD	9/11/2017	2084P0800X	NA	Psychiatry	026	PHYSICIANS	-	36	Psychiatry	2	Out of state provider	None	1732 S 72ND ST W	None	BILLINGS	MT	59106	3500	00	None	45.737316	-108.699975	Yellowstone County
50765	Fee-for-Service	1083372361	1083372361	1	1	AHMEDOV, FELIX N	4/27/2023	163WP0808X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
50773	Fee-for-Service	1164464947	1164464947	1	1	ATKINSON, LEE R MD	1/1/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60399	40	Pediatrics	0	In state provider	None	2450 EAST ST	None	CONCORD	CA	94520	0000	07	06013	37.9830627	-122.0342408	Contra Costa County
50784	Fee-for-Service	1083132849	1083132849	1	1	ALTAMED HEALTH SERVICES	4/25/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	2100 W 3RD STREET	SUITE 220	LOS ANGELES	CA	90057	1993	19	06037	34.06308947	-118.2733326	Los Angeles County
50791	Fee-for-Service	1548213820	1548213820	1	1	ANDERSON, KAMI K MD	2/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	80274	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
50818	Fee-for-Service	1710371778	1710371778	1	1	ASAWESNA, NATALIE LMFT	11/10/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13001 SEAL BEACH	STE 360	SEAL BEACH	CA	90740	2753	30	06059	33.77168418	-118.0773961	Orange County
50826	Fee-for-Service	1588263586	1588263586	1	1	ASTER HOSPICE INC	1/11/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	484 E LOS ANGELES AVE	STE 228	MOORPARK	CA	93021	1968	19	06037	34.27891154	-118.8753975	Ventura County
50830	Fee-for-Service	1174698989	1174698989	1	1	ANDERSON, MICHAEL G PHD	12/14/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
50836	Fee-for-Service	1801494893	1801494893	1	1	ADAMS, KATHERINE CCC-SLP	10/15/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2115 J ST	SUITE 210	SACRAMENTO	CA	95816	4738	34	06067	38.576475	-121.4777745	Sacramento County
50845	Fee-for-Service	1669423091	1669423091	1	1	ARNOLD, CODY C MD	5/21/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	164807	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
50848	Fee-for-Service	1861711863	1861711863	1	6	AME MEDICAL GROUP, INC.	8/9/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	8500 FLORENCE AVENUE	101	DOWNEY	CA	90240	4062	19	06037	33.94970699	-118.1216339	Los Angeles County
50903	Fee-for-Service	1659955714	1659955714	1	1	AMELIA KRISTINE ADAMS	5/11/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	33532 VALLE ROAD	None	SAN JUAN CAPISTRA	CA	92675	4808	30	06059	33.48039137	-117.6659989	Orange County
50909	Fee-for-Service	1184263733	1184263733	1	1	AWOLOLA, ADENIKE CNP	9/7/2021	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
50920	Fee-for-Service	1265153902	1265153902	1	1	AAA QUALITY RESIDENTIAL CORP	3/16/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	7843 STANSBURY AVE	None	PANORAMA CITY	CA	91402	5214	19	06037	34.21341833	-118.4399951	Los Angeles County
50926	Fee-for-Service	1700880218	1700880218	1	1	ADEEB, FAREEDA N MD	4/20/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	52996	40	Pediatrics	0	In state provider	None	275 OCONNOR DR	STE B	SAN JOSE	CA	95128	1657	43	06085	37.32543612	-121.9398923	Santa Clara County
50965	Fee-for-Service	1891831681	1891831681	1	1	ADLIFE MEDICAL SUPPLY &	2/2/2002	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	EQUIP INC	11436 ARTESIA BLVD	STE C	ARTESIA	CA	90701	3859	19	06037	33.87290578	-118.0898206	Los Angeles County
51021	Fee-for-Service	1811925225	1811925225	1	1	ADAMS, CHARLES MD	1/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	66102	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
51035	Fee-for-Service	1447425178	1447425178	1	1	AMATO, ERIN B MD	9/11/2017	2084P0800X	NA	Psychiatry	026	PHYSICIANS	-	26	Psychiatry (child)	2	Out of state provider	None	1732 S 72ND ST W	None	BILLINGS	MT	59106	3500	00	None	45.737316	-108.699975	Yellowstone County
51061	Fee-for-Service	1255461570	1255461570	1	1	ACEVEDO, URANIA LMFT	1/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27851 BRADLEY RD	SUITE #109	MENIFEE	CA	92586	2213	33	06065	33.71630969	-117.1904696	Riverside County
51071	Fee-for-Service	1083132849	1083132849	1	1	ALTAMED HEALTH SERVICES	4/25/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	2100 W 3RD STREET	SUITE 220	LOS ANGELES	CA	90057	1993	19	06037	34.06308947	-118.2733326	Los Angeles County
51104	Fee-for-Service	1962680033	1962680033	1	1	ANAHEIM URGENT CARE, INC	3/29/2013	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	831 S STATE COLLEGE BLVD	None	ANAHEIM	CA	92806	4104	30	06059	33.83059011	-117.889382	Orange County
51114	Fee-for-Service	1588263586	1588263586	1	1	ASTER HOSPICE INC	1/11/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	484 E LOS ANGELES AVE	STE 228	MOORPARK	CA	93021	1968	19	06037	34.27891154	-118.8753975	Ventura County
51120	Fee-for-Service	1871132613	1871132613	1	1	ATRIUM HOSPICE LLC	3/12/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	144 CONTINENTE AVE	SUITE 130	BRENTWOOD	CA	94513	7102	07	06013	37.92187328	-121.6977974	Contra Costa County
51129	Fee-for-Service	1083815500	1083815500	1	1	AUDRA MCCREIGHT, M.D.	7/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
51131	Fee-for-Service	1235624362	1235624362	1	1	AGGARWAL, ASHNA MD	8/4/2023	207ZP0102X	NA	Other	026	PHYSICIANS	186471	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
51138	Fee-for-Service	1861711863	1861711863	1	6	AME MEDICAL GROUP, INC.	8/9/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8500 FLORENCE AVENUE	101	DOWNEY	CA	90240	4062	19	06037	33.94970699	-118.1216339	Los Angeles County
51151	Fee-for-Service	1881038818	1881038818	1	1	ANASTASIOU, CHRISTINE M MD	5/5/2017	207R00000X	NA	Other	026	PHYSICIANS	133761	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
51174	Fee-for-Service	1104946607	1104946607	1	1	ALLEN, SALLY H AU	1/31/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
51193	Fee-for-Service	1659955714	1659955714	1	1	AMELIA KRISTINE ADAMS	5/11/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	33532 VALLE ROAD	None	SAN JUAN CAPISTRA	CA	92675	4808	30	06059	33.48039137	-117.6659989	Orange County
51202	Fee-for-Service	1447012513	1447012513	1	1	AIKEN, JEWELL	3/27/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
51204	Fee-for-Service	1124413620	1124413620	1	1	ATIVA LLC	1/11/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	18022 COWAN	SUITE 215	IRVINE	CA	92614	6806	30	06059	33.69043263	-117.8654551	Orange County
51238	Fee-for-Service	1265875256	1265875256	1	1	AYE, LE LE DO	6/24/2019	207ZP0213X	NA	Other	026	PHYSICIANS	13724	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
51254	Fee-for-Service	1467477653	1467477653	1	1	ATKINSON, JOSEPH H JR MD	10/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	25819	36	Psychiatry	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
51286	Fee-for-Service	1477022085	1477022085	1	1	A & F CARING HOME HEALTH INC	7/7/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	10523 BURBANK BLVD	SUITE 207	NORTH HOLLYWOOD	CA	91601	2238	19	06037	34.17216449	-118.36017	Los Angeles County
51343	Fee-for-Service	1093323644	1093323644	1	1	ANGEL HOUSE HOSPICE CARE INC	12/3/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 104	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
51352	Fee-for-Service	1386708816	1386708816	1	1	APPLIED CLINICAL RESEARCH	5/23/2006	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	6565 NANCY RIDE DRIVE	None	SAN DIEGO	CA	92121	2251	37	06073	32.88706511	-117.1809612	San Diego County
51396	Fee-for-Service	1073599858	1073599858	1	1	AHERN, THOMAS S MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85906	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	351 SANTA FE DR	STE 100	ENCINITAS	CA	92024	5137	37	06073	33.03617853	-117.2843775	San Diego County
51409	Fee-for-Service	1871132613	1871132613	1	1	ATRIUM HOSPICE LLC	3/12/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	144 CONTINENTE AVE	SUITE 130	BRENTWOOD	CA	94513	7102	07	06013	37.92187328	-121.6977974	Contra Costa County
51426	Fee-for-Service	1871089474	1871089474	1	1	ANAYA, MANUEL E	8/3/2018	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	9340 CLAIREMONT MESA BLV	STE D	SAN DIEGO	CA	92123	1224	37	06073	32.83152749	-117.127971	San Diego County
51449	Fee-for-Service	1023622453	1023622453	1	1	ARIAS, VALERIA LMFT	5/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
51467	Fee-for-Service	1922369834	1922369834	1	1	ASHTON DYKERT	9/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 W CLARENDON AVE	STE 142	PHOENIX	AZ	85013	3449	00	None	33.49179	-112.07844	Maricopa County
51482	Fee-for-Service	1093899239	1093899239	1	1	ARMSTRONG, RENEE A MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60984	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
51500	Fee-for-Service	1487602256	1487602256	1	1	ALAMEDA ANESTHESIA ASSOC	10/3/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	MEDICAL GROUP, INC	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
51517	Fee-for-Service	1689868770	1689868770	1	1	ANDERSON, ELIZABETH D NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
51528	Fee-for-Service	1720036692	1720036692	1	1	AMIRMOKRI, PARHAM MD	6/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93637	45	Nephrology (Renal-Kidney)	0	In state provider	None	5030 OFFICE PARK DR	None	BAKERSFIELD	CA	93309	0612	15	06029	35.36684025	-119.0581753	Kern County
51539	Fee-for-Service	1720390420	1720390420	1	1	ALLAEI, ATABAK MD	5/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	113120	30	Radiology	0	In state provider	None	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3101	30	06059	33.80318353	-118.0666665	Orange County
51546	Fee-for-Service	1366933186	1366933186	1	1	ABNEY, BENJAMIN I MD	5/1/2023	207L00000X	NA	Other	026	PHYSICIANS	184246	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
51550	Fee-for-Service	1679861819	1679861819	1	1	ALCAIRO, ISAGANI R CO	5/16/2011	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	2425 STOCKTON BLVD	#236	SACRAMENTO	CA	95817	2215	34	06067	38.553012	-121.45545	Sacramento County
51553	Fee-for-Service	1831604818	1831604818	1	1	ADVENTIST HEALTH PHYSICIANS	7/19/2018	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	2317 JENSEN AVE	None	SANGER	CA	93657	2290	10	06019	36.7067495	-119.5704135	Fresno County
51571	Fee-for-Service	1235155953	1235155953	1	1	ARANGO, JAMES F. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 W ANTELOPE DR	None	LAYTON	UT	84041	1142	00	None	41.091012	-111.995523	Davis County
51600	Fee-for-Service	1104958818	1104958818	1	1	AGUILAR, DENISE LCSW	6/18/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4070 JURAPA AVE	None	RIVERSIDE	CA	92506	2234	33	06065	33.96087652	-117.3960765	Riverside County
51615	Fee-for-Service	1407078496	1407078496	1	1	AGARWAL, SIDDHARTH MD	3/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123737	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2841 N VENTURA ROAD	SUITE 200	OXNARD	CA	93036	2213	56	06111	34.24385785	-119.1826417	Ventura County
51634	Fee-for-Service	1093323644	1093323644	1	1	ANGEL HOUSE HOSPICE CARE INC	12/3/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 104	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
51640	Fee-for-Service	1861711863	1861711863	1	5	AME MEDICAL GROUP, INC.	8/1/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	3300 E. SOUTH STREET	209	LAKEWOOD	CA	90805	4945	19	06037	33.86018093	-118.1537163	Los Angeles County
51654	Fee-for-Service	1265960215	1265960215	1	4	ANESTHESIOLOGY SPECIALISTS O	6/4/2020	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	31700 TEMECULA	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
51667	Fee-for-Service	1639256654	1639256654	1	1	ANG, CHOO SENG S	1/6/1998	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	TURNING POINT PT INC	9627 LAS TUNAS DR	None	TEMPLE CITY	CA	91780	2109	19	06037	34.10688501	-118.0598681	Los Angeles County
51709	Fee-for-Service	1073868279	1073868279	1	1	ARNON LLC	4/22/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8410 SPRINGFORD DRIVE	None	SUN VALLEY	CA	91352	3648	19	06037	34.22272527	-118.3515749	Los Angeles County
51734	Fee-for-Service	1558347187	1558347187	1	1	ATALLAH, NAJDAT A MD	2/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	51461	25	Physical Medicine and Rehabilitation	0	In state provider	None	2335 E KASHIAN LANE	STE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
51741	Fee-for-Service	1659687713	1659687713	1	1	ALEMZADEH, GOLNAZ MD	10/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138041	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
51767	Fee-for-Service	1073596888	1073596888	1	1	AIR EVAC EMS INC	9/3/2023	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	3202 OAK GROVE RD	None	POPLAR BLUFF	MO	63901	8960	00	None	36.78874933	-90.45279714	Butler County
51774	Fee-for-Service	1255780185	1255780185	1	1	ALGHUSSEIN, MOHAMMAD MD	12/27/2022	207R00000X	NA	Other	026	PHYSICIANS	161067	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
51803	Fee-for-Service	1245580729	1245580729	1	1	AROYAN, MARY LMFT	8/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16800 DEVONSHIRE STE	STE 212	GRANADA HILLS	CA	91344	7400	19	06037	34.25745651	-118.4982159	Los Angeles County
51824	Fee-for-Service	1013595248	1013595248	1	1	AUCHTER, ALLISON M MD	8/23/2024	390200000X	NA	Other	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
51835	Fee-for-Service	1578885778	1578885778	1	1	ALAMEDA HEALTHCARE &	2/4/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	WELLNESS CENTER LLC	430 WILLOW ST	None	ALAMEDA	CA	94501	6130	01	06001	37.75883085	-122.255467	Alameda County
51877	Fee-for-Service	1598842437	1598842437	1	1	AWSARE, SAMEER V MD	10/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	70829	None	None	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
51904	Fee-for-Service	1548475072	1548475072	1	1	AKINS, TARA M NP	1/7/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
51917	Fee-for-Service	1154736429	1154736429	1	4	AVENAL COMMUNITY HEALTH CENT	9/19/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	329 W 8TH STREET	SUITE 111	HANFORD	CA	93230	4533	16	06031	36.32698307	-119.6503466	Kings County
51921	Fee-for-Service	1417311366	1417311366	1	1	ANDERSON, SANCHIA MD	9/9/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	150502	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
51985	Fee-for-Service	1508817842	1508817842	1	1	ACHARI, RAJEEV L MD	6/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52123	41	Internal Medicine	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
51991	Fee-for-Service	1932238326	1932238326	1	1	ANAND, SHUCHI MD	9/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111707	45	Nephrology (Renal-Kidney)	0	In state provider	None	300 PASTEUR DR	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
52009	Fee-for-Service	1033267166	1033267166	1	1	ANDERSON, DANIEL D MD	5/28/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	64471	None	None	0	In state provider	None	2204 EL CAMINO REAL	SUITE 305	OCEANSIDE	CA	92054	6306	37	06073	33.18665681	-117.3282176	San Diego County
52029	Fee-for-Service	1578529673	1578529673	1	1	ANAGO, CHRISTOPHER C MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	78366	41	Internal Medicine	0	In state provider	None	11149 CRENSHAW BLVD	None	INGLEWOOD	CA	90303	2338	19	06037	33.933465	-118.3265975	Los Angeles County
52033	Fee-for-Service	1013142074	1013142074	1	1	ARIZONA CVS STORES LLC	11/14/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	3025 N WINDSONG DR	None	PRESCOTT VALLEY	AZ	86314	2248	00	None	34.586631	-112.326084	Yavapai County
52044	Fee-for-Service	1477747681	1477747681	1	1	ADOLESCENTS-BABIES & CHI	3/20/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PEDIATRIC MED GRP INC	702 WAKE AVE	None	EL CENTRO	CA	92243	7502	13	06025	32.77066047	-115.560144	Imperial County
52064	Fee-for-Service	1639564370	1639564370	1	1	AUSTIN, KARYN M MD	10/12/2022	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	182590	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
52100	Fee-for-Service	1518418862	1518418862	1	1	ALLIANCE MEDICAL CENTER INC	11/14/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	8499 OLD REDWOOD HIGHWAY	SUITE 111 & 112	WINDSOR	CA	95492	8057	49	06097	38.54390805	-122.8015407	Sonoma County
52112	Fee-for-Service	1013595248	1013595248	1	1	AUCHTER, ALLISON M MD	8/23/2024	390200000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
52121	Fee-for-Service	1447744180	1447744180	1	1	ABDELMEGUID, AHMED S MD	9/5/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
52155	Fee-for-Service	1043531346	1043531346	1	1	ALLIED EMERGENCY PHYSICIANS	8/12/2010	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	2975 N SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
52159	Fee-for-Service	1699719740	1699719740	1	1	ARNAUDOV, DIMITER G MD	7/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73150	05	Anesthesiology	0	In state provider	None	1200 N STATE ST	# 14-901	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
52179	Fee-for-Service	1356335731	1356335731	1	1	ALB, OVIDIU MD	7/28/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	52597	08	Family Practice	0	In state provider	None	480 FOURTH AVE	STE 202	CHULA VISTA	CA	91910	4412	37	06073	32.63411298	-117.0816772	San Diego County
52186	Fee-for-Service	1396262549	1396262549	1	1	AYALA, ALEXANDER MD	10/24/2024	390200000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
52204	Fee-for-Service	1154736429	1154736429	1	4	AVENAL COMMUNITY HEALTH CENT	9/19/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	329 W 8TH STREET	SUITE 111	HANFORD	CA	93230	4533	16	06031	36.32698307	-119.6503466	Kings County
52212	Fee-for-Service	1962967059	1962967059	1	1	ADVENTIST HEALTH PHYSICIANS	7/20/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1808 VERDUGO BLVD	414	GLENDALE	CA	91208	1474	19	06037	34.2056211	-118.2154553	Los Angeles County
52213	Fee-for-Service	1588299929	1588299929	1	1	AVNS LLC	5/1/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6600 SEPULVEDA BLVD	None	VAN NUYS	CA	91411	1203	19	06037	34.190532	-118.466152	Los Angeles County
52225	Fee-for-Service	1992325989	1992325989	1	1	ALDAAS, KHALID MD	7/3/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	4605 BROCKTON AVENUE	100	RIVERSIDE	CA	92506	0106	33	06065	33.97611422	-117.3860257	Riverside County
52233	Fee-for-Service	1053547174	1053547174	1	1	AGGARWAL, LAKSHMI C MD	1/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151727	41	Internal Medicine	0	In state provider	None	3559 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	1763	49	06097	38.47813376	-122.7279674	Sonoma County
52240	Fee-for-Service	1932759289	1932759289	1	1	AEGIS TREATMENT CENTERS, LLC	6/17/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1768 MITCHELL ROAD	301	CERES	CA	95307	2156	50	06099	37.605564	-120.9387115	Stanislaus County
52246	Fee-for-Service	1912308149	1912308149	2	1	AVILA, CHRISTAL LCSW	6/30/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ELING	202 E AIRPORT DR	STE 138	SAN BERNARDINO	CA	92408	3429	36	06071	34.06737938	-117.2834702	San Bernardino County
52277	Fee-for-Service	1932238326	1932238326	1	1	ANAND, SHUCHI MD	9/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111707	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	MC: 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
52324	Fee-for-Service	1265658595	1265658595	2	4	APOLLOMED HOSPITALISTS A MED	10/27/2022	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ICAL CORPORATION	525 NORTH GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
52333	Fee-for-Service	1689677221	1689677221	1	1	ASARIAN, JOHN MD	2/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	22667	40	Pediatrics	0	In state provider	None	940 UKIAH	None	MENDOCINO	CA	95460	9906	23	06045	39.30669409	-123.7967905	Mendocino County
52383	Fee-for-Service	1376630889	1376630889	1	1	ALLY, SANDRA BIRTH DOULA	4/16/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
52387	Fee-for-Service	1518418862	1518418862	1	1	ALLIANCE MEDICAL CENTER INC	11/14/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	8499 OLD REDWOOD HIGHWAY	SUITE 111 & 112	WINDSOR	CA	95492	8057	49	06097	38.54390805	-122.8015407	Sonoma County
52393	Fee-for-Service	1437160298	1437160298	1	1	ASHLEY, KRISTIN D MD	12/20/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	55754	13	Neurology (M.D. only)	0	In state provider	None	3288 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
52395	Fee-for-Service	1508114059	1508114059	1	1	ALEXANDER, BILL	11/20/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	780 W OLIVE AVE	100	MERCED	CA	95348	2437	24	06047	37.31916174	-120.4814268	Merced County
52398	Fee-for-Service	1770995664	1770995664	1	1	ARIF, FARYAL MD	3/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	01	General Practice	0	In state provider	None	4900 BARRANCA PKWY	SUITE 103	IRVINE	CA	92604	8603	30	06059	33.67629075	-117.7956464	Orange County
52473	Fee-for-Service	1396262549	1396262549	1	1	AYALA, ALEXANDER MD	10/24/2024	390200000X	NA	Other	026	PHYSICIANS	None	03	Allergy	0	In state provider	None	275 HOSPITAL DR	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
52503	Fee-for-Service	1356499271	1356499271	1	1	ADAMS, YARAMEEKAH MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	70605	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
52529	Fee-for-Service	1932759289	1932759289	1	1	AEGIS TREATMENT CENTERS, LLC	6/17/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1768 MITCHELL ROAD	301	CERES	CA	95307	2156	50	06099	37.605564	-120.9387115	Stanislaus County
52547	Fee-for-Service	1790272243	1790272243	1	1	AIDELOJE, JOSEPHINE E NP	2/25/2019	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1652 WEST AVE J	None	LANCASTER	CA	93534	2814	19	06037	34.6893627	-118.1602957	Los Angeles County
52552	Fee-for-Service	1508914417	1508914417	1	1	ANG, DORCAS C MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73560	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
52580	Fee-for-Service	1437464963	1437464963	1	1	AGNISH, VIKRAM DO	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14114	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
52590	Fee-for-Service	1336469790	1336469790	1	1	ALEXANDER REYZELMAN D P M IN	12/23/2014	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2299 POST STREET	SUITE 205	SAN FRANCISCO	CA	94115	3473	38	06075	37.78434298	-122.4392033	San Francisco County
52608	Fee-for-Service	1144501255	1144501255	1	1	ASHOURI, OMID MD	9/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127177	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
52619	Fee-for-Service	1780743443	1780743443	1	1	ASALONE, BRIAN A MD	12/31/1983	207P00000X	NA	Other	026	PHYSICIANS	47651	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
52620	Fee-for-Service	1477792109	1477792109	1	1	ALI, SHAHID D MD	2/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105327	08	Family Practice	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
52641	Fee-for-Service	1548802176	1548802176	1	1	ALPIDA PHARMACEUTICAL INC	4/1/2020	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4755 OCEANSIDE BLVD	SUITE 130	OCEANSIDE	CA	92056	3056	37	06073	33.2159661	-117.2712576	San Diego County
52648	Fee-for-Service	1912162199	1912162199	1	1	ANOUSHEH, RAMTIN MD	1/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113831	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365 420 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
52658	Fee-for-Service	1669885885	1669885885	1	1	AHAMBA, DAVID C MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149859	08	Family Practice	0	In state provider	None	25455 BARTON ROAD	SUITE 108A	LOMA LINDA	CA	92354	3139	36	06071	34.04805253	-117.249534	San Bernardino County
52724	Fee-for-Service	1649809328	1649809328	1	1	AKAMETALU, PAMELA	11/5/2024	363LX0001X	NA	Nurse Practitioner	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
52759	Fee-for-Service	1659872919	1659872919	1	1	ARNESON, ANTHONY J LMFT	3/12/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	104491	-	NOT APPLICABLE	0	In state provider	None	11501 DOLAN AVE	None	DOWNEY	CA	90241	4530	19	06037	33.93694144	-118.1331643	Los Angeles County
52785	Fee-for-Service	1073069316	1073069316	1	1	ALI, KAMRAN MD	11/20/2023	207R00000X	NA	Other	026	PHYSICIANS	191917	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
52797	Fee-for-Service	1326232810	1326232810	1	1	ACTIVE HOSPICE CARE, INC	8/28/2007	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	704 S VICTORY BLVD	STE 100	BURBANK	CA	91502	2471	19	06037	34.16889147	-118.3107904	Los Angeles County
52841	Fee-for-Service	1548558521	1548558521	1	1	ALMADEN OPERATING COMPANY	11/1/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	2065 LOS GATOS ALMADEN	None	SAN JOSE	CA	95124	5417	43	06085	37.24344733	-121.9333514	Santa Clara County
52874	Fee-for-Service	1427450568	1427450568	1	1	ANAGNOSTOU, ANTHONY A MD	2/8/2022	208600000X	NA	General Surgery	026	PHYSICIANS	133387	None	None	0	In state provider	None	2321 HARRISON AVE	STE S	EUREKA	CA	95501	3216	12	06023	40.786857	-124.1396125	Humboldt County
52881	Fee-for-Service	1932446309	1932446309	1	1	AMBURGEY, CHARLES	2/7/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
52893	Fee-for-Service	1891795613	1891795613	1	1	AZAD, JACK MD INC	10/1/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	54433	08	Family Practice	0	In state provider	TRI-CITY MEDICAL GROUP	11900 AVALON BLVD	STE 100	LOS ANGELES	CA	90061	2837	19	06037	33.92451047	-118.2652101	Los Angeles County
52905	Fee-for-Service	1558852418	1558852418	1	1	ALPHA HOME HEALTH AGENCY	12/20/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1220 W GLENOAKS BLVD	STE 201	GLENDALE	CA	91201	4101	19	06037	34.16551419	-118.2821828	Los Angeles County
52920	Fee-for-Service	1861945537	1861945537	1	2	ACTION FAMILY COUNSELING INC	12/22/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	4380 APRICOT ROAD	None	SIMI VALLEY	CA	93063	2317	56	06111	34.28074854	-118.709793	Ventura County
52921	Fee-for-Service	1982010781	1982010781	1	1	AMERICAN CAREQUEST NORTH BAY	3/23/2021	251G00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	4040 CIVIC CENTER DR	200	SAN RAFAEL	CA	94903	4150	21	06041	38.00598059	-122.5394125	Marin County
52932	Fee-for-Service	1306281084	1306281084	1	1	ALIGANGA, FRANK P MD	5/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134655	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
52933	Fee-for-Service	1154363554	1154363554	1	1	AMINIAN, ARASH	12/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99103	None	None	0	In state provider	None	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	30	06059	33.89343304	-117.9279349	Orange County
52938	Fee-for-Service	1912162199	1912162199	1	1	ANOUSHEH, RAMTIN MD	1/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113831	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365 420 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
52939	Fee-for-Service	1568798296	1568798296	1	1	AMIR G NASSERI MD PC	8/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	68974	None	None	0	In state provider	None	1155 W CENTRAL AVE	STE 214	SANTA ANA	CA	92707	3165	30	06059	33.71259106	-117.8843848	Orange County
53004	Fee-for-Service	1124052600	1124052600	1	1	ALLEN, PATRICIA L MD	12/4/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71645	30	Radiology	0	In state provider	None	2701 W ALAMEDA AVE	STE 203	BURBANK	CA	91505	4406	19	06037	34.15751343	-118.3303715	Los Angeles County
53009	Fee-for-Service	1093700148	1093700148	1	1	ALDERWOOD PARK HEALTH AND RE	4/16/2014	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2726 ALDERWOOD AVE	None	BELLINGHAM	WA	98225	1223	00	None	48.77991952	-122.502672	Whatcom County
53021	Fee-for-Service	1942242763	1942242763	1	1	ANNE J. RICHTER, M.D.	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 N BEAVER ST	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
53029	Fee-for-Service	1285701193	1285701193	1	1	ASHOK, GEETHA MD	10/31/1991	207U00000X	NA	Other	026	PHYSICIANS	47996	42	Nuclear Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
53044	Fee-for-Service	1285898734	1285898734	1	1	AMOS, AMANDA LCSW	11/14/2022	106H00000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
53055	Fee-for-Service	1013335082	1013335082	1	1	ANDERSON, BRANDON J MD	6/21/2021	208600000X	NA	General Surgery	026	PHYSICIANS	171538	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
53058	Fee-for-Service	1780701045	1780701045	1	1	AGULNEK, ROBERT M MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	24127	30	Radiology	0	In state provider	None	4929 VAN NUYS BLVD	None	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
53066	Fee-for-Service	1467734285	1467734285	1	1	AKINAPELLI, ABHILASH MD	6/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
53077	Fee-for-Service	1194944900	1194944900	1	1	AW CYTOHISTOLOGY LAB	8/15/2005	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	WU, AGNES Y	1700 C ST	None	BAKERSFIELD	CA	93301	3616	15	06029	35.374581	-119.026982	Kern County
53083	Fee-for-Service	1326232810	1326232810	1	1	ACTIVE HOSPICE CARE, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	704 S VICTORY BLVD	STE 100	BURBANK	CA	91502	2471	19	06037	34.16889147	-118.3107904	Los Angeles County
53084	Fee-for-Service	1811230766	1811230766	1	1	AGARWAL, DANIEL R MD	7/27/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	168859	18	Ophthalmology	0	In state provider	None	751 DAILY DR	STE 110	CAMARILLO	CA	93010	6077	56	06111	34.21880533	-119.0593374	Ventura County
53100	Fee-for-Service	1588609077	1588609077	1	1	ALIM, MUHAMMAD A MD, INC	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	54260	41	Internal Medicine	0	In state provider	None	6401 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0613	15	06029	35.36227673	-119.07391	Kern County
53107	Fee-for-Service	1427722990	1427722990	1	1	ARANGO ISAZA, DANIELA MD	3/14/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
53125	Fee-for-Service	1659796365	1659796365	1	1	ASHRAF, ASIFA R MD	11/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	152248	41	Internal Medicine	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
53148	Fee-for-Service	1982882734	1982882734	1	1	ANOTHER CHOICE ANOTHER CHANC	1/30/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	4420 MONHEGAN WAY	ROOM 13, 4, & LIBRARY	MATHER	CA	95655	3025	34	06067	38.544417	-121.2887385	Sacramento County
53163	Fee-for-Service	1336428861	1336428861	1	1	ATKINS, ALAN M MD	8/15/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	182569	36	Psychiatry	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
53180	Fee-for-Service	1184645095	1184645095	1	1	ATHYAL, VIDUSH P MD	10/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99304	08	Family Practice	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
53184	Fee-for-Service	1811045750	1811045750	1	1	ANDERSON, CATHERINE Z NP	11/1/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6860 AVENIDA ENCINAS	None	CARLSBAD	CA	92009	3201	37	06073	33.10754269	-117.3146974	San Diego County
53191	Fee-for-Service	1790824878	1790824878	1	1	ARASU, JUMNAH MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	34831	None	None	0	In state provider	None	9360 N NAME UNO	STE 210	GILROY	CA	95020	3535	43	06085	37.035801	-121.569858	Santa Clara County
53195	Fee-for-Service	1639491079	1639491079	1	1	ABBOU, SARA W LMFT	4/29/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
53244	Fee-for-Service	1225426851	1225426851	1	1	ABBASSI, SONJA MD	5/20/2021	207R00000X	NA	Other	026	PHYSICIANS	168880	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
53264	Fee-for-Service	1164693248	1164693248	1	1	ANKELE, JENNIFER M LCSW	8/23/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
53285	Fee-for-Service	1750477733	1750477733	1	1	ASLAN, ALEX A MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	62211	10	Gastroenterology (M.D. only)	0	In state provider	None	3903 LONE TREE WAY	STE 205	ANTIOCH	CA	94509	6269	07	06013	37.98216807	-121.8054744	Contra Costa County
53287	Fee-for-Service	1801276639	1801276639	1	1	ARON, ABRAHAM W MD	5/19/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	176208	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
53297	Fee-for-Service	1477524403	1477524403	1	1	AMUNDSON, DENNIS E MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	4862	None	None	0	In state provider	MS317	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
53307	Fee-for-Service	1104832047	1104832047	1	1	ABRAMOWITZ, BASIL S MD	12/31/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	52961	08	Family Practice	0	In state provider	None	2001 FRONT ST	None	SAN DIEGO	CA	92101	1905	37	06073	32.72619092	-117.1647406	San Diego County
53325	Fee-for-Service	1861131211	1861131211	1	1	AVVA MINA INC	7/18/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	639 N 13TH AVE	None	UPLAND	CA	91786	4906	36	06071	34.10150832	-117.6337607	San Bernardino County
53333	Fee-for-Service	1144849423	1144849423	1	1	ALWAYS BETTER HOSPICE CARE	7/29/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	11755 VICTORY BLVD	SUITE 205	NORTH HOLLYWOOD	CA	91606	3423	19	06037	34.18670448	-118.389699	Los Angeles County
53363	Fee-for-Service	1659716512	1659716512	1	1	ALJOHANI, OTHMAN A MD	8/14/2020	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	143155	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
53374	Fee-for-Service	1427286608	1427286608	1	1	ANAVIAN, JACK MD	11/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145197	20	Orthopedic Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
53388	Fee-for-Service	1588609077	1588609077	1	1	ALIM, MUHAMMAD A MD, INC	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	54260	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6401 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0613	15	06029	35.36227673	-119.07391	Kern County
53402	Fee-for-Service	1891948568	1891948568	1	1	AGRAWAL, SUNEIL MD	9/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105872	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
53418	Fee-for-Service	1205464336	1205464336	1	1	AFIF, NAWAL M DO	10/18/2023	207R00000X	NA	Other	026	PHYSICIANS	20756	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
53428	Fee-for-Service	1831515915	1831515915	1	1	ASHBY, DANIEL J CRNA	9/23/2017	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
53441	Fee-for-Service	1003879438	1003879438	1	1	ADRIAN, MARK C MD	3/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	78895	41	Internal Medicine	0	In state provider	None	1835 EL CAJON BLVD	None	SAN DIEGO	CA	92103	2591	37	06073	32.75515551	-117.1453277	San Diego County
53445	Fee-for-Service	1780865352	1780865352	1	1	ADIGOPULA, BINA MD INC	7/12/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6942 UNIVERSITY AVE	#A	LA MESA	CA	91941	5963	37	06073	32.75532823	-117.0487443	San Diego County
53462	Fee-for-Service	1730841545	1730841545	1	1	ADRIENNE COAKLEY PNP-BC	12/23/2023	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
53470	Fee-for-Service	1265859169	1265859169	1	1	AFSHIN A NAHAVANDI MD, INC	12/13/2020	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	35470 WHITEWOOD RD	None	MURRIETA	CA	92563	2415	33	06065	33.60671588	-117.1628131	Riverside County
53491	Fee-for-Service	1093277485	1093277485	1	1	AMERICAN SURGICAL MEDICAL SU	7/23/2019	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	PPLY INC	117 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	3603	36	06071	34.13592558	-117.2845311	San Bernardino County
53551	Fee-for-Service	1922493683	1922493683	1	1	AL- HAMAD, SUZANNE MD	10/5/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
53557	Fee-for-Service	1184783714	1184783714	1	1	ARAFA, MOSTAPHA A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30847	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
53558	Fee-for-Service	1487274494	1487274494	1	1	ARNOLD, VICTORIA MD	3/19/2025	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	1093 ROYAL COURT	None	MEDFORD	OR	97504	8383	00	None	42.34017467	-122.8666022	Jackson County
53564	Fee-for-Service	1043763998	1043763998	1	1	ANEW, HANNAH LMFT	2/15/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
53571	Fee-for-Service	1750477733	1750477733	1	1	ASLAN, ALEX A MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	62211	01	General Practice	0	In state provider	None	3903 LONE TREE WAY	STE 205	ANTIOCH	CA	94509	6269	07	06013	37.98216807	-121.8054744	Contra Costa County
53589	Fee-for-Service	1790822054	1790822054	1	1	ALVAREZ, ENRIQUE III MD	8/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	13	Neurology (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
53594	Fee-for-Service	1942580543	1942580543	1	1	ATA M KASHANI MD A	3/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	41464	None	None	0	In state provider	PROFESSIONAL CORP	18355 SHERMAN WAY	None	RESEDA	CA	91335	4436	19	06037	34.20121151	-118.533726	Los Angeles County
53604	Fee-for-Service	1265897078	1265897078	1	1	AVELLINO LAB USA, INC	3/1/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	1505 ADAMS DR	SUITE B2	MENLO PARK	CA	94025	1450	41	06081	37.47905145	-122.1424004	San Mateo County
53620	Fee-for-Service	1144849423	1144849423	1	1	ALWAYS BETTER HOSPICE CARE	7/29/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	11755 VICTORY BLVD	SUITE 205	NORTH HOLLYWOOD	CA	91606	3423	19	06037	34.18670448	-118.389699	Los Angeles County
53645	Fee-for-Service	1306200183	1306200183	1	1	AGTUCA, JOHN G DO	6/11/2019	207R00000X	NA	Other	026	PHYSICIANS	16933	41	Internal Medicine	0	In state provider	None	1901 TOWN AND COUNTRY DR	SUITE 104	NORCO	CA	92860	3611	33	06065	33.92721419	-117.561448	Riverside County
53649	Fee-for-Service	1083800098	1083800098	1	1	ALTAMED MEDICAL GROUP	3/19/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	5425 POMONA BLVD	None	LOS ANGELES	CA	90022	1716	19	06037	34.03338446	-118.1488966	Los Angeles County
53651	Fee-for-Service	1174796353	1174796353	1	1	ANDERSON, KIRK M MD	8/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	112201	34	Urology and Urological Surgery	0	In state provider	None	2725 CAPITAL AVENUE	None	SACRAMENTO	CA	95816	6006	34	06067	38.571084	-121.471074	Sacramento County
53675	Fee-for-Service	1588609077	1588609077	1	1	ALIM, MUHAMMAD A MD, INC	8/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	54260	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6401 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0613	15	06029	35.36227673	-119.07391	Kern County
53685	Fee-for-Service	1871081471	1871081471	1	1	ATHENA INC	1/7/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7636 N INGRAM AVE	SUITE 105	FRESNO	CA	93711	6200	10	06019	36.84906	-119.801783	Fresno County
53713	Fee-for-Service	1154736429	1154736429	1	2	AVENAL COMMUNITY HEALTH CENT	12/2/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	755 SEQUOIA AVENUE	SUITE B	LINDSAY	CA	93247	1422	54	06107	36.21173551	-119.0961155	Tulare County
53728	Fee-for-Service	1780865352	1780865352	1	1	ADIGOPULA, BINA MD INC	4/14/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6942 UNIVERSITY AVE	#A	LA MESA	CA	91941	5963	37	06073	32.75532823	-117.0487443	San Diego County
53732	Fee-for-Service	1447665971	1447665971	1	1	AZEEM, ALI MD	11/9/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	None	None	1	Border provider	None	520 MEDICAL CENTER DR	STE 200	MEDFORD	OR	97504	4314	00	None	42.318801	-122.831728	Jackson County
53745	Fee-for-Service	1295947364	1295947364	1	1	ALPHA PROJECT FOR THE	2/21/2018	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	HOMELESS	975 & 993 POSTAL WAY	None	VISTA	CA	92083	6945	37	06073	33.19137179	-117.2304896	San Diego County
53759	Fee-for-Service	1275187502	1275187502	1	1	AMELL, JANINE CPO	12/9/2019	222Z00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 S IMPERIAL AVE	STE 15	EL CENTRO	CA	92243	4242	13	06025	32.77882919	-115.5697116	Imperial County
53766	Fee-for-Service	1992174536	1992174536	1	1	AHUMADA, SARA A NP	11/5/2024	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
53795	Fee-for-Service	1952590135	1952590135	1	1	ALAI, NILI N MD INC	6/12/2018	193200000X	NA	Other	026	PHYSICIANS	54538	None	None	0	In state provider	None	26081 MERIT CIRCLE	STE 109	LAGUNA HILLS	CA	92653	7017	30	06059	33.57409231	-117.6744789	Orange County
53798	Fee-for-Service	1396962031	1396962031	1	1	ALCOHOLISM CENTER FOR WOMEN	9/3/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1147 SOUTH ALVARADO ST	None	LOS ANGELES	CA	90006	4100	19	06037	34.04901396	-118.2816075	Los Angeles County
53825	Fee-for-Service	1598144347	1598144347	1	1	AMINI, SHAKELLAH MD	10/11/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	155417	08	Family Practice	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
53863	Fee-for-Service	1568615482	1568615482	1	1	AZIMI, RANA M MD	11/10/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	102789	08	Family Practice	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
53900	Fee-for-Service	1902890726	1902890726	1	1	ARSENAULT,TODD MICHAEL	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	333 N SMITH AVE	None	ST PAUL	MN	55102	0000	00	None	44.94251219	-93.1074995	Ramsey County
53936	Fee-for-Service	1083800098	1083800098	1	1	ALTAMED MEDICAL GROUP	3/19/1992	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	5425 POMONA BLVD	None	LOS ANGELES	CA	90022	1716	19	06037	34.03338446	-118.1488966	Los Angeles County
53939	Fee-for-Service	1437952462	1437952462	1	1	ASHWORTH, BRETTINA LMFT	4/23/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2350 W SHAW AVE	SUITE 116	FRESNO	CA	93711	3400	10	06019	36.80841045	-119.834577	Fresno County
53956	Fee-for-Service	1013575448	1013575448	1	1	ALLAY HOSPICE CARE, INC.	7/20/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7840 FOOTHILL BLVD	STE F	SUNLAND	CA	91040	2907	19	06037	34.25958871	-118.3039956	Los Angeles County
53966	Fee-for-Service	1730618521	1730618521	1	1	ASGHAR, ALI MD	7/28/2020	208M00000X	NA	Other	026	PHYSICIANS	157514	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
53974	Fee-for-Service	1871081471	1871081471	1	1	ATHENA INC	1/7/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7636 N INGRAM AVE	SUITE 105	FRESNO	CA	93711	6200	10	06019	36.84906	-119.801783	Fresno County
53988	Fee-for-Service	1871024091	1871024091	1	1	ARASTU, ALI S MD	9/28/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	140337	40	Pediatrics	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
54001	Fee-for-Service	1154736429	1154736429	1	2	AVENAL COMMUNITY HEALTH CENT	12/2/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	755 SEQUOIA AVENUE	SUITE B	LINDSAY	CA	93247	1422	54	06107	36.21173551	-119.0961155	Tulare County
54011	Fee-for-Service	1740286517	1740286517	1	1	ALLEN, JOSEPH Y MD	9/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
54019	Fee-for-Service	1770612699	1770612699	1	1	ALANIS, RUDOLPH G OD	1/2/2025	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 PARK AVE	STE 120	POMONA	CA	91766	1501	19	06037	34.05635453	-117.7544297	Los Angeles County
54037	Fee-for-Service	1912415118	1912415118	1	1	APPLE PHARMACY INC	5/8/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5050 SAN BERNARDINO ST	SUITE 110	MONTCLAIR	CA	91763	2326	36	06071	34.0776775	-117.694521	San Bernardino County
54050	Fee-for-Service	1548430879	1548430879	1	1	ANGELES, JACQUELINE LMFT	6/5/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	93466	-	NOT APPLICABLE	0	In state provider	None	323 N PRAIRIE AVE	STE 350	INGLEWOOD	CA	90301	4502	19	06037	33.966333	-118.3439975	Los Angeles County
54121	Fee-for-Service	1285322321	1285322321	1	1	ASPEN PUBLIC SCHOOLS	7/1/2023	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	567 W SHAW AVE	SUITE A-1	FRESNO	CA	93704	2504	10	06019	36.80833	-119.8035403	Fresno County
54169	Fee-for-Service	1003436528	1003436528	1	1	ANTONIO, CHRISTIAN KARL NP	1/6/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
54222	Fee-for-Service	1154736429	1154736429	1	19	AVENAL COMMUNITY HEALTH CENT	12/3/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	858 N CHERRY ST	SUITE F	TULARE	CA	93274	2243	54	06107	36.22014749	-119.337642	Tulare County
54246	Fee-for-Service	1013575448	1013575448	1	1	ALLAY HOSPICE CARE, INC.	7/20/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7840 FOOTHILL BLVD	STE F	SUNLAND	CA	91040	2907	19	06037	34.25958871	-118.3039956	Los Angeles County
54274	Fee-for-Service	1417016015	1417016015	1	1	ANAND, SHAUN MD	12/2/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68547	41	Internal Medicine	0	In state provider	None	5525 ETIVANDA AVE	SUITE 305	TARZANA	CA	91356	0000	19	06037	34.17046451	-118.5308463	Los Angeles County
54288	Fee-for-Service	1154736429	1154736429	1	2	AVENAL COMMUNITY HEALTH CENT	6/8/2022	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	755 SEQUOIA AVENUE	SUITE B	LINDSAY	CA	93247	1422	54	06107	36.21173551	-119.0961155	Tulare County
54321	Fee-for-Service	1992879209	1992879209	1	1	ANNAMANENI, SUNITHA R MD	10/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90218	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
54352	Fee-for-Service	1699598144	1699598144	1	1	ACKERMAN, DAHLIA NP	3/4/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4043 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	0000	15	06029	35.35411151	-119.0532915	Kern County
54353	Fee-for-Service	1760487078	1760487078	1	1	ALLIED HOME MEDICAL INC	6/8/2007	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	ALLIED HOME MEDICAL INC	3075 POPLAR GROVE RD	None	COOKEVILLE	TN	38506	7466	00	None	36.13691098	-85.44634435	Putnam County
54360	Fee-for-Service	1760796304	1760796304	1	1	ARROYO, LINDA M LMFT	8/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	601 E DAILY DR	STE 210	CAMARILLO	CA	93010	5839	56	06111	34.21906637	-119.0621709	Ventura County
54389	Fee-for-Service	1538884929	1538884929	1	1	AILANI, ASHUTOSH DPM	1/17/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	16465 SIERRA LAKES	SUITE 240	FONTANA	CA	92336	1242	36	06071	34.13805177	-117.4457839	San Bernardino County
54393	Fee-for-Service	1588799670	1588799670	1	1	ARC IMPERIAL VALLEY #1	4/1/1984	320900000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	548 MESQUITE ST	None	IMPERIAL	CA	92251	8959	13	06025	32.82134603	-115.5819218	Imperial County
54437	Fee-for-Service	1831935022	1831935022	1	1	AMBER THOMAS LICENSED CLINIC	7/17/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	AL SOCIAL WORKER INC	690 E GREEN ST	202	PASADENA	CA	91101	2197	19	06037	34.14449605	-118.1361004	Los Angeles County
54439	Fee-for-Service	1225659089	1225659089	1	1	AKANDE, OLUWATOFEHINTI O MD	10/4/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
54440	Fee-for-Service	1790177582	1790177582	1	4	ALTAMED HEALTH SERVICES	3/22/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6021 CARMELITA AVENUE	None	HUNTINGTON PARK	CA	90255	3320	19	06037	33.987276	-118.1983365	Los Angeles County
54444	Fee-for-Service	1982932117	1982932117	1	1	AUM PHYSICAL THERAPY INC	5/27/2014	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3443 STATE STREET	None	SANTA BARBARA	CA	93105	2662	42	06083	34.4403417	-119.7384143	Santa Barbara County
54454	Fee-for-Service	1447366653	1447366653	1	1	AMJED JAVAID M.D.	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 3RD AVE SW	None	MINOT	ND	58701	3880	00	None	48.23336909	-101.2951165	Ward County
54457	Fee-for-Service	1154736429	1154736429	1	8	AVENAL COMMUNITY HEALTH CENT	6/8/2022	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	209 C ST	None	LEMOORE	CA	93245	2930	16	06031	36.30089987	-119.7833254	Kings County
54510	Fee-for-Service	1154736429	1154736429	1	19	AVENAL COMMUNITY HEALTH CENT	6/8/2022	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	858 N CHERRY ST	SUITE F	TULARE	CA	93274	2243	54	06107	36.22014749	-119.337642	Tulare County
54514	Fee-for-Service	1457422552	1457422552	1	1	ASSOCIATED CHRISTIAN THERAPY	8/26/2020	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	41765 12TH STREET WEST	SUITE D	PALMDALE	CA	93551	1422	19	06037	34.641891	-118.1513675	Los Angeles County
54541	Fee-for-Service	1265591820	1265591820	1	1	AHARONIAN, VICKEN J MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37554	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
54559	Fee-for-Service	1992233571	1992233571	1	1	AVELAR, PATRICIA A MD	12/28/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	157795	None	None	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
54561	Fee-for-Service	1417016015	1417016015	1	1	ANAND, SHAUN MD	12/2/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	68547	45	Nephrology (Renal-Kidney)	0	In state provider	None	5525 ETIVANDA AVE	SUITE 305	TARZANA	CA	91356	0000	19	06037	34.17046451	-118.5308463	Los Angeles County
54576	Fee-for-Service	1346293883	1346293883	1	1	ANTIC, NENAD MD	9/10/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	101 E BEVERLY	SUITE 200	MONTEBELLO	CA	90640	4315	19	06037	34.01556395	-118.0983878	Los Angeles County
54589	Fee-for-Service	1912520784	1912520784	1	1	ASTRUM HOSPICE INC	2/25/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	28100 BOUQUET CANYON RD	STE 206	SANTA CLARITA	CA	91350	2006	19	06037	34.45052733	-118.497654	Los Angeles County
54651	Fee-for-Service	1689454605	1689454605	1	1	ASCENDANT PHARMACY INCORPORA	11/6/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	TED	8125 RONSON RD	STE G	SAN DIEGO	CA	92111	2010	37	06073	32.82906348	-117.1479645	San Diego County
54655	Fee-for-Service	1659382588	1659382588	2	2	ALLEN, JOHN W MD	1/20/2020	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	37706	-	NOT APPLICABLE	0	In state provider	None	525 GRAND AVE	None	SPRING VALLEY	CA	91977	5933	37	06073	32.70681352	-116.9975147	San Diego County
54671	Fee-for-Service	1952356214	1952356214	1	1	AHDOOT,JACOB K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	46389	41	Internal Medicine	0	In state provider	None	16300 SAND CANYON AVE	STE 606	IRVINE	CA	92618	3706	30	06059	33.66115075	-117.7742405	Orange County
54674	Fee-for-Service	1972731891	1972731891	1	1	ANNE, RAJA S MD	5/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134028	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
54720	Fee-for-Service	1659892149	1659892149	1	1	AHN, DIANA D AU	11/14/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
54727	Fee-for-Service	1225659089	1225659089	1	1	AKANDE, OLUWATOFEHINTI O MD	10/4/2024	207R00000X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
54728	Fee-for-Service	1790177582	1790177582	1	4	ALTAMED HEALTH SERVICES	3/22/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6021 CARMELITA AVENUE	None	HUNTINGTON PARK	CA	90255	3320	19	06037	33.987276	-118.1983365	Los Angeles County
54735	Fee-for-Service	1629102710	1629102710	1	1	AMERICAN STAR HOME	10/7/2004	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5102 SIMS MOUNTAIN CT	None	ANTIOCH	CA	94531	8820	07	06013	37.96383047	-121.7966944	Contra Costa County
54738	Fee-for-Service	1063571693	1063571693	1	1	AVAZ, GULNAR MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	75477	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
54742	Fee-for-Service	1427246727	1427246727	1	1	AIELLO, ANDREW B DO	10/7/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	9690	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
54746	Fee-for-Service	1154736429	1154736429	1	8	AVENAL COMMUNITY HEALTH CENT	9/19/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	209 C ST	None	LEMOORE	CA	93245	2930	16	06031	36.30089987	-119.7833254	Kings County
54764	Fee-for-Service	1518918440	1518918440	1	1	ADAMS, LINDA MD	9/30/1988	207P00000X	NA	Other	026	PHYSICIANS	64691	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 BROOKLYN AVE	None	LOS ANGELES	CA	90033	2462	19	06037	34.040502	-118.191954	Los Angeles County
54767	Fee-for-Service	1043204522	1043204522	1	1	AG MONROVIA, LLC	10/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	615 W DUARTE RD	None	MONROVIA	CA	91016	4436	19	06037	34.13220952	-118.0120455	Los Angeles County
54769	Fee-for-Service	1205462264	1205462264	1	1	ABDULLAH, KHALID MD	4/26/2023	207R00000X	NA	Other	026	PHYSICIANS	182855	None	None	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
54770	Fee-for-Service	1952392375	1952392375	2	1	ALTAMONT EMERGENCY PHYSICIAN	2/12/2020	193400000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	S MEDICAL GROUP INC	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	39	06077	37.744011	-121.4349725	San Joaquin County
54798	Fee-for-Service	1154736429	1154736429	1	19	AVENAL COMMUNITY HEALTH CENT	9/5/2023	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	858 N CHERRY ST	SUITE F	TULARE	CA	93274	2243	54	06107	36.22014749	-119.337642	Tulare County
54801	Fee-for-Service	1457422552	1457422552	1	1	ASSOCIATED CHRISTIAN THERAPY	3/6/2020	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	41765 12TH STREET WEST	SUITE D	PALMDALE	CA	93551	1422	19	06037	34.641891	-118.1513675	Los Angeles County
54808	Fee-for-Service	1265960215	1265960215	1	2	ANESTHESIOLOGY SPECIALISTS O	6/4/2020	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	28062 BAXTER RD	None	MURRIETA	CA	92563	1401	33	06065	33.61350847	-117.1691225	Riverside County
54813	Fee-for-Service	1053707190	1053707190	1	1	AUYOUNG, MATTHEW S MD	6/28/2018	207R00000X	NA	Other	026	PHYSICIANS	148898	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
54823	Fee-for-Service	1285784264	1285784264	1	1	AKASHI, ALARIC K MD	8/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61081	01	General Practice	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
54824	Fee-for-Service	1922070838	1922070838	1	1	ANDREWS, ROGER N MD	2/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	31944	34	Urology and Urological Surgery	0	In state provider	None	624 W DUARTE RD	STE 203	ARCADIA	CA	91007	9262	19	06037	34.12637452	-118.0527313	Los Angeles County
54850	Fee-for-Service	1821423096	1821423096	1	1	AGUILAR, ROBERT A LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
54865	Fee-for-Service	1346293883	1346293883	1	1	ANTIC, NENAD MD	9/10/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	101 E BEVERLY	SUITE 200	MONTEBELLO	CA	90640	4315	19	06037	34.01556395	-118.0983878	Los Angeles County
54869	Fee-for-Service	1093104457	1093104457	1	1	ARAB, TALAL MD	4/2/2021	207R00000X	NA	Other	026	PHYSICIANS	170124	None	None	0	In state provider	None	1221 E SPRUCE AVE	None	FRESNO	CA	93720	3374	10	06019	36.84197867	-119.761714	Fresno County
54874	Fee-for-Service	1912520784	1912520784	1	1	ASTRUM HOSPICE INC	2/25/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	28100 BOUQUET CANYON RD	STE 206	SANTA CLARITA	CA	91350	2006	19	06037	34.45052733	-118.497654	Los Angeles County
54931	Fee-for-Service	1225226012	1225226012	1	1	AZIMI, ASIF M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89704	01	General Practice	0	In state provider	LAWNDALE MEDICAL CLINIC	16705 HAWTHORNE BLVD	None	LAWNDALE	CA	90260	3244	19	06037	33.879222	-118.352778	Los Angeles County
54948	Fee-for-Service	1487875027	1487875027	1	1	AMARGI, SOPHIA D LMFT	6/27/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21660 COPLEY DR	SUITE 210	DIAMOND BAR	CA	91765	4109	19	06037	33.99822893	-117.8340403	Los Angeles County
54963	Fee-for-Service	1790177582	1790177582	1	9	ALTAMED HEALTH SERVICES	11/2/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	3160 EAST DEL MAR BLVD	SUITE 100	PASADENA	CA	91107	4601	19	06037	34.14217551	-118.085292	Los Angeles County
55005	Fee-for-Service	1780374975	1780374975	1	1	AKINLOSOTU NURSING ANESTHESI	7/11/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	A INC	3300 RENNER DR	None	FORTUNA	CA	95540	3120	12	06023	40.58243651	-124.135992	Humboldt County
55032	Fee-for-Service	1154736429	1154736429	1	8	AVENAL COMMUNITY HEALTH CENT	6/15/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	209 C ST	None	LEMOORE	CA	93245	2930	16	06031	36.30089987	-119.7833254	Kings County
55039	Fee-for-Service	1588961676	1588961676	1	1	ADVENTIST HEALTH PHYSICIANS	3/30/2011	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	15322 LAKESHORE DR	STE 201	CLEARLAKE	CA	95422	9814	17	06033	38.95045805	-122.6255271	Lake County
55042	Fee-for-Service	1447989009	1447989009	1	1	ALL IN CAREHOME LLC	7/26/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1158 BEAVER WAY	None	LA VERNE	CA	91750	2517	19	06037	34.1206019	-117.7817915	Los Angeles County
55083	Fee-for-Service	1154736429	1154736429	1	19	AVENAL COMMUNITY HEALTH CENT	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	858 N CHERRY ST	SUITE F	TULARE	CA	93274	2243	54	06107	36.22014749	-119.337642	Tulare County
55097	Fee-for-Service	1609421254	1609421254	1	1	AHPC SAN DIEGO INC	1/7/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	500 LA TERRAZA BLVD	STE 150	ESCONDIDO	CA	92025	3876	37	06073	33.11238641	-117.096444	San Diego County
55107	Fee-for-Service	1639231780	1639231780	2	2	AEGIS TREATMENT CENTERS, LLC	5/15/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	6500 MORRO ROAD	C & D	ATASCADERO	CA	93422	4142	40	06079	35.48364845	-120.6655946	San Luis Obispo County
55112	Fee-for-Service	1508475518	1508475518	1	1	AU-YEUNG, MELODY H PT	6/2/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
55115	Fee-for-Service	1841480084	1841480084	1	1	ABHAY SRINIVASAN M.D	8/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 LOTHROP ST	None	PITTSBURGH	PA	15213	2536	00	None	40.44188737	-79.96079711	Allegheny County
55117	Fee-for-Service	1356312516	1356312516	1	1	AGASTYA, GAUTAMI MD	11/19/2009	207RA0401X	NA	Other	026	PHYSICIANS	51385	41	Internal Medicine	0	In state provider	None	552 W EATON AVE	None	TRACY	CA	95376	3422	39	06077	37.7432517	-121.4346354	San Joaquin County
55219	Fee-for-Service	1225226012	1225226012	1	1	AZIMI, ASIF M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89704	08	Family Practice	0	In state provider	LAWNDALE MEDICAL CLINIC	16705 HAWTHORNE BLVD	None	LAWNDALE	CA	90260	3244	19	06037	33.879222	-118.352778	Los Angeles County
55228	Fee-for-Service	1023754744	1023754744	1	1	ALDUENDA, CAITLYN N PT	12/13/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
55246	Fee-for-Service	1790177582	1790177582	1	9	ALTAMED HEALTH SERVICES	11/2/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	3160 EAST DEL MAR BLVD	SUITE 100	PASADENA	CA	91107	4601	19	06037	34.14217551	-118.085292	Los Angeles County
55261	Fee-for-Service	1861718363	1861718363	2	1	APRIA HEALTHCARE LLC	3/25/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3380 N SAN FERNANDO ROAD	UNIT 801	LOS ANGELES	CA	90065	1417	19	06037	34.1190242	-118.2500671	Los Angeles County
55309	Fee-for-Service	1922205442	1922205442	1	1	ASSOCIATED NEUROLOGY	5/14/1984	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	MEDICAL GROUP, INC	5401 NORRIS CANYON RD	STE 306	SAN RAMON	CA	94583	5408	07	06013	37.77752374	-121.9579277	Contra Costa County
55321	Fee-for-Service	1154736429	1154736429	1	8	AVENAL COMMUNITY HEALTH CENT	9/19/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	209 C ST	None	LEMOORE	CA	93245	2930	16	06031	36.30089987	-119.7833254	Kings County
55344	Fee-for-Service	1104071489	1104071489	1	1	ANDERSON, CAESAR MD	7/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112706	41	Internal Medicine	0	In state provider	None	2400 EAST 4TH STREET	None	NATIONAL CITY	CA	91950	1370	37	06073	32.68637926	-117.0828839	San Diego County
55350	Fee-for-Service	1376622407	1376622407	1	1	ANOOSHIAN, ROBERT V MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73929	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
55382	Fee-for-Service	1689451114	1689451114	1	1	ALI ABIDALI DO PROFESSIONAL	11/6/2023	208600000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	ST MEDICAL GROUP	500 N EUCLID AVE	None	UPLAND	CA	91786	4734	36	06071	34.09992682	-117.6509851	San Bernardino County
55383	Fee-for-Service	1609421254	1609421254	1	1	AHPC SAN DIEGO INC	1/7/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	500 LA TERRAZA BLVD	STE 150	ESCONDIDO	CA	92025	3876	37	06073	33.11238641	-117.096444	San Diego County
55385	Fee-for-Service	1588673743	1588673743	2	1	APOTHECARY PHARMACY INC	5/4/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	40 STONE PINE RD	STE I	HALF MOON BAY	CA	94019	8202	41	06081	37.46681588	-122.4282635	San Mateo County
55392	Fee-for-Service	1265767354	1265767354	1	1	ALLRED, KENDALL S MD	12/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114417	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
55395	Fee-for-Service	1639231780	1639231780	2	2	AEGIS TREATMENT CENTERS, LLC	5/15/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	6500 MORRO ROAD	C & D	ATASCADERO	CA	93422	4142	40	06079	35.48364845	-120.6655946	San Luis Obispo County
55400	Fee-for-Service	1164606380	1164606380	1	4	ABILITY PATHWAYS INC	6/1/2007	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	MESA TERRACE DIVISION	2489 MESA TER	None	UPLAND	CA	91784	1078	36	06071	34.15468668	-117.6685291	San Bernardino County
55415	Fee-for-Service	1124256235	1124256235	1	1	AUDON, MICHAEL MD	12/19/2018	207L00000X	NA	Other	026	PHYSICIANS	80821	05	Anesthesiology	0	In state provider	None	7677 CENTER ST	SUITE 104	HUNTINGTON BEACH	CA	92647	3030	30	06059	33.736257	-117.995535	Orange County
55431	Fee-for-Service	1821361148	1821361148	1	1	ACOSTA, FRANCISCA M LMFT	3/18/2019	106H00000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
55445	Fee-for-Service	1871091595	1871091595	1	1	ANGEL CHANG MD, INC.	11/28/2018	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	None	None	0	In state provider	None	2999 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	37	06073	32.79786855	-117.156346	San Diego County
55449	Fee-for-Service	1801282744	1801282744	1	1	ANDRIASIAN, MARIYA DO	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	16634	41	Internal Medicine	0	In state provider	None	26357 MCBEAN PKWY	None	VALENCIA	CA	91355	4488	19	06037	34.41257644	-118.5597683	Los Angeles County
55467	Fee-for-Service	1023196631	1023196631	1	1	ANDREWS, ELIZABETH A MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54371	01	General Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
55505	Fee-for-Service	1003195686	1003195686	1	1	ARBIT, BORIS MD	10/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124357	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
55531	Fee-for-Service	1336453810	1336453810	1	1	ANAND, SIDHARTH RAVI MD	5/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119320	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
55566	Fee-for-Service	1013919315	1013919315	1	1	ALANTICARE REGIONAL MEDICAL	3/27/2014	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	1925 PACIFIC AVE	None	ATLANTIC CITY	NJ	08401	6784	00	None	39.35793812	-74.43368434	Atlantic County
55568	Fee-for-Service	1043665219	1043665219	1	1	AGARI, KIMIKO M MD	10/18/2023	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	188249	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
55581	Fee-for-Service	1679587604	1679587604	1	1	AMERSI, FARIN F MD	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65822	02	General Surgery	0	In state provider	None	1328 22ND ST	FL 3	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
55590	Fee-for-Service	1043399462	1043399462	1	1	ALBERT, DENISE C MD	6/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81724	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
55606	Fee-for-Service	1730452731	1730452731	1	1	ALCANTAR, VIOLET V LCSW	3/27/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11800 CENTRAL AVE	STE 225	CHINO	CA	91710	7200	36	06071	34.0388092	-117.689654	San Bernardino County
55619	Fee-for-Service	1871703132	1871703132	1	1	AJEET DUBE M.D.	10/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
55636	Fee-for-Service	1376622407	1376622407	1	1	ANOOSHIAN, ROBERT V MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73929	24	Plastic Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
55639	Fee-for-Service	1467158428	1467158428	1	1	ALDRICH, KAYLEY E CCC-SLP	4/28/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2505 W SHAW AVE	STE. 101	FRESNO	CA	93711	3334	10	06019	36.80619423	-119.8359004	Fresno County
55641	Fee-for-Service	1477051464	1477051464	1	1	ADVENTIST HEALTH PHYSICIANS	8/3/2020	2086S0129X	NA	General Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	414 G ST	STE 106	MARYSVILLE	CA	95901	5669	58	06115	39.13913942	-121.5934649	Yuba County
55647	Fee-for-Service	1326229204	1326229204	1	1	AXELRAD, THOMAS W MD	10/6/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	132717	None	None	0	In state provider	None	1405 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4557	49	06097	38.44377	-122.699016	Sonoma County
55667	Fee-for-Service	1104993088	1104993088	1	1	ACHARYA, PRAVIN K MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	55321	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
55679	Fee-for-Service	1336323492	1336323492	1	1	AL BALAS, HASSAN A MD	1/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54326	30	Radiology	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
55704	Fee-for-Service	1750888095	1750888095	1	1	ARAVAGIRI-DO, ARUNMOZHI S MD	12/5/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	173475	None	None	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
55753	Fee-for-Service	1265174254	1265174254	1	1	ALI, ARUJ OD	1/7/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9221 SIERRA COLLEGE BLVD	STE 130	ROSEVILLE	CA	95661	5919	31	06061	38.735028	-121.225764	Placer County
55765	Fee-for-Service	1437487113	1437487113	1	1	ABRAMS, MICHAEL J LMFT	5/10/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
55772	Fee-for-Service	1972739159	1972739159	1	1	APPLEWOOD WOMEN'S CENTER PC	6/1/2010	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	2301 MOUNTAIN VIEW BLVD	STE A	KLAMATH FALLS	OR	97601	1137	00	None	42.25115811	-121.7850568	Klamath County
55789	Fee-for-Service	1841603586	1841603586	1	1	AHMAD, ALI MEDICAL CORP	7/28/2014	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	127870	01	General Practice	0	In state provider	None	1125 N MAGNOLIA AVE	SUITE 105	ANAHEIM	CA	92801	2638	30	06059	33.847875	-117.9761765	Orange County
55792	Fee-for-Service	1467638064	1467638064	1	4	ADVANCED IMAGING CENTER	9/16/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	900 N HERITAGE DR	BLDG B	RIDGECREST	CA	93555	5536	15	06029	35.6381566	-117.675128	Kern County
55793	Fee-for-Service	1003195686	1003195686	1	1	ARBIT, BORIS MD	10/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124357	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MED PLAZA	365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
55807	Fee-for-Service	1811420243	1811420243	1	1	AMIRI, SOHRAB MD	10/16/2020	207R00000X	NA	Other	026	PHYSICIANS	163390	41	Internal Medicine	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2266	07	06013	37.98417931	-122.0361585	Contra Costa County
55830	Fee-for-Service	1750661641	1750661641	1	1	AMERDAVIS, STACY K NP	4/18/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
55839	Fee-for-Service	1568658839	1568658839	1	2	ALAN FOZAILOFF MD INC	7/26/2023	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	2804	19	06037	34.16979433	-118.5312303	Los Angeles County
55854	Fee-for-Service	1013919315	1013919315	1	1	ALANTICARE REGIONAL MEDICAL	3/27/2014	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER	1925 PACIFIC AVE	None	ATLANTIC CITY	NJ	08401	6784	00	None	39.35793812	-74.43368434	Atlantic County
55868	Fee-for-Service	1609863638	1609863638	1	1	ABELLERA, NILDA AGNES MD	9/1/1980	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	35884	40	Pediatrics	0	In state provider	None	2350 MCKEE RD	None	SAN JOSE	CA	95116	1617	43	06085	37.36631785	-121.848368	Santa Clara County
55905	Fee-for-Service	1013972876	1013972876	1	1	ANTAKI, JEAN-PIERRE E MD	4/30/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	44202	77	Infectious Disease	0	In state provider	None	801 S CHEVY CHASE DR	STE 105	GLENDALE	CA	91205	4432	19	06037	34.136757	-118.2396195	Los Angeles County
55909	Fee-for-Service	1306075775	1306075775	1	2	ALL AMERICANS CHOICE HOME	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH INC	2619S WATERMAN AVE	SUITE C	SAN BERNARDINO	CA	92408	3724	36	06071	34.053786	-117.278703	San Bernardino County
55920	Fee-for-Service	1891741898	1891741898	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8920 FLETCHER PKWY	None	LA MESA	CA	91942	3231	37	06073	32.78544347	-117.0051058	San Diego County
55959	Fee-for-Service	1710418157	1710418157	1	1	ADVENTIST HEALTH PHYSICIANS	2/25/2019	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	804 W 7TH ST	None	HANFORD	CA	93230	4926	16	06031	36.32523147	-119.656845	Kings County
55966	Fee-for-Service	1821306648	1821306648	1	1	ASHLOCK, BENTON T MD	10/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	118255	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
56014	Fee-for-Service	1346297934	1346297934	1	1	ARANGURI, CESAR E MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44637	06	Cardiovascular Disease (M.D. only)	0	In state provider	INC	2955 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5836	19	06037	33.97333678	-118.2163277	Los Angeles County
56015	Fee-for-Service	1982353884	1982353884	1	1	ABELDT, BRITTANY MD	6/17/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	188881	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
56041	Fee-for-Service	1962868844	1962868844	1	1	ADVINCULA, SAMUEL C NP	6/19/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
56056	Fee-for-Service	1730170044	1730170044	1	1	AUDREY MARSHALL MD	1/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 LONGWOOD AVE	None	BOSTON	MA	02115	5724	00	None	42.337035	-71.105607	Suffolk County
56078	Fee-for-Service	1992816680	1992816680	1	1	ATABAI, KAMRAN MD	5/25/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71786	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
56084	Fee-for-Service	1699955575	1699955575	1	1	ACTIVE HEALTHCARE	3/20/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53766	08	Family Practice	0	In state provider	MEDICAL GROUP INC	512 S GLENDORA AVE	None	WEST COVINA	CA	91790	3022	19	06037	34.06561213	-117.927192	Los Angeles County
56140	Fee-for-Service	1265462337	1265462337	1	1	ARMAGAN, OSEP E MD	5/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	88110	20	Orthopedic Surgery	0	In state provider	None	2755 ALAMO ST	STE 100	SIMI VALLEY	CA	93065	1345	56	06111	34.28643348	-118.742904	Ventura County
56149	Fee-for-Service	1265502991	1265502991	1	1	AGAGON, MARIA-BEATINA K	1/16/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
56164	Fee-for-Service	1649531625	1649531625	1	1	ARAIN, MANSOOR A MD	8/30/2021	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	172489	41	Internal Medicine	0	In state provider	None	206 S STRATFORD AVE	STE A	SANTA MARIA	CA	93454	5901	42	06083	34.951851	-120.414681	Santa Barbara County
56168	Fee-for-Service	1548649775	1548649775	1	1	AHMAD, EMAN MD	11/1/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	152963	38	Geriatrics	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
56191	Fee-for-Service	1235507005	1235507005	1	1	AJAMI, JUHAYNA	1/23/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94569	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
56196	Fee-for-Service	1720664246	1720664246	1	1	APRICUS HOSPICE	4/12/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 334	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
56205	Fee-for-Service	1679173702	1679173702	1	1	ALTON, LEILA Y LMFT	6/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
56216	Fee-for-Service	1992219695	1992219695	1	1	AVERBUKH, ADRIANNE LCSW	10/2/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1714 IVAR AVE	SUITE D	LOS ANGELES	CA	90028	5124	19	06037	34.10240755	-118.3281352	Los Angeles County
56244	Fee-for-Service	1942380266	1942380266	1	1	ALEXANDER, DEBRA LYNN OD	9/11/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ALEXANDER, DEBRA LYN OD	1261 CABRILLO AVE	STE 200	TORRANCE	CA	90501	2868	19	06037	33.83564609	-118.3146523	Los Angeles County
56252	Fee-for-Service	1821306648	1821306648	1	1	ASHLOCK, BENTON T MD	10/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	118255	38	Geriatrics	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
56270	Fee-for-Service	1316304611	1316304611	1	1	ARCHANGEL MICHAEL PHARMACY	3/14/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	INC	31754 TEMECULA PKWY	STE D	TEMECULA	CA	92592	6814	33	06065	33.48011068	-117.1027146	Riverside County
56271	Fee-for-Service	1528599404	1528599404	1	1	ALAEI, SUSAN T MD	9/20/2022	207LP3000X	NA	Other	026	PHYSICIANS	160655	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
56280	Fee-for-Service	1669039327	1669039327	1	3	A MIND ABOVE, A PROFESSIONAL	8/23/2023	103TC0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1300 E. SHAW AVE.	SUITE 171	FRESNO	CA	93710	7911	10	06019	36.80872147	-119.765979	Fresno County
56288	Fee-for-Service	1790997252	1790997252	1	1	AYE, YEE Y MD	4/11/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	110946	40	Pediatrics	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
56289	Fee-for-Service	1588666515	1588666515	1	1	ALBERTSON, STEVEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2600 TUSCARAWAS ST W	STE 620	CANTON	OH	44708	4676	00	None	40.79892136	-81.40419585	Stark County
56333	Fee-for-Service	1477647386	1477647386	1	1	ASHOK, NAGASAMUDRA S	8/7/2008	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MD INC	229 W 7TH ST	None	SAN JACINTO	CA	92583	4662	33	06065	33.78027368	-116.9601627	Riverside County
56347	Fee-for-Service	1194875781	1194875781	1	1	AHN, ANDREW H MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65821	13	Neurology (M.D. only)	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
56357	Fee-for-Service	1376953992	1376953992	1	1	ATHENS HOSPICE INC	9/4/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	19725 SHERMAN WAY	SUITE 295 C	WINNETKA	CA	91306	3664	19	06037	34.20117847	-118.563057	Los Angeles County
56373	Fee-for-Service	1699955575	1699955575	1	1	ACTIVE HEALTHCARE	3/20/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53766	40	Pediatrics	0	In state provider	MEDICAL GROUP INC	512 S GLENDORA AVE	None	WEST COVINA	CA	91790	3022	19	06037	34.06561213	-117.927192	Los Angeles County
56379	Fee-for-Service	1376641548	1376641548	1	1	ARMSTRONG, JEFFREY	8/31/1990	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	65001	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
56394	Fee-for-Service	1275065211	1275065211	1	1	ARTINIAN, NICHOLAS N MD	10/19/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163907	08	Family Practice	0	In state provider	None	9000 MING AVE	STE L-1B	BAKERSFIELD	CA	93311	1318	15	06029	35.33989328	-119.1034715	Kern County
56402	Fee-for-Service	1316949779	1316949779	2	1	ARNOLD, COLIN B MD	10/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	47416	18	Ophthalmology	0	In state provider	None	7501 HOSPITAL DRIVE	SUITE 105	SACRAMENTO	CA	95823	5405	34	06067	38.464776	-121.416912	Sacramento County
56443	Fee-for-Service	1154736429	1154736429	1	14	AVENAL COMMUNITY HEALTH CENT	5/21/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	247 N L STREET	None	DINUBA	CA	93618	2107	54	06107	36.5422798	-119.3919232	Tulare County
56446	Fee-for-Service	1154747020	1154747020	1	7	ACN MEDICAL GROUP, INC	10/10/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	22590 VOSS AVE	None	CUPERTINO	CA	95014	2627	43	06085	37.31779679	-122.069389	Santa Clara County
56454	Fee-for-Service	1649531625	1649531625	1	1	ARAIN, MANSOOR A MD	8/30/2021	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	172489	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	206 S STRATFORD AVE	STE A	SANTA MARIA	CA	93454	5901	42	06083	34.951851	-120.414681	Santa Barbara County
56462	Fee-for-Service	1205819042	1205819042	1	1	ABBO, MICHAEL Y MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	47975	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
56472	Fee-for-Service	1669882668	1669882668	1	1	AGYEPONG, AKOSUA A MD	3/17/2025	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
56484	Fee-for-Service	1720664246	1720664246	1	1	APRICUS HOSPICE	4/12/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	STE 334	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
56490	Fee-for-Service	1801021514	1801021514	1	1	ALIKSANIAN, LORI S MD	6/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122286	02	General Surgery	0	In state provider	None	5750 DOWNEY AVENUE	SUITE 100	LAKEWOOD	CA	90712	1411	19	06037	33.859611	-118.1511435	Los Angeles County
56506	Fee-for-Service	1578889283	1578889283	1	1	ARORA, MELANIE MD	2/18/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	145131	None	None	0	In state provider	None	16167 SISKIYOU ROAD	SUITE A	APPLE VALLEY	CA	92307	0837	36	06071	34.54496692	-117.2664417	San Bernardino County
56557	Fee-for-Service	1396753703	1396753703	1	1	ABULHOSN, RAJY S MD	9/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	61653	08	Family Practice	0	In state provider	None	4510 VIEWRIDGE AVE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
56567	Fee-for-Service	1669039327	1669039327	1	3	A MIND ABOVE, A PROFESSIONAL	6/3/2024	103TC0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1300 E. SHAW AVE.	SUITE 171	FRESNO	CA	93710	7911	10	06019	36.80872147	-119.765979	Fresno County
56569	Fee-for-Service	1396888152	1396888152	1	1	ANTELOPE VALLEY UROLOGY	11/30/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	MEDICAL GROUP, INC	44105 15TH ST W	STE 302	LANCASTER	CA	93534	4088	19	06037	34.684218	-118.1568465	Los Angeles County
56578	Fee-for-Service	1881879930	1881879930	1	1	ADAMS, DUANE D	11/17/2006	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ADVANCED MEDICAL TECHNOL	5266 HOLLISTER AVE	STE 107	SANTA BARBARA	CA	93111	4027	42	06083	34.43497016	-119.8071895	Santa Barbara County
56582	Fee-for-Service	1770112450	1770112450	1	1	AU, KATHERINE M DO	1/22/2025	202D00000X	NA	Other	026	PHYSICIANS	20115	41	Internal Medicine	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
56602	Fee-for-Service	1992382949	1992382949	1	1	ALLAHVERDIAN, CHRISTOPHER E	7/1/2024	207R00000X	NA	Other	026	PHYSICIANS	192308	41	Internal Medicine	0	In state provider	MD	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
56603	Fee-for-Service	1992752158	1992752158	1	1	ARUMUGAM NARAYANAN, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 GOODMAN ST	None	CINCINNATI	OH	45219	2364	00	None	39.13677965	-84.5023814	Hamilton County
56645	Fee-for-Service	1376953992	1376953992	1	1	ATHENS HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	19725 SHERMAN WAY	SUITE 295 C	WINNETKA	CA	91306	3664	19	06037	34.20117847	-118.563057	Los Angeles County
56649	Fee-for-Service	1326427436	1326427436	1	1	A & G HOME HEALTH CARE INC	4/26/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6005 VINELAND AVE	SUITE 206	NORTH HOLLYWOOD	CA	91606	6005	19	06037	34.179921	-118.3703275	Los Angeles County
56672	Fee-for-Service	1326126194	1326126194	1	1	ALYAMI, TERI L MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30248	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
56687	Fee-for-Service	1831628429	1831628429	1	1	ALVAREZ-TOBIAS, LINDAY I LCS	12/7/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
56712	Fee-for-Service	1306460555	1306460555	1	1	AT EASE HOSPICE & PALLIATIVE	11/16/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	14545 FRIAR ST	STE 186	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
56730	Fee-for-Service	1154736429	1154736429	1	14	AVENAL COMMUNITY HEALTH CENT	5/21/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	247 N L STREET	None	DINUBA	CA	93618	2107	54	06107	36.5422798	-119.3919232	Tulare County
56779	Fee-for-Service	1508812975	1508812975	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2400 W COMMONWEALTH AVE	None	ALHAMBRA	CA	91803	1305	19	06037	34.08778681	-118.149982	Los Angeles County
56784	Fee-for-Service	1114583424	1114583424	1	1	ALZYOUD, LAMEES H MD	9/22/2023	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	186417	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
56793	Fee-for-Service	1114365269	1114365269	1	1	ARCADIA HOSPITALIST MEDICAL	8/26/2013	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP, INC	300 WEST HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
56806	Fee-for-Service	1568628782	1568628782	1	1	ASHISH PANDHARI WASNIK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 E MEDICAL CENTER	None	ANN ARBOR	MI	48109	5030	00	None	42.28391347	-83.72716554	Washtenaw County
56807	Fee-for-Service	1245681485	1245681485	1	2	ALBA, VANESSA C	8/25/2023	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	HERAPY SERVICES	22777 LYONS AVE	#107	NEWHALL	CA	91324	3985	19	06037	34.38063512	-118.5316765	Los Angeles County
56813	Fee-for-Service	1033376561	1033376561	1	1	ANTHONY AND JOSEFINA	11/25/1995	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	KAUTZMAN	21310 SOUTH RAVENNA AVE	None	CARSON	CA	90745	2143	19	06037	33.83496	-118.2688945	Los Angeles County
56857	Fee-for-Service	1669039327	1669039327	1	3	A MIND ABOVE, A PROFESSIONAL	10/7/2022	103TC0700X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1300 E. SHAW AVE.	SUITE 171	FRESNO	CA	93710	7911	10	06019	36.80872147	-119.765979	Fresno County
56873	Fee-for-Service	1770112450	1770112450	1	1	AU, KATHERINE M DO	1/22/2025	202D00000X	NA	Other	026	PHYSICIANS	20115	70	Clinic (mixed specialty)	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
56875	Fee-for-Service	1588140008	1588140008	1	1	ADDO-YIRENKYI, LORD LISTOWEL	12/20/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173243	None	None	0	In state provider	MD	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
56882	Fee-for-Service	1679973267	1679973267	1	1	ADVENTIST HEALTH PHYSICIANS	12/1/2014	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1701 E CESAR E CHAVEZ AV	STE 456	LOS ANGELES	CA	90033	2424	19	06037	34.05112725	-118.2173921	Los Angeles County
56888	Fee-for-Service	1275359028	1275359028	1	1	ANGELLE, AMBER E AU	12/17/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
56889	Fee-for-Service	1689888042	1689888042	1	1	AU, KATHERINE MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101676	None	None	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	7002	19	06037	34.06373445	-118.443537	Los Angeles County
56896	Fee-for-Service	1801281795	1801281795	1	1	ABUSEIF, SARAH MD	7/1/2018	207R00000X	NA	Other	026	PHYSICIANS	153297	41	Internal Medicine	0	In state provider	None	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2799	41	06081	37.48093988	-122.2531826	San Mateo County
56898	Fee-for-Service	1659782100	1659782100	1	1	ANDERSON, JAMIE E MD	8/30/2022	390200000X	NA	Other	026	PHYSICIANS	140553	None	None	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
56924	Fee-for-Service	1730226473	1730226473	1	2	ADDICTION RESEARCH AND TREAT	1/3/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1301 AND 1313 CUTTING BO	None	RICHMOND	CA	94804	2554	07	06013	37.92523852	-122.3565435	Contra Costa County
56941	Fee-for-Service	1093338386	1093338386	1	1	ARMER, ERIN G PHD	10/7/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
56948	Fee-for-Service	1548412596	1548412596	1	1	ADVANCED SLEEP MEDICINE SRVS	2/14/2011	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	INC	42544 10TH ST	SUITE D	LANCASTER	CA	93534	7079	19	06037	34.65636834	-118.1476356	Los Angeles County
56960	Fee-for-Service	1700121472	1700121472	1	1	AVULOV, VADIM DO	11/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13344	02	General Surgery	0	In state provider	None	6719 ALVARADO RD	STE 108	SAN DIEGO	CA	92120	5254	37	06073	32.77684978	-117.055137	San Diego County
56970	Fee-for-Service	1083230296	1083230296	1	1	A&E HOME HEALTH CARE INC	8/18/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	535 NORTH BRAND BLVD	STE 240	GLENDALE	CA	91203	1917	19	06037	34.154298	-118.2551395	Los Angeles County
56973	Fee-for-Service	1588639876	1588639876	1	1	ANDREWS, JOSEPH S MD	10/23/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53564	41	Internal Medicine	0	In state provider	None	10170 SORRENTO VALLEY RD	# 200	SAN DIEGO	CA	92121	1604	37	06073	32.88947089	-117.2089084	San Diego County
56984	Fee-for-Service	1942648118	1942648118	1	1	ANDONIAN, GREGORY MD	7/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140710	01	General Practice	0	In state provider	None	4955 VAN NUYS BLVD	STE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
57000	Fee-for-Service	1306460555	1306460555	1	1	AT EASE HOSPICE & PALLIATIVE	11/16/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	14545 FRIAR ST	STE 186	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
57016	Fee-for-Service	1255402145	1255402145	1	1	AMEZQUITA, DONNA S NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1900 E 4TH STREET	None	SANTA ANA	CA	92705	3910	30	06059	33.74805463	-117.8400671	Orange County
57023	Fee-for-Service	1497833164	1497833164	1	1	ANDERSON, NICOLE A MD	12/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92632	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
57034	Fee-for-Service	1912939208	1912939208	1	1	ANDREW NULLMAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4302 ALTON RD	STE 760	MIAMI BEACH	FL	33140	2893	00	None	25.81593542	-80.13749721	Miami-Dade County
57053	Fee-for-Service	1952917635	1952917635	1	2	ALL INCLUSIVE MEDICAL SERVIC	7/16/2024	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	391 HOWE AVE	STE 150	SACRAMENTO	CA	95825	5513	34	06067	38.571696	-121.41324	Sacramento County
57095	Fee-for-Service	1245681485	1245681485	1	2	ALBA, VANESSA C	8/25/2023	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	HERAPY SERVICES	22777 LYONS AVE	#107	NEWHALL	CA	91324	3985	19	06037	34.38063512	-118.5316765	Los Angeles County
57103	Fee-for-Service	1477139319	1477139319	1	1	AHOUBIM, JOSEPH	3/1/2024	207R00000X	NA	Other	026	PHYSICIANS	20691	41	Internal Medicine	0	In state provider	None	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
57125	Fee-for-Service	1295886190	1295886190	1	1	ALPHA PHARMACY	6/9/1994	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ATTN: THANH LE	707 E MARCH LN	STE 13	STOCKTON	CA	95207	5864	39	06077	38.00058335	-121.2976254	San Joaquin County
57136	Fee-for-Service	1962433383	1962433383	1	1	AZARM, ALI MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	88485	10	Gastroenterology (M.D. only)	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
57144	Fee-for-Service	1669039327	1669039327	1	3	A MIND ABOVE, A PROFESSIONAL	6/12/2023	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1300 E. SHAW AVE.	SUITE 171	FRESNO	CA	93710	7911	10	06019	36.80872147	-119.765979	Fresno County
57158	Fee-for-Service	1578094785	1578094785	1	1	ARZENO, JULIA MD	3/3/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	160666	None	None	0	In state provider	None	1324 NELSON AVE	STE B	MODESTO	CA	95350	5374	50	06099	37.66254751	-120.9881942	Stanislaus County
57168	Fee-for-Service	1487828620	1487828620	1	1	ATKINSON, PHILLIP PHD	7/25/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	790 MASON ST	STE 102	VACAVILLE	CA	95688	4661	48	06095	38.3550515	-121.9832505	Solano County
57202	Fee-for-Service	1063506400	1063506400	1	1	ADAM NICOL DELU MD	4/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
57209	Fee-for-Service	1730226473	1730226473	1	2	ADDICTION RESEARCH AND TREAT	1/3/2022	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1301 AND 1313 CUTTING BO	None	RICHMOND	CA	94804	2554	07	06013	37.92523852	-122.3565435	Contra Costa County
57255	Fee-for-Service	1043352032	1043352032	1	1	AHLUWALIA, NAVNEET S MD	3/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	80206	05	Anesthesiology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
57260	Fee-for-Service	1932364163	1932364163	1	1	APPLEBAUM, LAURA H MD	11/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104772	08	Family Practice	0	In state provider	None	685 TWELVE BRIDGES	None	LINCOLN	CA	95648	8689	31	06061	38.85108687	-121.2886018	Placer County
57267	Fee-for-Service	1487851812	1487851812	1	1	ANWAR, TEMOOR S MD	5/16/2014	390200000X	NA	Other	026	PHYSICIANS	103641	30	Radiology	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
57279	Fee-for-Service	1417058199	1417058199	1	1	AARDEN, PYRA M MD	10/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100140	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
57298	Fee-for-Service	1346827631	1346827631	1	1	ABDELMESEEH, ELIJAH MD	8/21/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
57303	Fee-for-Service	1164606380	1164606380	1	2	ABILITY PATHWAYS INC	6/1/2007	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1318 W HARVARD PL	None	ONTARIO	CA	91762	1721	36	06071	34.078941	-117.6753825	San Bernardino County
57337	Fee-for-Service	1104859909	1104859909	1	1	ALEXAN-SHIRABAD, RICHARD	8/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85082	13	Neurology (M.D. only)	0	In state provider	None	2601 OSWELL ST	STE 101	BAKERSFIELD	CA	93306	3173	15	06029	35.39259632	-118.9496489	Kern County
57339	Fee-for-Service	1760651814	1760651814	1	6	ALTAMED HEALTH SERVICES	6/5/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2701 SOUTH RAITT STREET	None	SANTA ANA	CA	92704	5526	30	06059	33.71109826	-117.8974792	Orange County
57352	Fee-for-Service	1790021848	1790021848	1	1	AGARWAL, NIVEDITA MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123379	41	Internal Medicine	0	In state provider	None	450 EAST ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
57359	Fee-for-Service	1447571179	1447571179	1	1	ARIAS, ANA A MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	122654	None	None	0	In state provider	None	219 N SANBORN ROAD	None	SALINAS	CA	93905	2218	27	06053	36.67720965	-121.6266381	Monterey County
57390	Fee-for-Service	1003478819	1003478819	1	1	ANAND RAMAN, ABHINANDAN	5/29/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	77	Infectious Disease	0	In state provider	None	1805 N CALIFORNIA ST	201	STOCKTON	CA	95204	6032	39	06077	37.9711691	-121.2894221	San Joaquin County
57405	Fee-for-Service	1326379926	1326379926	1	1	ARMT MEDICAL SPECIALISTS, IN	9/28/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	C.	4974 EL CAJON BOULEVARD	SUITE A	SAN DIEGO	CA	92115	4677	37	06073	32.75676923	-117.0872161	San Diego County
57426	Fee-for-Service	1962433383	1962433383	1	1	AZARM, ALI MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	88485	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
57431	Fee-for-Service	1669039327	1669039327	1	3	A MIND ABOVE, A PROFESSIONAL	12/26/2024	103TC0700X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1300 E. SHAW AVE.	SUITE 171	FRESNO	CA	93710	7911	10	06019	36.80872147	-119.765979	Fresno County
57457	Fee-for-Service	1659328110	1659328110	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6755 WESTMINSTER AVE	None	WESTMINSTER	CA	92683	3706	30	06059	33.761349	-118.00917	Orange County
57465	Fee-for-Service	1578728317	1578728317	1	1	AL SAFI, ZAIN A I MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137490	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	SUITE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
57474	Fee-for-Service	1013020999	1013020999	1	1	AMES MED EQUIP, INC	6/27/2011	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ALLIANCE MED SPLY & RNTL	301 N JACKSON AVE	STE 7A	SAN JOSE	CA	95133	2344	43	06085	37.36606741	-121.8510444	Santa Clara County
57546	Fee-for-Service	1932364163	1932364163	1	1	APPLEBAUM, LAURA H MD	11/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104772	41	Internal Medicine	0	In state provider	None	685 TWELVE BRIDGES	None	LINCOLN	CA	95648	8689	31	06061	38.85108687	-121.2886018	Placer County
57554	Fee-for-Service	1760198394	1760198394	1	1	ADDAI, ROSEMARY	3/30/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	14664 STEALTH WAY	None	MORENO VALLEY	CA	92553	3514	33	06065	0	0	None
57567	Fee-for-Service	1578946109	1578946109	1	1	AMICUS ARTHRITIS AND	9/21/2015	207RR0500X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OSTEOPOROSIS	12456 WASHINGTON BLVD	None	WHITTIER	CA	90602	1005	19	06037	33.96757592	-118.046351	Los Angeles County
57623	Fee-for-Service	1154736429	1154736429	1	10	AVENAL COMMUNITY HEALTH CENT	2/20/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	973 SEQUOIA AVE	None	LINDSAY	CA	93247	1426	54	06107	36.2151862	-119.0961292	Tulare County
57627	Fee-for-Service	1760651814	1760651814	1	6	ALTAMED HEALTH SERVICES	6/5/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2701 SOUTH RAITT STREET	None	SANTA ANA	CA	92704	5526	30	06059	33.71109826	-117.8974792	Orange County
57629	Fee-for-Service	1275174500	1275174500	1	1	ARIAS HOSPICE CARE INC	3/1/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2250 DOUGLAS BLVD	SUITE 135	ROSEVILLE	CA	95661	4290	31	06061	38.74418053	-121.2430005	Placer County
57642	Fee-for-Service	1629126644	1629126644	1	1	APPLEBY, STEVEN J MD	3/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91094	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
57661	Fee-for-Service	1467772426	1467772426	1	1	ALOCOZY, M NADIR MD INC	11/9/2010	207R00000X	NA	Other	026	PHYSICIANS	63564	41	Internal Medicine	0	In state provider	None	2211 PARK TOWNE CIRCLE	None	SACRAMENTO	CA	95825	6379	34	06067	38.605788	-121.3855965	Sacramento County
57692	Fee-for-Service	1811768369	1811768369	1	1	AREVALO CARRANZA, GABRIEL	3/27/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TATION	4920 ELYSIUM ST	None	BAKERSFIELD	CA	93304	7008	15	06029	35.309268	-119.0222725	Kern County
57695	Fee-for-Service	1013200583	1013200583	1	1	ARKIN, JASON D PSYD	5/12/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3152 RED HILL AVE	260	COSTA MESA	CA	92626	3436	30	06059	33.67898631	-117.8747698	Orange County
57698	Fee-for-Service	1952437576	1952437576	1	1	AEGIS AMBULANCE SVCS INC	12/1/1997	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	140 W CHESTNUT AVE	None	MONROVIA	CA	91016	3412	19	06037	34.14253305	-118.0021782	Los Angeles County
57699	Fee-for-Service	1033595202	1033595202	1	1	AGENCY PERSONAL CARE	3/24/2016	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	15205 YORK STREET	None	TUSTIN	CA	92782	1815	30	06059	33.71735883	-117.8243811	Orange County
57702	Fee-for-Service	1548432636	1548432636	1	1	ASLAM, KASHIF MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103057	41	Internal Medicine	0	In state provider	None	3288 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
57722	Fee-for-Service	1669039327	1669039327	1	3	A MIND ABOVE, A PROFESSIONAL	10/7/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1300 E. SHAW AVE.	SUITE 171	FRESNO	CA	93710	7911	10	06019	36.80872147	-119.765979	Fresno County
57730	Fee-for-Service	1548224546	1548224546	1	1	ABDUL RAHMAN HASAN, M.D.	9/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4000 HIGHLAND RD	STE 109	WATERFORD	MI	48328	2163	00	None	42.65002026	-83.36714366	Oakland County
57746	Fee-for-Service	1124220249	1124220249	2	1	ADVENTIST HEALTH MENDOCINO	7/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	721 RIVER DRIVE	SUITE A, B, C	FORT BRAGG	CA	95437	5403	23	06045	39.43204627	-123.801581	Mendocino County
57797	Fee-for-Service	1578127676	1578127676	1	2	A2Z TRANSIT INC	6/5/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1345 BROADWAY	None	EL CAJON	CA	92021	5811	37	06073	32.80768651	-116.934012	San Diego County
57817	Fee-for-Service	1598794596	1598794596	1	1	AUYEUNG, KARLA J MD	4/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141896	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	SC05	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
57825	Fee-for-Service	1154736429	1154736429	1	22	AVENAL COMMUNITY HEALTH CENT	6/10/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1000 SKYLINE BLVD	SUITE B	AVENAL	CA	93204	1850	16	06031	36.00790722	-120.1216067	Kings County
57837	Fee-for-Service	1811564479	1811564479	1	1	ASCADA HEALTH PC	4/15/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	301 W BASTANCHURY RD	220	FULLERTON	CA	92835	3424	30	06059	33.89397383	-117.9316737	Orange County
57842	Fee-for-Service	1760198394	1760198394	1	1	ADDAI, ROSEMARY	3/30/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	14664 STEALTH WAY	None	MORENO VALLEY	CA	92553	3514	33	06065	0	0	None
57861	Fee-for-Service	1922427327	1922427327	1	1	ARAYA, HIWOT H MD	8/26/2019	208M00000X	NA	Other	026	PHYSICIANS	141877	None	None	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
57867	Fee-for-Service	1023471091	1023471091	1	1	A GILBERT AND ASSOCIATES INC	10/6/2015	347C00000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1490 N MARCELLA AVE	None	RIALTO	CA	92376	3678	36	06071	34.12643136	-117.3634848	San Bernardino County
57888	Fee-for-Service	1801286695	1801286695	1	1	ADULT HOME HEALTH CARE LLC	1/23/2024	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	5013 GLEN ST	None	LA MESA	CA	91942	9531	37	06073	32.77014609	-117.0099341	San Diego County
57912	Fee-for-Service	1154736429	1154736429	1	10	AVENAL COMMUNITY HEALTH CENT	2/20/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	973 SEQUOIA AVE	None	LINDSAY	CA	93247	1426	54	06107	36.2151862	-119.0961292	Tulare County
57918	Fee-for-Service	1275174500	1275174500	1	1	ARIAS HOSPICE CARE INC	3/1/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2250 DOUGLAS BLVD	SUITE 135	ROSEVILLE	CA	95661	4290	31	06061	38.74418053	-121.2430005	Placer County
57940	Fee-for-Service	1669458485	1669458485	1	1	ADAM V RATNER, M.D.	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
57951	Fee-for-Service	1578745303	1578745303	1	1	ARC OF SAN DIEGO	11/29/1988	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CORTE MARIA HOUSE	368 CORTE MARIA AVE	None	CHULA VISTA	CA	91910	3136	37	06073	32.64162482	-117.0692995	San Diego County
57988	Fee-for-Service	1346288321	1346288321	1	1	ATLAS, THOMAS MD	1/1/1999	2085B0100X	NA	MRI Provider	026	PHYSICIANS	74535	30	Radiology	0	In state provider	None	155 SOLANO ST	None	CORNING	CA	96021	3511	52	06103	39.92779745	-122.1687508	Tehama County
57998	Fee-for-Service	1982870457	1982870457	1	1	ALEXEENKO, LADA MD	9/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140937	36	Psychiatry	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
58006	Fee-for-Service	1811984859	1811984859	1	1	ARNOLD, JERRY P MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35233	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 MADISON AVE	STE 11	CARMICHAEL	CA	95608	0645	34	06067	38.663028	-121.310271	Sacramento County
58022	Fee-for-Service	1578907085	1578907085	1	1	ANG, MICHAEL MD	8/11/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	132776	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
58031	Fee-for-Service	1326000324	1326000324	1	1	ALMOND, CHRISTOPHER S MD	2/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128501	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC: 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
58033	Fee-for-Service	1124220249	1124220249	2	1	ADVENTIST HEALTH MENDOCINO	7/1/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	721 RIVER DRIVE	SUITE A, B, C	FORT BRAGG	CA	95437	5403	23	06045	39.43204627	-123.801581	Mendocino County
58049	Fee-for-Service	1487136941	1487136941	1	1	AVETISYAN, ALLA A	12/13/2020	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
58061	Fee-for-Service	1487725792	1487725792	1	1	AVENSON, ROBERT L PHD	5/1/2012	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1035 SAN PABLO AVE	#5	ALBANY	CA	94706	2275	01	06001	37.88531142	-122.2973343	Alameda County
58062	Fee-for-Service	1710174818	1710174818	1	1	AHMC SAN GABRIEL VALLEY	12/22/2007	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER LP	438 W LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
58084	Fee-for-Service	1396771044	1396771044	1	1	AUJLA, BIMAL D MD	2/10/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	158567	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
58105	Fee-for-Service	1598794596	1598794596	1	1	AUYEUNG, KARLA J MD	4/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141896	10	Gastroenterology (M.D. only)	0	In state provider	None	9300 VALLEY CHILDRENS PL	SC05	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
58113	Fee-for-Service	1154736429	1154736429	1	22	AVENAL COMMUNITY HEALTH CENT	6/10/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1000 SKYLINE BLVD	SUITE B	AVENAL	CA	93204	1850	16	06031	36.00790722	-120.1216067	Kings County
58159	Fee-for-Service	1841411568	1841411568	1	1	AFARI, ARASH MD	5/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97866	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
58172	Fee-for-Service	1417009705	1417009705	1	1	AFTER HOUR PEDIATRICS URGENT	1/6/2021	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CARE CLINIC, INC.	210 BALDWIN AVE	None	SAN MATEO	CA	94401	3915	41	06081	37.56682977	-122.3257349	San Mateo County
58181	Fee-for-Service	1861711863	1861711863	1	4	AME MEDICAL GROUP, INC.	7/31/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	12472 WASHINGTON BLVD	B	WHITTIER	CA	90602	1005	19	06037	33.96774843	-118.0457572	Los Angeles County
58195	Fee-for-Service	1164849360	1164849360	1	1	AFRICA, LIA A A MD	8/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140919	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
58199	Fee-for-Service	1033678990	1033678990	1	1	AUERBACH, LAUREN J MD	7/1/2024	207P00000X	NA	Other	026	PHYSICIANS	191566	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
58200	Fee-for-Service	1154736429	1154736429	1	1	AVENAL COMMUNITY HEALTH CENT	9/18/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3554 W MT WHITNEY AVE	None	RIVERDALE	CA	93656	0000	10	06019	36.43083157	-119.8619557	Fresno County
58206	Fee-for-Service	1114230059	1114230059	1	1	AMIT GROVER	3/4/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1035 116TH AVE NE	None	BELLEVUE	WA	98004	4604	00	None	47.620296	-122.1856955	King County
58241	Fee-for-Service	1811605637	1811605637	1	1	ANZA WELLNESS AND RECOVERY	2/28/2024	101YM0800X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	350 E COMMERCIAL ROAD	STE 112	SAN BERNARDINO	CA	92408	3764	36	06071	34.05584763	-117.2773573	San Bernardino County
58267	Fee-for-Service	1467431122	1467431122	1	1	ADLER, SHARON G MD	8/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	35663	01	General Practice	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
58269	Fee-for-Service	1619995800	1619995800	1	1	ANAYA, JUAN P OD	11/5/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	14240 SAN PABLO AVE	None	SAN PABLO	CA	94806	3328	07	06013	37.96332885	-122.345488	Contra Costa County
58273	Fee-for-Service	1417912726	1417912726	1	1	ALI, MIR E MD	4/1/2001	207L00000X	NA	Other	026	PHYSICIANS	73147	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
58292	Fee-for-Service	1811984859	1811984859	1	1	ARNOLD, JERRY P MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35233	30	Radiology	0	In state provider	None	6600 MADISON AVE	STE 11	CARMICHAEL	CA	95608	0645	34	06067	38.663028	-121.310271	Sacramento County
58305	Fee-for-Service	1346530342	1346530342	1	1	ANGULO, MARCO A MD	6/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125066	01	General Practice	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
58311	Fee-for-Service	1942253596	1942253596	1	1	ANDREA C.HORNBUCKLE M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LANE	None	NORFOLK	VA	23507	0000	00	None	36.8619664	-76.30130371	Norfolk city
58349	Fee-for-Service	1922449081	1922449081	1	1	ALCHITS, EKATERINA E MD	8/27/2020	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
58354	Fee-for-Service	1861437683	1861437683	1	1	APPLE, SOPHIA K MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77815	None	None	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
58360	Fee-for-Service	1114202892	1114202892	1	1	ALVARADO EYE SURGERY CENTER	10/1/2011	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	1127 WILSHIRE BLVD	STE 1515	LOS ANGELES	CA	90017	4006	19	06037	34.05270508	-118.2641005	Los Angeles County
58362	Fee-for-Service	1558898437	1558898437	1	1	AMEZQUITA, JOEL MD	7/20/2021	207P00000X	NA	Other	026	PHYSICIANS	160319	None	None	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
58389	Fee-for-Service	1134324262	1134324262	1	1	AHIRE, VAISHALI S MD	12/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99338	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
58402	Fee-for-Service	1912665787	1912665787	1	1	AVEON HOME HEALTH, INC	11/13/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	655 N CENTRAL AVE	SUITE 1723	GLENDALE	CA	91203	1225	19	06037	34.15562424	-118.2579732	Los Angeles County
58404	Fee-for-Service	1831695428	1831695428	1	1	ABBASSI, PUYA DO	3/24/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	20734	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
58425	Fee-for-Service	1093761249	1093761249	1	1	ARENAS, MAGDALENA C MD	6/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	66947	41	Internal Medicine	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91109	7013	19	06037	34.133598	-118.1534895	Los Angeles County
58449	Fee-for-Service	1376602987	1376602987	1	1	ADAMS, BERNEVA J MD	8/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	43536	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
58456	Fee-for-Service	1689227225	1689227225	1	1	ALLEN, CLARA LMFT	7/18/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	350 E ST	STE 305	EUREKA	CA	95501	0378	12	06023	40.8030305	-124.1674522	Humboldt County
58486	Fee-for-Service	1154736429	1154736429	1	10	AVENAL COMMUNITY HEALTH CENT	6/9/2022	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	973 SEQUOIA AVE	None	LINDSAY	CA	93247	1426	54	06107	36.2151862	-119.0961292	Tulare County
58508	Fee-for-Service	1669402863	1669402863	1	1	AZARBAL, BABAK MD	1/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	72352	42	Nuclear Medicine	0	In state provider	None	15243 VANOWEN ST	STE 301	VAN NUYS	CA	91405	3646	19	06037	34.19394848	-118.4654115	Los Angeles County
58531	Fee-for-Service	1811605637	1811605637	1	1	ANZA WELLNESS AND RECOVERY	2/28/2024	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	26	Psychiatry (child)	0	In state provider	None	350 E COMMERCIAL ROAD	STE 112	SAN BERNARDINO	CA	92408	3764	36	06071	34.05584763	-117.2773573	San Bernardino County
58536	Fee-for-Service	1255395596	1255395596	2	1	A 1 HOME HEALTHCARE INC	5/1/2019	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	536 N EL CAMINO REAL	None	SAN CLEMENTE	CA	92672	4719	30	06059	33.42994637	-117.616771	Orange County
58545	Fee-for-Service	1437448834	1437448834	1	1	ALPHASCRIPT, INC	11/14/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	420 INDUSTRIAL RD	None	SAN CARLOS	CA	94070	6286	41	06081	37.51320239	-122.2595324	San Mateo County
58548	Fee-for-Service	1417058561	1417058561	1	1	ALCANTAR, JESSICA M LMFT	1/10/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	438 COLUSA AVE	A	YUBA CITY	CA	95991	4148	51	06101	39.14074601	-121.6172196	Sutter County
58555	Fee-for-Service	1467431122	1467431122	1	1	ADLER, SHARON G MD	8/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	35663	13	Neurology (M.D. only)	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
58556	Fee-for-Service	1922542612	1922542612	2	1	AVILA, ALEJANDRO A LMFT	5/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	45926 OASIS ST	None	INDIO	CA	92201	4559	33	06065	33.715512	-116.2207015	Riverside County
58573	Fee-for-Service	1588697478	1588697478	1	1	ACKLEY, HARRY A MD	7/15/1976	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	14161	40	Pediatrics	0	In state provider	None	1200 SONOMA AVE	None	SANTA ROSA	CA	95405	6664	49	06097	38.440854	-122.6985165	Sonoma County
58588	Fee-for-Service	1043373020	1043373020	1	1	ADIB-SAMII, TRACY A PHD	12/20/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2185 WEST GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
58593	Fee-for-Service	1588799670	1588799670	1	2	ARC IMPERIAL VALLEY #1	4/1/1984	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	709 S H ST	None	IMPERIAL	CA	92251	1848	13	06025	32.84081678	-115.5711768	Imperial County
58601	Fee-for-Service	1831279314	1831279314	1	1	APPEL, CURTIS MD	10/16/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	187160	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
58644	Fee-for-Service	1104262708	1104262708	1	1	ABE, BRIAN T MD	7/14/2020	207RR0500X	NA	Other	026	PHYSICIANS	132224	83	Rheumatology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
58648	Fee-for-Service	1144581497	1144581497	1	1	AGUILAR, MARIA S LCSW	11/7/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	76304	-	NOT APPLICABLE	0	In state provider	None	649 EAST ALBERTONI ST	SUITE 100	CARSON	CA	90746	1538	19	06037	33.87194399	-118.2643054	Los Angeles County
58655	Fee-for-Service	1023594850	1023594850	1	1	APPASANI, RAGHU K	12/5/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	164516	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
58667	Fee-for-Service	1013448224	1013448224	1	1	AMER, ADEEL Z MD	4/27/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	170863	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
58713	Fee-for-Service	1194588392	1194588392	1	1	ACUTE CARE ASSOCIATES OF CAL	3/1/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	IFORNIA PC	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	33	06065	33.5580705	-117.1835458	Riverside County
58737	Fee-for-Service	1942236617	1942236617	1	1	ADHIKARI, SRIKAR REDDY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
58753	Fee-for-Service	1619263597	1619263597	1	2	ALTAMED HEALTH SERVICES CORP	4/13/2022	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	10418 E VALLEY BLVD	SUITE A	EL MONTE	CA	91731	3600	19	06037	34.07647884	-118.0458956	Los Angeles County
58754	Fee-for-Service	1760011241	1760011241	1	1	ALALAMI, HUDA I MD	8/13/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
58766	Fee-for-Service	1841750767	1841750767	1	1	AGUILAR, JASMINE M CCC-SLP	4/4/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 S HAVEN AVE	SUITE 190	ONTARIO	CA	91761	2969	36	06071	34.046307	-117.576387	San Bernardino County
58776	Fee-for-Service	1154736429	1154736429	1	1	AVENAL COMMUNITY HEALTH CENT	9/18/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3554 W MT WHITNEY AVE	None	RIVERDALE	CA	93656	0000	10	06019	36.43083157	-119.8619557	Fresno County
58798	Fee-for-Service	1669402863	1669402863	1	1	AZARBAL, BABAK MD	1/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	72352	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	15243 VANOWEN ST	STE 301	VAN NUYS	CA	91405	3646	19	06037	34.19394848	-118.4654115	Los Angeles County
58819	Fee-for-Service	1811605637	1811605637	1	1	ANZA WELLNESS AND RECOVERY	2/28/2024	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	350 E COMMERCIAL ROAD	STE 112	SAN BERNARDINO	CA	92408	3764	36	06071	34.05584763	-117.2773573	San Bernardino County
58822	Fee-for-Service	1639616600	1639616600	1	1	ACCESS MYRX PHARMACY LLC	2/23/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9632 EMERALD OAK DR	None	ELK GROVE	CA	95624	2258	34	06067	38.407986	-121.379733	Sacramento County
58832	Fee-for-Service	1730647991	1730647991	1	2	AGUDAH, VICTORIA CNP	11/27/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95026136	-	NOT APPLICABLE	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
58840	Fee-for-Service	1225445497	1225445497	1	1	ARABYAN, MARIAM MD	10/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145650	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
58843	Fee-for-Service	1982191672	1982191672	1	1	ABOU-NASR, AYA MD	3/30/2022	390200000X	NA	Other	026	PHYSICIANS	163792	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
58854	Fee-for-Service	1023736493	1023736493	1	1	ABRX PHARMACY INC	10/25/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9791 LINCOLN VILLAGE DR	STE. E	SACRAMENTO	CA	95827	3326	34	06067	38.562219	-121.331466	Sacramento County
58930	Fee-for-Service	1104262708	1104262708	1	1	ABE, BRIAN T MD	7/14/2020	207RR0500X	NA	Other	026	PHYSICIANS	132224	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
58980	Fee-for-Service	1609946169	1609946169	1	1	ASHOURI, SHAHRYAR A MD	6/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87932	78	Neoplastic Diseases/Oncology	0	In state provider	None	220 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06541218	-118.4462792	Los Angeles County
58984	Fee-for-Service	1154736429	1154736429	1	25	AVENAL COMMUNITY HEALTH CENT	7/24/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1000 SKYLINE BLVD	STE C	AVENAL	CA	93204	1850	16	06031	36.00790722	-120.1216067	Kings County
58993	Fee-for-Service	1447746938	1447746938	1	1	AZUBUIKE, UGOCHI O NP	2/16/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
58998	Fee-for-Service	1578039129	1578039129	1	1	ADCOCK, ROBYN E LAC	10/22/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
59002	Fee-for-Service	1154736429	1154736429	1	20	AVENAL COMMUNITY HEALTH CENT	10/25/2021	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	191 E POLK ST	None	COALINGA	CA	93210	0000	10	06019	36.1365831	-120.3601669	Fresno County
59003	Fee-for-Service	1194588392	1194588392	1	2	ACUTE CARE ASSOCIATES OF CAL	3/1/2024	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	IFORNIA PC	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
59011	Fee-for-Service	1053338095	1053338095	1	1	ALFANDARY, VIVIANE D MD	12/31/1992	207R00000X	NA	Other	026	PHYSICIANS	77361	01	General Practice	0	In state provider	None	350 HAWTHORNE AVE	STE 2320	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
59018	Fee-for-Service	1972706083	1972706083	1	1	AMSTER, ROBERT C MD	3/12/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	34265	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 W ROWLAND ST	None	COVINA	CA	91723	2943	19	06037	34.078949	-117.8963031	Los Angeles County
59023	Fee-for-Service	1922505452	1922505452	1	1	ARROYO, PAOLA E LCSW	5/3/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
59063	Fee-for-Service	1154736429	1154736429	1	10	AVENAL COMMUNITY HEALTH CENT	10/22/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	973 SEQUOIA AVE	None	LINDSAY	CA	93247	1426	54	06107	36.2151862	-119.0961292	Tulare County
59087	Fee-for-Service	1700245115	1700245115	1	1	AHMED, MOHAMMED O MD	1/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152250	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
59098	Fee-for-Service	1659724490	1659724490	1	1	ARIAS, INGRID A	1/6/2017	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2700 N MAIN ST	SUITE 945	SANTA ANA	CA	92705	6678	30	06059	33.7737545	-117.8687284	Orange County
59104	Fee-for-Service	1811605637	1811605637	1	1	ANZA WELLNESS AND RECOVERY	2/28/2024	101YM0800X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	350 E COMMERCIAL ROAD	STE 112	SAN BERNARDINO	CA	92408	3764	36	06071	34.05584763	-117.2773573	San Bernardino County
59117	Fee-for-Service	1518037787	1518037787	2	1	ALA HLTHCR RESRCES, INC	3/27/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2808 METROPOLITAN PL	None	POMONA	CA	91767	1854	19	06037	34.09770152	-117.7525763	Los Angeles County
59150	Fee-for-Service	1679837108	1679837108	1	1	AWAD, PETER Y DPM	8/17/2023	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	18151 BEAR VALLEY RD	None	HESPERIA	CA	92345	4907	36	06071	34.47084429	-117.2672208	San Bernardino County
59178	Fee-for-Service	1609331370	1609331370	1	1	AKIN, SARAH G RCP	11/9/2021	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1777 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	39	06077	37.79735946	-121.2461325	San Joaquin County
59209	Fee-for-Service	1154736429	1154736429	1	15	AVENAL COMMUNITY HEALTH CENT	6/13/2022	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	229 W CHERRY AVE	None	PORTERVILLE	CA	93257	3401	54	06107	36.06917549	-119.0215574	Tulare County
59217	Fee-for-Service	1811186356	1811186356	1	1	ARREDONDO, SHELLEY A MD	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93952	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
59262	Fee-for-Service	1609946169	1609946169	1	1	ASHOURI, SHAHRYAR A MD	6/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87932	41	Internal Medicine	0	In state provider	None	220 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06541218	-118.4462792	Los Angeles County
59270	Fee-for-Service	1154736429	1154736429	1	25	AVENAL COMMUNITY HEALTH CENT	7/24/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1000 SKYLINE BLVD	STE C	AVENAL	CA	93204	1850	16	06031	36.00790722	-120.1216067	Kings County
59282	Fee-for-Service	1629747399	1629747399	1	1	ATKINSON, ERIN N LCSW	3/11/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
59288	Fee-for-Service	1194588392	1194588392	1	1	ACUTE CARE ASSOCIATES OF CAL	3/1/2024	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	IFORNIA PC	25500 MEDICAL CENTER DR	None	MURRIETA	CA	92562	5965	33	06065	33.5580705	-117.1835458	Riverside County
59290	Fee-for-Service	1154736429	1154736429	1	20	AVENAL COMMUNITY HEALTH CENT	6/8/2022	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	191 E POLK ST	None	COALINGA	CA	93210	0000	10	06019	36.1365831	-120.3601669	Fresno County
59291	Fee-for-Service	1154736429	1154736429	1	24	AVENAL COMMUNITY HEALTH CENT	8/15/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	581 W PUTNAM AVENUE	None	PORTERVILLE	CA	93257	3260	54	06107	36.0695765	-119.0301795	Tulare County
59297	Fee-for-Service	1801144142	1801144142	1	1	ADUCAYEN, PACITA R MD INC	10/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	49795	41	Internal Medicine	0	In state provider	None	2250 GLADSTONE DRIVE	SUITE 2	PITTSBURG	CA	94565	5124	07	06013	38.00610511	-121.8669076	Contra Costa County
59299	Fee-for-Service	1053338095	1053338095	1	1	ALFANDARY, VIVIANE D MD	12/31/1992	207R00000X	NA	Other	026	PHYSICIANS	77361	41	Internal Medicine	0	In state provider	None	350 HAWTHORNE AVE	STE 2320	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
59305	Fee-for-Service	1972706083	1972706083	1	1	AMSTER, ROBERT C MD	3/12/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	34265	08	Family Practice	0	In state provider	None	420 W ROWLAND ST	None	COVINA	CA	91723	2943	19	06037	34.078949	-117.8963031	Los Angeles County
59307	Fee-for-Service	1609178136	1609178136	1	1	ABE, SHOKO E MD	11/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132984	02	General Surgery	0	In state provider	None	3300 WEBSTER STREET	SUITE 212	OAKLAND	CA	94609	3120	01	06001	37.82132826	-122.2621843	Alameda County
59309	Fee-for-Service	1396264271	1396264271	1	1	ALBERT, JAN K CRNA	2/6/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
59324	Fee-for-Service	1528448198	1528448198	1	1	ASHBY-AHEARN, MARY P MD	10/5/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	160967	15	Obstetrics (D.O. only)	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
59328	Fee-for-Service	1366196784	1366196784	1	1	ARPELS HOME HEALTH, INC.	8/2/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4315 WOODMAN AVE	STE A	SHERMAN OAKS	CA	91423	3086	19	06037	34.148637	-118.4312565	Los Angeles County
59342	Fee-for-Service	1750575874	1750575874	1	1	AGREDANO DE MAREN0, Y	3/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96450	36	Psychiatry	0	In state provider	Z MD	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
59344	Fee-for-Service	1942474713	1942474713	1	1	ALIABADI, HAMIDREZA MD	3/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111988	14	Neurological Surgery	0	In state provider	None	1301 SECRET RAVINE PKWY	SUITE 200	ROSEVILLE	CA	95661	3102	31	06061	38.7634713	-121.2456577	Placer County
59352	Fee-for-Service	1154736429	1154736429	1	1	AVENAL COMMUNITY HEALTH CENT	12/1/2015	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	3554 W MT WHITNEY AVE	None	RIVERDALE	CA	93656	0000	10	06019	36.43083157	-119.8619557	Fresno County
59376	Fee-for-Service	1205431251	1205431251	1	1	ADVANTAGE HOME HEALTHCARE	1/26/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PROVIDER INC	15545 DEVONSHIRE ST	UNIT 111	MISSION HILLS	CA	91345	2687	19	06037	34.25734153	-118.4710734	Los Angeles County
59432	Fee-for-Service	1982629564	1982629564	1	1	ARONOW, HOWARD A MD	3/4/2004	207T00000X	NA	General Surgery	026	PHYSICIANS	46529	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA # B200	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
59472	Fee-for-Service	1932983012	1932983012	1	1	ADVENTIST HEALTH PHYSICIANS	3/22/2024	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	2950 SYCAMORE DR	200	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
59490	Fee-for-Service	1902033632	1902033632	1	1	ASADI, SARA MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139643	45	Nephrology (Renal-Kidney)	0	In state provider	None	11539 HAWTHORNE BLVD	6TH FL	HAWTHORNE	CA	90250	2325	19	06037	33.929352	-118.352747	Los Angeles County
59495	Fee-for-Service	1154736429	1154736429	1	15	AVENAL COMMUNITY HEALTH CENT	7/16/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	229 W CHERRY AVE	None	PORTERVILLE	CA	93257	3401	54	06107	36.06917549	-119.0215574	Tulare County
59552	Fee-for-Service	1023072816	1023072816	1	1	ARNAOUT, WALID S MD AMC	8/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	53180	01	General Practice	0	In state provider	None	7345 MEDICAL CENTER DR	STE 200	WEST HILLS	CA	91307	1953	19	06037	34.20369349	-118.629837	Los Angeles County
59555	Fee-for-Service	1609946169	1609946169	1	1	ASHOURI, SHAHRYAR A MD	6/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87932	77	Infectious Disease	0	In state provider	None	220 MEDICAL PLAZA	#365	LOS ANGELES	CA	90095	0001	19	06037	34.06541218	-118.4462792	Los Angeles County
59577	Fee-for-Service	1154736429	1154736429	1	24	AVENAL COMMUNITY HEALTH CENT	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	581 W PUTNAM AVENUE	None	PORTERVILLE	CA	93257	3260	54	06107	36.0695765	-119.0301795	Tulare County
59578	Fee-for-Service	1154736429	1154736429	1	20	AVENAL COMMUNITY HEALTH CENT	3/5/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	191 E POLK ST	None	COALINGA	CA	93210	0000	10	06019	36.1365831	-120.3601669	Fresno County
59579	Fee-for-Service	1194588392	1194588392	1	2	ACUTE CARE ASSOCIATES OF CAL	3/1/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	IFORNIA PC	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
59590	Fee-for-Service	1770718421	1770718421	1	1	ARMSTRONG, MATTHEW A MD	4/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
59593	Fee-for-Service	1811239304	1811239304	1	1	AIT RAIS, MARIA MD	12/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124306	41	Internal Medicine	0	In state provider	None	3687 MT DIABLO BLVD	STE 200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
59634	Fee-for-Service	1679568430	1679568430	1	1	AMERICAN AMBULANCE OF	10/6/1988	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	VISALIA	2017 E NOBLE AVE	None	VISALIA	CA	93292	1520	54	06107	36.32589	-119.270754	Tulare County
59641	Fee-for-Service	1154736429	1154736429	1	1	AVENAL COMMUNITY HEALTH CENT	10/15/2015	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	3554 W MT WHITNEY AVE	None	RIVERDALE	CA	93656	0000	10	06019	36.43083157	-119.8619557	Fresno County
59646	Fee-for-Service	1063592145	1063592145	1	1	ARMSTRONG, WILLIAM B MD	1/1/1993	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	66175	84	Surgery-Head and Neck	0	In state provider	None	101 CITY DR S	BLDG 25	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
59671	Fee-for-Service	1104195916	1104195916	1	1	AHERN, TERENCE L MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123764	None	None	0	In state provider	None	275 HOSPITAL DRIVE	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
59686	Fee-for-Service	1891701553	1891701553	1	1	ACKING, MARIE I LCSW	2/1/2003	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1305 FRANKLIN ST	STE 506	OAKLAND	CA	94612	3224	01	06001	37.80339088	-122.2702731	Alameda County
59711	Fee-for-Service	1417244930	1417244930	1	1	ARASE, AHREN A MD	1/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131675	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
59739	Fee-for-Service	1700475167	1700475167	1	1	AQUINO, ISABELLA	2/28/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
59776	Fee-for-Service	1902033632	1902033632	1	1	ASADI, SARA MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139643	41	Internal Medicine	0	In state provider	None	11539 HAWTHORNE BLVD	6TH FL	HAWTHORNE	CA	90250	2325	19	06037	33.929352	-118.352747	Los Angeles County
59777	Fee-for-Service	1154736429	1154736429	1	18	AVENAL COMMUNITY HEALTH CENT	6/13/2022	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	591 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3260	54	06107	36.06957649	-119.0302065	Tulare County
59781	Fee-for-Service	1154736429	1154736429	1	15	AVENAL COMMUNITY HEALTH CENT	7/16/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	229 W CHERRY AVE	None	PORTERVILLE	CA	93257	3401	54	06107	36.06917549	-119.0215574	Tulare County
59786	Fee-for-Service	1184928236	1184928236	1	1	ATONDO, ROSE LPCC	4/1/2021	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	212 1/2 LANE ST	None	YREKA	CA	96097	2915	47	06093	41.73040672	-122.6368507	Siskiyou County
59788	Fee-for-Service	1891115606	1891115606	1	1	ADLER, LISA D MD	8/15/2019	2084P0804X	NA	Psychiatry	026	PHYSICIANS	161206	36	Psychiatry	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
59820	Fee-for-Service	1902267479	1902267479	1	4	ALTAMED HEALTH SERVICES	1/3/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2560 TWEEDY BLVD	None	SOUTH GATE	CA	90280	5557	19	06037	33.94622844	-118.2248981	Los Angeles County
59838	Fee-for-Service	1023072816	1023072816	1	1	ARNAOUT, WALID S MD AMC	8/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	53180	02	General Surgery	0	In state provider	None	7345 MEDICAL CENTER DR	STE 200	WEST HILLS	CA	91307	1953	19	06037	34.20369349	-118.629837	Los Angeles County
59854	Fee-for-Service	1942771704	1942771704	1	1	ABELLANA, ARLENE B RCP	7/25/2020	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
59865	Fee-for-Service	1154736429	1154736429	1	20	AVENAL COMMUNITY HEALTH CENT	3/5/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	191 E POLK ST	None	COALINGA	CA	93210	0000	10	06019	36.1365831	-120.3601669	Fresno County
59869	Fee-for-Service	1659366292	1659366292	1	1	AMANI, RAMIN MD	9/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53984	40	Pediatrics	0	In state provider	INC	1907 APPLE ST	STE 8,9,10	OCEANSIDE	CA	92054	4442	37	06073	33.19467496	-117.3572223	San Diego County
59885	Fee-for-Service	1619105426	1619105426	1	1	ATABAKI, ALI MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136648	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1910 OUTLET CENTER DR	None	OXNARD	CA	93036	0677	56	06111	34.2202663	-119.1484221	Ventura County
59904	Fee-for-Service	1205408515	1205408515	1	1	AKHIMIEN, ANNE MD	10/10/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	183521	-	NOT APPLICABLE	0	In state provider	None	2150 N VICTORIA AVE	None	OXNARD	CA	93036	7791	56	06111	34.22559401	-119.2209704	Ventura County
59912	Fee-for-Service	1215901244	1215901244	1	1	ALLEN-BLAINE, ROBERT C	3/1/1999	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1717 E LINCOLN AVE	None	ANAHEIM	CA	92805	4345	30	06059	33.84023885	-117.8929264	Orange County
59933	Fee-for-Service	1063592145	1063592145	1	1	ARMSTRONG, WILLIAM B MD	1/1/1993	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	66175	04	Otology, Laryngology, Rhinology	0	In state provider	None	101 CITY DR S	BLDG 25	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
59936	Fee-for-Service	1437441524	1437441524	1	1	AKPENGBE, TONY A NP	10/26/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15720 VENTURA BLVD	SUITE 420	ENCINO	CA	91436	1000	19	06037	34.15524484	-118.4756687	Los Angeles County
59939	Fee-for-Service	1477518371	1477518371	1	1	AZIZ, NATALI MD	10/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	76358	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
59974	Fee-for-Service	1619107984	1619107984	1	1	ALLEN, CHARESE L M LCSW	4/21/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
59990	Fee-for-Service	1376883751	1376883751	1	1	AHN, PHILLIP C M D A MEDICAL	8/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	52241	13	Neurology (M.D. only)	0	In state provider	CORPORATION	520 S VIRGIL AVE	SUITE 205	LOS ANGELES	CA	90020	1425	19	06037	34.064487	-118.2870305	Los Angeles County
60004	Fee-for-Service	1891873667	1891873667	1	1	ABRAMSON, SCOTT A MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39478	13	Neurology (M.D. only)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
60055	Fee-for-Service	1134483332	1134483332	1	1	ALSHOUBI, ABDALHAI MD	7/9/2020	207L00000X	NA	Other	026	PHYSICIANS	168775	05	Anesthesiology	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
60060	Fee-for-Service	1508220377	1508220377	1	1	AVAKIAN, SABRINA MD	1/31/2020	390200000X	NA	Other	026	PHYSICIANS	151530	09	Gynecology (D.O. only)	0	In state provider	None	4700 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6082	19	06037	34.09812055	-118.2921165	Los Angeles County
60066	Fee-for-Service	1154736429	1154736429	1	18	AVENAL COMMUNITY HEALTH CENT	9/3/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	591 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3260	54	06107	36.06957649	-119.0302065	Tulare County
60067	Fee-for-Service	1902267479	1902267479	1	2	ALTAMED HEALTH SERVICES	4/26/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE	8627 ATLANTIC AVENUE	None	SOUTH GATE	CA	90280	3501	19	06037	33.95462085	-118.1838426	Los Angeles County
60072	Fee-for-Service	1598935009	1598935009	1	1	ASHERAH HOME & PALLIATIVE	7/10/2010	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	444 IRVING DR	None	BURBANK	CA	91504	2415	19	06037	34.20035367	-118.3274018	Los Angeles County
60073	Fee-for-Service	1881676823	1881676823	1	1	AMAR NATH, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 E UNIVERSITY AVE	None	DES MOINES	IA	50316	2302	00	None	41.60040747	-93.609657	Polk County
60108	Fee-for-Service	1902267479	1902267479	1	4	ALTAMED HEALTH SERVICES	1/3/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2560 TWEEDY BLVD	None	SOUTH GATE	CA	90280	5557	19	06037	33.94622844	-118.2248981	Los Angeles County
60112	Fee-for-Service	1932159530	1932159530	1	1	AFONICHEVA, LUDMILA W MD	7/16/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	81344	08	Family Practice	0	In state provider	None	2204 TORRANCE BLVD	STE 105	TORRANCE	CA	90501	0505	19	06037	33.83638629	-118.3217142	Los Angeles County
60136	Fee-for-Service	1568171783	1568171783	1	1	AN ANGEL GARDEN INC	8/4/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	9873 TRAVELER CT	None	ELK GROVE	CA	95624	4724	34	06067	38.398356	-121.347108	Sacramento County
60212	Fee-for-Service	1518226968	1518226968	1	1	ATTARI, ELHAM	2/24/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
60234	Fee-for-Service	1730696220	1730696220	1	1	ACOSTA, EMILIO CRNA	12/10/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
60283	Fee-for-Service	1063017317	1063017317	1	1	A-Z HOSPICE CARE 366D 247	2/4/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6356 VAN NUYS BLVD	STE 226	VAN NUYS	CA	91401	2627	19	06037	34.185861	-118.4487045	Los Angeles County
60297	Fee-for-Service	1053568030	1053568030	1	1	ADVANCED INTERVENTIONAL PAIN	6/3/2010	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	66008	25	Physical Medicine and Rehabilitation	0	In state provider	AND WELLNESS CENTER INC	4343 MARKET ST	STE C	RIVERSIDE	CA	92501	3567	33	06065	33.97734857	-117.3791849	Riverside County
60334	Fee-for-Service	1962580761	1962580761	1	1	APTAKER, RICHARD L DO	4/5/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	6050	25	Physical Medicine and Rehabilitation	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
60338	Fee-for-Service	1609376144	1609376144	1	1	ASSAF, RAYMEN R MD	6/13/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	146936	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
60352	Fee-for-Service	1154736429	1154736429	1	18	AVENAL COMMUNITY HEALTH CENT	9/3/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	591 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3260	54	06107	36.06957649	-119.0302065	Tulare County
60353	Fee-for-Service	1902267479	1902267479	1	2	ALTAMED HEALTH SERVICES	4/26/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MOBILE	8627 ATLANTIC AVENUE	None	SOUTH GATE	CA	90280	3501	19	06037	33.95462085	-118.1838426	Los Angeles County
60358	Fee-for-Service	1598814527	1598814527	1	1	AZUS, ALICE N OD	10/16/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
60360	Fee-for-Service	1316291503	1316291503	1	2	AUBURN ORTHOPEDIC & SPORTS P	10/20/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	HYSICAL THERAPY	565 BRUNSWICK RD	SUITE 4	GRASS VALLEY	CA	95945	9529	29	06057	39.23341432	-121.0294421	Nevada County
60365	Fee-for-Service	1184823494	1184823494	1	1	ALIZADEHSOVARI, ALI MD	5/18/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102067	41	Internal Medicine	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
60404	Fee-for-Service	1306913223	1306913223	1	1	ARAKAKI, CRAIG K	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	58465	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
60414	Fee-for-Service	1376102392	1376102392	1	1	ANGELS ON WHEELS LLC	8/23/2021	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	253 S LINCOLN WAY	None	GALT	CA	95632	1711	34	06067	38.25360421	-121.300748	Sacramento County
60423	Fee-for-Service	1154736429	1154736429	1	26	AVENAL COMMUNITY HEALTH CENT	8/24/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	781 SEQUOIA AVE	STE 4	LINDSAY	CA	93247	1448	54	06107	36.21240571	-119.0961081	Tulare County
60432	Fee-for-Service	1225336696	1225336696	1	1	ANELLO, MELANIE M NP	4/17/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
60440	Fee-for-Service	1821183559	1821183559	1	1	ALVAREZ, JORGE A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4411 MEDICAL DR	STE 300	SAN ANTONIO	TX	78229	3824	00	None	29.51000304	-98.57210273	Bexar County
60461	Fee-for-Service	1497817183	1497817183	2	2	AEGIS TREATMENT CENTERS, LLC	5/15/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	582, 584, 586, 588, & 59	None	CHICO	CA	95926	1817	04	06007	0	0	None
60509	Fee-for-Service	1790177582	1790177582	1	14	ALTAMED HEALTH SERVICES	12/16/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	10234 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2602	19	06037	33.90197379	-118.1144208	Los Angeles County
60533	Fee-for-Service	1427692375	1427692375	1	1	ALSTON, JADA CNP	4/18/2020	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
60558	Fee-for-Service	1558497263	1558497263	1	1	ARTHUR N DONALDSON MD IN	4/5/1989	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	SONORA EYE SURGERY CTR	940 SYLVA LN	STE G	SONORA	CA	95370	5969	55	06109	37.98764779	-120.3681842	Tuolumne County
60571	Fee-for-Service	1063017317	1063017317	1	1	A-Z HOSPICE CARE 366D 247	2/4/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6356 VAN NUYS BLVD	STE 226	VAN NUYS	CA	91401	2627	19	06037	34.185861	-118.4487045	Los Angeles County
60574	Fee-for-Service	1740397793	1740397793	1	1	APRIA HEALTHCARE LLC	10/21/1998	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1 LOWER RAGSDALE DR	STE 600	MONTEREY	CA	93940	5749	27	06053	36.57640687	-121.8192579	Monterey County
60576	Fee-for-Service	1316434236	1316434236	1	1	AHMADIEH, YASAMAN DO	7/17/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	21348	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
60588	Fee-for-Service	1346660727	1346660727	1	1	AWAR, LENA Z MD	8/24/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	139179	None	None	0	In state provider	None	315 N THIRD AVE	STE 207	COVINA	CA	91723	1915	19	06037	34.08873786	-117.8923869	Los Angeles County
60606	Fee-for-Service	1992002083	1992002083	1	1	ADVENTIST HEALTH PHYSICIANS	3/30/2011	208600000X	NA	General Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	15322 LAKESHORE DR	STE 203	ST HELENA	CA	94574	0000	28	06055	0	0	None
60611	Fee-for-Service	1609141910	1609141910	1	1	ALONSO-JECKELL, YAIMA MD	5/3/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	144674	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
60622	Fee-for-Service	1962580761	1962580761	1	1	APTAKER, RICHARD L DO	4/5/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	6050	01	General Practice	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
60673	Fee-for-Service	1437499712	1437499712	1	1	ADVENTIST HEALTH PHYSICIANS	2/6/2019	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	821 ST HELENA HWY S	STE 2	SAINT HELENA	CA	94574	2266	28	06055	38.48731402	-122.448269	Napa County
60688	Fee-for-Service	1528057585	1528057585	1	1	ANDREW J ONDRACEK, MD	12/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9201 W THOMAS RD	None	PHOENIX	AZ	85037	0000	00	None	33.47892	-112.2579	Maricopa County
60691	Fee-for-Service	1306913223	1306913223	1	1	ARAKAKI, CRAIG K	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	58465	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
60711	Fee-for-Service	1154736429	1154736429	1	26	AVENAL COMMUNITY HEALTH CENT	8/24/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	781 SEQUOIA AVE	STE 4	LINDSAY	CA	93247	1448	54	06107	36.21240571	-119.0961081	Tulare County
60731	Fee-for-Service	1942353560	1942353560	1	1	ARMSTRONG, RACHEL M LCSW	12/18/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVENUE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
60742	Fee-for-Service	1073844304	1073844304	1	1	ALCANTARA, TERESA I B CRNA	12/8/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
60748	Fee-for-Service	1497817183	1497817183	2	2	AEGIS TREATMENT CENTERS, LLC	5/15/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	582, 584, 586, 588, & 59	None	CHICO	CA	95926	1817	04	06007	0	0	None
60778	Fee-for-Service	1386746832	1386746832	1	1	APPLIED MEDICALS, LLC	11/4/2012	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	20 S E 3RD AVE	FLOOR 3	MIAMI	FL	33131	1703	00	None	25.77405074	-80.18901898	Miami-Dade County
60794	Fee-for-Service	1790177582	1790177582	1	14	ALTAMED HEALTH SERVICES	12/16/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	10234 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2602	19	06037	33.90197379	-118.1144208	Los Angeles County
60811	Fee-for-Service	1558473272	1558473272	2	1	ADVENT HEALTHCARE SERVICES	3/17/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	3333 S BREA CANYON RD	SUITE 123	DIAMOND BAR	CA	91765	3783	19	06037	33.96679922	-117.8485622	Los Angeles County
60825	Fee-for-Service	1639305295	1639305295	1	1	ADUSUMALLI, SUNDEEP MD	11/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141235	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
60836	Fee-for-Service	1306015425	1306015425	1	3	ALTAMED HEALTH SERVICES CORP	5/24/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	8902 HEWITT PLACE	None	GARDEN GROVE	CA	92844	2630	30	06059	33.76183853	-117.97335	Orange County
60840	Fee-for-Service	1124097043	1124097043	1	1	ANDHAVARAPU, GIRIDHAR MD	2/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102374	40	Pediatrics	0	In state provider	None	1524 W LACEY BLVD	SUITE 105	HANFORD	CA	93230	5968	16	06031	36.32816338	-119.6690189	Kings County
60865	Fee-for-Service	1508494832	1508494832	1	1	AZAM, SAIF MD	10/1/2023	390200000X	NA	Other	026	PHYSICIANS	183307	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
60896	Fee-for-Service	1548203912	1548203912	4	1	ACCESS HEALTHCARE SERVICES &	10/23/2017	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	SUPPLIES LLC	931 MARINA WAY SOUTH	SUITE C	RICHMOND	CA	94804	3457	07	06013	37.918881	-122.355947	Contra Costa County
60905	Fee-for-Service	1922688464	1922688464	1	1	ABAYA GHAZALEH, HYDEE MD	9/13/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
60910	Fee-for-Service	1902325467	1902325467	1	1	ANDERSON, CHANCE R	10/26/2022	207P00000X	NA	Other	026	PHYSICIANS	177385	None	None	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
60911	Fee-for-Service	1417934670	1417934670	1	1	AHN, MARK M MD	5/10/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	81655	05	Anesthesiology	0	In state provider	None	201 NEW STINE RD	STE 130	BAKERSFIELD	CA	93309	2659	15	06029	35.352801	-119.0612865	Kern County
60932	Fee-for-Service	1265960215	1265960215	1	1	ANESTHESIOLOGY SPECIALISTS O	9/18/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OF CALIFORNIA	31700 TEMECULA PARKWAY	None	TEMECULA	CA	92592	5896	33	06065	33.481134	-117.1060515	Riverside County
60934	Fee-for-Service	1558495135	1558495135	1	1	AGUILAR, OLGA A LMFT	11/2/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5027 EAGLE ROCK BLVD	None	LOS ANGELES	CA	90041	1923	19	06037	34.13797666	-118.2145087	Los Angeles County
60951	Fee-for-Service	1871619601	1871619601	1	1	ABOUZEID, AHMED R MD	11/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
60960	Fee-for-Service	1124413182	1124413182	1	1	AVILA, ALFONSO DO	2/27/2020	207P00000X	NA	Other	026	PHYSICIANS	15338	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
60968	Fee-for-Service	1952620346	1952620346	1	1	AVILA, CRIS LMFT	1/22/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
60977	Fee-for-Service	1043573785	1043573785	1	1	ANTOUN, DAVID A G MD	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137117	41	Internal Medicine	0	In state provider	None	4002 VISTA WY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
60985	Fee-for-Service	1144598467	1144598467	1	1	ADVANCEMENT FOR BEHAVIORAL &	5/11/2020	103K00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	315 CENTENNIAL WAY	None	TUSTIN	CA	92780	3714	30	06059	33.743016	-117.8188045	Orange County
60995	Fee-for-Service	1154736429	1154736429	1	27	AVENAL COMMUNITY HEALTH CENT	5/14/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE	555 E STREET	None	LEMOORE	CA	93245	2617	16	06031	36.30217833	-119.7891683	Kings County
61008	Fee-for-Service	1578030953	1578030953	1	1	ARTINYAN, EDMON G PSYD	4/17/2020	103TH0004X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	30423 CANWOOD ST	SUITE 138	AGOURA HILLS	CA	91301	4315	19	06037	34.14710182	-118.7842501	Los Angeles County
61014	Fee-for-Service	1285028191	1285028191	1	1	ANDERSON, KENDELL R DO	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15598	41	Internal Medicine	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
61015	Fee-for-Service	1578740874	1578740874	1	1	ALHUSHKI, WASEEM S MD	9/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	68	Hematology	1	Border provider	None	3121 S MARYLAND PKWY	STE 300	LAS VEGAS	NV	89109	2302	00	None	36.13284	-115.136929	Clark County
61022	Fee-for-Service	1285154807	1285154807	1	1	ABID, ARIANA N MD	9/24/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	167020	None	None	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
61028	Fee-for-Service	1073675385	1073675385	1	1	ALIANZA MEDICAL CENTER	6/10/1997	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INC	6907 SEVILLE AVE	None	HUNTINGTON PARK	CA	90255	4901	19	06037	33.97664362	-118.2225466	Los Angeles County
61073	Fee-for-Service	1114442621	1114442621	1	1	ABU-GHANEM, SARA MD	8/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
61110	Fee-for-Service	1952355562	1952355562	1	1	ARMIJO, JAVIER A MD	3/31/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	74634	01	General Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
61112	Fee-for-Service	1639305295	1639305295	1	1	ADUSUMALLI, SUNDEEP MD	11/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141235	41	Internal Medicine	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3031	19	06037	34.07771682	-117.7485431	Los Angeles County
61123	Fee-for-Service	1306015425	1306015425	1	3	ALTAMED HEALTH SERVICES CORP	5/24/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	8902 HEWITT PLACE	None	GARDEN GROVE	CA	92844	2630	30	06059	33.76183853	-117.97335	Orange County
61145	Fee-for-Service	1902267479	1902267479	1	1	ALTAMED HEALTH SERVICES	4/27/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	8627 ATLANTIC AVENUE	None	SOUTH GATE	CA	90280	3501	19	06037	33.95462085	-118.1838426	Los Angeles County
61161	Fee-for-Service	1013379387	1013379387	1	1	ARTHUR, JAYMESON MD	9/27/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	178474	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
61171	Fee-for-Service	1265609671	1265609671	1	1	ALAMGIR, MOHAMMAD A MD	9/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103636	41	Internal Medicine	0	In state provider	None	3551 Q ST	STE 100	BAKERSFIELD	CA	93301	1658	15	06029	35.392059	-119.010556	Kern County
61176	Fee-for-Service	1457403263	1457403263	1	1	AYE, SWE S W MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	56124	41	Internal Medicine	0	In state provider	None	770 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5491	43	06085	37.43378232	-121.8920598	Santa Clara County
61242	Fee-for-Service	1245694017	1245694017	1	1	AVILA, HUMBERTO MD	4/26/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	154080	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
61244	Fee-for-Service	1376167106	1376167106	1	1	AMOS, LESLIE LCSW	2/6/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	121 S PALM CANYON DR	SUITE 217	PALM SPRINGS	CA	92262	6378	33	06065	33.822774	-116.5468275	Riverside County
61249	Fee-for-Service	1316131832	1316131832	1	1	ANDER, AZIZ N	11/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	118000	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
61252	Fee-for-Service	1891129839	1891129839	1	1	ANDERSON, COREY D MD	11/26/2024	367500000X	NA	Other	026	PHYSICIANS	192246	05	Anesthesiology	0	In state provider	None	465 PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
61266	Fee-for-Service	1104454446	1104454446	1	1	ACOSTA, JOSE	8/22/2023	207P00000X	NA	Other	026	PHYSICIANS	185406	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
61277	Fee-for-Service	1003918459	1003918459	1	1	ABAYA, CONSTANTE MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	24454	41	Internal Medicine	0	In state provider	None	1200 N VENTURA RD	STE C	OXNARD	CA	93030	3827	56	06111	34.21435634	-119.1943831	Ventura County
61285	Fee-for-Service	1154736429	1154736429	1	27	AVENAL COMMUNITY HEALTH CENT	5/14/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MOBILE	555 E STREET	None	LEMOORE	CA	93245	2617	16	06031	36.30217833	-119.7891683	Kings County
61299	Fee-for-Service	1578740874	1578740874	1	1	ALHUSHKI, WASEEM S MD	9/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	78	Neoplastic Diseases/Oncology	1	Border provider	None	3121 S MARYLAND PKWY	STE 300	LAS VEGAS	NV	89109	2302	00	None	36.13284	-115.136929	Clark County
61308	Fee-for-Service	1194995563	1194995563	1	1	ALDRICH, KATHARINE D CNW	4/27/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
61346	Fee-for-Service	1982876082	1982876082	1	1	ALKAYED, KHALDOUN J MD	8/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134720	40	Pediatrics	0	In state provider	None	311 WEST I STREET	None	LOS BANOS	CA	93635	3479	24	06047	37.06343055	-120.8570545	Merced County
61349	Fee-for-Service	1144883521	1144883521	1	1	AGARWAL, AARTI MD	5/24/2024	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
61381	Fee-for-Service	1043612831	1043612831	1	1	AYABE, REED I MD	9/25/2024	208600000X	NA	General Surgery	026	PHYSICIANS	138818	02	General Surgery	0	In state provider	None	101 CITY DR S	# B10	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
61385	Fee-for-Service	1972553576	1972553576	1	1	ABRISHAMI, BABAK B DO	8/1/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	7450	None	None	0	In state provider	None	933 CENTINELA AVENUE	STE B	INGLEWOOD	CA	90302	1501	19	06037	33.97609809	-118.356369	Los Angeles County
61414	Fee-for-Service	1720407034	1720407034	1	1	ABSI, MICHELLE LMFT	7/18/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
61419	Fee-for-Service	1588964969	1588964969	1	1	ALLEN, KAREN M PHD	12/15/2014	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9550 WARNER AVE	SUITE 250-20	FOUNTAIN VALLEY	CA	92708	2800	30	06059	33.71597354	-117.9624555	Orange County
61433	Fee-for-Service	1902267479	1902267479	1	1	ALTAMED HEALTH SERVICES	4/27/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	8627 ATLANTIC AVENUE	None	SOUTH GATE	CA	90280	3501	19	06037	33.95462085	-118.1838426	Los Angeles County
61467	Fee-for-Service	1255539748	1255539748	1	1	ADAM JEFFERS MD	6/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
61537	Fee-for-Service	1316131832	1316131832	1	1	ANDER, AZIZ N	11/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	118000	13	Neurology (M.D. only)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
61565	Fee-for-Service	1104952647	1104952647	1	1	ARKIND, CHRISTOPHER R MD	7/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89683	05	Anesthesiology	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
61611	Fee-for-Service	1861962516	1861962516	1	1	ANDREW IMPARATO INC	4/18/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	None	None	0	In state provider	None	255 LAGUNA RD	None	FULLERTON	CA	92835	2515	30	06059	33.89613386	-117.9305457	Orange County
61651	Fee-for-Service	1235971516	1235971516	1	1	ANDREW WANG MD INC	8/21/2024	2086S0127X	NA	General Surgery	026	PHYSICIANS	None	89	Surgery-Traumatic	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3195	27	06053	36.696987	-121.633164	Monterey County
61673	Fee-for-Service	1316057854	1316057854	1	1	APRIA HEALTHCARE LLC	12/19/2000	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	None	1395 GREG ST	STE 113	SPARKS	NV	89431	6063	00	None	39.52224	-119.7609565	Washoe County
61679	Fee-for-Service	1467803759	1467803759	1	1	ARTHUR, WILLIAM P DPM	7/23/2019	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
61695	Fee-for-Service	1043478563	1043478563	1	1	ALCALA, ANNA B LMFT	9/3/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	155 GRANADA ST	STE I	CAMARILLO	CA	93010	7725	56	06111	34.21527102	-119.0535007	Ventura County
61720	Fee-for-Service	1902267479	1902267479	1	1	ALTAMED HEALTH SERVICES	7/3/2017	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	8627 ATLANTIC AVENUE	None	SOUTH GATE	CA	90280	3501	19	06037	33.95462085	-118.1838426	Los Angeles County
61736	Fee-for-Service	1538354139	1538354139	1	1	ALT, RACHEL S MD	6/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125320	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1165 MONTGOMERY DRIVE	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
61751	Fee-for-Service	1174545651	1174545651	1	1	ARSLANIAN, ZAVEN M MD	12/21/1994	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	53792	01	General Practice	0	In state provider	ARSLANIAN MEDICAL CLINIC	908 S CENTRAL AVENUE	None	GLENDALE	CA	91204	2005	19	06037	34.135425	-118.257844	Los Angeles County
61795	Fee-for-Service	1366716623	1366716623	1	1	ADVANCED SLEEP MEDICINE SRVS	7/3/2018	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2420 VISTA WAY	SUITE 115	OCEANSIDE	CA	92045	6190	37	06073	33.18323517	-117.3361196	San Diego County
61846	Fee-for-Service	1588752687	1588752687	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	655 14TH ST	None	SAN DIEGO	CA	92101	7584	37	06073	32.7120814	-117.1518881	San Diego County
61872	Fee-for-Service	1841479573	1841479573	1	1	ADVANCED BIONICS, LLC	3/10/2009	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	28515 WESTINGHOUSE PLACE	None	VALENCIA	CA	91355	1398	19	06037	34.44267168	-118.6009042	Los Angeles County
61882	Fee-for-Service	1285976431	1285976431	1	1	AHMED, KHWAJA A	7/17/2019	390200000X	NA	Other	026	PHYSICIANS	135436	30	Radiology	0	In state provider	None	4640 ADMIRALTY WAY	STE 102	MARINA DEL REY	CA	90292	6629	19	06037	33.98120707	-118.4409729	Los Angeles County
61900	Fee-for-Service	1568960565	1568960565	1	1	ADVENTIST HEALTH PHYSICIANS	9/18/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	414 G ST	STE 208	MARYSVILLE	CA	95901	5669	58	06115	39.13913942	-121.5934649	Yuba County
61925	Fee-for-Service	1629277967	1629277967	1	1	ALESHI, PEDRAM MD	8/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100024	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
61938	Fee-for-Service	1235971516	1235971516	1	1	ANDREW WANG MD INC	8/21/2024	2086S0127X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3195	27	06053	36.696987	-121.633164	Monterey County
61940	Fee-for-Service	1760970255	1760970255	1	1	ACUPUNCTURE&CHIROPRACTIC CEN	6/24/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	TER OF ESCONDIDO PROFESS	1733 SOUTH ESCONDIDO BLV	None	ESCONDIDO	CA	92025	6519	37	06073	33.10401451	-117.0726812	San Diego County
61956	Fee-for-Service	1790177582	1790177582	1	5	ALTAMED HEALTH SERVICES	4/17/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	5909 LILLIAN STREET	None	LOS ANGELES	CA	90001	1433	19	06037	33.98633995	-118.2399345	Los Angeles County
61959	Fee-for-Service	1447805486	1447805486	1	1	ANCHETA, STEPHEN J PT	7/7/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
61991	Fee-for-Service	1093061442	1093061442	1	1	ANCHETA, KIMBERLY P MD	12/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123765	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
61992	Fee-for-Service	1386782035	1386782035	1	1	ALLAN, CINDYLOU B	6/15/2005	163W00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	563 BASCULE WAY	None	OAKDALE	CA	95361	9382	50	06099	37.74694738	-120.8796576	Stanislaus County
62074	Fee-for-Service	1811926603	1811926603	1	1	ASH HOLDINGS, LLC	10/19/1999	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	REDLANDS HEALTHCARE CTR	1620 W FERN AVE	None	REDLANDS	CA	92373	4918	36	06071	34.03703172	-117.2030882	San Bernardino County
62091	Fee-for-Service	1215540869	1215540869	1	1	ANDERSON, PAUL RCP	7/2/2021	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	280 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
62145	Fee-for-Service	1154736429	1154736429	1	16	AVENAL COMMUNITY HEALTH CENT	9/17/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	781 SEQUOIA AVE	SUITE 3	LINDSAY	CA	93247	1448	54	06107	36.21240571	-119.0961081	Tulare County
62150	Fee-for-Service	1073973129	1073973129	1	2	A.K. BEAN FOUNDATION	3/12/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	600 NUT TREE ROAD	SUITE 240	VACAVILLE	CA	95687	4686	48	06095	38.36133624	-121.9496789	Solano County
62176	Fee-for-Service	1629215074	1629215074	1	1	AGUILAR, HOLLY A MD	4/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126924	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
62196	Fee-for-Service	1285831602	1285831602	1	1	ABBOTT, CHAD M MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118223	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
62215	Fee-for-Service	1174765952	1174765952	1	1	ARMSTRONG, THEODORE N MD	7/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113222	66	Emergency Medicine (Urgent Care)	0	In state provider	None	207 WEST LEGION ROAD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
62217	Fee-for-Service	1740778398	1740778398	1	1	ALHURANI, RABE MD	9/20/2022	207R00000X	NA	Other	026	PHYSICIANS	174826	None	None	0	In state provider	None	12998 HESPERIA RD	101	VICTORVILLE	CA	92395	8316	36	06071	34.48789715	-117.2906992	San Bernardino County
62244	Fee-for-Service	1790177582	1790177582	1	5	ALTAMED HEALTH SERVICES	4/17/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	5909 LILLIAN STREET	None	LOS ANGELES	CA	90001	1433	19	06037	33.98633995	-118.2399345	Los Angeles County
62261	Fee-for-Service	1790430007	1790430007	1	1	ANY-TIME HOME HEALTH CARE	7/29/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	14531 HAMLIN ST	STE 115	VAN NUYS	CA	91411	1627	19	06037	34.18870941	-118.449902	Los Angeles County
62280	Fee-for-Service	1386782035	1386782035	1	1	ALLAN, CINDYLOU B	6/15/2005	163W00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	563 BASCULE WAY	None	OAKDALE	CA	95361	9382	50	06099	37.74694738	-120.8796576	Stanislaus County
62284	Fee-for-Service	1962932566	1962932566	1	1	AVONDALE HME	8/21/2017	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2020 CAMINO DEL RIO NORT	STE 205	SAN DIEGO	CA	92108	1542	37	06073	32.77020579	-117.1423463	San Diego County
62364	Fee-for-Service	1720026305	1720026305	1	1	AYE, TANDY MD	6/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95092	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
62380	Fee-for-Service	1801202676	1801202676	1	1	ANPHON CORPORATION	7/1/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	333 E NUTWOOD STREET	SUITE C	INGLEWOOD	CA	90301	2357	19	06037	33.96053226	-118.3506276	Los Angeles County
62402	Fee-for-Service	1689210783	1689210783	1	1	ANGEL HOSPICE SERVICE INC	9/17/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6850 VAN NUYS BLVD	STE 320	VAN NUYS	CA	91405	4629	19	06037	34.195401	-118.4487235	Los Angeles County
62405	Fee-for-Service	1952795239	1952795239	1	1	ASIS, MARLO G MD	2/10/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	159516	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
62411	Fee-for-Service	1295260529	1295260529	1	1	ABDULMAULA, MAJDI L MD	7/23/2020	207R00000X	NA	Other	026	PHYSICIANS	169175	41	Internal Medicine	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
62412	Fee-for-Service	1952307720	1952307720	1	1	ARORA, RAVINDER K MD	4/27/1999	2085R0001X	NA	Other	026	PHYSICIANS	36088	41	Internal Medicine	0	In state provider	None	13847 E 14TH ST	STE 217	SAN LEANDRO	CA	94578	2626	01	06001	37.71457844	-122.1418551	Alameda County
62425	Fee-for-Service	1205880408	1205880408	1	1	ALINO, MARIA A MD	3/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	49574	40	Pediatrics	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
62433	Fee-for-Service	1154736429	1154736429	1	16	AVENAL COMMUNITY HEALTH CENT	10/25/2021	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	781 SEQUOIA AVE	SUITE 3	LINDSAY	CA	93247	1448	54	06107	36.21240571	-119.0961081	Tulare County
62442	Fee-for-Service	1407061930	1407061930	1	1	ALTAMED HEALTH SVS CORP	11/1/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3820 MARTIN LUTHER KING	None	LYNWOOD	CA	90262	3625	19	06037	33.92760854	-118.1976943	Los Angeles County
62446	Fee-for-Service	1487230843	1487230843	1	1	AU, CHRISTINE CNP	1/4/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
62474	Fee-for-Service	1669628319	1669628319	2	1	ALOMARI, IHAB B MD	1/24/2022	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	127175	None	None	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
62512	Fee-for-Service	1790177582	1790177582	1	13	ALTAMED HEALTH SERVICES	12/9/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	6811 EASTERN AVENUE	None	BELL GARDENS	CA	90201	3901	19	06037	33.97121126	-118.1643921	Los Angeles County
62514	Fee-for-Service	1437121605	1437121605	1	1	ABBAN, CECILIA W NP	10/9/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43112 N 15TH STREET	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
62532	Fee-for-Service	1336557602	1336557602	1	1	ASHLI HEALTHCARE INC	7/7/2020	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	9484 CHESAPEAKE DRIVE	807	SAN DIEGO	CA	92123	1028	37	06073	32.836725	-117.1243005	San Diego County
62555	Fee-for-Service	1447231329	1447231329	1	1	ALI, AARON A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3705 MEDICAL PKWY	STE 570	AUSTIN	TX	78705	1024	00	None	30.30500791	-97.74430984	Travis County
62598	Fee-for-Service	1801864269	1801864269	1	1	AREVIAN, SARKIS T MD	10/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	26549	36	Psychiatry	0	In state provider	None	4525 ATHERTON	None	LONG BEACH	CA	90815	3700	19	06037	33.78988246	-118.1397653	Los Angeles County
62600	Fee-for-Service	1205131422	1205131422	1	1	AHMAD, AMNA MD	8/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122843	30	Radiology	0	In state provider	None	9394 BIG HORN BLVD	None	ELK GROVE	CA	95758	7977	34	06067	38.420028	-121.40712	Sacramento County
62631	Fee-for-Service	1154736429	1154736429	1	5	AVENAL COMMUNITY HEALTH CENT	9/19/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1320 BAILEY DR	SUITE 102	HANFORD	CA	93230	4378	16	06031	36.32737153	-119.665747	Kings County
62643	Fee-for-Service	1871741082	1871741082	1	1	ABILITY PATHWAYS INC	11/30/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1890 W ARROW ROUTE	None	UPLAND	CA	91786	4280	36	06071	34.0995605	-117.6873795	San Bernardino County
62657	Fee-for-Service	1720026305	1720026305	1	1	AYE, TANDY MD	6/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95092	67	Endocrinology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
62666	Fee-for-Service	1801202676	1801202676	1	1	ANPHON CORPORATION	7/1/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	333 E NUTWOOD STREET	SUITE C	INGLEWOOD	CA	90301	2357	19	06037	33.96053226	-118.3506276	Los Angeles County
62678	Fee-for-Service	1932127578	1932127578	1	3	AMERICAN MEDICAL RESPONSE	2/16/2017	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	WEST	1255 TRIANGLE COURT	None	WEST SACRAMENTO	CA	95605	2343	57	06113	38.58762329	-121.5314663	Yolo County
62686	Fee-for-Service	1689210783	1689210783	1	1	ANGEL HOSPICE SERVICE INC	9/17/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6850 VAN NUYS BLVD	STE 320	VAN NUYS	CA	91405	4629	19	06037	34.195401	-118.4487235	Los Angeles County
62720	Fee-for-Service	1154736429	1154736429	1	16	AVENAL COMMUNITY HEALTH CENT	9/17/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	781 SEQUOIA AVE	SUITE 3	LINDSAY	CA	93247	1448	54	06107	36.21240571	-119.0961081	Tulare County
62722	Fee-for-Service	1003111519	1003111519	1	1	ALREZK, RAMI MD	2/25/2020	207RE0101X	NA	Endocrinology	026	PHYSICIANS	118224	67	Endocrinology	0	In state provider	None	2510 AIRPARK DR	STE 301	REDDING	CA	96001	2462	45	06089	40.57119566	-122.4016582	Shasta County
62725	Fee-for-Service	1316102833	1316102833	1	1	AZAR, BABAK P MD	1/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123166	36	Psychiatry	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
62730	Fee-for-Service	1407061930	1407061930	1	1	ALTAMED HEALTH SVS CORP	11/1/2002	171M00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3820 MARTIN LUTHER KING	None	LYNWOOD	CA	90262	3625	19	06037	33.92760854	-118.1976943	Los Angeles County
62798	Fee-for-Service	1790177582	1790177582	1	13	ALTAMED HEALTH SERVICES	12/9/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	6811 EASTERN AVENUE	None	BELL GARDENS	CA	90201	3901	19	06037	33.97121126	-118.1643921	Los Angeles County
62819	Fee-for-Service	1285215129	1285215129	1	1	AILI HOME HEALTH AGENCY INC	4/20/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2626 FOOTHILL BLVD	STE 290	LA CRESCENTA	CA	91214	4570	19	06037	34.22187547	-118.2363189	Los Angeles County
62822	Fee-for-Service	1669438842	1669438842	1	1	ANTONIN JAROS MD	10/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9225 N 3RD ST	STE 304	PHOENIX	AZ	85020	2466	00	None	33.57054	-112.0692465	Maricopa County
62839	Fee-for-Service	1720072374	1720072374	1	1	AG LAGUNA HILLS, LLC	10/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	24452 HEALTH CENTER DR	None	LAGUNA HILLS	CA	92653	3604	30	06059	33.60743243	-117.7081139	Orange County
62864	Fee-for-Service	1750868741	1750868741	1	1	ANGHELUS, LAURA N NP	4/18/2022	282N00000X	NA	Hospitals	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1211 W LA PALMA AVE	STE 207	ANAHEIM	CA	92801	2139	30	06059	33.84718298	-117.933758	Orange County
62875	Fee-for-Service	1225867633	1225867633	1	1	ANDES, ALICE OT	12/30/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	39650 LIBERTY ST	SUITE 140	FREMONT	CA	94538	2225	01	06001	37.54662058	-121.9736002	Alameda County
62917	Fee-for-Service	1154736429	1154736429	1	5	AVENAL COMMUNITY HEALTH CENT	9/19/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1320 BAILEY DR	SUITE 102	HANFORD	CA	93230	4378	16	06031	36.32737153	-119.665747	Kings County
62919	Fee-for-Service	1417669219	1417669219	1	1	ANGELA CHIANG MEDICAL GROUP	3/14/2023	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	INC.	525 N GARFIELD AVE	None	MONTEREY PARK	CA	91801	1205	19	06037	34.06794352	-118.1229278	Los Angeles County
62928	Fee-for-Service	1710065420	1710065420	1	1	ANZAI, ALAN K MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	77199	08	Family Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
62945	Fee-for-Service	1841558186	1841558186	1	1	APATIRA, LATIFAT T MD	10/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118881	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
62948	Fee-for-Service	1336519404	1336519404	1	1	AHMADI, MONA PHD	8/23/2016	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	44407 10TH STREET WEST	None	LANCASTER	CA	93534	3345	19	06037	34.68965953	-118.148053	Los Angeles County
62958	Fee-for-Service	1114980703	1114980703	1	1	ALTURJUMAN, AHMAD M MD	9/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	64941	41	Internal Medicine	0	In state provider	HEART CTR OF RIVERSIDE	4500 BROCKTON AVE	STE 315	RIVERSIDE	CA	92501	4028	33	06065	33.97785263	-117.3836152	Riverside County
62965	Fee-for-Service	1801929344	1801929344	1	1	ADVANCED HEARING AID	4/27/2011	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	301 ALAMO DRIVE	STE G	VACAVILLE	CA	95688	9530	48	06095	38.35489564	-122.0093426	Solano County
63035	Fee-for-Service	1063424919	1063424919	1	1	AJIT ALLES	10/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13103 E MANSFIELD AVE	None	SPOKANE VLY	WA	99216	1642	00	None	47.67755045	-117.228357	Spokane County
63040	Fee-for-Service	1083773170	1083773170	1	2	ANDERSON, CASANDRA MD	9/3/2020	208600000X	NA	General Surgery	026	PHYSICIANS	95564	02	General Surgery	0	In state provider	None	7130 N MILLBROOK AVE	SUITE 100	FRESNO	CA	93720	3347	10	06019	36.83832032	-119.7632391	Fresno County
63069	Fee-for-Service	1821078379	1821078379	1	1	ALSEIDI, ADNAN A MD	1/16/2020	208600000X	NA	General Surgery	026	PHYSICIANS	167415	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
63094	Fee-for-Service	1740424480	1740424480	1	1	ARTEAGA FALCONI, DIANA L MD	11/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118646	08	Family Practice	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
63128	Fee-for-Service	1316659360	1316659360	1	1	ALCALA, MICHELLE J	1/11/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3085 S ARCHIBALD AVE	SUITE A	ONTARIO	CA	91761	9005	36	06071	34.017894	-117.592695	San Bernardino County
63173	Fee-for-Service	1538202528	1538202528	1	1	ALEXANDER, DAVID A MD	11/14/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	167979	None	None	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
63175	Fee-for-Service	1760895882	1760895882	1	1	ANGEL OF GOD HOSPICE AND	2/29/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	266 MOBIL AVE	SUITE 203	CAMARILLO	CA	93010	6309	56	06111	34.219179	-119.042954	Ventura County
63179	Fee-for-Service	1922528975	1922528975	1	1	ABRAHAM, ADITI M MD	10/7/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	167232	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
63187	Fee-for-Service	1730571332	1730571332	1	1	AT2J ENTERPRISES INC	9/2/2014	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1717 SIMI TOWN CENTER WY	STE 3	SIMI VALLEY	CA	93065	8408	56	06111	34.28339152	-118.765242	Ventura County
63237	Fee-for-Service	1154736429	1154736429	1	6	AVENAL COMMUNITY HEALTH CENT	6/13/2022	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	329 W 8TH STREET	SUITE 109	HANFORD	CA	93230	4533	16	06031	36.32698307	-119.6503466	Kings County
63246	Fee-for-Service	1114980703	1114980703	1	1	ALTURJUMAN, AHMAD M MD	9/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	64941	06	Cardiovascular Disease (M.D. only)	0	In state provider	HEART CTR OF RIVERSIDE	4500 BROCKTON AVE	STE 315	RIVERSIDE	CA	92501	4028	33	06065	33.97785263	-117.3836152	Riverside County
63258	Fee-for-Service	1093256828	1093256828	1	1	ADAMS, BRIAN NP	11/20/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
63276	Fee-for-Service	1598734832	1598734832	1	1	ARQUILLA, MICHAEL E MD	12/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	42344	01	General Practice	0	In state provider	MEDICAL OFFICE INC	970 W TOWN AND COUNTRY R	None	ORANGE	CA	92868	4714	30	06059	33.7764927	-117.86259	Orange County
63295	Fee-for-Service	1295760841	1295760841	1	1	AMY M DELORIE, DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	ONE PARKLAND DRIVE	None	DERRY	NH	03038	2746	00	None	42.87620843	-71.3168876	Rockingham County
63298	Fee-for-Service	1902691314	1902691314	1	1	AYA BIRTH COLLECTIVE LLC	4/23/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	30	06059	0	0	None
63301	Fee-for-Service	1164606380	1164606380	1	5	ABILITY PATHWAYS INC	6/21/2007	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SHEPHERD DIVISION	862 W 23RD ST	None	UPLAND	CA	91784	1214	36	06071	34.14688851	-117.662544	San Bernardino County
63330	Fee-for-Service	1316125941	1316125941	1	1	ALTAF, MUJEEB MD	9/5/2008	193400000X	NA	Other	026	PHYSICIANS	103416	41	Internal Medicine	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
63361	Fee-for-Service	1992148266	1992148266	1	1	ARULANANDAN, AHILAN MD	8/30/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	132459	41	Internal Medicine	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
63365	Fee-for-Service	1730123548	1730123548	1	1	ANDREW LEE WALSH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 BROOKLYN AVE	STE 250	SAN ANTONIO	TX	78212	0000	00	None	29.44004367	-98.4908328	Bexar County
63407	Fee-for-Service	1669443685	1669443685	1	1	ADLOUNI, LOUBABA A MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63201	40	Pediatrics	0	In state provider	None	1001 E GRAND AVE	None	ESCONDIDO	CA	92025	4604	37	06073	33.12634291	-117.0682058	San Diego County
63417	Fee-for-Service	1790177582	1790177582	1	6	ALTAMED HEALTH SERVICES	8/9/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	3208 SANTA ANITA AVE	SUITE 200	EL MONTE	CA	91733	1304	19	06037	34.06628897	-118.0425098	Los Angeles County
63446	Fee-for-Service	1972628006	1972628006	1	1	AURORA HEALTH CARE	1/1/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SOUTHERN LAKES INC	W3985 COUNTY ROAD NN	None	ELKHORN	WI	53121	4337	00	None	42.66259847	-88.496226	Walworth County
63457	Fee-for-Service	1023316023	1023316023	1	1	AZALEA HOLDINGS LLC	6/7/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3700 H STREET	None	SACRAMENTO	CA	95816	4611	34	06067	38.572137	-121.4562375	Sacramento County
63459	Fee-for-Service	1679235055	1679235055	1	1	ARZATE, VANESSA CCC-SLP	8/1/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
63466	Fee-for-Service	1760895882	1760895882	1	1	ANGEL OF GOD HOSPICE AND	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	266 MOBIL AVE	SUITE 203	CAMARILLO	CA	93010	6309	56	06111	34.219179	-119.042954	Ventura County
63470	Fee-for-Service	1124186002	1124186002	1	1	AZIZI, IRAJ MD	6/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	43320	01	General Practice	0	In state provider	None	9200 W PICO BLVD	None	LOS ANGELES	CA	90035	1319	19	06037	34.0552525	-118.3922955	Los Angeles County
63477	Fee-for-Service	1386880326	1386880326	1	1	ABOU, PAUL MD APC	12/1/2008	207R00000X	NA	Other	026	PHYSICIANS	56122	41	Internal Medicine	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
63479	Fee-for-Service	1487661120	1487661120	1	1	ABOUESH, AHMED I MD	3/6/2023	174400000X	NA	Other	026	PHYSICIANS	69153	None	None	0	In state provider	None	560 COHASSET RD	None	CHICO	CA	95926	2281	04	06007	39.7519137	-121.8477606	Butte County
63523	Fee-for-Service	1194801613	1194801613	1	1	ALAMELU,VASUMITHA	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73430	41	Internal Medicine	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
63524	Fee-for-Service	1154736429	1154736429	1	6	AVENAL COMMUNITY HEALTH CENT	9/19/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	329 W 8TH STREET	SUITE 109	HANFORD	CA	93230	4533	16	06031	36.32698307	-119.6503466	Kings County
63559	Fee-for-Service	1326289711	1326289711	1	1	AZARAN, BENJAMIN MD	8/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110252	40	Pediatrics	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
63565	Fee-for-Service	1932451234	1932451234	1	1	AMIRKHANYAN, GOHAR K LMFT	8/22/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
63594	Fee-for-Service	1932265204	1932265204	2	1	ALAMEDA HEALTH SYSTEM	12/11/2017	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1009	01	06001	37.7069698	-122.1191104	Alameda County
63603	Fee-for-Service	1598323370	1598323370	1	1	AMBO, MIDIAN L MD	8/1/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	182581	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
63620	Fee-for-Service	1881012193	1881012193	1	1	ADLAO, GLADELYNN L NP	1/2/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5970 S CENTRAL AVE	None	LOS ANGELES	CA	90001	1150	19	06037	33.985584	-118.256433	Los Angeles County
63634	Fee-for-Service	1649513805	1649513805	1	1	AUNG, SU N	8/18/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	169620	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
63636	Fee-for-Service	1306604681	1306604681	1	1	ADVENTIST HEALTH PHYSICIANS	7/9/2024	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1154 E GRAND AVE	None	ARROYO GRANDE	CA	93420	2583	40	06079	35.12006347	-120.598114	San Luis Obispo County
63664	Fee-for-Service	1336663574	1336663574	1	1	ALEJANDRO, MADELAINE LCSW	12/17/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
63667	Fee-for-Service	1376076372	1376076372	1	1	AJISEFINNI, BRANDIE	12/9/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
63679	Fee-for-Service	1275095259	1275095259	1	1	ALEM, MONIKANKANA A MD	9/6/2022	390200000X	NA	Other	026	PHYSICIANS	179554	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
63706	Fee-for-Service	1790177582	1790177582	1	6	ALTAMED HEALTH SERVICES	1/16/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	3208 SANTA ANITA AVE	SUITE 200	EL MONTE	CA	91733	1304	19	06037	34.06628897	-118.0425098	Los Angeles County
63734	Fee-for-Service	1972628006	1972628006	1	1	AURORA HEALTH CARE	1/11/2006	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SOUTHERN LAKES INC	W3985 COUNTY ROAD NN	None	ELKHORN	WI	53121	4337	00	None	42.66259847	-88.496226	Walworth County
63735	Fee-for-Service	1366824385	1366824385	1	1	AIDOO, RITA DO	1/10/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21743	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
63755	Fee-for-Service	1992742118	1992742118	1	1	ANDERS, DEREK DPM	3/15/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
63758	Fee-for-Service	1124186002	1124186002	1	1	AZIZI, IRAJ MD	6/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	43320	08	Family Practice	0	In state provider	None	9200 W PICO BLVD	None	LOS ANGELES	CA	90035	1319	19	06037	34.0552525	-118.3922955	Los Angeles County
63785	Fee-for-Service	1538489729	1538489729	1	1	APICELLA, AMANDA S MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142121	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
63800	Fee-for-Service	1801176912	1801176912	1	1	ANYANWU, CYNTHIA P LCSW	6/13/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13529 MASHONA AVE	None	CHINO	CA	91710	8343	36	06071	34.00788022	-117.6516063	San Bernardino County
63803	Fee-for-Service	1730330515	1730330515	1	1	ASHRAFY, MAJID CP	6/11/2019	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	660 E REGENT ST	None	INGLEWOOD	CA	90301	1415	19	06037	33.96448548	-118.344402	Los Angeles County
63813	Fee-for-Service	1154736429	1154736429	1	6	AVENAL COMMUNITY HEALTH CENT	9/19/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	329 W 8TH STREET	SUITE 109	HANFORD	CA	93230	4533	16	06031	36.32698307	-119.6503466	Kings County
63826	Fee-for-Service	1386703965	1386703965	1	1	AIGNER, MICHAEL MD	2/28/1986	207P00000X	NA	Other	026	PHYSICIANS	58150	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
63831	Fee-for-Service	1326481185	1326481185	1	1	ANDERSON, SCOTT R MD	7/10/2020	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	131852	20	Orthopedic Surgery	0	In state provider	None	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	5730	27	06053	36.57482436	-121.8101797	Monterey County
63906	Fee-for-Service	1063894814	1063894814	1	1	AUNG, PYE MD	8/9/2019	207R00000X	NA	Other	026	PHYSICIANS	156618	41	Internal Medicine	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
63933	Fee-for-Service	1881252336	1881252336	1	2	AKAZA LLC	6/27/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1104 CORPORATE WAY	201 - 212	SACRAMENTO	CA	95831	3875	34	06067	38.490201	-121.5160515	Sacramento County
63948	Fee-for-Service	1912351651	1912351651	1	1	ALLEN, NANCY MD	2/26/2021	207RC0200X	NA	Other	026	PHYSICIANS	154450	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
63962	Fee-for-Service	1811921224	1811921224	1	1	ARGAND, ROBERT D MD	7/15/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	22509	41	Internal Medicine	0	In state provider	850 NORTHLAKE	PO BOX 7739	None	TAHOE CITY	CA	96145	7739	31	06061	0	0	None
63994	Fee-for-Service	1790177582	1790177582	1	6	ALTAMED HEALTH SERVICES	1/16/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	3208 SANTA ANITA AVE	SUITE 200	EL MONTE	CA	91733	1304	19	06037	34.06628897	-118.0425098	Los Angeles County
64033	Fee-for-Service	1548354285	1548354285	1	1	ALSOUFIEV, ALEXANDER MD	5/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	95198	41	Internal Medicine	0	In state provider	None	300 WEST HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
64081	Fee-for-Service	1497956585	1497956585	1	1	AGUILAR, EDGAR C OD INC	2/28/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	506 W ATEN ROAD	None	IMPERIAL	CA	92251	9718	13	06025	32.82560573	-115.5798455	Imperial County
64094	Fee-for-Service	1154736429	1154736429	1	17	AVENAL COMMUNITY HEALTH CENT	6/9/2022	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	210 E MERCED ST	None	FOWLER	CA	93625	2313	10	06019	36.63067035	-119.6786702	Fresno County
64163	Fee-for-Service	1306395959	1306395959	1	1	ADVENTIST HEALTH PHYSICIANS	2/8/2019	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	6 WOODLAND RD	STE 205	SAINT HELENA	CA	94139	8794	28	06055	38.54297115	-122.4754501	Napa County
64193	Fee-for-Service	1467040147	1467040147	1	1	ANGELS OF PEACE HOSPICE INC	5/17/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	13609 VICTORY BLVD	STE 237	VAN NUYS	CA	91401	6439	19	06037	34.18671049	-118.429353	Los Angeles County
64220	Fee-for-Service	1811251325	1811251325	1	1	AUSTRIA, KRISTINE J CRNA	3/2/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	531 W COLLEGE STREET	None	LOS ANGELES	CA	90012	2315	19	06037	34.0645892	-118.2391033	Los Angeles County
64234	Fee-for-Service	1487600037	1487600037	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7201 W YORKTOWN AVE	None	HUNTINGTON BEACH	CA	92648	2465	30	06059	33.67933951	-118.0027992	Orange County
64251	Fee-for-Service	1811921224	1811921224	1	1	ARGAND, ROBERT D MD	7/15/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	22509	66	Emergency Medicine (Urgent Care)	0	In state provider	850 NORTHLAKE	PO BOX 7739	None	TAHOE CITY	CA	96145	7739	31	06061	0	0	None
64256	Fee-for-Service	1487208534	1487208534	1	1	APEX PHARMACY PLUS INC	9/30/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9914 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92844	1645	30	06059	33.77397547	-117.9595845	Orange County
64276	Fee-for-Service	1487666079	1487666079	1	1	ARCADIA SURGICAL ASSOC	10/17/1989	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	612 W DUARTE RD	STE 602	ARCADIA	CA	91007	9241	19	06037	34.12647805	-118.051994	Los Angeles County
64294	Fee-for-Service	1326017286	1326017286	1	1	ALCID, MARK G MD	1/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91092	05	Anesthesiology	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2083	19	06037	34.39696803	-118.5525278	Los Angeles County
64305	Fee-for-Service	1740685387	1740685387	1	1	ABINANTE, MATTHEW W DO	6/23/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	13506	None	None	0	In state provider	None	18800 DELAWARE ST	800	HUNTINGTON BEACH	CA	92648	6019	30	06059	33.68911733	-117.9931535	Orange County
64354	Fee-for-Service	1568921716	1568921716	1	1	ANTRIM, LAUREN MD	9/16/2024	207RX0202X	NA	Oncology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
64369	Fee-for-Service	1831345099	1831345099	1	1	ASHTON-BEASLEY, ROCHELLE D L	4/11/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
64376	Fee-for-Service	1306819081	1306819081	1	1	ASHLEY, SHARON A MD	6/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	32906	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
64382	Fee-for-Service	1154736429	1154736429	1	17	AVENAL COMMUNITY HEALTH CENT	10/25/2021	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	210 E MERCED ST	None	FOWLER	CA	93625	2313	10	06019	36.63067035	-119.6786702	Fresno County
64415	Fee-for-Service	1154747020	1154747020	1	5	ACN MEDICAL GROUP, INC	10/10/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2351 LOVERIDGE RD	None	PITTSBURG	CA	94565	5117	07	06013	38.00579658	-121.8716881	Contra Costa County
64440	Fee-for-Service	1598943748	1598943748	1	1	AMIRGHOLAMI, MAHIN MD	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	102566	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11303 WASHINGTON BLVD	STE 100	LOS ANGELES	CA	90066	0003	19	06037	34.00408212	-118.4147433	Los Angeles County
64455	Fee-for-Service	1326133182	1326133182	1	1	AROM, MARION PHD	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1125 S BEVERLY DR	STE 401	LOS ANGELES	CA	90035	1152	19	06037	34.05696658	-118.3966613	Los Angeles County
64468	Fee-for-Service	1497736334	1497736334	1	1	AMIRNOVIN, RAMIN MD	4/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98619	14	Neurological Surgery	0	In state provider	None	255 E BONITA AVE	BLDG 9	POMONA	CA	91767	1923	19	06037	34.097913	-117.7474635	Los Angeles County
64476	Fee-for-Service	1568731446	1568731446	1	1	ANDONI, ERGYS MD	12/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131234	41	Internal Medicine	0	In state provider	None	1600 NORTH ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
64477	Fee-for-Service	1093990426	1093990426	1	1	ALI, RUBY S MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99849	13	Neurology (M.D. only)	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
64479	Fee-for-Service	1467040147	1467040147	1	1	ANGELS OF PEACE HOSPICE INC	5/17/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	13609 VICTORY BLVD	STE 237	VAN NUYS	CA	91401	6439	19	06037	34.18671049	-118.429353	Los Angeles County
64494	Fee-for-Service	1225225543	1225225543	2	1	ANAHEIM FAMILY MEDICAL INC	8/6/1991	193400000X	NA	Other	026	PHYSICIANS	49801	38	Geriatrics	0	In state provider	None	1781 W ROMNEYA DR	SUITE A	ANAHEIM	CA	92801	1825	30	06059	33.85067272	-117.9447342	Orange County
64530	Fee-for-Service	1154804565	1154804565	1	1	AVILA, SANDRA PSYD	10/9/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
64544	Fee-for-Service	1679597033	1679597033	1	1	ANANTH, LALITHA MD	9/27/2009	207RR0500X	NA	Other	026	PHYSICIANS	40291	83	Rheumatology	0	In state provider	None	11160 WARNER AVE	STE 209	FOUNTAIN VALLEY	CA	92708	4048	30	06059	33.71630854	-117.934317	Orange County
64576	Fee-for-Service	1457782526	1457782526	1	1	AUDREY PHARMACY INC	1/23/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9822 BOLSA AVE	STE G	WESTMINSTER	CA	92683	6601	30	06059	33.74482554	-117.957555	Orange County
64579	Fee-for-Service	1841322674	1841322674	1	1	AYCOCK, JOYCE K MD	8/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	24	Plastic Surgery	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
64610	Fee-for-Service	1831384163	1831384163	1	1	AMBULATORY FOOT CARE	3/15/1994	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	PODAITRY CLINIC	12902 BROOKHURST ST	STE B	GARDEN GROVE	CA	92840	4881	30	06059	33.77536084	-117.9555967	Orange County
64616	Fee-for-Service	1801979620	1801979620	1	1	ASHJIAN, PETER H MD	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	73735	24	Plastic Surgery	0	In state provider	None	200 MEDICAL PLAZA	STE 465	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
64621	Fee-for-Service	1619045002	1619045002	1	1	ALDEGUER, MARIA I MD	12/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52678	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
64634	Fee-for-Service	1023484813	1023484813	1	1	A KWAN ACUPUNCTURE INC	7/3/2018	193400000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	750 W GONZALES RD	STE 260	OXNARD	CA	93036	0708	56	06111	34.21907131	-119.1858729	Ventura County
64669	Fee-for-Service	1417416272	1417416272	1	1	AMIRIANFAR, EDWIN DO	5/2/2024	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	22377	25	Physical Medicine and Rehabilitation	0	In state provider	None	1334 W COVINA BLVD 105	None	SAN DIMAS	CA	91773	3211	19	06037	34.097067	-117.833751	Los Angeles County
64670	Fee-for-Service	1154736429	1154736429	1	17	AVENAL COMMUNITY HEALTH CENT	5/29/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	210 E MERCED ST	None	FOWLER	CA	93625	2313	10	06019	36.63067035	-119.6786702	Fresno County
64676	Fee-for-Service	1386781144	1386781144	1	1	ANGEL VIEW INC	3/13/1991	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1758 SCOTIA LN	None	PALM SPRINGS	CA	92262	5400	33	06065	33.84517637	-116.5176586	Riverside County
64683	Fee-for-Service	1225172612	1225172612	1	1	AHMADI, ARSHANOUSH N MD	9/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	90530	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
64684	Fee-for-Service	1689786907	1689786907	1	1	AMIN, HEMAL G MD	1/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84771	41	Internal Medicine	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
64714	Fee-for-Service	1023575693	1023575693	1	1	ADVENTIST HEALTH PHYSICIANS	2/22/2021	208600000X	NA	General Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	200 W ROSEBURG AVE	B1	MODESTO	CA	95350	5255	50	06099	37.66005508	-120.995031	Stanislaus County
64750	Fee-for-Service	1417280504	1417280504	1	1	ANDERSON, VIVIEN K PHD	1/27/2025	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
64781	Fee-for-Service	1225225543	1225225543	2	1	ANAHEIM FAMILY MEDICAL INC	8/6/1991	193400000X	NA	Other	026	PHYSICIANS	49801	01	General Practice	0	In state provider	None	1781 W ROMNEYA DR	SUITE A	ANAHEIM	CA	92801	1825	30	06059	33.85067272	-117.9447342	Orange County
64798	Fee-for-Service	1831143700	1831143700	1	1	ANTHONY LLEWELLYN	1/31/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	901 W REX ALLEN DR	None	WILLCOX	AZ	85643	1009	00	None	32.265	-109.8382095	Cochise County
64800	Fee-for-Service	1700446408	1700446408	1	1	AL-OMARI, ASIM A MD	8/12/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
64831	Fee-for-Service	1679597033	1679597033	1	1	ANANTH, LALITHA MD	9/27/2009	207RR0500X	NA	Other	026	PHYSICIANS	40291	41	Internal Medicine	0	In state provider	None	11160 WARNER AVE	STE 209	FOUNTAIN VALLEY	CA	92708	4048	30	06059	33.71630854	-117.934317	Orange County
64865	Fee-for-Service	1497732093	1497732093	1	1	ABDULLA, FAROOQ MD	3/31/1996	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
64889	Fee-for-Service	1619363819	1619363819	1	1	AZIZ, MEHAK MD	6/18/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	161947	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
64928	Fee-for-Service	1275769143	1275769143	1	1	AL-JAZAYRLY, GHASSAN MD INC	12/15/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1300 N VERMONT AVE	STE 606	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
64932	Fee-for-Service	1356377212	1356377212	1	1	ALEXANDER, KELLY L MD	6/4/2019	208600000X	NA	General Surgery	026	PHYSICIANS	162278	02	General Surgery	0	In state provider	None	1199 BUSH ST	STE 650	SAN FRANCISCO	CA	94109	5975	38	06075	37.7891291	-122.4167087	San Francisco County
64956	Fee-for-Service	1831312677	1831312677	1	1	ADVOCATE, ARIANNE R LMFT	8/3/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	132 LELAND ST	None	SANTA ROSA	CA	95404	4030	49	06097	38.445525	-122.7031155	Sonoma County
64958	Fee-for-Service	1154736429	1154736429	1	17	AVENAL COMMUNITY HEALTH CENT	5/29/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	210 E MERCED ST	None	FOWLER	CA	93625	2313	10	06019	36.63067035	-119.6786702	Fresno County
64971	Fee-for-Service	1003862491	1003862491	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6045 COFFEE RD	None	BAKERSFIELD	CA	93308	9414	15	06029	35.413947	-119.092359	Kern County
64999	Fee-for-Service	1629369517	1629369517	1	1	ACABAL, MARIA J L R CRNA	10/25/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
65009	Fee-for-Service	1689750796	1689750796	1	1	ALEJANDRO, E A MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60683	40	Pediatrics	0	In state provider	ALEJANDRO PEDIATRICS INC	1800 N WESTERN AVE	STE 300	SAN BERNARDINO	CA	92411	1354	36	06071	34.1315778	-117.3182453	San Bernardino County
65019	Fee-for-Service	1669978342	1669978342	1	1	AHMAD, YEMBUR MD	9/25/2023	207ZP0101X	NA	Other	026	PHYSICIANS	188893	None	None	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
65030	Fee-for-Service	1205953247	1205953247	1	1	AULT, JENNIFER L DO	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12255	13	Neurology (M.D. only)	0	In state provider	None	2850 TELEGRAPH AVE	#110	BERKELEY	CA	94705	2118	01	06001	37.85808554	-122.2594469	Alameda County
65038	Fee-for-Service	1134778806	1134778806	1	1	ANDREW H.R. SINGLETON, M.D.,	1/21/2020	2086S0127X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	INC	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
65056	Fee-for-Service	1700177557	1700177557	1	1	ANDERSEN, KRISTEN N MD	8/5/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	123766	None	None	0	In state provider	None	21311 MADRONA AVE	STE 100B	TORRANCE	CA	90503	5970	19	06037	33.835599	-118.3450965	Los Angeles County
65064	Fee-for-Service	1154736429	1154736429	1	7	AVENAL COMMUNITY HEALTH CENT	9/19/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	329 W 8TH STREET	SUITE 107	HANFORD	CA	93230	4533	16	06031	36.32698307	-119.6503466	Kings County
65070	Fee-for-Service	1225225543	1225225543	2	1	ANAHEIM FAMILY MEDICAL INC	8/6/1991	193400000X	NA	Other	026	PHYSICIANS	49801	08	Family Practice	0	In state provider	None	1781 W ROMNEYA DR	SUITE A	ANAHEIM	CA	92801	1825	30	06059	33.85067272	-117.9447342	Orange County
65081	Fee-for-Service	1225301419	1225301419	1	1	ADVANCED SLEEP MEDICINE SRVS	7/3/2018	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1250 S SUNSET AVE	SUITE 101	RIVERSIDE	CA	91790	3900	19	06037	34.0610671	-117.9463685	Los Angeles County
65115	Fee-for-Service	1467638064	1467638064	1	3	ADVANCED IMAGING CENTER	4/7/2008	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1529 E PALMDALE BLVD	STE 100	PALMDALE	CA	93550	2028	19	06037	34.57966052	-118.102275	Los Angeles County
65136	Fee-for-Service	1598380495	1598380495	1	1	ASTILLERO, MARIA P NP	12/27/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
65154	Fee-for-Service	1700318763	1700318763	1	1	ARELLANO, JANETTA L MD	8/3/2022	2084N0402X	NA	Neurology	026	PHYSICIANS	159278	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
65166	Fee-for-Service	1417916107	1417916107	1	1	ATIENZA, PAMELA V. MD,	9/19/2006	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	64995	40	Pediatrics	0	In state provider	None	890 EASTLAKE PKWY	STE 200	CHULA VISTA	CA	91914	4521	37	06073	32.65223126	-116.9677279	San Diego County
65174	Fee-for-Service	1669896619	1669896619	1	1	ARCHINAS-MURPHIN, STEPHANIE	10/29/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
65184	Fee-for-Service	1922033497	1922033497	1	1	ADAMS, ANISE R MD	12/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91840	08	Family Practice	0	In state provider	None	2601 W ALAMEDA AVE	STE 111	BURBANK	CA	91505	4810	19	06037	34.15783817	-118.3293969	Los Angeles County
65194	Fee-for-Service	1376685412	1376685412	1	1	ANDREWS, ROBERT T MD	11/1/2019	2085R0204X	NA	Other	026	PHYSICIANS	72217	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
65203	Fee-for-Service	1801853197	1801853197	1	1	AZAKIE, ANTHONY MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	51758	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
65207	Fee-for-Service	1710433719	1710433719	1	1	AVECILLA, OLIVIA PT	1/28/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	350 JOHN MUIR PKWY	250	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
65218	Fee-for-Service	1609283944	1609283944	1	1	APP, ETHAN	9/16/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9425 PRINCIPAL AVE	None	ATASCADERO	CA	93422	5589	40	06079	35.46806855	-120.6488173	San Luis Obispo County
65219	Fee-for-Service	1427162437	1427162437	1	1	ALPARCE, JACKSON S JR MD	5/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	43079	01	General Practice	0	In state provider	None	15302 EL PRADO ROAD	None	CHINO	CA	91710	7659	36	06071	33.97632113	-117.6883119	San Bernardino County
65233	Fee-for-Service	1386902583	1386902583	1	2	AWAD, PAMELA LMFT	10/7/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	626 W LANCASTER BLVD.	#96	LANCASTER	CA	93534	3108	19	06037	34.69792171	-118.1404554	Los Angeles County
65236	Fee-for-Service	1144723800	1144723800	1	2	AV CRITICAL CARE INC.	10/11/2021	207RC0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1600 WEST AVENUE J	None	LANCASTER	CA	93534	9353	19	06037	34.68938848	-118.158354	Los Angeles County
65243	Fee-for-Service	1316061674	1316061674	1	1	ABAIAN, ALI MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72830	None	None	0	In state provider	None	8460 S CENTRAL AVENUE	None	LOS ANGELES	CA	90001	3761	19	06037	33.961635	-118.256393	Los Angeles County
65252	Fee-for-Service	1093375669	1093375669	1	1	ALONZO, KATHLEEN ANNE M	7/1/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5088 HIGHLAND VIEW AVE	UNIT 2	LOS ANGELES	CA	90041	2037	19	06037	34.1387313	-118.2084681	Los Angeles County
65279	Fee-for-Service	1871116574	1871116574	1	1	ALTAMED HEALTH SERVICES CORP	8/17/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1300 S SUNSET AVE	ROOM 100	WEST COVINA	CA	91790	3342	19	06037	34.0601054	-117.9474205	Los Angeles County
65332	Fee-for-Service	1457856882	1457856882	1	1	ALI, SLAMAT MD PC	7/6/2018	193400000X	NA	Other	026	PHYSICIANS	145592	41	Internal Medicine	0	In state provider	None	8605 CAMINO MEDIA	STE 300	BAKERSFIELD	CA	93311	1361	15	06029	35.34283622	-119.0991309	Kern County
65353	Fee-for-Service	1154736429	1154736429	1	7	AVENAL COMMUNITY HEALTH CENT	9/19/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	329 W 8TH STREET	SUITE 107	HANFORD	CA	93230	4533	16	06031	36.32698307	-119.6503466	Kings County
65363	Fee-for-Service	1629488416	1629488416	1	1	ARBABI, CASSRA N MD	7/29/2021	208600000X	NA	General Surgery	026	PHYSICIANS	139281	None	None	0	In state provider	None	99 N LA CIENEGA BLVD	None	BEVERLY HILLS	CA	90211	2222	19	06037	34.06736471	-118.3763201	Los Angeles County
65365	Fee-for-Service	1831392885	1831392885	1	1	AHSAN, NUSRAT MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92597	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
65378	Fee-for-Service	1801002464	1801002464	1	1	ADVANCED SURGICAL CARE	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64245	02	General Surgery	0	In state provider	ADVANCED SURGICAL CARE	12555 GARDEN GROVE BLVD	STE 303	GARDEN GROVE	CA	92843	1903	30	06059	33.77450946	-117.913041	Orange County
65388	Fee-for-Service	1164472890	1164472890	1	1	ABUABARA, FUAD MD	1/1/1982	207N00000X	NA	Dermatology	026	PHYSICIANS	42285	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
65407	Fee-for-Service	1821625955	1821625955	1	1	ADDO-YOBO, CHARLES DO	9/23/2023	207P00000X	NA	Other	026	PHYSICIANS	20801	None	None	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
65410	Fee-for-Service	1790933257	1790933257	1	1	AGGARWAL, NIDHI MD	3/9/2020	207RC0200X	NA	Other	026	PHYSICIANS	153508	41	Internal Medicine	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
65420	Fee-for-Service	1699438143	1699438143	1	1	ALPIGER, DANIEL LCSW	1/13/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
65452	Fee-for-Service	1366587768	1366587768	1	1	AGRAWAL, GYANESH MD	12/3/2020	207R00000X	NA	Other	086	MEDICAL DIRECTORS	51785	-	NOT APPLICABLE	0	In state provider	None	335 E AVENUE I	RM 2D15, 2D16, CONF. RM.	LANCASTER	CA	93535	1916	19	06037	34.7041113	-118.1247548	Los Angeles County
65543	Fee-for-Service	1093375669	1093375669	1	1	ALONZO, KATHLEEN ANNE M	7/1/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5088 HIGHLAND VIEW AVE	UNIT 2	LOS ANGELES	CA	90041	2037	19	06037	34.1387313	-118.2084681	Los Angeles County
65609	Fee-for-Service	1386208379	1386208379	1	1	APGUARD HOSPICE, LLC	8/10/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6404A INDEPENDENCE AVE	None	WOODLAND HILLS	CA	91367	2607	19	06037	34.18718317	-118.5905322	Los Angeles County
65611	Fee-for-Service	1730274671	1730274671	1	1	ARMSTRONG, CRAIG S DC	4/30/1992	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1136 TULLY RD	STE 1	MODESTO	CA	95350	4932	50	06099	37.66013656	-121.0121085	Stanislaus County
65612	Fee-for-Service	1043841612	1043841612	1	1	AMARI HOSPICE CARE INC	7/9/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6720 FAIR OAKS BLVD	STE 100	CARMICHAEL	CA	95608	3826	34	06067	38.623068	-121.3279695	Sacramento County
65621	Fee-for-Service	1457499964	1457499964	1	1	AZUSA UNIFIED SCH DIST	3/18/1998	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	546 S CITRUS AVE	None	AZUSA	CA	91702	5932	19	06037	34.1125527	-117.8901613	Los Angeles County
65637	Fee-for-Service	1306248703	1306248703	1	1	AHN, SO YUN CNP	3/25/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	19042 SOLEDAD CANYON RD	A	SANTA CLARITA	CA	91351	3362	19	06037	34.4156522	-118.46848	Los Angeles County
65648	Fee-for-Service	1891137915	1891137915	1	1	ASHMAN, ZANE W MD	11/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	131866	02	General Surgery	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
65652	Fee-for-Service	1356366108	1356366108	1	1	ALTMAN, STEVEN J DPM	1/1/1988	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	13372 NEWPORT AVE	#I	TUSTIN	CA	92780	3426	30	06059	33.74482862	-117.8152129	Orange County
65696	Fee-for-Service	1700074853	1700074853	1	1	ABBI, GAURAV MD	11/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	102193	20	Orthopedic Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
65702	Fee-for-Service	1598387151	1598387151	1	1	A & R HOSPICE AND PALLIATIVE	6/25/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	12444 VICTORY BLVD	STE 514	NORTH HOLLYWOOD	CA	91606	3199	19	06037	34.18663951	-118.4043555	Los Angeles County
65735	Fee-for-Service	1669575874	1669575874	1	1	AGUIRRE-CARLOS, MYRA L MD	11/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104621	08	Family Practice	0	In state provider	None	1700 N WATERMAN AVENUE	None	SAN BERNARDINO	CA	92404	5115	36	06071	34.130214	-117.2788065	San Bernardino County
65759	Fee-for-Service	1326576539	1326576539	1	1	ATCKISON, CHASE M DO	9/4/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17432	08	Family Practice	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
65786	Fee-for-Service	1669623153	1669623153	1	1	AMUKELE, ANN MD	2/21/2022	208600000X	NA	General Surgery	026	PHYSICIANS	98290	None	None	0	In state provider	None	590 S INDIAN HILL BLVD	None	CLAREMONT	CA	91711	5212	19	06037	34.085313	-117.7191945	Los Angeles County
65808	Fee-for-Service	1548355118	1548355118	1	1	ALLEN, LEIGH M MD	4/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	74343	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
65832	Fee-for-Service	1629187745	1629187745	3	1	APRIA HEALTHCARE LLC	4/9/2019	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	10318 SANTA FE SPRINGS R	None	SANTA FE SPRINGS	CA	90670	3355	19	06037	33.94241502	-118.0639215	Los Angeles County
65833	Fee-for-Service	1811928021	1811928021	1	1	ARTHUR D HAGAN M.D.	4/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1323 W 6TH AVE	None	STILLWATER	OK	74074	4306	00	None	36.11584141	-97.07504326	Payne County
65851	Fee-for-Service	1285418616	1285418616	1	1	A PLUS RX PHARMACY INC	1/16/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7743 N WEST LN	STE A3	STOCKTON	CA	95210	3350	39	06077	38.02006367	-121.2950347	San Joaquin County
65856	Fee-for-Service	1104324102	1104324102	1	1	ADVENTIST HEALTH PHYSICIANS	9/18/2019	207RI0011X	NA	Cardiology/Interventional Cardiology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	414 G ST	STE 108	MARYSVILLE	CA	95901	5669	58	06115	39.13913942	-121.5934649	Yuba County
65871	Fee-for-Service	1821301086	1821301086	1	1	ALSHAREEF, AMEEN MD	6/19/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123164	40	Pediatrics	0	In state provider	None	1503 NORTH IMPERIAL	SUITE 204	EL CENTRO	CA	92243	6302	13	06025	32.806881	-115.5697535	Imperial County
65886	Fee-for-Service	1184061418	1184061418	1	1	ABBOTT, TARA L PT	6/27/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11276 5TH ST	STE 400	RANCHO CUCAMONGA	CA	91730	0921	36	06071	34.0809351	-117.559021	San Bernardino County
65894	Fee-for-Service	1144616541	1144616541	1	1	ADAMS, LAURA MD	8/4/2021	208600000X	NA	General Surgery	026	PHYSICIANS	169184	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
65897	Fee-for-Service	1386208379	1386208379	1	1	APGUARD HOSPICE, LLC	8/10/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6404A INDEPENDENCE AVE	None	WOODLAND HILLS	CA	91367	2607	19	06037	34.18718317	-118.5905322	Los Angeles County
65899	Fee-for-Service	1043841612	1043841612	1	1	AMARI HOSPICE CARE INC	7/9/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6720 FAIR OAKS BLVD	STE 100	CARMICHAEL	CA	95608	3826	34	06067	38.623068	-121.3279695	Sacramento County
65901	Fee-for-Service	1568547438	1568547438	1	2	ACUPUNCTURE FAMILY & HERBS I	5/15/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	NC	615 SOUTH BROADWAY	None	SANTA MARIA	CA	93454	5110	42	06083	34.94639295	-120.4360158	Santa Barbara County
65925	Fee-for-Service	1578108817	1578108817	1	1	ALISASIS, JOSE ELIAS A PT	3/23/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7033 N FRESNO ST STE 202	None	FRESNO	CA	93720	2976	10	06019	36.838044	-119.7813175	Fresno County
65927	Fee-for-Service	1922197466	1922197466	3	1	ACHIEVE COMFORT MEDICAL	12/30/2014	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	EQUIPMENT & SUPPLY INC	370 S FAIRFAX AVE	None	LOS ANGELES	CA	90036	3138	19	06037	34.0702569	-118.3613769	Los Angeles County
65928	Fee-for-Service	1588076962	1588076962	1	1	ALZGHARI, MOHAMMAD MD	8/18/2020	208600000X	NA	General Surgery	026	PHYSICIANS	169122	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
65934	Fee-for-Service	1679379481	1679379481	1	1	ACTIVATING LIGHT STUDIO LLC	2/25/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	1	Border provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	00	None	0	0	None
65948	Fee-for-Service	1417165218	1417165218	1	1	AZULAY, OREN MD	6/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99945	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
65983	Fee-for-Service	1679706089	1679706089	1	1	AUSTIN-WILLIAMS, KYMIL LMFT	12/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
65991	Fee-for-Service	1598387151	1598387151	1	1	A & R HOSPICE AND PALLIATIVE	6/25/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	12444 VICTORY BLVD	STE 514	NORTH HOLLYWOOD	CA	91606	3199	19	06037	34.18663951	-118.4043555	Los Angeles County
65992	Fee-for-Service	1639551435	1639551435	1	1	AL-DAHWI, JAAFAR MD	11/18/2020	207R00000X	NA	Other	026	PHYSICIANS	168763	None	None	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
65993	Fee-for-Service	1588003727	1588003727	1	1	ALMANZAR, SERGIO LCSW	2/15/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
65994	Fee-for-Service	1043235849	1043235849	1	1	ALKORAISHI, ALI H MD	12/2/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	36353	-	NOT APPLICABLE	0	In state provider	None	2101 ALEXIAN DRIVE	SUITE A & B	SAN JOSE	CA	95116	1901	43	06085	37.35943657	-121.848055	Santa Clara County
66012	Fee-for-Service	1699823518	1699823518	1	1	ABDELMESEEH, AMIN S MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72793	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
66013	Fee-for-Service	1093107104	1093107104	1	1	ADVANCED NEUROSURGERY	4/10/2015	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	ASSOCIATES INC	28078 BAXTER ROAD	SUITE 430	MURRIETA	CA	92563	1404	33	06065	33.615	-117.1670265	Riverside County
66032	Fee-for-Service	1568446037	1568446037	2	1	AIDS HEALTHCARE FOUNDATION	4/6/2009	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	400 30TH STREET	STE 300	OAKLAND	CA	94609	3318	01	06001	37.81907725	-122.2648838	Alameda County
66042	Fee-for-Service	1477975324	1477975324	1	1	ALTAMED HEALTH SERVICES	9/25/2014	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	535 S 2ND AVE	None	COVINA	CA	91723	3013	19	06037	34.08008204	-117.8879145	Los Angeles County
66057	Fee-for-Service	1558610808	1558610808	1	1	ASTRA HEALTH CARE	4/5/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	55 SANTA CLARA AVE	SUITE 255	OAKLAND	CA	94610	1399	01	06001	37.82062352	-122.2550997	Alameda County
66086	Fee-for-Service	1164868451	1164868451	1	1	ARCADI, JANE MD	9/16/2021	207LP3000X	NA	Other	026	PHYSICIANS	173535	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
66090	Fee-for-Service	1437323144	1437323144	1	1	ANDERSON, KRISTIN S MD	3/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 EAST THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
66096	Fee-for-Service	1649483991	1649483991	1	1	ARVON, REGINA L MD	9/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100240	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
66103	Fee-for-Service	1205289790	1205289790	1	1	ASLAMI, MARIAM OD	8/20/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4200 CHINO HILLS PKWY	STE 390	CHINO HILLS	CA	91709	5825	36	06071	33.98274451	-117.7129305	San Bernardino County
66112	Fee-for-Service	1215673918	1215673918	1	1	ANTALEK, BOBBY J NP	3/14/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
66126	Fee-for-Service	1134492184	1134492184	1	1	AEGIS SCIENCES CORPORATION	2/6/2017	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	345 HILL AVENUE	None	NASHVILLE	TN	37210	4711	00	None	36.13411797	-86.7279365	Davidson County
66133	Fee-for-Service	1265930218	1265930218	1	1	ADVENTIST HEALTH PHYSICIANS	8/20/2019	207V00000X	NA	Obstetrics & Gynecology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1007 LIVE OAK BLVD	STE B2	YUBA CITY	CA	95991	3443	51	06101	39.14368281	-121.6207923	Sutter County
66162	Fee-for-Service	1356852578	1356852578	1	1	ANDERSON, ALEXIS B PT	10/3/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	588 NORTH SUNRISE AVENUE	SUITE 100	ROSEVILLE	CA	95661	2843	31	06061	38.7585915	-121.2527015	Placer County
66168	Fee-for-Service	1821072943	1821072943	1	2	AIDS HEALTH FOUNDATION	2/6/2023	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2146 W ADAMS BLVD	None	LOS ANGELES	CA	90018	2039	19	06037	34.03263233	-118.3133583	Los Angeles County
66172	Fee-for-Service	1033120787	1033120787	1	1	ANANIAN, CHARLES E DPM	8/31/2018	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3616 E 1ST ST	None	LOS ANGELES	CA	90063	2326	19	06037	34.03597969	-118.1884647	Los Angeles County
66177	Fee-for-Service	1962662783	1962662783	1	1	ALEXANDER FILATOV	5/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
66184	Fee-for-Service	1730649278	1730649278	1	1	AGARWAL, REEMA MD	6/7/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
66196	Fee-for-Service	1306343587	1306343587	1	1	ASSURITY HOSPICE INC	5/19/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1241 S GLENDALE AVE	SUITE 305C	GLENDALE	CA	91205	3386	19	06037	34.13065269	-118.2524619	Los Angeles County
66203	Fee-for-Service	1023231891	1023231891	1	1	ANTELOPE VALLEY UNION HSD	5/22/1994	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	176 HOLSTON DRIVE	None	LANCASTER	CA	93535	4531	19	06037	34.6649465	-118.1286477	Los Angeles County
66228	Fee-for-Service	1104890987	1104890987	1	1	ARROYO, JAIME I.	4/30/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	59863	41	Internal Medicine	0	In state provider	None	555 WASHINGTON ST	None	SAN DIEGO	CA	92103	2289	37	06073	32.74986289	-117.1599343	San Diego County
66240	Fee-for-Service	1578013447	1578013447	1	1	ARMANYOUS, ANNE PT	9/3/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9470 FIRESTONE BLVD	None	DOWNEY	CA	90241	5504	19	06037	33.93069029	-118.1144429	Los Angeles County
66257	Fee-for-Service	1528049954	1528049954	1	1	ATHERTON BAPTIST HOMES	12/15/1970	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	214 S ATLANTIC BLVD	None	ALHAMBRA	CA	91801	3257	19	06037	34.08861897	-118.1345742	Los Angeles County
66274	Fee-for-Service	1790177582	1790177582	1	8	ALTAMED HEALTH SERVICES	11/2/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	513 EAST LIME AVENUE	SUITE 102	MONROVIA	CA	91016	2983	19	06037	34.14819851	-117.993105	Los Angeles County
66281	Fee-for-Service	1508183195	1508183195	1	1	ARKO, LEOPOLD MD	6/18/2019	207T00000X	NA	General Surgery	026	PHYSICIANS	161340	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
66298	Fee-for-Service	1801430335	1801430335	1	1	ASSIST ON CALL HOSPICE CARE	4/12/2024	163WH1000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	HOSPICE CARE, INC.	2100 MONUMENT BLVD	STE 8B	PLEASANT HILL	CA	94523	3489	07	06013	37.94624834	-122.0534331	Contra Costa County
66335	Fee-for-Service	1508024647	1508024647	1	1	ABDULHAQ, HAIFAA MD	5/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111931	68	Hematology	0	In state provider	None	2828 FRESNO ST	STE 203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
66356	Fee-for-Service	1588964969	1588964969	1	2	ALLEN, KAREN M PHD	12/15/2014	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9550 WARNER AVENUE	SUITE 227	FOUNTAIN VALLEY	CA	92708	4714	30	06059	33.71597354	-117.9624555	Orange County
66362	Fee-for-Service	1639871841	1639871841	1	1	APEX CARE ENTERPRISE LLC	5/17/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	6928 ORIOLE AVE	None	LA VERNE	CA	91750	5914	19	06037	34.14057235	-117.7503004	Los Angeles County
66379	Fee-for-Service	1811675754	1811675754	1	1	ADVENTIST HEALTH PHYSICIANS	1/29/2024	261QU0200X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	14540 MONO WAY	None	SONORA	CA	95370	8858	55	06109	37.97783107	-120.3263045	Tuolumne County
66384	Fee-for-Service	1154437432	1154437432	1	1	AHSAN, ARZOU D	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71481	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1310 TARA HILLS DR	STE A	PINOLE	CA	94564	2533	07	06013	37.99581609	-122.3050212	Contra Costa County
66391	Fee-for-Service	1477104099	1477104099	1	1	ADVENTIST HEALTH CLEARLAKE	3/4/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL, INC	15322 LAKESHORE DR	SUITE 101, 102, 201	CLEARLAKE	CA	95422	9815	17	06033	38.95045805	-122.6255271	Lake County
66415	Fee-for-Service	1114468360	1114468360	1	1	AROUS, TANIA MD	7/1/2022	207R00000X	NA	Other	026	PHYSICIANS	174460	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
66417	Fee-for-Service	1275804205	1275804205	1	2	AMERICAN ADDICTION TREATMENT	11/6/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC	1496 - 1498 N BEALE RD	None	MARYSVILLE	CA	95901	6205	58	06115	39.12743446	-121.5621716	Yuba County
66418	Fee-for-Service	1689627051	1689627051	1	1	AHMED, JAVEED MD	2/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51672	41	Internal Medicine	0	In state provider	None	44835 DATE AVE	None	LANCASTER	CA	93534	3102	19	06037	34.69706565	-118.1406679	Los Angeles County
66427	Fee-for-Service	1720015258	1720015258	1	1	ANVARI, VASILIKI M MD	6/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88444	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 PROSPECT PL	None	CORONADO	CA	92110	1943	37	06073	32.69409033	-117.1680508	San Diego County
66437	Fee-for-Service	1700146487	1700146487	1	1	ARIMA, CATHERINE C NP	4/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
66443	Fee-for-Service	1942571146	1942571146	1	1	ACUTE MEDICAL PROVIDERS INC	2/6/2012	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	10 WOODLAND RD	None	ST HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
66447	Fee-for-Service	1447847793	1447847793	1	1	ARVALO INC	12/30/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	280 RIVER PARK DR	None	REDDING	CA	96003	2169	45	06089	40.6042939	-122.3962974	Shasta County
66455	Fee-for-Service	1992530992	1992530992	1	1	ABCHAL, SIERRA LAC	9/20/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	709 FREDRICK STREET	None	SANTA CRUZ	CA	95060	3715	44	06087	36.98046339	-122.0045291	Santa Cruz County
66486	Fee-for-Service	1306343587	1306343587	1	1	ASSURITY HOSPICE INC	5/19/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1241 S GLENDALE AVE	SUITE 305C	GLENDALE	CA	91205	3386	19	06037	34.13065269	-118.2524619	Los Angeles County
66548	Fee-for-Service	1841581584	1841581584	1	1	APELIAN, TAMAR L PSYD	7/3/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD BLVD	None	LOS ANGELES	CA	90095	8631	19	06037	34.07067	-118.4432445	Los Angeles County
66555	Fee-for-Service	1851002208	1851002208	1	1	ARMEN CHOULAKIAN MD INC	4/25/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	4418	50	06099	37.66508443	-120.9962589	Stanislaus County
66556	Fee-for-Service	1821579152	1821579152	1	1	AIC HEALTH CARE, INC	10/11/2018	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1159 CITRON WAY	None	HAYWARD	CA	94545	2459	01	06001	37.64570021	-122.1032808	Alameda County
66563	Fee-for-Service	1790177582	1790177582	1	8	ALTAMED HEALTH SERVICES	11/2/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	513 EAST LIME AVENUE	SUITE 102	MONROVIA	CA	91016	2983	19	06037	34.14819851	-117.993105	Los Angeles County
66622	Fee-for-Service	1508024647	1508024647	1	1	ABDULHAQ, HAIFAA MD	5/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111931	41	Internal Medicine	0	In state provider	None	2828 FRESNO ST	STE 203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
66626	Fee-for-Service	1710922471	1710922471	2	1	AC HEALTH INC	4/26/2008	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1843 E FIR AVE	STE 101	FRESNO	CA	93720	3863	10	06019	36.83911653	-119.7492705	Fresno County
66648	Fee-for-Service	1043703911	1043703911	1	1	AFABLE, REGINE B MD	7/13/2022	207R00000X	NA	Other	026	PHYSICIANS	177232	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
66658	Fee-for-Service	1336550680	1336550680	1	1	ALAMZAI, RESHTINA Z DO	2/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	14711	01	General Practice	0	In state provider	None	2720 LOW COURT	None	FAIRFIELD	CA	94534	9774	48	06095	38.23580279	-122.0858445	Solano County
66666	Fee-for-Service	1073642138	1073642138	2	1	ASKARI, GITI PSYD	3/21/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1133 BOYLE AVE	None	ESCONDIDO	CA	92027	4411	37	06073	33.12345854	-117.049191	San Diego County
66674	Fee-for-Service	1477104099	1477104099	1	1	ADVENTIST HEALTH CLEARLAKE	3/4/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL, INC	15322 LAKESHORE DR	SUITE 101, 102, 201	CLEARLAKE	CA	95422	9815	17	06033	38.95045805	-122.6255271	Lake County
66705	Fee-for-Service	1689627051	1689627051	1	1	AHMED, JAVEED MD	2/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51672	83	Rheumatology	0	In state provider	None	44835 DATE AVE	None	LANCASTER	CA	93534	3102	19	06037	34.69706565	-118.1406679	Los Angeles County
66709	Fee-for-Service	1578914644	1578914644	1	1	ADVANCED SLEEP MEDICINE SRVS	7/3/2018	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	4909 MURPHY CANYON RD	SUITE 410	SAN DIEGO	CA	92123	4301	37	06073	32.8287682	-117.1197549	San Diego County
66711	Fee-for-Service	1457771966	1457771966	1	1	ANTHONY, KIRSTEN F PT	3/22/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2625 W ALAMEDA AVE	102	BURBANK	CA	91505	4815	19	06037	34.1577056	-118.329779	Los Angeles County
66712	Fee-for-Service	1144644170	1144644170	1	1	ARTEMIS MEDICAL GROUP INC	1/23/2015	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	770 WASHINGTON ST	SUITE 200	SAN DIEGO	CA	92103	2209	37	06073	32.75014189	-117.1579654	San Diego County
66728	Fee-for-Service	1851079354	1851079354	1	1	ALIAV, DIANNA	1/17/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	16907 SAN FERNANDO MISSI	STE. C3	SAN FERNANDO	CA	91340	4250	19	06037	34.27207425	-118.5004598	Los Angeles County
66730	Fee-for-Service	1518332972	1518332972	1	1	ATKINS, ANDREW W PT	3/31/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	31515 RANCHO PUEBLO RD	SUITE 101	TEMECULA	CA	92592	0000	33	06065	33.47922478	-117.1107757	Riverside County
66743	Fee-for-Service	1205890837	1205890837	1	1	ANNE L SAARHEIM-RIGGS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 E KINCAID STREET	None	MOUNT VERNON	WA	98274	4127	00	None	48.41742639	-122.323873	Skagit County
66771	Fee-for-Service	1679078109	1679078109	1	1	AZZAM, JOSEPH S MD	7/12/2021	208M00000X	NA	Other	026	PHYSICIANS	173245	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
66773	Fee-for-Service	1598986507	1598986507	2	1	ARCE, JORGE T MD INC	4/1/2018	193400000X	NA	Other	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	480 4TH AVE	STE 211	CHULA VISTA	CA	91910	4412	37	06073	32.63411298	-117.0816772	San Diego County
66787	Fee-for-Service	1609106137	1609106137	1	1	ABRAMSON, SIMON R MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130313	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
66804	Fee-for-Service	1467934943	1467934943	1	1	ALAM, ARFEEN MD	3/1/2023	207L00000X	NA	Other	026	PHYSICIANS	183370	None	None	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
66828	Fee-for-Service	1902267479	1902267479	1	6	ALTAMED HEALTH SERVICES	3/22/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	5220 TWEEDY BLVD	None	SOUTH GATE	CA	90280	5333	19	06037	33.94107585	-118.1799162	Los Angeles County
66835	Fee-for-Service	1033400718	1033400718	1	1	ALMEIDA-SAWYER, NIA K MD	5/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141350	30	Radiology	0	In state provider	None	1524 MCHENRY AVENUE	SUITE 430	MODESTO	CA	95350	4567	50	06099	37.666233	-120.993933	Stanislaus County
66843	Fee-for-Service	1164699302	1164699302	1	1	AMINI, AMIR MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106982	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
66891	Fee-for-Service	1902859416	1902859416	1	1	ALGHANNAM, MUHAMMAD MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78203	05	Anesthesiology	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
66916	Fee-for-Service	1902422124	1902422124	1	2	ALL MINDS CLEAR FAMILY THERA	3/15/2021	261QM0801X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	PY, INC.	7121 MAGNOLIA AVE	J	RIVERSIDE	CA	92504	3805	33	06065	33.9455319	-117.4027101	Riverside County
66918	Fee-for-Service	1730372038	1730372038	1	1	ADVANCED FAMILY CARE	1/28/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MEDICAL GROUP	2704 W MANCHESTER BLVD	None	INGLEWOOD	CA	90305	2436	19	06037	33.9598587	-118.3235034	Los Angeles County
66933	Fee-for-Service	1114287224	1114287224	1	1	AVILA, MIGUEL A	7/1/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3831 HUGHES AVE	SUITE 600-B	CULVER CITY	CA	90232	6843	19	06037	34.02243278	-118.3981492	Los Angeles County
66999	Fee-for-Service	1124219696	1124219696	1	1	AKINSANMI, EVENLYN MD	9/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106391	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
67000	Fee-for-Service	1679033237	1679033237	1	1	ABDOU, SALMA A MD	5/1/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	24	Plastic Surgery	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
67004	Fee-for-Service	1144644170	1144644170	1	1	ARTEMIS MEDICAL GROUP INC	1/23/2015	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	770 WASHINGTON ST	SUITE 200	SAN DIEGO	CA	92103	2209	37	06073	32.75014189	-117.1579654	San Diego County
67020	Fee-for-Service	1477148476	1477148476	1	1	ARCINUE, PETA NOREEN G CRNA	8/5/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
67034	Fee-for-Service	1629063409	1629063409	1	1	ANDREA SEGUE ANDREWS MD	8/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5501 N PORTLAND AVE	None	OKLAHOMA CITY	OK	73112	2074	00	None	35.526339	-97.58344848	Oklahoma County
67043	Fee-for-Service	1669639639	1669639639	1	1	APACHE JUNCTION HOSPITAL LLC	3/2/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	515 NORTH MESA DRIVE	None	MESA	AZ	85201	5914	00	None	33.424767	-111.8219445	Maricopa County
67060	Fee-for-Service	1649748088	1649748088	1	1	ANN FLAHERTY	4/19/2022	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 1ST AVE	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
67084	Fee-for-Service	1649906348	1649906348	1	1	ARARAT HOME OF LOS ANGELES	2/28/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	1230 E WINDSOR ROAD	None	GLENDALE	CA	91205	2656	19	06037	34.13709568	-118.2384518	Los Angeles County
67102	Fee-for-Service	1538285622	1538285622	1	1	AIZPURU, VIVIAN K LMFT	10/3/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
67117	Fee-for-Service	1902267479	1902267479	1	6	ALTAMED HEALTH SERVICES	3/22/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	5220 TWEEDY BLVD	None	SOUTH GATE	CA	90280	5333	19	06037	33.94107585	-118.1799162	Los Angeles County
67122	Fee-for-Service	1013024488	1013024488	1	1	APPLEGATE, LAURA J MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	42802	None	None	0	In state provider	None	2393 TOWNSGATE RD	STE 202	WESTLAKE VILLAGE	CA	91361	2517	56	06111	34.16103602	-118.834026	Ventura County
67143	Fee-for-Service	1144455262	1144455262	1	1	AL NAHLAWI, BASMA MD	1/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	115924	83	Rheumatology	0	In state provider	None	3633 CAMINO DEL RIO	SUITE 300	SAN DIEGO	CA	92108	4014	37	06073	32.77801447	-117.1163618	San Diego County
67193	Fee-for-Service	1073176277	1073176277	1	1	AUKERMAN, CARRIE LICENSED	10/17/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MARRIAGE AND FAMILY THER	190 SIERRA COURT	STE C4	PALMDALE	CA	93550	7609	19	06037	34.64013337	-118.1280539	Los Angeles County
67204	Fee-for-Service	1902422124	1902422124	1	2	ALL MINDS CLEAR FAMILY THERA	3/15/2021	261QM0801X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	PY, INC.	7121 MAGNOLIA AVE	J	RIVERSIDE	CA	92504	3805	33	06065	33.9455319	-117.4027101	Riverside County
67218	Fee-for-Service	1114676186	1114676186	1	1	AMY'S COMFORT CARE INC	5/26/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	9613 GHIRARDELLI DR	None	BAKERSFIELD	CA	93311	9684	15	06029	35.30917716	-119.1095795	Kern County
67252	Fee-for-Service	1487732574	1487732574	1	1	ADAD,BASIL W MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60061	04	Otology, Laryngology, Rhinology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
67255	Fee-for-Service	1427346758	1427346758	1	1	ANTALAN, TESSA M MD	10/29/2019	207R00000X	NA	Other	026	PHYSICIANS	130238	41	Internal Medicine	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
67260	Fee-for-Service	1770582165	1770582165	1	1	ALBORZI, ARASH MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89523	77	Infectious Disease	0	In state provider	None	1300 N VERMONT AVE	STE 407	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
67269	Fee-for-Service	1356427009	1356427009	1	1	ADVANCED CARDIOVASCULAR	4/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	INSTITUTE	1022 MURRIETA BLVD	None	LIVERMORE	CA	94550	4111	01	06001	37.67591468	-121.7832215	Alameda County
67273	Fee-for-Service	1891033544	1891033544	1	1	ACEVEDO, JEREMY LCSW	12/27/2022	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	801 E CHAPEL ST	1-6	SANTA MARIA	CA	93454	4607	42	06083	34.9542915	-120.424455	Santa Barbara County
67277	Fee-for-Service	1144487042	1144487042	1	1	AKKARY, EHAB E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PHYSICIAN OFFICE CTR	1 MEDICAL CENTER DRIVE	None	MORGANTOWN	WV	26506	7911	00	None	39.65333742	-79.95924145	Monongalia County
67286	Fee-for-Service	1720048887	1720048887	1	1	ANDEREGG,CHRISTINE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 W ANTELOPE DR	None	LAYTON	UT	84041	1142	00	None	41.091012	-111.995523	Davis County
67289	Fee-for-Service	1689651176	1689651176	2	2	AGAPE HOME CARE INC	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	99 N SAN ANTONIO AVE	SUITE 306	UPLAND	CA	91786	4579	36	06071	34.095078	-117.660769	San Bernardino County
67290	Fee-for-Service	1144644170	1144644170	1	1	ARTEMIS MEDICAL GROUP INC	1/23/2015	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	770 WASHINGTON ST	SUITE 200	SAN DIEGO	CA	92103	2209	37	06073	32.75014189	-117.1579654	San Diego County
67304	Fee-for-Service	1134421860	1134421860	1	1	AGUILAR, ALEJANDRO F MD INC	12/8/2015	193400000X	NA	Other	026	PHYSICIANS	36086	None	None	0	In state provider	None	3034 E FLORENCE AVENUE	None	HUNTINGTON PARK	CA	90255	5828	19	06037	33.97302389	-118.2141733	Los Angeles County
67314	Fee-for-Service	1275913642	1275913642	1	1	ASHION ANALYTICS, LLC	1/24/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	445 N 5TH ST	FIRST FLOOR	PHOENIX	AZ	85004	2157	00	None	33.453081	-112.066983	Maricopa County
67328	Fee-for-Service	1669639639	1669639639	1	1	APACHE JUNCTION HOSPITAL LLC	3/2/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	515 NORTH MESA DRIVE	None	MESA	AZ	85201	5914	00	None	33.424767	-111.8219445	Maricopa County
67336	Fee-for-Service	1083870968	1083870968	1	1	ARYAL, NITU MD	2/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139984	41	Internal Medicine	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
67376	Fee-for-Service	1902889512	1902889512	1	1	ARELLANES, ROSE E MD	9/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	66839	08	Family Practice	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
67379	Fee-for-Service	1851547061	1851547061	1	1	AL-MUFTI, HASEEB I MD	10/10/2008	193400000X	NA	Other	026	PHYSICIANS	37195	41	Internal Medicine	0	In state provider	None	13939 E 14TH STREET	SUITE 170	SAN LEANDRO	CA	94578	2613	01	06001	37.71377536	-122.1407447	Alameda County
67426	Fee-for-Service	1629257530	1629257530	1	1	AMIN, MARLI A MD	9/4/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	101312	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
67431	Fee-for-Service	1972134872	1972134872	1	1	ATALLA, YOUSTINA PT	11/1/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
67467	Fee-for-Service	1417247255	1417247255	1	1	ADRAKTAS, DIONESIA D MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141819	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
67477	Fee-for-Service	1154736429	1154736429	1	12	AVENAL COMMUNITY HEALTH CENT	2/20/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	575 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3270	54	06107	36.06956695	-119.0296813	Tulare County
67493	Fee-for-Service	1265701163	1265701163	1	1	AMPL MANAGEMENT INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2855 TEMPLE AVE	STE H	SIGNAL HILL	CA	90755	2212	19	06037	33.809013	-118.1589655	Los Angeles County
67517	Fee-for-Service	1053870402	1053870402	1	1	ADVENTIST HEALTH PHYSICIANS	10/9/2020	261QU0200X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	520 BOGUE RD	E4, E5, E6	YUBA CITY	CA	95991	9242	51	06101	39.10048207	-121.6168831	Sutter County
67524	Fee-for-Service	1972844835	1972844835	1	1	ASYYED, ASMA H MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124085	41	Internal Medicine	0	In state provider	None	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
67543	Fee-for-Service	1427346758	1427346758	1	1	ANTALAN, TESSA M MD	10/29/2019	207R00000X	NA	Other	026	PHYSICIANS	130238	38	Geriatrics	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
67545	Fee-for-Service	1770582165	1770582165	1	1	ALBORZI, ARASH MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89523	41	Internal Medicine	0	In state provider	None	1300 N VERMONT AVE	STE 407	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
67554	Fee-for-Service	1104239870	1104239870	1	1	ADAMS, BARBARA E DPM	7/1/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	3800 J ST	SUITE 200	SACRAMENTO	CA	95816	5551	34	06067	38.569869	-121.455729	Sacramento County
67557	Fee-for-Service	1861070625	1861070625	1	1	ASMAIL, NOOR T MD	7/8/2024	207R00000X	NA	Other	026	PHYSICIANS	191183	41	Internal Medicine	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
67573	Fee-for-Service	1073543963	1073543963	1	1	ANESTHESIA ASSOCIATES OF MED	1/1/1979	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	1	Border provider	FORD PC	1093 ROYAL COURT	None	MEDFORD	OR	97504	8383	00	None	42.34017467	-122.8666022	Jackson County
67621	Fee-for-Service	1275083453	1275083453	1	1	ASHLEY, RAMONA R	9/12/2019	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	8953 N CHESTNUT AVE	None	FRESNO	CA	93720	5366	10	06019	36.86634375	-119.7388705	Fresno County
67627	Fee-for-Service	1922377878	1922377878	1	1	ALTA CARE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7100 HAYVENHURST AVE	SUITE 202	VAN NUYS	CA	91406	3804	19	06037	34.199064	-118.4923845	Los Angeles County
67628	Fee-for-Service	1538776042	1538776042	1	1	AMARI HOME HEALTH CARE INC	12/17/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6722 FAIR OAKS BLVD	SUITE 203	CARMICHAEL	CA	95608	3826	34	06067	38.623059	-121.327641	Sacramento County
67640	Fee-for-Service	1467465930	1467465930	1	1	ADOUMIE, RIAD MD	5/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84252	02	General Surgery	0	In state provider	None	23451 MADISON ST	STE 340	TORRANCE	CA	90505	4762	19	06037	33.81197627	-118.3478154	Los Angeles County
67644	Fee-for-Service	1407202518	1407202518	1	1	AARON, JACOB	12/4/2020	207R00000X	NA	Other	026	PHYSICIANS	168040	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
67655	Fee-for-Service	1063601086	1063601086	1	1	APOSTOL CASTRO, MARYANNE L	11/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107188	08	Family Practice	0	In state provider	None	3800 DALE RD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
67664	Fee-for-Service	1851547061	1851547061	1	1	AL-MUFTI, HASEEB I MD	10/10/2008	193400000X	NA	Other	026	PHYSICIANS	37195	45	Nephrology (Renal-Kidney)	0	In state provider	None	13939 E 14TH STREET	SUITE 170	SAN LEANDRO	CA	94578	2613	01	06001	37.71377536	-122.1407447	Alameda County
67677	Fee-for-Service	1134311319	1134311319	1	1	ANESTHESIA SPECIALISTS	7/31/2007	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
67698	Fee-for-Service	1336558196	1336558196	1	1	ANN HOSPICE INC	9/13/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	16530 VENTURA BLVD	SUITE 204	ENCINO	CA	91436	4589	19	06037	34.15766626	-118.4934057	Los Angeles County
67704	Fee-for-Service	1588011357	1588011357	1	1	ANCHETA, ARABELLA A NP	4/26/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9000 MING AVE	STE L-1B	BAKERSFIELD	CA	93311	1318	15	06029	35.33989328	-119.1034715	Kern County
67708	Fee-for-Service	1245857085	1245857085	2	1	ALL FAMILY HOSPICE INC	8/11/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	103 W ALAMEDA AVE	SUITE 130	BURBANK	CA	91502	2253	19	06037	34.17123949	-118.3032671	Los Angeles County
67746	Fee-for-Service	1851713838	1851713838	1	2	ALVARADO, NERY LCSW	3/25/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	110 N MACLAY AVE	114	SAN FERNANDO	CA	91340	2989	19	06037	34.28449525	-118.4396137	Los Angeles County
67747	Fee-for-Service	1487170247	1487170247	1	1	ALNAYEM, WEAM MD	9/7/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	186130	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
67762	Fee-for-Service	1154736429	1154736429	1	12	AVENAL COMMUNITY HEALTH CENT	11/4/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	575 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3270	54	06107	36.06956695	-119.0296813	Tulare County
67813	Fee-for-Service	1265701163	1265701163	1	1	AMPL MANAGEMENT INC	5/16/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2855 TEMPLE AVE	STE H	SIGNAL HILL	CA	90755	2212	19	06037	33.809013	-118.1589655	Los Angeles County
67910	Fee-for-Service	1285976662	1285976662	1	1	ALI, ZEINA MD	5/28/2019	390200000X	NA	Other	026	PHYSICIANS	138439	01	General Practice	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
67917	Fee-for-Service	1922377878	1922377878	1	1	ALTA CARE HOSPICE INC	3/26/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7100 HAYVENHURST AVE	SUITE 202	VAN NUYS	CA	91406	3804	19	06037	34.199064	-118.4923845	Los Angeles County
67935	Fee-for-Service	1255350971	1255350971	1	1	ALVAREZ, FRANK MD	9/30/1991	2083P0901X	NA	Adult Primary Care	026	PHYSICIANS	68732	01	General Practice	0	In state provider	None	286 EUCLID AVE	STE 310	SAN DIEGO	CA	92114	3613	37	06073	32.70706919	-117.0850896	San Diego County
67939	Fee-for-Service	1790080539	1790080539	1	1	AKARANTA INC	3/11/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8661 BASELINE ROAD	None	RANCHO CUCAMONGA	CA	91730	1111	36	06071	34.12154051	-117.617798	San Bernardino County
67956	Fee-for-Service	1891948048	1891948048	1	1	AMORN, MELISSA M MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115925	04	Otology, Laryngology, Rhinology	0	In state provider	None	19845 LAKE CHABOT	STE 302	CASTRO VALLEY	CA	94546	4055	01	06001	37.69995352	-122.087795	Alameda County
67984	Fee-for-Service	1336558196	1336558196	1	1	ANN HOSPICE INC	9/13/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	16530 VENTURA BLVD	SUITE 204	ENCINO	CA	91436	4589	19	06037	34.15766626	-118.4934057	Los Angeles County
67999	Fee-for-Service	1245857085	1245857085	2	1	ALL FAMILY HOSPICE INC	8/11/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	103 W ALAMEDA AVE	SUITE 130	BURBANK	CA	91502	2253	19	06037	34.17123949	-118.3032671	Los Angeles County
68014	Fee-for-Service	1629054499	1629054499	2	1	A-1 OXYGEN INC	12/26/2007	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	A-1 OXYGEN INC	16218 VENTURA BLVD	STE 3	ENCINO	CA	91436	4623	19	06037	34.15667857	-118.4860946	Los Angeles County
68051	Fee-for-Service	1154736429	1154736429	1	12	AVENAL COMMUNITY HEALTH CENT	2/20/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	575 W PUTNAM AVE	None	PORTERVILLE	CA	93257	3270	54	06107	36.06956695	-119.0296813	Tulare County
68059	Fee-for-Service	1619309002	1619309002	1	1	AU, KATHERINE M LMFT	12/13/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39650 LIBERTY ST	STE 310	FREMONT	CA	94358	2227	01	06001	37.54662058	-121.9736002	Alameda County
68106	Fee-for-Service	1528088283	1528088283	1	1	ARANT BANDY, NEEL CNM	7/3/2018	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3779 PIEDMONT AVE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
68168	Fee-for-Service	1588027981	1588027981	1	1	AMIN, MARIAM MD	3/14/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	169945	None	None	0	In state provider	None	632 W 11TH ST	STE 219	TRACY	CA	95376	3861	39	06077	37.73965648	-121.4352045	San Joaquin County
68182	Fee-for-Service	1194150086	1194150086	1	1	AKHTARRAMAY, SANA LMFT	9/9/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
68217	Fee-for-Service	1316955123	1316955123	1	1	ADAM D SNIDER, D.O.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	427 GUY PARK AVE	None	AMSTERDAM	NY	12010	1054	00	None	42.954579	-74.2164255	Montgomery County
68231	Fee-for-Service	1366725764	1366725764	1	1	ALAMEDA NEUROPSYCH INC	12/31/2015	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1516 OAK ST	STE 313	ALAMEDA	CA	94501	7850	01	06001	37.76659159	-122.2428627	Alameda County
68247	Fee-for-Service	1053680181	1053680181	1	2	APEX HEALTHCARE MEDICAL CENT	6/17/2020	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	29826 HAUN RD.	STE. 200	MENIFEE	CA	92586	6546	33	06065	33.68719818	-117.1748757	Riverside County
68286	Fee-for-Service	1750650982	1750650982	1	1	APEX RADIOLOGY MEDICAL GROUP	4/9/2015	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
68295	Fee-for-Service	1134632623	1134632623	1	1	ALEXANDRA, LAINE LCSW	7/24/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1695 NORTH SUNRISE WAY	None	PALM SPRINGS	CA	92262	3701	33	06065	33.844239	-116.5282075	Riverside County
68337	Fee-for-Service	1013418961	1013418961	1	1	ARGUETA, DAVID J	7/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
68350	Fee-for-Service	1518905322	1518905322	1	1	ARDILLES, ELVIO E MD	1/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106068	41	Internal Medicine	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3194	07	06013	37.9141514	-122.0422089	Contra Costa County
68372	Fee-for-Service	1083350649	1083350649	1	1	ATLAS INTENSIVE CARE	10/26/2023	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	2425 SAMARITAN DRIVE	None	SAN JOSE	CA	95124	0000	43	06085	37.25111017	-121.9465891	Santa Clara County
68383	Fee-for-Service	1144244823	1144244823	1	1	ARIGO, RICHARD C MD	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82503	None	None	0	In state provider	None	330 LEWIS ST	None	SAN DIEGO	CA	92103	2108	37	06073	32.75187491	-117.1617402	San Diego County
68420	Fee-for-Service	1720175268	1720175268	1	1	ADAMS, GREGG A MD	9/30/1990	208600000X	NA	General Surgery	026	PHYSICIANS	70824	02	General Surgery	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
68440	Fee-for-Service	1134186901	1134186901	1	1	ALLEN, KEITH R MD	7/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156509	01	General Practice	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
68453	Fee-for-Service	1255647145	1255647145	1	1	ATHAVALE, AMBARISH M MD	8/29/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	179632	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
68476	Fee-for-Service	1093755498	1093755498	1	1	AOKI, MAKI MD	7/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142122	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
68492	Fee-for-Service	1003291832	1003291832	1	1	AZAR, EDWARD S DPM	4/25/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
68496	Fee-for-Service	1710504204	1710504204	1	1	AVE MARIA HOSPICE	6/23/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	16438 VANOWEN ST	STE 208	VAN NUYS	CA	91406	4762	19	06037	34.1938865	-118.491471	Los Angeles County
68519	Fee-for-Service	1699089557	1699089557	1	1	ALDEGUER, YLAINE R T MD	6/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130235	01	General Practice	0	In state provider	None	2000 MOWRY AVENUE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
68526	Fee-for-Service	1194783829	1194783829	1	1	ABOLNIK, IGOR Z MD	11/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145403	41	Internal Medicine	0	In state provider	None	2280 HARRISON AVE	SUITE B	EUREKA	CA	95501	3200	12	06023	40.78745765	-124.1396643	Humboldt County
68531	Fee-for-Service	1326063843	1326063843	1	1	ANDERSSON, PETER-BRIAN	9/1/1995	2084N0400X	NA	Neurology	026	PHYSICIANS	52853	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
68543	Fee-for-Service	1942210505	1942210505	1	1	AGNEW, MATTHEW L MD	2/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113939	02	General Surgery	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
68586	Fee-for-Service	1295864684	1295864684	1	1	ARE, ESTHER	10/7/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	LAYO HIDDEN TREA MED SUP	15342 HAWTHORNE BLVD	STE 207	LAWNDALE	CA	90260	2193	19	06037	33.89134249	-118.3523351	Los Angeles County
68619	Fee-for-Service	1356703201	1356703201	1	1	ANLA MANAGMENT CORP	5/14/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	19720 VENTURA BLVD	UNIT 100	WOODLAND HILLS	CA	91364	2624	19	06037	34.17245599	-118.5633517	Los Angeles County
68662	Fee-for-Service	1063546786	1063546786	1	1	ARDON, SALVADOR LMFT	8/7/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10630 TOWN CENTER DR	STE 123A/B	RANCHO CUCAMONGA	CA	91730	6843	36	06071	34.11112305	-117.5729644	San Bernardino County
68675	Fee-for-Service	1972557411	1972557411	1	1	AGRAWAL, NINA MD	1/27/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	192506	40	Pediatrics	0	In state provider	None	15400 LOS GATOS BLVD	None	LOS GATOS	CA	95032	2502	43	06085	37.24572659	-121.957997	Santa Clara County
68680	Fee-for-Service	1114058310	1114058310	1	1	ARMANDO, OSCAR LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
68710	Fee-for-Service	1720175268	1720175268	1	1	ADAMS, GREGG A MD	9/30/1990	208600000X	NA	General Surgery	026	PHYSICIANS	70824	66	Emergency Medicine (Urgent Care)	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
68726	Fee-for-Service	1134186901	1134186901	1	1	ALLEN, KEITH R MD	7/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156509	02	General Surgery	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
68740	Fee-for-Service	1790893857	1790893857	1	2	ANABI, SAMIR I MD	6/14/2005	207R00000X	NA	Other	026	PHYSICIANS	61382	None	None	0	In state provider	PLAZA DE VALLE MED CLINI	504 S GAREY AVE	None	POMONA	CA	91766	3319	19	06037	34.05434933	-117.749939	Los Angeles County
68766	Fee-for-Service	1053680181	1053680181	1	1	APEX HEALTHCARE MEDICAL CENT	12/6/2012	193400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CENTER INC	1515 W FLORIDA AVE	None	HEMET	CA	92543	3817	33	06065	33.74738653	-116.9879535	Riverside County
68771	Fee-for-Service	1508363334	1508363334	1	1	AL-GHRAIRI, AHMED MD	9/1/2023	207R00000X	NA	Other	026	PHYSICIANS	186461	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
68784	Fee-for-Service	1710504204	1710504204	1	1	AVE MARIA HOSPICE	6/23/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	16438 VANOWEN ST	STE 208	VAN NUYS	CA	91406	4762	19	06037	34.1938865	-118.491471	Los Angeles County
68790	Fee-for-Service	1982949053	1982949053	1	1	ASSIST ON CALL PROFESSIONAL	10/21/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	IN-HOME CARE SERVICES IN	2100 MONUMENT BLVD	SUITE 8A	PLEASANT HILL	CA	94523	3429	07	06013	37.94624834	-122.0534331	Contra Costa County
68792	Fee-for-Service	1346884947	1346884947	1	1	APRIL PRICE	6/9/2020	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	202 PROSPECT DR	None	GLENDIVE	MT	59330	1943	00	None	47.116899	-104.7042405	Dawson County
68802	Fee-for-Service	1730869702	1730869702	1	1	AJAY BHATNAGAR MD PC	11/6/2023	2085R0001X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	CALIFORNIA	11100 WARNER AVE	SUITE 206	FOUNTAIN VALLEY	CA	92708	7511	30	06059	33.716291	-117.9355051	Orange County
68824	Fee-for-Service	1023369824	1023369824	1	1	AMERICAN MEDICAL DIAGNOSTIC	1/1/2014	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	LABORATORIES INC	12665 GARDEN GROVE BLVD	STE 111	GARDEN GROVE	CA	92843	1915	30	06059	33.77450141	-117.9123364	Orange County
68825	Fee-for-Service	1093964769	1093964769	1	1	AHOUI, ALI MD	4/14/2020	208M00000X	NA	Other	026	PHYSICIANS	164659	41	Internal Medicine	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
68832	Fee-for-Service	1861429631	1861429631	1	1	ARENAS, JESSE P MD	12/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37465	01	General Practice	0	In state provider	None	1840 N HACIENDA BLVD	STE 6	LA PUENTE	CA	91744	1143	19	06037	34.05164127	-117.9426446	Los Angeles County
68867	Fee-for-Service	1225364052	1225364052	1	1	AKRAMI, KEVAN M MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115008	41	Internal Medicine	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
68870	Fee-for-Service	1932214657	1932214657	1	14	AJAY G. MEKA M.D. INC.	8/17/2021	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	9041 MAGNOLIA AVE	301	RIVERSIDE	CA	92503	3957	33	06065	33.92541585	-117.4378266	Riverside County
68892	Fee-for-Service	1053398222	1053398222	1	1	ALPER, LINDSEY STROBEN	2/8/2015	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8318 UNIVERSITY AVE	STE A4	LA MESA	CA	91941	3858	37	06073	32.76790659	-117.0185664	San Diego County
68908	Fee-for-Service	1295507598	1295507598	1	1	ALFONSO-MONTERROSA, JESSICA	12/29/2023	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	N RRT	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
68916	Fee-for-Service	1164606380	1164606380	1	7	ABILITY PATHWAYS INC	7/13/2007	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	GIBBS DIVISION	1463 N ALBRIGHT AVE	None	UPLAND	CA	91786	2725	36	06071	34.116516	-117.6620385	San Bernardino County
68960	Fee-for-Service	1144704008	1144704008	1	1	AMIGO TRANSPORTATION INC	3/15/2018	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	895 PALOMAR ST	STE B3	CHULA VISTA	CA	91911	2627	37	06073	32.60451466	-117.0919661	San Diego County
68979	Fee-for-Service	1992179360	1992179360	1	1	A NEW CREATION CHILD, INDIVI	12/31/2019	261QM0801X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	DUAL & FAMILY COUNSELING	23800 SUNNYMEAD BLVD	SUITE D	MORENO VALLEY	CA	92553	7731	33	06065	33.93901947	-117.2473637	Riverside County
68980	Fee-for-Service	1285667758	1285667758	1	1	AMPLA HEALTH	9/1/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	& DENTAL	1211 CORTINA DR	None	ORLAND	CA	95963	1699	11	06021	39.74167912	-122.201695	Glenn County
69021	Fee-for-Service	1992219646	1992219646	2	1	AEGIS TREATMENT CENTERS, LLC	6/2/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1889 W REDLANDS BLVD.	BLDG 9	REDLANDS	CA	92373	3119	36	06071	34.06288549	-117.21717	San Bernardino County
69063	Fee-for-Service	1801509328	1801509328	1	1	AMADI, EDITH	3/23/2023	2084P0800X	NA	Psychiatry	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
69084	Fee-for-Service	1710923404	1710923404	1	1	AUSTIN, JEANNETTE M CRNA	6/15/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
69098	Fee-for-Service	1073276994	1073276994	1	1	ALL FOR ONE HOME HEALTH	12/7/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	8925 SEPULVEDA BLVD	STE 207B	NORTH HILLS	CA	91343	4300	19	06037	34.232355	-118.467768	Los Angeles County
69102	Fee-for-Service	1588161483	1588161483	1	1	AHMED, MOHAMMED ASFHAN DO	12/22/2021	207R00000X	NA	Other	026	PHYSICIANS	19107	None	None	0	In state provider	None	400 E OAK AVE	None	VISALIA	CA	93291	5034	54	06107	36.332253	-119.288691	Tulare County
69113	Fee-for-Service	1366548307	1366548307	1	1	ANVEKAR, VAIBHAV M MD	9/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	71040	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
69155	Fee-for-Service	1336152396	1336152396	1	1	AKINTUNDE, CELEDOR MD	2/24/2025	207QA0401X	NA	Adult Primary Care	026	PHYSICIANS	191918	70	Clinic (mixed specialty)	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
69168	Fee-for-Service	1629113402	1629113402	1	1	ANSORG, HENNING MD	5/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138870	41	Internal Medicine	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93310	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
69170	Fee-for-Service	1023287489	1023287489	1	1	AGHANIAN, ELSA MD	12/9/2009	207W00000X	NA	Ophthalmology	026	PHYSICIANS	97896	18	Ophthalmology	0	In state provider	None	607 N CENTRAL AVENUE	None	GLENDALE	CA	91203	1804	19	06037	34.153974	-118.2579675	Los Angeles County
69172	Fee-for-Service	1598383739	1598383739	1	1	ALLWISE CARE COMPANION INC	10/20/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	14299 POINTER LOOP	None	EASTVALE	CA	92880	0310	33	06065	33.94474041	-117.5937012	Riverside County
69185	Fee-for-Service	1003476953	1003476953	1	1	AMAZING HEALTH HOME CARE INC	12/7/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	74333 HWY 111	STE 106	PALM DESERT	CA	92260	4130	33	06065	33.72105174	-116.3680184	Riverside County
69186	Fee-for-Service	1578502480	1578502480	1	1	ATAMDEDE, FIKRET I MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	56999	78	Neoplastic Diseases/Oncology	0	In state provider	None	21840 NORMANDIE AVE	# 1000	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
69193	Fee-for-Service	1598409674	1598409674	1	1	AKBARI, AMIR-HOSSEIN MD	5/16/2023	207ZC0006X	NA	Other	026	PHYSICIANS	184031	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
69203	Fee-for-Service	1710409289	1710409289	1	1	ABORDO, JOHANN-CHRISTIAN O D	12/1/2020	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	PM	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
69208	Fee-for-Service	1588180749	1588180749	1	1	AFICIAL, JEAN L	12/21/2017	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1831 RED SAGE	None	IRVINE	CA	92618	1536	30	06059	33.68160701	-117.7519358	Orange County
69224	Fee-for-Service	1598722027	1598722027	1	1	AURORA SAN DIEGO, LLC	9/8/2000	283Q00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11878 AVE OF INDUSTRY	None	SAN DIEGO	CA	92128	3423	37	06073	32.99058739	-117.0752486	San Diego County
69258	Fee-for-Service	1366419517	1366419517	1	1	ANTELOPE VALLEY HEALTHCARE	1/1/1995	282N00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	HEALTHCARE DISTRICT	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
69270	Fee-for-Service	1285667758	1285667758	1	1	AMPLA HEALTH	3/25/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	& DENTAL	1211 CORTINA DR	None	ORLAND	CA	95963	1699	11	06021	39.74167912	-122.201695	Glenn County
69288	Fee-for-Service	1255542601	1255542601	1	2	ALTAMED MEDICAL & DENTAL	11/21/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	WILLIAMS MEAD	268 E BLOOM STREET	#322	LOS ANGELES	CA	90012	1973	19	06037	34.06371101	-118.2294271	Los Angeles County
69307	Fee-for-Service	1992219646	1992219646	2	1	AEGIS TREATMENT CENTERS, LLC	6/2/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1889 W REDLANDS BLVD.	BLDG 9	REDLANDS	CA	92373	3119	36	06071	34.06288549	-117.21717	San Bernardino County
69384	Fee-for-Service	1528389145	1528389145	1	1	ANWAR, SHAHZAD MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115075	08	Family Practice	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
69497	Fee-for-Service	1588180749	1588180749	1	1	AFICIAL, JEAN L	12/21/2017	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1831 RED SAGE	None	IRVINE	CA	92618	1536	30	06059	33.68160701	-117.7519358	Orange County
69510	Fee-for-Service	1760936959	1760936959	1	1	ALVES, KARLENE M PSYD	8/14/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
69512	Fee-for-Service	1598722027	1598722027	1	1	AURORA SAN DIEGO, LLC	9/8/2000	283Q00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	11878 AVE OF INDUSTRY	None	SAN DIEGO	CA	92128	3423	37	06073	32.99058739	-117.0752486	San Diego County
69522	Fee-for-Service	1073507174	1073507174	1	1	ALAYNICK, MICHAEL H MD	2/8/2015	207P00000X	NA	Other	026	PHYSICIANS	41249	66	Emergency Medicine (Urgent Care)	0	In state provider	None	161 THUNDER DR	STE 112	VISTA	CA	92083	6051	37	06073	33.18638925	-117.2882216	San Diego County
69543	Fee-for-Service	1780322123	1780322123	1	1	ALBA WELLNESS GROUP, A LICEN	3/27/2025	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	SED CLINICAL SOCIAL WO	14500 ROSCOE BLVD	400	PANORAMA CITY	CA	91402	4190	19	06037	34.2215055	-118.44918	Los Angeles County
69547	Fee-for-Service	1366419517	1366419517	1	1	ANTELOPE VALLEY HEALTHCARE	12/1/1977	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HEALTHCARE DISTRICT	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
69551	Fee-for-Service	1548211436	1548211436	1	2	ADIBI, KAMI MD	8/2/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	64723	-	NOT APPLICABLE	0	In state provider	None	405 W. MANCHESTER BLVD	SUITE A & 4	INGLEWOOD	CA	90301	1196	19	06037	33.96175122	-118.3621356	Los Angeles County
69557	Fee-for-Service	1285667758	1285667758	1	1	AMPLA HEALTH	9/1/1992	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	& DENTAL	1211 CORTINA DR	None	ORLAND	CA	95963	1699	11	06021	39.74167912	-122.201695	Glenn County
69571	Fee-for-Service	1760707749	1760707749	1	1	AUNG, KEVIN C MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128018	05	Anesthesiology	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
69574	Fee-for-Service	1255542601	1255542601	1	2	ALTAMED MEDICAL & DENTAL	11/21/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	WILLIAMS MEAD	268 E BLOOM STREET	#322	LOS ANGELES	CA	90012	1973	19	06037	34.06371101	-118.2294271	Los Angeles County
69593	Fee-for-Service	1093712820	1093712820	1	1	ARORA, RAJESH MD	1/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	49040	05	Anesthesiology	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
69603	Fee-for-Service	1063467116	1063467116	1	1	ALEGRE, GARY M MD	8/20/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65392	None	None	0	In state provider	None	333 E ALPINE AVE	None	STOCKTON	CA	95204	3407	39	06077	37.98100681	-121.2957195	San Joaquin County
69636	Fee-for-Service	1033460795	1033460795	1	1	AMERICARE HOME HEALTH INC	3/11/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	16501 SHERMAN WAY	STE 225	VAN NUYS	CA	91406	3787	19	06037	34.20125005	-118.4927785	Los Angeles County
69675	Fee-for-Service	1811177637	1811177637	1	1	ALLEN, LENA M LCSW	10/26/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	24675	-	NOT APPLICABLE	0	In state provider	None	165 CLAY ST	None	SALINAS	CA	93901	2509	27	06053	36.67006578	-121.6591741	Monterey County
69716	Fee-for-Service	1184299042	1184299042	1	1	AZI HOSPICE, INC	1/15/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7200 VINELAND AVE	STE 220	SUN VALLEY	CA	91352	5088	19	06037	34.2016328	-118.3703012	Los Angeles County
69729	Fee-for-Service	1346351517	1346351517	1	1	ALVERGUE, JUAN C MD	6/3/2008	207R00000X	NA	Other	026	PHYSICIANS	93050	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	PASADENA	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
69746	Fee-for-Service	1568439644	1568439644	1	1	ABRAMSON, WENDY B MD	10/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103928	05	Anesthesiology	0	In state provider	None	200 W ARBOR DRIVE	8201	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
69747	Fee-for-Service	1558812479	1558812479	1	1	ABC BIRTH SERVICES, INC	5/14/2019	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	LLNESS CENTER	123 E ALVARADO ST	None	FALLBROOK	CA	92028	2049	37	06073	33.38202549	-117.2506995	San Diego County
69760	Fee-for-Service	1336110956	1336110956	1	1	ALFORD, DAVID P OD	5/1/2000	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	937 E MAIN ST	STE 102	SANTA MARIA	CA	93454	5309	42	06083	34.95309189	-120.4209855	Santa Barbara County
69777	Fee-for-Service	1023105558	1023105558	1	1	ARTINYAN, LUDVIK MD	10/15/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	50018	13	Neurology (M.D. only)	0	In state provider	None	5300 SANTA MONICA BLVD	STE 200	LOS ANGELES	CA	90029	1258	19	06037	34.09075271	-118.305509	Los Angeles County
69778	Fee-for-Service	1891821666	1891821666	1	1	AFEWORK, SEBHAT MD	12/1/1997	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	53762	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
69783	Fee-for-Service	1225437437	1225437437	1	1	ABC WORLD MEDICAL, INC.	11/18/2015	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	10256 WESTMINSTER AVE	None	GARDEN GROVE	CA	92843	4830	30	06059	33.75949952	-117.9497955	Orange County
69799	Fee-for-Service	1598722027	1598722027	1	1	AURORA SAN DIEGO, LLC	9/8/2000	283Q00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	11878 AVE OF INDUSTRY	None	SAN DIEGO	CA	92128	3423	37	06073	32.99058739	-117.0752486	San Diego County
69810	Fee-for-Service	1073507174	1073507174	1	1	ALAYNICK, MICHAEL H MD	2/8/2015	207P00000X	NA	Other	026	PHYSICIANS	41249	41	Internal Medicine	0	In state provider	None	161 THUNDER DR	STE 112	VISTA	CA	92083	6051	37	06073	33.18638925	-117.2882216	San Diego County
69845	Fee-for-Service	1285667758	1285667758	1	1	AMPLA HEALTH	7/1/1994	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	& DENTAL	1211 CORTINA DR	None	ORLAND	CA	95963	1699	11	06021	39.74167912	-122.201695	Glenn County
69876	Fee-for-Service	1841735263	1841735263	1	1	ALLEN, KATHERINE B LMFT	4/26/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	735 12TH ST	None	ARCATA	CA	95521	5865	12	06023	40.8713849	-124.0857261	Humboldt County
69891	Fee-for-Service	1538528336	1538528336	1	1	ADAM CONLIN	4/14/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 W KINNICKINNIC	RIVER PKW STE 413	MILWAUKEE	WI	53215	3660	00	None	42.99102049	-87.95148734	Milwaukee County
69905	Fee-for-Service	1639468747	1639468747	1	1	ASFAR, RAFID R MD	9/20/2021	207RR0500X	NA	Other	026	PHYSICIANS	156620	None	None	0	In state provider	None	1590 SOUTH IMPERIAL AVE	None	EL CENTRO	CA	92243	4241	13	06025	32.77950118	-115.5697279	Imperial County
69907	Fee-for-Service	1053313544	1053313544	2	1	ALI, YUSUF MD	12/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	73465	40	Pediatrics	0	In state provider	None	203 WALKER ST	STE 3	ORLAND	CA	95963	1450	11	06021	39.74734953	-122.1918345	Glenn County
69946	Fee-for-Service	1629650973	1629650973	1	1	ANSARI, SAMEEN MD	7/26/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
69964	Fee-for-Service	1912666587	1912666587	1	1	ANAFARM HOME HEALTH INC	5/20/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3171 LOS FELIZ BLVD	#201	LOS ANGELES	CA	90039	1536	19	06037	34.12369709	-118.2682266	Los Angeles County
69978	Fee-for-Service	1730657412	1730657412	1	1	AMALFI HOSPICE CARE INC	11/20/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	435 ORANGE SHOW LN	STE 201 AND 202	SAN BERNARDINO	CA	92408	2031	36	06071	34.08100788	-117.2922379	San Bernardino County
69984	Fee-for-Service	1265810055	1265810055	1	1	ABU-TABIKH, SARA Q MD	7/1/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	149761	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
70002	Fee-for-Service	1184299042	1184299042	1	1	AZI HOSPICE, INC	1/15/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7200 VINELAND AVE	STE 220	SUN VALLEY	CA	91352	5088	19	06037	34.2016328	-118.3703012	Los Angeles County
70024	Fee-for-Service	1306951827	1306951827	1	1	ANDERSON, MANDY L	3/29/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
70032	Fee-for-Service	1558812479	1558812479	1	1	ABC BIRTH SERVICES, INC	4/18/2025	176B00000X	NA	Licensed Midwife	107	DOULA GROUP PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
70055	Fee-for-Service	1477577351	1477577351	1	1	AKHAVAN, RAHA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69155	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
70063	Fee-for-Service	1023105558	1023105558	1	1	ARTINYAN, LUDVIK MD	10/15/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	50018	01	General Practice	0	In state provider	None	5300 SANTA MONICA BLVD	STE 200	LOS ANGELES	CA	90029	1258	19	06037	34.09075271	-118.305509	Los Angeles County
70077	Fee-for-Service	1972070555	1972070555	1	1	AHMAD, SHAHRIN PT	11/27/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
70096	Fee-for-Service	1215144043	1215144043	1	1	ANDREWS, SONIA T PHD	5/15/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3551 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.6057383	-122.0834562	Alameda County
70104	Fee-for-Service	1124352034	1124352034	1	1	ABID, AFSHEEN MD	9/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109285	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
70109	Fee-for-Service	1346216926	1346216926	1	1	ARTEAGA JOHNNY WO	1/1/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4041 N FRESNO ST	STE 102	FRESNO	CA	93726	4038	10	06019	36.79116667	-119.7814409	Fresno County
70146	Fee-for-Service	1922608223	1922608223	1	1	AVAZIAN, ELIZABETH L PT	12/11/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	27450 YNEZ RD	SUITE 120	TEMECULA	CA	92591	4671	33	06065	33.50684549	-117.1502048	Riverside County
70156	Fee-for-Service	1598948036	1598948036	1	1	ALLELUIA	2/11/1997	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HOLLYWOOD HOME	405 W HOLLYWOOD CT	None	REEDLEY	CA	93654	2154	10	06019	36.61049452	-119.4520815	Fresno County
70173	Fee-for-Service	1346328531	1346328531	1	1	ARABO, KUSAY I OD	1/27/2014	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5893 COPLEY DR	None	SAN DIEGO	CA	92111	7906	37	06073	32.84332697	-117.1728709	San Diego County
70194	Fee-for-Service	1689357238	1689357238	1	1	ACTIVUS TRANSPORT LLC	11/13/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	4410 GLACIER AVENUE	SUITE 102	SAN DIEGO	CA	92120	3327	37	06073	32.7887939	-117.0990429	San Diego County
70228	Fee-for-Service	1932442944	1932442944	1	2	ABOAZIZA, AHMAD A MD	12/16/2022	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	138964	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
70237	Fee-for-Service	1932217544	1932217544	1	1	ABDELKARIM, BASIM Z MD	11/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	74259	10	Gastroenterology (M.D. only)	0	In state provider	None	1310 SAN BERNARDINO RD	STE 103	UPLAND	CA	91786	4985	36	06071	34.10260261	-117.6332582	San Bernardino County
70246	Fee-for-Service	1003651639	1003651639	1	1	ABRAMOWITZ, ILANA NP	11/6/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
70254	Fee-for-Service	1952938300	1952938300	1	1	ARMITAGE, ANNA MD	7/21/2023	207R00000X	NA	Other	026	PHYSICIANS	186394	None	None	0	In state provider	None	501 N ORANGE STREET	None	GLENDALE	CA	91203	1970	19	06037	34.15323119	-118.2565389	Los Angeles County
70268	Fee-for-Service	1730657412	1730657412	1	1	AMALFI HOSPICE CARE INC	11/20/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	435 ORANGE SHOW LN	STE 201 AND 202	SAN BERNARDINO	CA	92408	2031	36	06071	34.08100788	-117.2922379	San Bernardino County
70286	Fee-for-Service	1295814325	1295814325	1	1	ARELLANO, PETER D MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69898	08	Family Practice	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
70290	Fee-for-Service	1396996245	1396996245	1	1	AIKENS, ALAN C MD	2/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130752	34	Urology and Urological Surgery	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
70306	Fee-for-Service	1376202507	1376202507	1	1	APEX MED FAMILY HEALTHCARE	5/9/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	99 N SAN ANTONIO AVE	210	UPLAND	CA	91786	4578	36	06071	34.095078	-117.660769	San Bernardino County
70350	Fee-for-Service	1619181427	1619181427	1	1	ABIDOV AIDEN MD	2/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	UNIVERSITY MEDICAL CENTE	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
70361	Fee-for-Service	1053543942	1053543942	1	1	AHUJA, ASMITA MD	9/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144455	41	Internal Medicine	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
70375	Fee-for-Service	1790018497	1790018497	1	1	ADEINA, DALIA PSYD	4/22/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
70425	Fee-for-Service	1962492876	1962492876	1	1	ADVENTIST HEALTH CLEARLAKE	1/31/2011	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL, INC	5290 STATE ST	None	KELSEYVILLE	CA	95451	9450	17	06033	38.97752113	-122.8337561	Lake County
70439	Fee-for-Service	1346615457	1346615457	1	1	ASSURE HOSPICE CARE INC	3/21/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	24404 S VERMONT AVENUE	STE 303	HARBOR CITY	CA	90710	2324	19	06037	33.80302968	-118.2902917	Los Angeles County
70461	Fee-for-Service	1679813497	1679813497	1	1	ANDERSON, LESLIE R LMFT	9/4/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	505 MCCLELLAND ST	STE A	SANTA MARIA	CA	93454	5186	42	06083	34.948287	-120.434338	Santa Barbara County
70487	Fee-for-Service	1598375271	1598375271	1	1	ASPIRUS WAUSAU HOSPITAL, INC	6/4/2023	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	5409 VERN HOLMES DR	None	STEVENS POINT	WI	54482	8853	00	None	44.49886911	-89.51555548	Portage County
70489	Fee-for-Service	1538994108	1538994108	1	1	ALLEGIANCE STEAM ACADEMY	10/1/2024	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	5862 C STREET	None	CHINO	CA	91710	4471	36	06071	34.01561748	-117.6773715	San Bernardino County
70495	Fee-for-Service	1255803516	1255803516	1	1	ARTEAGA-BERMUDEZ, AMY J CCC-	5/23/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	SLP	6965 SAN LUIS AVE	None	ATASCADERO	CA	93422	5201	40	06079	35.48021573	-120.6597811	San Luis Obispo County
70501	Fee-for-Service	1770242182	1770242182	1	1	ALI, ILHAN LPCC	2/19/2025	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
70519	Fee-for-Service	1649206418	1649206418	1	1	ADELE BRUDNICKI M.D.	11/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 WOODS RD	None	VALHALLA	NY	10595	1530	00	None	41.08902532	-73.80449573	Westchester County
70535	Fee-for-Service	1679668016	1679668016	1	1	AQUINO-CARO, EVELYN B MD	12/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	40198	36	Psychiatry	0	In state provider	None	723 E LOCUST AVE	STE 120	FRESNO	CA	93720	3021	10	06019	36.84055248	-119.7718605	Fresno County
70585	Fee-for-Service	1154399632	1154399632	1	1	AVALOS, ROY T MD	8/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68893	41	Internal Medicine	0	In state provider	None	351 SANTA FE DR	STE 100	ENCINITAS	CA	92024	5137	37	06073	33.03617853	-117.2843775	San Diego County
70591	Fee-for-Service	1801967724	1801967724	1	1	ASRAT, ALEM MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74261	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
70594	Fee-for-Service	1780274472	1780274472	1	1	ALCANTARA, HONEYLYNN M CNP	10/9/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
70602	Fee-for-Service	1396764353	1396764353	1	4	ALAMEDA HEALTH SYSTEM	8/1/2023	282N00000X	NA	Hospitals	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4399	01	06001	37.76333626	-122.253868	Alameda County
70621	Fee-for-Service	1346609740	1346609740	1	1	ABOUSAMRA, OUSSAMA MD	8/13/2018	207XP3100X	NA	Orthopedic Surgery	026	PHYSICIANS	166005	20	Orthopedic Surgery	0	In state provider	None	19414 W SIERRA ESTATS DR	None	SANTA CLARITA	CA	91321	2128	19	06037	34.39782763	-118.4752058	Los Angeles County
70640	Fee-for-Service	1144358755	1144358755	1	1	ARELLANO-KRUSE, ANTHONY	9/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88537	05	Anesthesiology	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
70646	Fee-for-Service	1053543942	1053543942	1	1	AHUJA, ASMITA MD	9/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144455	78	Neoplastic Diseases/Oncology	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
70666	Fee-for-Service	1003279621	1003279621	1	1	AMANAT, SOROOSH MD	7/17/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153022	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
70682	Fee-for-Service	1023336294	1023336294	1	1	ALLISON, STEPHEN C MD	4/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118576	36	Psychiatry	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
70688	Fee-for-Service	1205997327	1205997327	1	1	ACUNA, JHONNARD J S CRNA	2/15/2006	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
70714	Fee-for-Service	1558459180	1558459180	1	1	ADVANCED PEDIATRICS MEDI	4/24/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	GROUP INC	5222 BALBOA AVE	STE 42	SAN DIEGO	CA	92117	6991	37	06073	32.81873589	-117.1838368	San Diego County
70716	Fee-for-Service	1962492876	1962492876	1	1	ADVENTIST HEALTH CLEARLAKE	3/1/1998	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL, INC	5290 STATE ST	None	KELSEYVILLE	CA	95451	9450	17	06033	38.97752113	-122.8337561	Lake County
70726	Fee-for-Service	1346615457	1346615457	1	1	ASSURE HOSPICE CARE INC	3/21/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	24404 S VERMONT AVENUE	STE 303	HARBOR CITY	CA	90710	2324	19	06037	33.80302968	-118.2902917	Los Angeles County
70738	Fee-for-Service	1922381326	1922381326	1	1	ASANTE PHYSICIAN PARTNERS	7/10/2018	207RC0200X	NA	Other	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	1	Border provider	None	520 MEDICAL CENTER DRIVE	SUITE 201	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
70752	Fee-for-Service	1669567319	1669567319	1	1	ATHENS REGIONAL MEDICAL	8/30/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER, LLC	1114 W MADISON AVE	None	ATHENS	TN	37303	4150	00	None	35.44033538	-84.60780869	McMinn County
70757	Fee-for-Service	1770031718	1770031718	1	1	ABENDROTH, KATHLEEN PHD	1/27/2025	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3416 AMERICAN RIVER DR	STE B	SACRAMENTO	CA	95864	5753	34	06067	38.569212	-121.3840755	Sacramento County
70762	Fee-for-Service	1477163798	1477163798	1	1	ANODYNE HOSPICE CARE LLC	5/17/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	90 MISSION DR	STE 2	PLEASANTON	CA	94566	7655	01	06001	37.65245399	-121.8782639	Alameda County
70771	Fee-for-Service	1225252596	1225252596	1	1	AGOPIAN, LUCIE G	4/19/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
70773	Fee-for-Service	1396764353	1396764353	1	5	ALAMEDA HEALTH SYSTEM	8/1/2023	282N00000X	NA	Hospitals	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	13855 14TH ST	None	SAN LEANDRO	CA	94578	2611	01	06001	37.712385	-122.143428	Alameda County
70781	Fee-for-Service	1598375271	1598375271	1	1	ASPIRUS WAUSAU HOSPITAL, INC	6/4/2023	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	5409 VERN HOLMES DR	None	STEVENS POINT	WI	54482	8853	00	None	44.49886911	-89.51555548	Portage County
70791	Fee-for-Service	1487158168	1487158168	1	1	AJALAT, MARK J MD	8/1/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	164475	None	None	0	In state provider	None	200 MEDICAL PLAZA	565	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
70849	Fee-for-Service	1184660318	1184660318	1	1	AUMONT, ELISA E MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77495	01	General Practice	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
70850	Fee-for-Service	1215921242	1215921242	1	1	AVALON CARE CENTER-SAN	12/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER	900 MOUNTAIN RANCH RD	None	SAN ANDREAS	CA	95249	9713	05	06009	38.19015021	-120.6678307	Calaveras County
70873	Fee-for-Service	1154399632	1154399632	1	1	AVALOS, ROY T MD	8/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68893	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	351 SANTA FE DR	STE 100	ENCINITAS	CA	92024	5137	37	06073	33.03617853	-117.2843775	San Diego County
70882	Fee-for-Service	1891090163	1891090163	1	1	ABAIAN, MEKABIZ MD	10/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120978	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
70891	Fee-for-Service	1396764353	1396764353	1	4	ALAMEDA HEALTH SYSTEM	1/20/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4399	01	06001	37.76333626	-122.253868	Alameda County
70908	Fee-for-Service	1346609740	1346609740	1	1	ABOUSAMRA, OUSSAMA MD	5/1/2019	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	19414 W SIERRA ESTATS DR	None	SANTA CLARITA	CA	91321	2128	19	06037	34.39782763	-118.4752058	Los Angeles County
70935	Fee-for-Service	1053543942	1053543942	1	1	AHUJA, ASMITA MD	9/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144455	68	Hematology	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
70941	Fee-for-Service	1902105562	1902105562	1	1	AYA REISS MD	1/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4800 SAND POINT WAY NE	None	SEATTLE	WA	98105	3901	00	None	47.662389	-122.281857	King County
70954	Fee-for-Service	1942230495	1942230495	1	1	AMINI, PARVIZ MD	10/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	48740	41	Internal Medicine	0	In state provider	None	22110 ROSCOE BLVD	STE 305	CANOGA PARK	CA	91304	3860	19	06037	34.21957849	-118.6082685	Los Angeles County
70969	Fee-for-Service	1164606380	1164606380	1	6	ABILITY PATHWAYS INC	6/1/2007	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	YORKTOWN DIVISION	315 YORKTOWN CT	None	UPLAND	CA	91784	1640	36	06071	34.12942954	-117.647219	San Bernardino County
70977	Fee-for-Service	1154736429	1154736429	1	11	AVENAL COMMUNITY HEALTH CENT	2/20/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	781 SEQUOIA AVE	SUITE 2	LINDSAY	CA	93247	1422	54	06107	36.21240571	-119.0961081	Tulare County
71000	Fee-for-Service	1962492876	1962492876	1	1	ADVENTIST HEALTH CLEARLAKE	3/1/1998	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL, INC	5290 STATE ST	None	KELSEYVILLE	CA	95451	9450	17	06033	38.97752113	-122.8337561	Lake County
71023	Fee-for-Service	1922381326	1922381326	1	1	ASANTE PHYSICIAN PARTNERS	7/10/2018	207RC0200X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	1	Border provider	None	520 MEDICAL CENTER DRIVE	SUITE 201	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
71043	Fee-for-Service	1003378415	1003378415	1	1	AFSHAR, YAMA A DO	10/12/2022	207R00000X	NA	Other	026	PHYSICIANS	19926	None	None	0	In state provider	None	26800 CROWN VALLEY PKWY	525, 545	MISSION VIEJO	CA	92691	8030	30	06059	33.56286021	-117.6673449	Orange County
71049	Fee-for-Service	1477163798	1477163798	1	1	ANODYNE HOSPICE CARE LLC	5/17/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	90 MISSION DR	STE 2	PLEASANTON	CA	94566	7655	01	06001	37.65245399	-121.8782639	Alameda County
71065	Fee-for-Service	1396764353	1396764353	1	5	ALAMEDA HEALTH SYSTEM	9/4/2023	282N00000X	NA	Hospitals	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	13855 14TH ST	None	SAN LEANDRO	CA	94578	2611	01	06001	37.712385	-122.143428	Alameda County
71082	Fee-for-Service	1376049767	1376049767	1	1	ALPUERTO, ALDRIN C MD	12/18/2024	208G00000X	NA	General Surgery	026	PHYSICIANS	None	33	Thoracic Surgery	0	In state provider	None	3838 SAN DIMAS ST	STE A 100	BAKERSFIELD	CA	93301	2284	15	06029	35.3946385	-119.008203	Kern County
71117	Fee-for-Service	1063861391	1063861391	1	1	ACEVEDO MANZO, MARLENE	1/15/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8421 AUBURN BLVD	SUITE 110	CITRUS HEIGHTS	CA	95610	0359	34	06067	38.719026	-121.291335	Sacramento County
71120	Fee-for-Service	1558745869	1558745869	1	1	ADIB, FARZAD MD	4/30/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	155211	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
71139	Fee-for-Service	1184660318	1184660318	1	1	AUMONT, ELISA E MD	9/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77495	66	Emergency Medicine (Urgent Care)	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
71142	Fee-for-Service	1376149294	1376149294	1	1	ALGOS INC., A MEDICAL CORPOR	3/29/2021	103TB0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	567 W PUTNAM AVE	SUITE 2	PORTERVILLE	CA	93257	3260	54	06107	36.06956761	-119.0296417	Tulare County
71179	Fee-for-Service	1396764353	1396764353	1	4	ALAMEDA HEALTH SYSTEM	3/31/2025	282N00000X	NA	Hospitals	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4399	01	06001	37.76333626	-122.253868	Alameda County
71195	Fee-for-Service	1770502650	1770502650	1	1	ALCOULOUMRE, MARCIA S MD	6/30/1992	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	67012	41	Internal Medicine	0	In state provider	None	101 CITY DR S	# 53	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
71203	Fee-for-Service	1083132849	1083132849	1	2	ALTAMED HEALTH SERVICES	4/3/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2100 WEST 3RD STREET	SUITE 301	LOS ANGELES	CA	90057	2285	19	06037	34.06308947	-118.2733326	Los Angeles County
71242	Fee-for-Service	1215006101	1215006101	1	1	ALEGENT HEALTH	5/7/2008	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	COMMUNITY HOSPITAL	11111 S 84TH ST	None	PAPILLION	NE	68046	4122	00	None	41.135958	-96.040035	Sarpy County
71257	Fee-for-Service	1689927535	1689927535	1	1	AHMAD, SABA MD	6/15/2022	207R00000X	NA	Other	026	PHYSICIANS	175737	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
71265	Fee-for-Service	1154736429	1154736429	1	11	AVENAL COMMUNITY HEALTH CENT	2/20/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	781 SEQUOIA AVE	SUITE 2	LINDSAY	CA	93247	1422	54	06107	36.21240571	-119.0961081	Tulare County
71268	Fee-for-Service	1538357637	1538357637	1	1	ADLER, ALISON S LMFT	8/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7293 DUMOSA AVE	STE 8	YUCCA VALLEY	CA	92284	3700	36	06071	34.12094334	-116.4177385	San Bernardino County
71276	Fee-for-Service	1164606380	1164606380	1	3	ABILITY PATHWAYS INC	6/21/2007	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	MORENO DIVISION	4853 MORENO ST	None	MONTCLAIR	CA	91763	1419	36	06071	34.08867162	-117.6991493	San Bernardino County
71280	Fee-for-Service	1467167627	1467167627	1	1	ALBERS, STEPHANIE LCSW	5/15/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
71281	Fee-for-Service	1093074122	1093074122	1	1	AGRAWAL, KUNAL MD	7/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134968	13	Neurology (M.D. only)	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
71288	Fee-for-Service	1518034388	1518034388	1	1	ARVIZU, MONICA J OD	12/24/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5119 POMONA BLVD	None	LOS ANGELES	CA	90022	1711	19	06037	34.03350406	-118.154384	Los Angeles County
71311	Fee-for-Service	1922381326	1922381326	1	1	ASANTE PHYSICIAN PARTNERS	9/4/2018	207RC0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	1	Border provider	None	520 MEDICAL CENTER DRIVE	SUITE 201	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
71318	Fee-for-Service	1881214237	1881214237	1	1	ABIDO, KIMBERLY N CNP	8/20/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26891 ALISO CREEK RD	None	ALISO VIEJO	CA	92656	3392	30	06059	33.5723715	-117.7235968	Orange County
71340	Fee-for-Service	1972534048	1972534048	1	1	ANESTHESIOLOGY CONSUL	1/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	MEDICAL GROUP, INC	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
71343	Fee-for-Service	1639109648	1639109648	1	1	ATIYA, AZMI W MD	3/2/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	78432	02	General Surgery	0	In state provider	None	18350 ROSCOE BLVD	STE 303	NORTHRIDGE	CA	91325	4157	19	06037	34.22071855	-118.5341175	Los Angeles County
71352	Fee-for-Service	1215976550	1215976550	1	1	ALAN TENAGLIA, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3099 N CIVIC CENTER PLZ	None	SCOTTSDALE	AZ	85251	6903	00	None	33.483456	-111.921516	Maricopa County
71355	Fee-for-Service	1396764353	1396764353	1	5	ALAMEDA HEALTH SYSTEM	1/20/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	13855 14TH ST	None	SAN LEANDRO	CA	94578	2611	01	06001	37.712385	-122.143428	Alameda County
71357	Fee-for-Service	1194195255	1194195255	1	1	AGRAMONTE, ZENAIDA LCSW	2/23/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39650 LIBERTY ST	STE 310	FREMONT	CA	94358	2227	01	06001	37.54662058	-121.9736002	Alameda County
71395	Fee-for-Service	1033712880	1033712880	1	1	ALL FOR HEALTH HOSPICE CARE	12/17/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	815 S CENTRAL AVE	SUITE 25	GLENDALE	CA	91204	4300	19	06037	34.13606127	-118.2578932	Los Angeles County
71396	Fee-for-Service	1083762017	1083762017	1	1	AHN, KENT E MD	3/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96797	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
71423	Fee-for-Service	1053726182	1053726182	1	1	ADAMS, DENNIS W MD	6/17/2020	207ZP0102X	NA	Other	026	PHYSICIANS	140041	22	Pathology (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
71429	Fee-for-Service	1376149294	1376149294	1	1	ALGOS INC., A MEDICAL CORPOR	3/29/2021	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	567 W PUTNAM AVE	SUITE 2	PORTERVILLE	CA	93257	3260	54	06107	36.06956761	-119.0296417	Tulare County
71431	Fee-for-Service	1912267691	1912267691	1	1	ANWAR, ABBAS A MD	9/13/2021	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	148123	None	None	0	In state provider	None	5215 TORRANCE BLVD	STE 300	TORRANCE	CA	90503	4009	19	06037	33.83760237	-118.3692467	Los Angeles County
71455	Fee-for-Service	1902267479	1902267479	1	8	ALTAMED HEALTH SERVICES	11/2/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2055 LINCOLN AVENUE	None	PASADENA	CA	91103	1324	19	06037	34.18113421	-118.1596972	Los Angeles County
71459	Fee-for-Service	1578659066	1578659066	1	1	ALATRISTE, ANDRES J MD	4/1/1999	2084N0400X	NA	Neurology	026	PHYSICIANS	45474	13	Neurology (M.D. only)	0	In state provider	None	1550 S IMPERIAL AVE	None	EL CENTRO	CA	92243	4241	13	06025	32.7798991	-115.5697418	Imperial County
71466	Fee-for-Service	1396764353	1396764353	1	4	ALAMEDA HEALTH SYSTEM	9/4/2023	282N00000X	NA	Hospitals	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4399	01	06001	37.76333626	-122.253868	Alameda County
71478	Fee-for-Service	1316181225	1316181225	1	1	AMIN, AMAR M MD	6/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129256	30	Radiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
71488	Fee-for-Service	1083132849	1083132849	1	2	ALTAMED HEALTH SERVICES	4/3/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2100 WEST 3RD STREET	SUITE 301	LOS ANGELES	CA	90057	2285	19	06037	34.06308947	-118.2733326	Los Angeles County
71499	Fee-for-Service	1013407519	1013407519	1	1	ANTIDO, SHERYL R	5/17/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
71523	Fee-for-Service	1619266749	1619266749	1	2	AXIOM REHABILITATION INC	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	17111 BEACH BLVD	SUITE 210	HUNTINGTON BEACH	CA	92647	7444	30	06059	33.713937	-117.9892085	Orange County
71529	Fee-for-Service	1215006101	1215006101	1	1	ALEGENT HEALTH	12/3/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	COMMUNITY HOSPITAL	11111 S 84TH ST	None	PAPILLION	NE	68046	4122	00	None	41.135958	-96.040035	Sarpy County
71534	Fee-for-Service	1245612787	1245612787	1	1	ARSLANIAN, TALIN MD	5/26/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	159533	40	Pediatrics	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
71560	Fee-for-Service	1689971889	1689971889	1	1	ADVENTIST HEALTH PHYSICIANS	2/6/2019	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	6 WOODLAND RD	STE 307	SAINT HELENA	CA	94574	9562	28	06055	38.54297115	-122.4754501	Napa County
71563	Fee-for-Service	1326275520	1326275520	1	1	ANNEN, MICHAEL J MD	11/25/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	162745	30	Radiology	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
71582	Fee-for-Service	1871504548	1871504548	1	1	ALLAIN, DANIEL L NP	6/20/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1110 S BEN MADDOX WAY	SUITE B	VISALIA	CA	93292	3643	54	06107	36.321048	-119.2761675	Tulare County
71593	Fee-for-Service	1447351580	1447351580	1	1	ADDES, SHIRLEY A DPM	3/5/2013	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	7524 FAIRMOUNT AVE	None	EL CERRITO	CA	94530	3746	07	06013	37.90405432	-122.2914004	Contra Costa County
71601	Fee-for-Service	1922381326	1922381326	1	1	ASANTE PHYSICIAN PARTNERS	12/18/2018	207RC0200X	NA	Other	005	CERTIFIED NURSE MIDWIFE	-	None	None	1	Border provider	None	520 MEDICAL CENTER DRIVE	SUITE 201	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
71622	Fee-for-Service	1528365285	1528365285	1	1	AKRAM, TAHIRA MD INC	3/1/2011	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	54187	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	12588-90 CENTRAL AVE	None	CHINO	CA	91710	3507	36	06071	34.024617	-117.689477	San Bernardino County
71623	Fee-for-Service	1316281314	1316281314	1	1	ALFANDY, FNU CNP	9/2/2022	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1150 INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
71641	Fee-for-Service	1396764353	1396764353	1	5	ALAMEDA HEALTH SYSTEM	3/31/2025	282N00000X	NA	Hospitals	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	13855 14TH ST	None	SAN LEANDRO	CA	94578	2611	01	06001	37.712385	-122.143428	Alameda County
71655	Fee-for-Service	1821448606	1821448606	1	1	ARROWHEAD HOSPICE, INC	2/21/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	STE 426	ENCINO	CA	91436	2204	19	06037	34.15682212	-118.4871886	Los Angeles County
71656	Fee-for-Service	1699317644	1699317644	1	2	AVICENNA CRITICAL CARE, PC	10/14/2020	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	8787 CENTER	None	LA MESA	CA	91942	3034	37	06073	32.7816307	-117.008915	San Diego County
71657	Fee-for-Service	1447455423	1447455423	1	1	APEX HEALTHCARE MEDICAL	7/28/2010	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER INC	1525 W FLORIDA AVE	STE D	HEMET	CA	92543	3869	33	06065	33.7473507	-116.9878543	Riverside County
71687	Fee-for-Service	1033712880	1033712880	1	1	ALL FOR HEALTH HOSPICE CARE	12/17/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	815 S CENTRAL AVE	SUITE 25	GLENDALE	CA	91204	4300	19	06037	34.13606127	-118.2578932	Los Angeles County
71703	Fee-for-Service	1255795084	1255795084	1	1	AYENI, TOKUNBO I MD	4/15/2025	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
71717	Fee-for-Service	1376149294	1376149294	1	1	ALGOS INC., A MEDICAL CORPOR	3/29/2021	103TB0200X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	567 W PUTNAM AVE	SUITE 2	PORTERVILLE	CA	93257	3260	54	06107	36.06956761	-119.0296417	Tulare County
71735	Fee-for-Service	1225494370	1225494370	1	1	ACTIVE HEALTH CARE, INC	10/30/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	8337 FOOTHILL BLVD	SUITE C	SUNLAND	CA	91040	8337	19	06037	34.25971753	-118.314657	Los Angeles County
71739	Fee-for-Service	1831249200	1831249200	1	1	ALINIAZEE, MATEEN K MD	2/8/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	52071	18	Ophthalmology	0	In state provider	None	1010 MURRAY AVENUE	None	SAN LUIS OBISPO	CA	93405	1806	40	06079	35.292168	-120.6658665	San Luis Obispo County
71744	Fee-for-Service	1902267479	1902267479	1	8	ALTAMED HEALTH SERVICES	11/2/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2055 LINCOLN AVENUE	None	PASADENA	CA	91103	1324	19	06037	34.18113421	-118.1596972	Los Angeles County
71755	Fee-for-Service	1396764353	1396764353	1	4	ALAMEDA HEALTH SYSTEM	1/20/2023	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4399	01	06001	37.76333626	-122.253868	Alameda County
71765	Fee-for-Service	1659787174	1659787174	1	1	ALVAREZ, CLAUDIA A DO MD	12/1/2017	390200000X	NA	Other	026	PHYSICIANS	14433	08	Family Practice	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
71819	Fee-for-Service	1053758524	1053758524	1	1	ATLURI, MAHESH G DO	12/8/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	16116	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
71879	Fee-for-Service	1912392937	1912392937	1	1	ABDELMALAK, FARID K MD	6/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	151785	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
71892	Fee-for-Service	1922381326	1922381326	1	1	ASANTE PHYSICIAN PARTNERS	7/10/2018	207RC0200X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	520 MEDICAL CENTER DRIVE	SUITE 201	MEDFORD	OR	97504	4334	00	None	42.318801	-122.831728	Jackson County
71928	Fee-for-Service	1396764353	1396764353	1	5	ALAMEDA HEALTH SYSTEM	1/20/2023	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	13855 14TH ST	None	SAN LEANDRO	CA	94578	2611	01	06001	37.712385	-122.143428	Alameda County
71943	Fee-for-Service	1821448606	1821448606	1	1	ARROWHEAD HOSPICE, INC	2/21/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	STE 426	ENCINO	CA	91436	2204	19	06037	34.15682212	-118.4871886	Los Angeles County
71951	Fee-for-Service	1982900718	1982900718	1	1	AIDASANI, MIRA B NP	7/26/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2016 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
71953	Fee-for-Service	1114380789	1114380789	1	1	AL-AZZAWI, AMBER	6/10/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	667 LIGHTHOUSE AVE	201	PACIFIC GROVE	CA	93950	2644	27	06053	36.62205802	-121.9200608	Monterey County
71987	Fee-for-Service	1699555334	1699555334	1	1	ABUNDANT GRACE CARE VILLA,	3/22/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	INC.	9672 COLONY STREET	None	ANAHEIM	CA	92804	3475	30	06059	33.82232551	-117.9608381	Orange County
72056	Fee-for-Service	1437302007	1437302007	1	1	AMIN, AJAYKUMAR N DO	4/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	9715	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6901 ATLANTIC AVE	None	BELL	CA	90201	3646	19	06037	33.97291242	-118.1878808	Los Angeles County
72120	Fee-for-Service	1205830890	1205830890	1	1	ALPERN, KENNETH S MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	49395	07	Dermatology	0	In state provider	None	1400 S GRAND AVE	None	LOS ANGELES	CA	90015	3048	19	06037	34.03692236	-118.2655238	Los Angeles County
72123	Fee-for-Service	1720134299	1720134299	1	1	ALAMIN, TODD F MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	62194	20	Orthopedic Surgery	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
72134	Fee-for-Service	1891912044	1891912044	1	1	ASB ASSOCIATES, INC	10/6/2004	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	GENESIS II ADULT DAY HLT	20215 SATICOY ST	None	CANOGA PARK	CA	91306	0000	19	06037	34.20838647	-118.573731	Los Angeles County
72139	Fee-for-Service	1790893857	1790893857	1	1	ANABI, SAMIR I	6/14/2005	207R00000X	NA	Other	026	PHYSICIANS	61382	None	None	0	In state provider	None	160 E ARTESIA ST	STE 225	POMONA	CA	91767	2925	19	06037	34.07556833	-117.7507835	Los Angeles County
72143	Fee-for-Service	1891979746	1891979746	1	1	ALVARADO, ELISA C MD	2/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98438	41	Internal Medicine	0	In state provider	None	401 S FAIR OAKS	None	PASADENA	CA	91105	2603	19	06037	34.13887038	-118.1504485	Los Angeles County
72152	Fee-for-Service	1902122260	1902122260	1	1	ACOSTA-PADRON, CRISTINA MD	6/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118467	01	General Practice	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
72155	Fee-for-Service	1902132012	1902132012	1	1	ADVANCED INTEGRATIVE REHABIL	2/26/2020	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NTER	1200 41ST AVE	SUITE H	CAPITOLA	CA	95010	3900	44	06087	36.969003	-121.964871	Santa Cruz County
72185	Fee-for-Service	1225575640	1225575640	1	1	AGARWAL, PRIYA LMFT	9/21/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1030 NEVADA ST.	SUITE 103	REDLANDS	CA	92374	2957	36	06071	34.064172	-117.217431	San Bernardino County
72207	Fee-for-Service	1154662583	1154662583	1	1	ARISTIZABAL, MARIA PAULA MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127586	68	Hematology	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
72209	Fee-for-Service	1851013312	1851013312	2	1	ALL SCRIPT RX INC	10/21/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18308 SHERMAN WAY	STE 2	RESEDA	CA	91335	4476	19	06037	34.20104853	-118.532097	Los Angeles County
72222	Fee-for-Service	1023011632	1023011632	1	1	ALTURA CENTERS FOR HEALTH	12/1/1998	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1101 N CHERRY ST	None	TULARE	CA	93274	2231	54	06107	36.22333808	-119.337575	Tulare County
72270	Fee-for-Service	1063497568	1063497568	1	1	APPLEMAN, DUVA JEAN MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85445	18	Ophthalmology	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
72284	Fee-for-Service	1396942413	1396942413	1	1	ATIF, MUZNA MD	4/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144330	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVENUE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
72299	Fee-for-Service	1851002208	1851002208	1	2	ARMEN CHOULAKIAN MD INC	4/25/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	4016 DALE RD	None	MODESTO	CA	95356	9268	50	06099	37.69723812	-121.049967	Stanislaus County
72340	Fee-for-Service	1194392555	1194392555	1	2	ALLEN'S PALM COVE RESIDENCE	9/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	CARE INC	18714 KINGS ROW AVE	None	CERRITOS	CA	90703	8050	19	06037	33.86080255	-118.1049259	Los Angeles County
72358	Fee-for-Service	1871689299	1871689299	1	1	AMU, JAVIER MD	7/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	81420	40	Pediatrics	0	In state provider	None	1121 F ST	None	REEDLEY	CA	93654	3028	10	06019	36.59666106	-119.4494476	Fresno County
72459	Fee-for-Service	1730933805	1730933805	1	1	ALTUNYAN, ANI NP	12/9/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7204 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2719	19	06037	34.24862229	-118.2886742	Los Angeles County
72461	Fee-for-Service	1568939635	1568939635	1	1	AGAPE COTTAGES FLORA LLC	10/12/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	4931 CARTHAGE STREET	None	PLACENTIA	CA	92870	3004	30	06059	33.89002497	-117.850959	Orange County
72483	Fee-for-Service	1154998730	1154998730	1	1	AMBATI, HARIKRISHNA MD	6/24/2024	390200000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	4955 VAN NUYS BLVD	SUITE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
72489	Fee-for-Service	1639425663	1639425663	1	1	ACE MEDICAL ASSOCIATES INC A	8/15/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	15031 RINALDI STREET	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
72496	Fee-for-Service	1154662583	1154662583	1	1	ARISTIZABAL, MARIA PAULA MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127586	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
72504	Fee-for-Service	1265880017	1265880017	1	1	ARROWHEAD HOME HEALTH INC	12/18/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	144 N GLENDALE AVE	STE 301	GLENDALE	CA	91206	4730	19	06037	34.14799289	-118.2464845	Los Angeles County
72505	Fee-for-Service	1407298086	1407298086	1	1	ALDANA, MARIA A LMFT	9/8/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1255 W COLTON AVE STE 58	None	REDLANDS	CA	92374	2861	36	06071	34.06285254	-117.20178	San Bernardino County
72506	Fee-for-Service	1447455423	1447455423	1	2	APEX HEALTHCARE MEDICAL	10/1/2018	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	44	Public Health	0	In state provider	CENTER INC	1225 E LATHAM AVE	STE A	HEMET	CA	92543	4423	33	06065	33.74937952	-116.959626	Riverside County
72513	Fee-for-Service	1023011632	1023011632	1	1	ALTURA CENTERS FOR HEALTH	10/1/1998	261Q00000X	NA	Other	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1101 N CHERRY ST	None	TULARE	CA	93274	2231	54	06107	36.22333808	-119.337575	Tulare County
72528	Fee-for-Service	1093722142	1093722142	1	1	ALAN LEE ANSEL MD	3/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1830 S ALMA SCHOOL RD	STE 108	MESA	AZ	85210	3086	00	None	33.381846	-111.859056	Maricopa County
72560	Fee-for-Service	1477561777	1477561777	1	1	AHADIAN, EMELYA M MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67647	41	Internal Medicine	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
72561	Fee-for-Service	1831333624	1831333624	1	1	ALEXANDER SHUNE, M.D.	4/27/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
72591	Fee-for-Service	1780751693	1780751693	1	1	AJIR, FARROUKH MD	12/1/1987	207T00000X	NA	General Surgery	026	PHYSICIANS	37062	14	Neurological Surgery	0	In state provider	None	2230 LYNN RD	None	THOUSAND OAKS	CA	91360	1901	56	06111	34.20894685	-118.885185	Ventura County
72626	Fee-for-Service	1063593739	1063593739	1	1	ABDELKARIM, BASIM Z MD	4/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	74259	10	Gastroenterology (M.D. only)	0	In state provider	INC	1310 SAN BERNARDINO RD	SUITE 103	UPLAND	CA	91786	4985	36	06071	34.10260261	-117.6332582	San Bernardino County
72647	Fee-for-Service	1659540870	1659540870	1	1	AGASTYA, GAUTAMI MD INC	12/29/2009	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	652 W 11TH ST	SUITE 133	TRACY	CA	95376	3869	39	06077	37.73965047	-121.435452	San Joaquin County
72648	Fee-for-Service	1144237272	1144237272	1	1	ADVENTIST HEALTH DELANO	5/17/1992	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1401 GARCES HWY	None	DELANO	CA	93215	3690	15	06029	35.76144847	-119.238912	Kern County
72653	Fee-for-Service	1942592159	1942592159	1	1	AYULO JR, MARCO A MD	6/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116669	40	Pediatrics	0	In state provider	None	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
72660	Fee-for-Service	1851788962	1851788962	1	1	ALFREY, DANIELLE D PHD	8/24/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
72742	Fee-for-Service	1437627312	1437627312	1	1	ALVARADO HOSPITAL LLC	1/1/2019	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
72770	Fee-for-Service	1942764758	1942764758	1	1	ALESHIRE, BRANDON CRNA	2/22/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
72773	Fee-for-Service	1912387713	1912387713	1	1	AMATRUDA, JONATHAN MD	6/1/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	155033	45	Nephrology (Renal-Kidney)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
72782	Fee-for-Service	1154662583	1154662583	1	1	ARISTIZABAL, MARIA PAULA MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	127586	78	Neoplastic Diseases/Oncology	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
72787	Fee-for-Service	1447343496	1447343496	1	1	ASFOUR, FAREED R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	71648	77	Infectious Disease	0	In state provider	None	2000 VAN NESS AVE	STE 702	SAN FRANCISCO	CA	94109	3015	38	06075	37.79415339	-122.422986	San Francisco County
72792	Fee-for-Service	1447455423	1447455423	1	2	APEX HEALTHCARE MEDICAL	10/1/2018	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CENTER INC	1225 E LATHAM AVE	STE A	HEMET	CA	92543	4423	33	06065	33.74937952	-116.959626	Riverside County
72799	Fee-for-Service	1023011632	1023011632	1	1	ALTURA CENTERS FOR HEALTH	12/11/2024	261Q00000X	NA	Other	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1101 N CHERRY ST	None	TULARE	CA	93274	2231	54	06107	36.22333808	-119.337575	Tulare County
72801	Fee-for-Service	1619035151	1619035151	1	1	ADMIRE, KIM E	4/1/1999	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 BROADWAY	STE 127	CHULA VISTA	CA	91910	5344	37	06073	32.630292	-117.085293	San Diego County
72802	Fee-for-Service	1316975162	1316975162	1	1	ALBERTSON, JANET E CRNA	4/5/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	436 N ROXBURY DR STE 101	None	BEVERLY HILLS	CA	90210	5016	19	06037	34.06771782	-118.4065755	Los Angeles County
72821	Fee-for-Service	1063041887	1063041887	1	1	AL AZZAWI, SARAH W	7/12/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
72865	Fee-for-Service	1477038982	1477038982	1	1	ATHOME HEALTHCARE TEAM-	10/21/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	EAST BAY LLC	1875 OLYMPIC BLVD	STE 201	WALNUT CREEK	CA	94596	5026	07	06013	37.89526458	-122.0653108	Contra Costa County
72873	Fee-for-Service	1104437763	1104437763	1	1	ALL INCLUSIVE HOME CARE INC	11/9/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6819 SEPULVEDA BLVD	SUITE 206	VAN NUYS	CA	91405	4440	19	06037	34.194564	-118.4662195	Los Angeles County
72881	Fee-for-Service	1437203635	1437203635	1	1	ALLIANCE EYE MEDICAL GRP	5/20/1994	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1700 E CESAR E CHAVEZ AV	STE 2400	LOS ANGELES	CA	90033	2474	19	06037	34.05101259	-118.217259	Los Angeles County
72891	Fee-for-Service	1114474699	1114474699	1	1	AGUILAR, CYNTHIA PSYD	6/12/2018	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10801 NATIONAL BLVD	STE 611	LOS ANGELES	CA	90064	4170	19	06037	34.03101398	-118.4202342	Los Angeles County
72914	Fee-for-Service	1063593739	1063593739	1	1	ABDELKARIM, BASIM Z MD	4/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	74259	41	Internal Medicine	0	In state provider	INC	1310 SAN BERNARDINO RD	SUITE 103	UPLAND	CA	91786	4985	36	06071	34.10260261	-117.6332582	San Bernardino County
72936	Fee-for-Service	1144237272	1144237272	1	1	ADVENTIST HEALTH DELANO	5/17/1992	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1401 GARCES HWY	None	DELANO	CA	93215	3690	15	06029	35.76144847	-119.238912	Kern County
72941	Fee-for-Service	1629259890	1629259890	1	1	AZIZ, SAAD Q	12/7/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	17566	None	None	0	In state provider	None	460 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	51	06101	39.13140416	-121.6141951	Sutter County
72945	Fee-for-Service	1801836580	1801836580	1	1	ANDREW W TAN	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	THE QUEEN'S MEDICAL	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	0000	00	None	21.30800017	-157.8550765	Honolulu County
72972	Fee-for-Service	1265584635	1265584635	1	1	ATILANO, LORRAINE C MD	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75703	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
72974	Fee-for-Service	1750410999	1750410999	1	1	ADIL IMRAN	2/24/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
72993	Fee-for-Service	1811073000	1811073000	1	1	AMERICAN MOBILITY CENTER INC	12/31/2007	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3753 MISSION AVE.	SUITE 114	OCEANSIDE	CA	92058	1473	37	06073	33.22461675	-117.3321959	San Diego County
73023	Fee-for-Service	1588020382	1588020382	1	1	ADAMS, RYAN J PSYD	1/28/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3825 HOPYARD ROAD	SUITE 140	PLEASANTON	CA	94566	8528	01	06001	37.683009	-121.9036935	Alameda County
73042	Fee-for-Service	1326126822	1326126822	1	1	ADAMS, JACOB C MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95608	36	Psychiatry	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
73065	Fee-for-Service	1326319682	1326319682	1	1	AGARWAL, AAKASH K MD	7/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120075	01	General Practice	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
73076	Fee-for-Service	1447343496	1447343496	1	1	ASFOUR, FAREED R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	71648	41	Internal Medicine	0	In state provider	None	2000 VAN NESS AVE	STE 702	SAN FRANCISCO	CA	94109	3015	38	06075	37.79415339	-122.422986	San Francisco County
73082	Fee-for-Service	1447455423	1447455423	1	2	APEX HEALTHCARE MEDICAL	10/1/2018	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	CENTER INC	1225 E LATHAM AVE	STE A	HEMET	CA	92543	4423	33	06065	33.74937952	-116.959626	Riverside County
73087	Fee-for-Service	1023011632	1023011632	1	1	ALTURA CENTERS FOR HEALTH	12/1/1998	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1101 N CHERRY ST	None	TULARE	CA	93274	2231	54	06107	36.22333808	-119.337575	Tulare County
73106	Fee-for-Service	1457840787	1457840787	1	1	ADJEPONG, KWAME O MD	11/28/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	167045	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
73122	Fee-for-Service	1336264241	1336264241	1	1	ALAMI, OTHMAN MD	6/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148200	36	Psychiatry	0	In state provider	None	1660 E ROSEVILLE PARKWAY	BUILDING C	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
73126	Fee-for-Service	1902551500	1902551500	1	1	AWAKENING ACUPUNCTURE INC.	10/21/2023	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2075 FOREST AVE	STE 7	SAN JOSE	CA	95128	4812	43	06085	37.32708635	-121.9358317	Santa Clara County
73150	Fee-for-Service	1861558413	1861558413	2	2	AEGIS TREATMENT CENTERS, LLC	6/11/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1133 COLOMA WAY	A, B & C	ROSEVILLE	CA	95661	4480	31	06061	38.73639952	-121.2734295	Placer County
73151	Fee-for-Service	1912085184	1912085184	1	2	ALEGENT HEALTH IMMANUEL MEDI	9/7/2020	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	6901 N 72ND ST	None	OMAHA	NE	68122	1709	00	None	41.32103124	-96.02114037	Douglas County
73158	Fee-for-Service	1073392080	1073392080	1	1	AGAPE CARE MEDICAL TRANSPORT	10/17/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ATION, INC.	9833 DEERING AVE	C	CHATSWORTH	CA	91311	4338	19	06037	34.249248	-118.5973475	Los Angeles County
73159	Fee-for-Service	1184112526	1184112526	1	1	ABBASI, CYRUS O MD	8/8/2022	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	175847	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
73165	Fee-for-Service	1669860615	1669860615	1	1	ALLEN, RHONDA E LCSW	4/22/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	99318	-	NOT APPLICABLE	0	In state provider	None	8665 GIBBS DR	STE 150	SAN DIEGO	CA	92123	1739	37	06073	32.81043091	-117.1419105	San Diego County
73190	Fee-for-Service	1134934714	1134934714	1	1	AGAPE DOULA SERVICES LLC	3/3/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	12	06023	0	0	None
73256	Fee-for-Service	1487350211	1487350211	1	1	ANTHEM SENIOR CARE LLC	4/8/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	12813 FRIAR STREET	None	NORTH HOLLYWOOD	CA	91606	3021	19	06037	34.1856485	-118.4123417	Los Angeles County
73260	Fee-for-Service	1417397357	1417397357	1	1	ANAND, AMARINDER K MD	12/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135538	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
73340	Fee-for-Service	1679326441	1679326441	1	1	ADVANCED FOOT AND ANKLE CENT	2/20/2025	193400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	ERS INC	2131 HERNDON AVE	SUITE 101	CLOVIS	CA	93611	6304	10	06019	36.83752991	-119.6766888	Fresno County
73359	Fee-for-Service	1881866341	1881866341	1	1	ANTONIETTE, LETIZIA C MD	7/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84819	30	Radiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	0628	38	06075	37.7634502	-122.4579779	San Francisco County
73369	Fee-for-Service	1871549386	1871549386	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1735 ARTESIA BLVD	None	GARDENA	CA	90247	3220	19	06037	33.87298146	-118.308258	Los Angeles County
73377	Fee-for-Service	1821221946	1821221946	1	1	ABAYAZEED, ALY H MD	3/29/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175152	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
73382	Fee-for-Service	1689088361	1689088361	1	1	ALLAMI, MUSTAFA S MD	10/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148958	41	Internal Medicine	0	In state provider	None	800 SOUTH MAIN STREET	None	CORONA	CA	92882	3240	33	06065	33.872958	-117.568359	Riverside County
73412	Fee-for-Service	1790757219	1790757219	1	1	ANGELL, CATHY D MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	85431	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
73437	Fee-for-Service	1861558413	1861558413	2	2	AEGIS TREATMENT CENTERS, LLC	6/11/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1133 COLOMA WAY	A, B & C	ROSEVILLE	CA	95661	4480	31	06061	38.73639952	-121.2734295	Placer County
73440	Fee-for-Service	1912085184	1912085184	1	2	ALEGENT HEALTH IMMANUEL MEDI	9/7/2020	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	6901 N 72ND ST	None	OMAHA	NE	68122	1709	00	None	41.32103124	-96.02114037	Douglas County
73459	Fee-for-Service	1467949727	1467949727	1	1	AMES, ANGHARAD E MD	8/26/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	165388	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	180 S LAKE AVE	SUITE 615	PASADENA	CA	91101	4763	19	06037	34.14274552	-118.1322395	Los Angeles County
73501	Fee-for-Service	1316649742	1316649742	1	1	ALL WE NEED IS LOVE LLC	4/27/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5340 KIRTLAND AVE	None	LAKEWOOD	CA	90713	1733	19	06037	33.85457008	-118.1069305	Los Angeles County
73506	Fee-for-Service	1174381461	1174381461	1	1	ADVENTIST HEALTH PHYSICIANS	10/9/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	892 AEROVISTA PL	130	SAN LUIS OBISPO	CA	93401	8054	40	06079	35.24277125	-120.6405941	San Luis Obispo County
73539	Fee-for-Service	1891854527	1891854527	1	1	AUSTIN, DOROTHY A CNM	11/1/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	9333 E ROSECRANS AVE	None	BELLFLOWER	CA	90706	2141	19	06037	33.90413858	-118.1346616	Los Angeles County
73569	Fee-for-Service	1770188013	1770188013	1	1	AB'S HUMBLE HOME LLC	9/4/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	14798 CAMBRIA ST	None	FONTANA	CA	92335	2520	36	06071	34.07885484	-117.482475	San Bernardino County
73592	Fee-for-Service	1184797227	1184797227	1	1	ASMAN, INGE LCSW	6/13/1999	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	4116 AUBURN BLVD	None	SACRAMENTO	CA	95841	4401	34	06067	38.641437	-121.3688745	Sacramento County
73621	Fee-for-Service	1306464979	1306464979	1	1	ALERACARE MEDICAL GROUP OF C	3/26/2024	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ALIFORNIA, A MEDICAL COR	4849 VAN NUYS BLVD	211	SHERMAN OAKS	CA	91403	2110	19	06037	34.159113	-118.4487465	Los Angeles County
73629	Fee-for-Service	1679326441	1679326441	1	1	ADVANCED FOOT AND ANKLE CENT	2/20/2025	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	ERS INC	2131 HERNDON AVE	SUITE 101	CLOVIS	CA	93611	6304	10	06019	36.83752991	-119.6766888	Fresno County
73651	Fee-for-Service	1396238184	1396238184	1	1	ALNAJJAR, DELAIR L MD	10/20/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181114	None	None	0	In state provider	None	41540 WINCHESTER	None	TEMECULA	CA	92590	4877	33	06065	33.52069117	-117.1653103	Riverside County
73658	Fee-for-Service	1497290233	1497290233	1	1	ADVENTIST HEALTH PHYSICIANS	4/16/2018	193200000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	9900 STOCKDALE HWY	SUITE 200	BAKERSFIELD	CA	93311	3634	15	06029	35.35412167	-119.1124089	Kern County
73665	Fee-for-Service	1639628183	1639628183	1	1	ALAPHIA CARE HOME HEALTH	1/12/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	8300 UTICA AVE	STE 247	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
73674	Fee-for-Service	1225136484	1225136484	1	1	AGRAWAL, ASHISH T MD	3/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67061	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1801 W ROMNEYA DR	STE 409	ANAHEIM	CA	92801	1827	30	06059	33.8506615	-117.946413	Orange County
73692	Fee-for-Service	1083693766	1083693766	1	1	AFSHANI, PARVIZ D MD INC	11/30/1989	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	30351	10	Gastroenterology (M.D. only)	0	In state provider	None	2001 SANTA MONICA BLVD	# 470W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
73699	Fee-for-Service	1073816070	1073816070	1	1	ADVANCED VISION CARE A	2/8/2011	193400000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	CALIFORNIA GENERAL PARTN	2080 CENTURY PARK E	STE 911	LOS ANGELES	CA	90067	2001	19	06037	34.05887194	-118.4122914	Los Angeles County
73799	Fee-for-Service	1811045743	1811045743	1	1	AMBERRY, THOMAS R-J DPM	9/21/2011	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
73825	Fee-for-Service	1942571146	1942571146	1	3	ACUTE MEDICAL PROVIDERS INC	10/30/2015	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	501 PETALUMA AVE	None	SEBASTOPOL	CA	95472	4215	49	06097	38.39674221	-122.8201502	Sonoma County
73842	Fee-for-Service	1124149794	1124149794	1	1	ASHBY, JENNIFER L	9/11/2017	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
73908	Fee-for-Service	1306464979	1306464979	1	1	ALERACARE MEDICAL GROUP OF C	10/14/2021	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ALIFORNIA, A MEDICAL COR	4849 VAN NUYS BLVD	211	SHERMAN OAKS	CA	91403	2110	19	06037	34.159113	-118.4487465	Los Angeles County
73911	Fee-for-Service	1710763321	1710763321	1	1	ARJAN CARE HOME INC	10/24/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	9320 PALMERSON DRIVE	None	ANTELOPE	CA	95843	4617	34	06067	38.715282	-121.339935	Sacramento County
73918	Fee-for-Service	1477639995	1477639995	1	1	ASUNCION, GREGORY F MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	68889	24	Plastic Surgery	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
73931	Fee-for-Service	1609289669	1609289669	1	1	A PLUS HOSPICE CARE INC	12/27/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10501 VALLEY BLVD	STE 1216	EL MONTE	CA	91731	2461	19	06037	34.07643256	-118.0444602	Los Angeles County
73940	Fee-for-Service	1386773372	1386773372	1	2	ALHAMBRA COMM HOSP PHCY	7/2/1998	282N00000X	NA	Hospitals	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CENTER D/P NF	100 S RAYMOND AVE	None	ALHAMBRA	CA	91801	3199	19	06037	34.09027878	-118.1450083	Los Angeles County
73974	Fee-for-Service	1447388756	1447388756	2	1	ABILITY PATHWAYS	6/19/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED	8137 TROOST AVE	None	NORTH HOLLYWOOD	CA	91605	1627	19	06037	34.21882616	-118.3863406	Los Angeles County
73977	Fee-for-Service	1164950689	1164950689	1	1	AMIDI, OMID MD	8/24/2023	390200000X	NA	Other	026	PHYSICIANS	170248	None	None	0	In state provider	None	191 S BUENA VISTA STREET	SUITE 420-440	BURBANK	CA	91505	4551	19	06037	34.15872557	-118.3283863	Los Angeles County
73982	Fee-for-Service	1659409571	1659409571	1	1	ALLEN, AKIKO LMFT	11/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
74023	Fee-for-Service	1316963606	1316963606	1	1	AMPLA HEALTH	7/1/1994	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	680 COHASSET RD	None	CHICO	CA	95926	2213	04	06007	39.752856	-121.8454685	Butte County
74034	Fee-for-Service	1902453731	1902453731	1	1	ALTAMED HEALTH SERVICES	4/21/2020	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	2100 W 3RD STREET	STE 400	LOS ANGELES	CA	90057	2290	19	06037	34.06308947	-118.2733326	Los Angeles County
74043	Fee-for-Service	1952444150	1952444150	1	1	AYERS, DAVID G	2/8/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1310 HANNA AVE	None	CORCORAN	CA	93212	2314	16	06031	36.09975818	-119.5641426	Kings County
74056	Fee-for-Service	1255736443	1255736443	1	1	ALEGRIA INC	8/9/2018	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	1101 CN PERRY AVENUE	None	CALEXICO	CA	92231	9723	13	06025	32.67916755	-115.4925662	Imperial County
74060	Fee-for-Service	1396399986	1396399986	1	2	ALI ANARI MD INC	4/10/2024	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	URGENT CARE	31920 HILLTOP BLVD	None	RUNNING SPRINGS	CA	92382	0482	36	06071	34.20491461	-117.1069531	San Bernardino County
74099	Fee-for-Service	1770003519	1770003519	1	1	AHMED, AYESHA MD	5/17/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
74116	Fee-for-Service	1669877577	1669877577	1	1	AHANI, KAVEH MD	10/26/2018	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	158194	84	Surgery-Head and Neck	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
74120	Fee-for-Service	1457392847	1457392847	1	1	AZEN, STANLEY MD	5/5/1995	207P00000X	NA	Other	026	PHYSICIANS	39558	41	Internal Medicine	0	In state provider	None	1000 W 9TH ST	None	LOS ANGELES	CA	90015	1377	19	06037	34.04745182	-118.2658125	Los Angeles County
74121	Fee-for-Service	1629004890	1629004890	1	1	ABDULHADI, HUSSEIN M	10/11/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	61032	41	Internal Medicine	0	In state provider	None	6645 ALVARADO RD	STE 253	SAN DIEGO	CA	92120	5208	37	06073	32.7772577	-117.0575222	San Diego County
74124	Fee-for-Service	1396764353	1396764353	1	2	ALAMEDA HEALTH SYSTEM	5/2/2017	282N00000X	NA	Hospitals	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
74152	Fee-for-Service	1740295419	1740295419	1	2	AW, THAN A MD	4/22/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	53206	-	NOT APPLICABLE	0	In state provider	None	1945 N HELM AVENUE	SUITE 101	FRESNO	CA	93727	1670	10	06019	36.76803257	-119.723713	Fresno County
74169	Fee-for-Service	1639107543	1639107543	1	1	AHERN, MATTHEW T DO	11/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15381	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
74175	Fee-for-Service	1568032704	1568032704	1	1	AGIRIGA, OBIOMA J NP	11/16/2021	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
74219	Fee-for-Service	1609289669	1609289669	1	1	A PLUS HOSPICE CARE INC	12/27/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10501 VALLEY BLVD	STE 1216	EL MONTE	CA	91731	2461	19	06037	34.07643256	-118.0444602	Los Angeles County
74241	Fee-for-Service	1821310939	1821310939	1	1	AFSHAR, HOSEIN T MD AMC	7/28/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	35988	41	Internal Medicine	0	In state provider	None	2230 LYNN RD	STE 210	THOUSAND OAKS	CA	91360	1994	56	06111	34.20894685	-118.885185	Ventura County
74259	Fee-for-Service	1386957926	1386957926	1	1	ABRAMS, DIANA N LMFT	3/20/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
74265	Fee-for-Service	1689671240	1689671240	1	1	ALO,MELANIE J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6621 FANNIN ST	None	HOUSTON	TX	77030	0000	00	None	29.70724683	-95.4026169	Harris County
74312	Fee-for-Service	1316963606	1316963606	1	1	AMPLA HEALTH	3/25/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	680 COHASSET RD	None	CHICO	CA	95926	2213	04	06007	39.752856	-121.8454685	Butte County
74319	Fee-for-Service	1902453731	1902453731	1	1	ALTAMED HEALTH SERVICES	12/30/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	2100 W 3RD STREET	STE 400	LOS ANGELES	CA	90057	2290	19	06037	34.06308947	-118.2733326	Los Angeles County
74404	Fee-for-Service	1487834396	1487834396	1	1	ALIED FIVE STAR CORPORATION	7/1/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7365 CARNELIAN ST	SUITE 124	RANCHO CUCAMONGA	CA	91730	1158	36	06071	34.12038413	-117.6160525	San Bernardino County
74410	Fee-for-Service	1457392847	1457392847	1	1	AZEN, STANLEY MD	5/5/1995	207P00000X	NA	Other	026	PHYSICIANS	39558	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1000 W 9TH ST	None	LOS ANGELES	CA	90015	1377	19	06037	34.04745182	-118.2658125	Los Angeles County
74417	Fee-for-Service	1396764353	1396764353	1	2	ALAMEDA HEALTH SYSTEM	2/17/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
74429	Fee-for-Service	1649757683	1649757683	1	1	ABEL, CHRISTINE E CNP	12/31/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	683 LOMAS SANTA FE DR	None	SOLANA BEACH	CA	92075	1412	37	06073	32.99596006	-117.2594441	San Diego County
74434	Fee-for-Service	1821387853	1821387853	1	1	ANIL PUNJABI	6/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	221 MAHALANI ST	None	WAILUKU	HI	96793	2526	00	None	20.88554026	-156.4902142	Maui County
74440	Fee-for-Service	1871603258	1871603258	1	1	ACACIA FAMILY MED GRP	5/1/1998	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	400 E ROMIE LN	None	SALINAS	CA	93901	4017	27	06053	36.66043696	-121.6483124	Monterey County
74450	Fee-for-Service	1093743924	1093743924	2	1	ABERGEL, GLEN MD	8/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	67324	41	Internal Medicine	0	In state provider	None	1910 OUTLET CENTER DRIVE	None	OXNARD	CA	93036	0677	56	06111	34.2202663	-119.1484221	Ventura County
74473	Fee-for-Service	1912296971	1912296971	1	1	AVALOS, JOSEPH A MD	8/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143574	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
74482	Fee-for-Service	1508986621	1508986621	1	1	ASHLAND SURGERY CENTER	2/11/2022	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	1	Border provider	None	658 N MAIN STREET	None	ASHLAND	OR	97520	1710	00	None	42.207541	-122.7220128	Jackson County
74529	Fee-for-Service	1821310939	1821310939	1	1	AFSHAR, HOSEIN T MD AMC	7/28/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	35988	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2230 LYNN RD	STE 210	THOUSAND OAKS	CA	91360	1994	56	06111	34.20894685	-118.885185	Ventura County
74532	Fee-for-Service	1669059820	1669059820	1	1	ALFARO, MARLENE MD	8/21/2024	390200000X	NA	Other	026	PHYSICIANS	181923	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
74544	Fee-for-Service	1417722232	1417722232	1	2	AMG, A PROFESSIONAL MEDICAL	5/24/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	ORPORATION	2765 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5750	19	06037	33.97378898	-118.2206761	Los Angeles County
74554	Fee-for-Service	1366208548	1366208548	1	1	ABUNDANT WELLNESS INC	5/14/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	301 N PEPPER AVE	STE 300	COLTON	CA	92324	1839	36	06071	34.07085827	-117.353113	San Bernardino County
74563	Fee-for-Service	1386025930	1386025930	1	1	AWAD, OMNIA D MD	12/9/2021	207R00000X	NA	Other	026	PHYSICIANS	175264	None	None	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
74576	Fee-for-Service	1437302007	1437302007	1	2	AMIN, AJAYKUMAR N DO	7/29/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	9715	None	None	0	In state provider	None	8627 ATLANTIC AVE	None	SOUTH GATE	CA	90280	3501	19	06037	33.95462085	-118.1838426	Los Angeles County
74600	Fee-for-Service	1316963606	1316963606	1	1	AMPLA HEALTH	9/1/1992	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	680 COHASSET RD	None	CHICO	CA	95926	2213	04	06007	39.752856	-121.8454685	Butte County
74606	Fee-for-Service	1902453731	1902453731	1	1	ALTAMED HEALTH SERVICES	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	2100 W 3RD STREET	STE 400	LOS ANGELES	CA	90057	2290	19	06037	34.06308947	-118.2733326	Los Angeles County
74608	Fee-for-Service	1902269186	1902269186	1	1	ABBEY MATTES	2/13/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
74619	Fee-for-Service	1912026238	1912026238	1	1	ALI, MIR J MD	8/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86034	84	Surgery-Head and Neck	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
74638	Fee-for-Service	1861623506	1861623506	1	1	AL KHIAMI, BELAL O MD	5/31/2018	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	141418	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
74651	Fee-for-Service	1487624599	1487624599	1	1	AULD, VICTOR H CRNA	12/7/2007	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
74658	Fee-for-Service	1033144704	1033144704	1	1	ABRAHAM, GIZEL A MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	53854	40	Pediatrics	0	In state provider	None	1510 S CENTRAL AVE	STE 510	GLENDALE	CA	91204	2543	19	06037	34.12709764	-118.2577911	Los Angeles County
74676	Fee-for-Service	1639711179	1639711179	1	1	ADKINS, MASON CRNA	1/19/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
74695	Fee-for-Service	1639713258	1639713258	1	1	ALL FOR HEALTH, HEALTH FOR	10/20/2021	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	5160 VINELAND AVE	UNIT 109	NORTH HOLLYWOOD	CA	91601	3888	19	06037	34.164126	-118.3702625	Los Angeles County
74699	Fee-for-Service	1396764353	1396764353	1	2	ALAMEDA HEALTH SYSTEM	12/5/2018	282N00000X	NA	Hospitals	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
74710	Fee-for-Service	1417031402	1417031402	1	1	ALPERT, PAUL F MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	16327	34	Urology and Urological Surgery	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
74723	Fee-for-Service	1306296082	1306296082	1	1	AL-SAMRRAI, MOHAMMED	3/16/2024	207L00000X	NA	Other	026	PHYSICIANS	191719	05	Anesthesiology	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
74727	Fee-for-Service	1982153797	1982153797	1	1	ANAS KAWAYEH MD INC	2/17/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
74733	Fee-for-Service	1093743924	1093743924	2	1	ABERGEL, GLEN MD	8/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	67324	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1910 OUTLET CENTER DRIVE	None	OXNARD	CA	93036	0677	56	06111	34.2202663	-119.1484221	Ventura County
74740	Fee-for-Service	1558572313	1558572313	1	1	ABDOLLAHI, SHAGHAY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
74783	Fee-for-Service	1346699022	1346699022	1	1	AHN, SAMUEL S MD	10/12/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	153769	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
74801	Fee-for-Service	1144277344	1144277344	1	1	AHANGAR, BRIAN A MD	7/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	81555	25	Physical Medicine and Rehabilitation	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
74833	Fee-for-Service	1417722232	1417722232	1	2	AMG, A PROFESSIONAL MEDICAL	5/24/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	ORPORATION	2765 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5750	19	06037	33.97378898	-118.2206761	Los Angeles County
74840	Fee-for-Service	1255620837	1255620837	1	1	ANANTHARAMAN, ARCHANA MD	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131229	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
74867	Fee-for-Service	1306035118	1306035118	1	1	ADVANCED EYE CARE	2/29/2008	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	A PROF OPTOMETRIC GROUP	330 N BRAND BLVD	STE 110	GLENDALE	CA	91203	2308	19	06037	34.15116156	-118.2549512	Los Angeles County
74887	Fee-for-Service	1316963606	1316963606	1	1	AMPLA HEALTH	9/1/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	680 COHASSET RD	None	CHICO	CA	95926	2213	04	06007	39.752856	-121.8454685	Butte County
74889	Fee-for-Service	1447999388	1447999388	1	1	AGUSTIN, CHARLESON PRINCE P	10/15/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	T	805 E WALNUT AVE	None	LOMPOC	CA	93436	7027	42	06083	34.64061286	-120.4487303	Santa Barbara County
74891	Fee-for-Service	1609879386	1609879386	1	1	AREEN, RICHARD G MD	2/1/1983	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	46817	None	None	0	In state provider	None	3810 J ST	None	SACRAMENTO	CA	95816	5521	34	06067	38.569743	-121.455378	Sacramento County
74892	Fee-for-Service	1841638293	1841638293	1	1	AYER, AMIT B MD	5/21/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	166651	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
74897	Fee-for-Service	1548411739	1548411739	1	1	ARELLANO, ANGELA LMFT	9/1/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6800 INDIANA AVE STE 130	None	RIVERSIDE	CA	92506	4266	33	06065	33.94303679	-117.391856	Riverside County
74982	Fee-for-Service	1639713258	1639713258	1	1	ALL FOR HEALTH, HEALTH FOR	10/20/2021	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	5160 VINELAND AVE	UNIT 109	NORTH HOLLYWOOD	CA	91601	3888	19	06037	34.164126	-118.3702625	Los Angeles County
74983	Fee-for-Service	1386021244	1386021244	1	1	ASKREN, SHOSHANA LCSW	5/9/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
74988	Fee-for-Service	1396764353	1396764353	1	2	ALAMEDA HEALTH SYSTEM	1/25/2017	282N00000X	NA	Hospitals	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
75003	Fee-for-Service	1033142088	1033142088	2	1	ADUBOFOUR, KWABENA O MD	3/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	52394	41	Internal Medicine	0	In state provider	None	2524 E MAIN ST	None	STOCKTON	CA	95205	6523	39	06077	37.95478956	-121.251428	San Joaquin County
75009	Fee-for-Service	1003969114	1003969114	1	1	ASAP HOME HEALTH, INC	12/17/2000	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	602 COMMERCE AVE	STE C	PALMDALE	CA	93551	3882	19	06037	34.58955354	-118.141074	Los Angeles County
75031	Fee-for-Service	1275783276	1275783276	1	1	ACHROL, ACHAL MD	5/18/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	117358	14	Neurological Surgery	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
75073	Fee-for-Service	1386888147	1386888147	1	1	ANNABERDYEV, SHOHRAT	11/17/2022	208C00000X	NA	General Surgery	026	PHYSICIANS	182791	None	None	0	In state provider	None	5 MEDICAL PLAZA DR	STE 140	ROSEVILLE	CA	95661	2866	31	06061	38.76604411	-121.2466761	Placer County
75088	Fee-for-Service	1306668025	1306668025	1	1	ANGELS MENTAL HEALTH & WELLN	4/11/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	ESS SERVICES P.C	5757 W CENTURY BLVD	FL 6, STE 650R	LOS ANGELES	CA	90045	6401	19	06037	33.94561146	-118.382661	Los Angeles County
75097	Fee-for-Service	1801122247	1801122247	1	1	ATOMIC SHRINK PSYCHOLOGY, IN	6/16/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1034 W AVENUE L12	SUITE 111	LANCASTER	CA	93534	7083	19	06037	34.64939211	-118.1491318	Los Angeles County
75098	Fee-for-Service	1194731133	1194731133	1	1	ABRAMS, SHIRZAD A MD	1/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	30870	20	Orthopedic Surgery	0	In state provider	None	16311 VENTURA BLVD	SUITE 1150	ENCINO	CA	91436	4307	19	06037	34.15706864	-118.4885978	Los Angeles County
75120	Fee-for-Service	1417722232	1417722232	1	2	AMG, A PROFESSIONAL MEDICAL	2/21/2025	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ORPORATION	2765 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5750	19	06037	33.97378898	-118.2206761	Los Angeles County
75124	Fee-for-Service	1114902616	1114902616	1	1	AVCH INC	8/21/1995	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1035 GRAVENSTEIN AVE	None	SEBASTOPOL	CA	95472	4537	49	06097	38.38928468	-122.8152866	Sonoma County
75125	Fee-for-Service	1396764353	1396764353	1	3	ALAMEDA HEALTH SYSTEM	4/19/2023	282N00000X	NA	Hospitals	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1009	01	06001	37.7069698	-122.1191104	Alameda County
75131	Fee-for-Service	1205257920	1205257920	1	1	AMANAM, IDOROENYI U	3/15/2016	207RH0000X	NA	Hematology	026	PHYSICIANS	131624	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
75208	Fee-for-Service	1558423814	1558423814	1	1	AHN, SAM S MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147289	03	Allergy	0	In state provider	None	1100 PEAR TREE LANE	None	NAPA	CA	94558	6446	28	06055	38.32087983	-122.2946228	Napa County
75210	Fee-for-Service	1023266848	1023266848	1	1	ABRAM PERSONAL CARE AGEN	12/29/2008	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	ABRAM PERSONAL CARE AGEN	18341 SHERMAN WAY	SUITE 204	RESEDA	CA	91335	4437	19	06037	34.20120746	-118.533105	Los Angeles County
75211	Fee-for-Service	1508905761	1508905761	1	1	AZIZOLLAHI, ELLIOT S MD	12/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99659	30	Radiology	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
75242	Fee-for-Service	1356127765	1356127765	1	1	ABEYTA, ALEXANDER PT	8/12/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
75269	Fee-for-Service	1336968437	1336968437	1	1	ACOSTA, THANYA LCSW	2/28/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12440 FIRESTONE BLVD	3001	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
75275	Fee-for-Service	1396764353	1396764353	1	2	ALAMEDA HEALTH SYSTEM	2/17/2017	282N00000X	NA	Hospitals	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
75277	Fee-for-Service	1598744237	1598744237	2	1	A HURT, PATRICIA H LCSW	7/18/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3120 W MAIN ST	STE B	VISALIA	CA	93291	5764	54	06107	36.328302	-119.3252625	Tulare County
75314	Fee-for-Service	1275580037	1275580037	1	1	ABDULHADI, YOUMNA M MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55715	41	Internal Medicine	0	In state provider	None	8851 CENTER DR	STE 305	LA MESA	CA	91942	3048	37	06073	32.78189749	-117.0075062	San Diego County
75353	Fee-for-Service	1396845335	1396845335	1	1	ARSHAD REHMAN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7800 LAKE UNDERHILL RD	None	ORLANDO,	FL	32822	0000	00	None	28.53910255	-81.280179	Orange County
75369	Fee-for-Service	1992052369	1992052369	1	1	ALLAMEH MEDICAL CORPORATION	12/19/2012	207RN0300X	NA	Nephrology	026	PHYSICIANS	102735	None	None	0	In state provider	None	24881 ALICIA PKWY	UNIT N	LAGUNA HILLS	CA	92653	4617	30	06059	33.60104538	-117.6916176	Orange County
75401	Fee-for-Service	1548410251	1548410251	1	1	ADIMORAH, REGINALD N	2/23/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	REAZAD MED SUPPLY SERV	2507 W 54TH STREET	None	LOS ANGELES	CA	90043	2612	19	06037	33.99321795	-118.3206618	Los Angeles County
75408	Fee-for-Service	1417722232	1417722232	1	2	AMG, A PROFESSIONAL MEDICAL	5/24/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ORPORATION	2765 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5750	19	06037	33.97378898	-118.2206761	Los Angeles County
75413	Fee-for-Service	1396764353	1396764353	1	3	ALAMEDA HEALTH SYSTEM	1/20/2023	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1009	01	06001	37.7069698	-122.1191104	Alameda County
75417	Fee-for-Service	1205257920	1205257920	1	1	AMANAM, IDOROENYI U	3/15/2016	207RH0000X	NA	Hematology	026	PHYSICIANS	131624	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
75453	Fee-for-Service	1669973343	1669973343	1	1	ARIZA, ERICA LCSW	7/15/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2741 HAMNER AVENUE	202	NORCO	CA	92860	3628	33	06065	33.92216844	-117.5591658	Riverside County
75459	Fee-for-Service	1023061405	1023061405	1	1	AFFINITY HOSPITAL LLC	8/4/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	800 MONTCLAIR RD	None	BIRMINGHAM	AL	35213	1908	00	None	33.517179	-86.749407	Jefferson County
75472	Fee-for-Service	1407341530	1407341530	1	1	ABELLO, ALLEN DO	8/6/2022	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
75494	Fee-for-Service	1962933838	1962933838	1	1	AHN, KATHREEN DO	11/19/2019	390200000X	NA	Other	026	PHYSICIANS	17381	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
75512	Fee-for-Service	1881702348	1881702348	1	1	AGRAWAL, SONAL MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73087	None	None	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
75552	Fee-for-Service	1659765576	1659765576	1	1	AMLADI-GOMEZ, ANJANI K MD	9/8/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	145048	None	None	0	In state provider	None	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
75556	Fee-for-Service	1922636372	1922636372	1	1	AL-ANI, YASIR T MD	3/13/2024	207R00000X	NA	Other	026	PHYSICIANS	189597	None	None	0	In state provider	None	1010 MURRAY AVE	None	SAN LUIS OBISPO	CA	93405	1806	40	06079	35.292168	-120.6658665	San Luis Obispo County
75568	Fee-for-Service	1396764353	1396764353	1	2	ALAMEDA HEALTH SYSTEM	6/12/2008	No Taxonomy Provided	NA	None	060	COUNTY HOSPITAL INPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
75593	Fee-for-Service	1770536468	1770536468	1	1	ARROYO OAKS MED ASSOC	2/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	2230 LYNN RD	STE 200	THOUSAND OAKS	CA	91360	1900	56	06111	34.20894685	-118.885185	Ventura County
75619	Fee-for-Service	1336310093	1336310093	1	1	ABOUELHOSN, KHALDOUN MD	2/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108970	41	Internal Medicine	0	In state provider	None	225 EAST 2ND AVE	None	ESCONDIDO	CA	92025	4249	37	06073	33.12175817	-117.0787555	San Diego County
75646	Fee-for-Service	1922072370	1922072370	1	1	AKATSU, HARUKO MD	10/2/2008	174400000X	NA	Other	026	PHYSICIANS	54537	67	Endocrinology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
75701	Fee-for-Service	1396764353	1396764353	1	3	ALAMEDA HEALTH SYSTEM	4/19/2023	282N00000X	NA	Hospitals	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1009	01	06001	37.7069698	-122.1191104	Alameda County
75705	Fee-for-Service	1033267216	1033267216	1	1	ADVANCED FAMILY CARE	2/2/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MEDICAL GROUP	1201 E FLORENCE AVE	None	LOS ANGELES	CA	90001	2432	19	06037	33.97478347	-118.253943	Los Angeles County
75712	Fee-for-Service	1821338302	1821338302	1	1	ADVENTIST HEALTH PHYSICIANS	2/6/2019	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	6 WOODLAND RD	STE 304	SAINT HELENA	CA	94574	9562	28	06055	38.54297115	-122.4754501	Napa County
75732	Fee-for-Service	1598875239	1598875239	1	1	AL-ASADI, GHADA O MD	1/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	50587	36	Psychiatry	0	In state provider	None	415 W ROUTE 66	STE 202	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
75748	Fee-for-Service	1023061405	1023061405	1	1	AFFINITY HOSPITAL LLC	8/4/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	800 MONTCLAIR RD	None	BIRMINGHAM	AL	35213	1908	00	None	33.517179	-86.749407	Jefferson County
75800	Fee-for-Service	1346777646	1346777646	1	1	AWADEH, JASMIN DO	10/24/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16985	None	None	0	In state provider	None	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
75805	Fee-for-Service	1437380441	1437380441	1	1	ACTIVE ORTHOPEDIC MEDICAL	9/29/2009	193400000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	CORPORATION	1051 E TUOLUMNE	STE 103	TURLOCK	CA	95382	1546	50	06099	37.51464553	-120.837501	Stanislaus County
75813	Fee-for-Service	1083883763	1083883763	1	2	AFFINITY HOME HEALTH CARE	8/10/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	6960 MAGNOLIA AVE	SUITE 201	RIVERSIDE	CA	92506	2816	33	06065	33.94706367	-117.4005187	Riverside County
75821	Fee-for-Service	1699258756	1699258756	1	1	ABADI, SALOUMEH OD	5/7/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 STEIN PLAZA	#1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
75846	Fee-for-Service	1780092262	1780092262	1	4	ASHER SHAHZAD MD PC	11/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	5400 S RAINBOW BLVD	None	LAS VEGAS	NV	89118	1859	00	None	36.090072	-115.2405585	Clark County
75853	Fee-for-Service	1396764353	1396764353	1	2	ALAMEDA HEALTH SYSTEM	12/5/2018	282N00000X	NA	Hospitals	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
75854	Fee-for-Service	1336431600	1336431600	1	1	AHMC INTERNATIONAL CANCER	1/30/2012	174400000X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	CENTER A MEDICAL CORP	605 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1102	19	06037	34.06890387	-118.1229537	Los Angeles County
75876	Fee-for-Service	1396701504	1396701504	1	1	ANTHONY G HADDEN, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2275 NE DOCTORS DR	STE 2	BEND	OR	97701	6324	00	None	44.06963188	-121.2672829	Deschutes County
75877	Fee-for-Service	1184803959	1184803959	1	1	ABEGBE, JOSHUA G	11/9/2007	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	MIENDE MEDICAL SUPPLY	2149 E GARVEY AVE	STE A-1	WEST COVINA	CA	91791	1508	19	06037	34.07283575	-117.8994346	Los Angeles County
75878	Fee-for-Service	1033606389	1033606389	1	1	ALCARAZ, ALEXANDRIA	12/30/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
75881	Fee-for-Service	1770536468	1770536468	1	1	ARROYO OAKS MED ASSOC	2/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2230 LYNN RD	STE 200	THOUSAND OAKS	CA	91360	1900	56	06111	34.20894685	-118.885185	Ventura County
75924	Fee-for-Service	1982120861	1982120861	1	1	AGUERO, PETER D PT	10/16/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
75937	Fee-for-Service	1508256868	1508256868	1	1	ABOUBECHARA, DANIEL MD	11/18/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175256	None	None	0	In state provider	None	1524 MCHENRY AVE	STE 100	MODESTO	CA	95350	4566	50	06099	37.666233	-120.993933	Stanislaus County
75988	Fee-for-Service	1629061700	1629061700	1	1	ANTALL, INGRID W MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65624	08	Family Practice	0	In state provider	None	612 E JANSS RD	None	THOUSAND OAKS	CA	91360	5113	56	06111	34.19957051	-118.8666284	Ventura County
75989	Fee-for-Service	1033267216	1033267216	1	1	ADVANCED FAMILY CARE	1/28/2016	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	MEDICAL GROUP	1201 E FLORENCE AVE	None	LOS ANGELES	CA	90001	2432	19	06037	33.97478347	-118.253943	Los Angeles County
75995	Fee-for-Service	1396764353	1396764353	1	3	ALAMEDA HEALTH SYSTEM	3/31/2023	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1009	01	06001	37.7069698	-122.1191104	Alameda County
76034	Fee-for-Service	1528046463	1528046463	1	1	APPELBAUM, BRUCE D M D	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	69512	36	Psychiatry	0	In state provider	None	18811 HUNTINGTON ST	STE 200	HUNTINGTON BEACH	CA	92648	6003	30	06059	33.68962104	-117.9954102	Orange County
76091	Fee-for-Service	1790201077	1790201077	1	1	AUR PODIATRY DPM INC	3/27/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1810 GRAND CANAL BLVD	2	STOCKTON	CA	95207	8110	39	06077	37.98632376	-121.328172	San Joaquin County
76115	Fee-for-Service	1467593749	1467593749	1	1	ARNOLD, SARAH G LMFT	4/21/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2150 E TAHQUITZ CANYON W	SUITE 3	PALM SPRINGS	CA	92262	6817	33	06065	33.82322949	-116.5230675	Riverside County
76130	Fee-for-Service	1316407711	1316407711	1	1	AYARZAGOITIA, NELIDA CCC-SL	5/1/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	P	2505 W SHAW AVE	STE. 101	FRESNO	CA	93711	3334	10	06019	36.80619423	-119.8359004	Fresno County
76134	Fee-for-Service	1710474176	1710474176	1	1	ARUN, JANHAVI MD	5/26/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	184575	None	None	0	In state provider	None	2185 CITRACADA PARKWAY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
76136	Fee-for-Service	1780092262	1780092262	1	4	ASHER SHAHZAD MD PC	11/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	77	Infectious Disease	1	Border provider	None	5400 S RAINBOW BLVD	None	LAS VEGAS	NV	89118	1859	00	None	36.090072	-115.2405585	Clark County
76140	Fee-for-Service	1396764353	1396764353	1	2	ALAMEDA HEALTH SYSTEM	4/5/2017	282N00000X	NA	Hospitals	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
76142	Fee-for-Service	1336431600	1336431600	1	1	AHMC INTERNATIONAL CANCER	1/30/2012	174400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	CENTER A MEDICAL CORP	605 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1102	19	06037	34.06890387	-118.1229537	Los Angeles County
76147	Fee-for-Service	1649776980	1649776980	1	1	AVILEZ, JASMINE LMFT	8/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
76148	Fee-for-Service	1720268998	1720268998	1	2	AMERICAN FAMILY MEDICAL	10/7/2010	174400000X	NA	Other	026	PHYSICIANS	85470	41	Internal Medicine	0	In state provider	PROVIDERS INC	931 BUENA VISTA ST	SUITE 102	DUARTE	CA	91010	1712	19	06037	34.141635	-117.9775755	Los Angeles County
76167	Fee-for-Service	1770536468	1770536468	1	1	ARROYO OAKS MED ASSOC	2/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2230 LYNN RD	STE 200	THOUSAND OAKS	CA	91360	1900	56	06111	34.20894685	-118.885185	Ventura County
76172	Fee-for-Service	1821041229	1821041229	1	1	AL-JUBURI, AMAR MD	8/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	70187	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
76179	Fee-for-Service	1013392224	1013392224	1	1	ABBASI, ZOHAIB MD	8/26/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	161255	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
76182	Fee-for-Service	1841680527	1841680527	1	1	ABDELKERIM, KATHERINE LMFT	2/13/2025	171M00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
76183	Fee-for-Service	1750304234	1750304234	1	1	ANDERSON, THOMAS L MD	10/31/1985	2084N0400X	NA	Neurology	026	PHYSICIANS	33316	13	Neurology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
76194	Fee-for-Service	1114336567	1114336567	1	1	ANGELICUM HOME HEALTH INC	5/2/2017	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	9434 CHESAPEAKE DRIVE	STE 1203	SAN DIEGO	CA	92123	1390	37	06073	32.83767404	-117.1245854	San Diego County
76230	Fee-for-Service	1053692566	1053692566	1	1	AMBER CASTER	8/20/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	765 W INTERSTATE AVE	None	BISMARCK	ND	58503	0936	00	None	46.832112	-100.8031005	Burleigh County
76247	Fee-for-Service	1356486054	1356486054	1	1	AVALOS-MIRELES, GENOVEVA M	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
76276	Fee-for-Service	1033267216	1033267216	1	1	ADVANCED FAMILY CARE	2/2/2015	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	MEDICAL GROUP	1201 E FLORENCE AVE	None	LOS ANGELES	CA	90001	2432	19	06037	33.97478347	-118.253943	Los Angeles County
76277	Fee-for-Service	1396764353	1396764353	1	3	ALAMEDA HEALTH SYSTEM	4/19/2023	282N00000X	NA	Hospitals	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1009	01	06001	37.7069698	-122.1191104	Alameda County
76297	Fee-for-Service	1093395535	1093395535	1	1	ABAYA GHAZALEH, JONATHAN MD	9/13/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
76352	Fee-for-Service	1568070100	1568070100	1	1	ANDREWS, BRENNA AU	10/15/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
76368	Fee-for-Service	1801806385	1801806385	2	1	APRIA HEALTHCARE LLC	11/19/2019	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4001 BROADWAY	STE B	EUREKA	CA	95503	5708	12	06023	40.77014271	-124.1913718	Humboldt County
76378	Fee-for-Service	1396399986	1396399986	1	1	ALI ANARI MD INC	12/27/2019	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	GENT CARE	107 N MACLAY AVE	None	SAN FERNANDO	CA	91340	2906	19	06037	34.28446581	-118.439746	Los Angeles County
76412	Fee-for-Service	1801059266	1801059266	1	1	ABRISHAMIAN, LUIS K MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111105	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
76432	Fee-for-Service	1396764353	1396764353	1	2	ALAMEDA HEALTH SYSTEM	8/28/2017	282N00000X	NA	Hospitals	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
76437	Fee-for-Service	1518487313	1518487313	1	1	ALPAJARO, SIGFRED I MD	12/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
76438	Fee-for-Service	1750974697	1750974697	1	1	ARCHO GROUP INC	4/12/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6309 VAN NUYS BLVD	STE 209	VAN NUYS	CA	91401	6628	19	06037	34.18496271	-118.4487785	Los Angeles County
76453	Fee-for-Service	1659876084	1659876084	1	1	AMIN, KRINA H DO	8/2/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	18974	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
76457	Fee-for-Service	1013780188	1013780188	1	1	ARAVIND RANGARAJ MEDICAL COR	11/13/2023	208600000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	PORATION	200 JOSE FIGUERES AVE	225	SAN JOSE	CA	95116	1588	43	06085	37.36122014	-121.8505998	Santa Clara County
76465	Fee-for-Service	1831358928	1831358928	1	1	ALTMAN, NATASHA L MD	3/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
76513	Fee-for-Service	1487792677	1487792677	2	1	ADDICTION RESEARCH AND TREAT	11/11/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	15229 AMAR RD	None	LA PUENTE	CA	91744	2066	19	06037	34.03783114	-117.9526334	Los Angeles County
76564	Fee-for-Service	1396764353	1396764353	1	3	ALAMEDA HEALTH SYSTEM	3/31/2025	282N00000X	NA	Hospitals	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1009	01	06001	37.7069698	-122.1191104	Alameda County
76596	Fee-for-Service	1831895598	1831895598	1	1	ARNOLD STERN, MERRISA	9/7/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
76631	Fee-for-Service	1356993984	1356993984	1	1	ALEKSANYAN, MANE MD	11/4/2022	163WG0000X	NA	Other	026	PHYSICIANS	179653	None	None	0	In state provider	None	191 S BUENA VISTA ST	SUITE 100	BURBANK	CA	91505	4562	19	06037	34.15872557	-118.3283863	Los Angeles County
76646	Fee-for-Service	1871660688	1871660688	1	1	ANDERSON, DAVID V MD	11/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40924	20	Orthopedic Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
76669	Fee-for-Service	1245371541	1245371541	1	1	ASIAN HEALTH SVS	7/1/1994	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	818 WEBSTER ST	None	OAKLAND	CA	94607	4220	01	06001	37.79946052	-122.2711864	Alameda County
76717	Fee-for-Service	1396764353	1396764353	1	2	ALAMEDA HEALTH SYSTEM	9/30/2015	282N00000X	NA	Hospitals	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
76725	Fee-for-Service	1821477498	1821477498	1	1	AMERI, GILDA MD	9/17/2018	208M00000X	NA	Other	026	PHYSICIANS	150400	41	Internal Medicine	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	3663	30	06059	33.62421676	-117.9309656	Orange County
76727	Fee-for-Service	1750974697	1750974697	1	1	ARCHO GROUP INC	4/12/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6309 VAN NUYS BLVD	STE 209	VAN NUYS	CA	91401	6628	19	06037	34.18496271	-118.4487785	Los Angeles County
76742	Fee-for-Service	1659315109	1659315109	1	1	ARIZ, CHARLES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 SQUALICUM PKWY	None	BELLINGHAM	WA	98225	1854	00	None	48.77211992	-122.473101	Whatcom County
76751	Fee-for-Service	1568152379	1568152379	1	1	ASSISTED SENIOR CARE FACILIT	6/7/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	7039 CLAIRE AVE	None	RESEDA	CA	91335	3822	19	06037	34.19865059	-118.5502523	Los Angeles County
76754	Fee-for-Service	1831358928	1831358928	1	1	ALTMAN, NATASHA L MD	3/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
76773	Fee-for-Service	1568763068	1568763068	1	1	ALL EARS AUDIOLOGY INC	3/22/2011	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	302 W LA VETA	STE 201	ORANGE	CA	92866	2607	30	06059	33.78057554	-117.8554725	Orange County
76785	Fee-for-Service	1013087410	1013087410	1	1	AGNER,MARIA TERESA C MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70721	41	Internal Medicine	0	In state provider	None	10941 BLOOMFIELD ST	STE A	LOS ALAMITOS	CA	90720	6702	30	06059	33.804234	-118.0632055	Orange County
76800	Fee-for-Service	1477646776	1477646776	1	1	ABBASI, MEHRDAD MD	6/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91781	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
76806	Fee-for-Service	1285130708	1285130708	1	1	ABDULLAH, BUTOOL S MD	10/13/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	180513	None	None	0	In state provider	None	16465 SIERRA LAKES PKWY	SUITE 275	FONTANA	CA	92336	1242	36	06071	34.13805177	-117.4457839	San Bernardino County
76814	Fee-for-Service	1982462263	1982462263	1	1	ADVENTIST HEALTH PHYSICIANS	10/9/2024	207X00000X	NA	Orthopedic Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1064 MURRAY AVE	None	SAN LUIS OBISPO	CA	93405	1806	40	06079	35.29096261	-120.6649484	San Luis Obispo County
76852	Fee-for-Service	1396764353	1396764353	1	3	ALAMEDA HEALTH SYSTEM	8/1/2023	282N00000X	NA	Hospitals	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1009	01	06001	37.7069698	-122.1191104	Alameda County
76884	Fee-for-Service	1417722232	1417722232	1	4	AMG, A PROFESSIONAL MEDICAL	5/31/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	ORPORATION	3564 SANTA ANITA AVE	STE A	EL MONTE	CA	91731	2458	19	06037	34.07413975	-118.0415264	Los Angeles County
76909	Fee-for-Service	1235572983	1235572983	1	1	AWODELE, OLUSEYI A MD	12/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	134816	01	General Practice	0	In state provider	None	102 MILE OF CARS WAY	None	NATIONAL CITY	CA	91950	6603	37	06073	32.66148939	-117.1033907	San Diego County
76953	Fee-for-Service	1528050242	1528050242	1	1	ARNOLD GOLDMAN, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11313 76TH RD	None	FOREST HILLS	NY	11375	6528	00	None	40.718223	-73.833885	Queens County
76978	Fee-for-Service	1215119045	1215119045	1	1	ARC OF SAN DIEGO	7/23/1988	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SANTANA HOUSE	8513 ATLAS VIEW DR	None	SANTEE	CA	92071	4111	37	06073	32.828382	-116.9929145	San Diego County
76980	Fee-for-Service	1710026067	1710026067	1	1	AYYOUB,Z A MEDICAL GROUP INC	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	53397	25	Physical Medicine and Rehabilitation	0	In state provider	None	16660 PARAMOUNT BLVD	SUITE 203	PARAMOUNT	CA	90723	5458	19	06037	33.882723	-118.1599535	Los Angeles County
76996	Fee-for-Service	1073665295	1073665295	1	1	ANANIAS, MARTIN P MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67788	41	Internal Medicine	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
77004	Fee-for-Service	1396764353	1396764353	1	2	ALAMEDA HEALTH SYSTEM	9/26/2018	282N00000X	NA	Hospitals	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
77018	Fee-for-Service	1427304120	1427304120	1	1	ALVAREZ, RITA V	3/30/2022	2080P0203X	NA	Other	026	PHYSICIANS	172752	None	None	0	In state provider	None	9300 VALLEY CHILRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
77036	Fee-for-Service	1588278717	1588278717	1	1	AVIOR HOSPICE CARE INC	12/9/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	927 W OLIVE AVE	STE C	BURBANK	CA	91506	3402	19	06037	34.17283458	-118.3173191	Los Angeles County
77055	Fee-for-Service	1407997281	1407997281	2	1	A1 DEL MONTE INC.	7/22/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	517 E FULTON STREET	None	STOCKTON	CA	95204	2227	39	06077	37.98468676	-121.2944462	San Joaquin County
77083	Fee-for-Service	1003458704	1003458704	1	2	ANESTHESIA MANAGEMENT SERVIC	2/8/2021	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ES OF CALIFORNIA INC	275 HOSPITAL	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
77090	Fee-for-Service	1437263787	1437263787	1	1	ADAMS, BRIAN E LMFT	5/25/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 N LANTANA ST	269	CAMARILLO	CA	93010	9008	56	06111	34.219503	-119.055108	Ventura County
77100	Fee-for-Service	1194982298	1194982298	1	1	ARANHA, NEIL A MD	3/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131307	05	Anesthesiology	0	In state provider	None	2185 CITRACADO PARKWAY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
77116	Fee-for-Service	1063829398	1063829398	1	1	ANGEL, VENICE LCSW	12/28/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	32640 COUGAR PASS CT	None	WINCHESTER	CA	92596	8396	33	06065	33.60890535	-117.0894175	Riverside County
77158	Fee-for-Service	1518938950	1518938950	1	1	ADAMSON, MARIE H MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85881	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
77173	Fee-for-Service	1417722232	1417722232	1	4	AMG, A PROFESSIONAL MEDICAL	2/21/2025	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ORPORATION	3564 SANTA ANITA AVE	STE A	EL MONTE	CA	91731	2458	19	06037	34.07413975	-118.0415264	Los Angeles County
77181	Fee-for-Service	1932133832	1932133832	1	1	ALFERT, JONATHAN MD	1/23/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
77211	Fee-for-Service	1467459222	1467459222	1	1	ABEDI, MEHRDAD MD	6/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53685	68	Hematology	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
77223	Fee-for-Service	1376610196	1376610196	1	1	ARORA, SUKHNINDER K MD	5/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77311	08	Family Practice	0	In state provider	None	3733 DIMAS ST	None	BAKERSFIELD	CA	93301	0000	15	06029	35.393499	-119.008257	Kern County
77237	Fee-for-Service	1841831625	1841831625	1	1	A1KARE HOSPICE & PALLIATIVE	10/6/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	8300 TAMPA AVE	SUITE G	NORTHRIDGE	CA	91324	4275	19	06037	34.220709	-118.5534835	Los Angeles County
77268	Fee-for-Service	1710026067	1710026067	1	1	AYYOUB,Z A MEDICAL GROUP INC	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	53397	01	General Practice	0	In state provider	None	16660 PARAMOUNT BLVD	SUITE 203	PARAMOUNT	CA	90723	5458	19	06037	33.882723	-118.1599535	Los Angeles County
77270	Fee-for-Service	1992779482	1992779482	1	1	ANNA JAQUES HOSPITAL	7/20/2022	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	25 HIGHLAND AVE	None	NEWBURYPORT	MA	01950	3867	00	None	42.814386	-70.8910785	Essex County
77325	Fee-for-Service	1588278717	1588278717	1	1	AVIOR HOSPICE CARE INC	12/9/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	927 W OLIVE AVE	STE C	BURBANK	CA	91506	3402	19	06037	34.17283458	-118.3173191	Los Angeles County
77335	Fee-for-Service	1205535663	1205535663	1	1	ABEL, GEORGIANA LMFT	1/31/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	386 W. LINE ST	None	BISHOP	CA	93514	1100	14	06027	37.36135856	-118.3979892	Inyo County
77349	Fee-for-Service	1710970223	1710970223	1	1	ARNOLD, CONRAD N MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85382	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
77372	Fee-for-Service	1003458704	1003458704	1	2	ANESTHESIA MANAGEMENT SERVIC	2/8/2021	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	ES OF CALIFORNIA INC	275 HOSPITAL	None	UKIAH	CA	95482	4531	23	06045	39.15305697	-123.2037774	Mendocino County
77406	Fee-for-Service	1760854988	1760854988	1	1	AVILA, CRISTINA	1/12/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	114350	-	NOT APPLICABLE	0	In state provider	None	1904 RICHLAND AVE	None	CERES	CA	95307	9440	50	06099	37.60031128	-120.9658226	Stanislaus County
77436	Fee-for-Service	1962615377	1962615377	1	1	ARBOGAST, STEVEN	8/29/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	21608	None	None	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
77461	Fee-for-Service	1417722232	1417722232	1	4	AMG, A PROFESSIONAL MEDICAL	5/31/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	ORPORATION	3564 SANTA ANITA AVE	STE A	EL MONTE	CA	91731	2458	19	06037	34.07413975	-118.0415264	Los Angeles County
77468	Fee-for-Service	1841557683	1841557683	1	1	ACOSTA-GOLDSTEIN, SUSELINA	9/15/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	185103	None	None	0	In state provider	MD	2299 MOWRY AVE	2C	FREMONT	CA	94538	1621	01	06001	37.55671415	-121.9817758	Alameda County
77475	Fee-for-Service	1255956132	1255956132	1	1	ADVENTIST HEALTH PHYSICIANS	11/17/2020	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	10200 TRINITY PKWY	102	STOCKTON	CA	95219	7286	39	06077	38.04745959	-121.3721294	San Joaquin County
77490	Fee-for-Service	1659026615	1659026615	1	2	ARCHWAY RECOVERY SERVICES IN	12/30/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	C	1095 E TABOR AVE	None	FAIRFIELD	CA	94533	4190	48	06095	38.26521721	-122.0137119	Solano County
77500	Fee-for-Service	1467459222	1467459222	1	1	ABEDI, MEHRDAD MD	6/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	53685	78	Neoplastic Diseases/Oncology	0	In state provider	None	4501 X STREET	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
77524	Fee-for-Service	1841831625	1841831625	1	1	A1KARE HOSPICE & PALLIATIVE	10/6/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	8300 TAMPA AVE	SUITE G	NORTHRIDGE	CA	91324	4275	19	06037	34.220709	-118.5534835	Los Angeles County
77534	Fee-for-Service	1801083241	1801083241	1	1	ALMAZAN, DONDEE E MD	5/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	96863	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
77540	Fee-for-Service	1326045949	1326045949	1	1	ANTELOPE AMBULANCE SRVC	1/22/1998	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	42540 N 6TH ST EAST	STE A	LANCASTER	CA	93535	5202	19	06037	34.6559367	-118.1188418	Los Angeles County
77557	Fee-for-Service	1992779482	1992779482	1	1	ANNA JAQUES HOSPITAL	7/20/2022	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	25 HIGHLAND AVE	None	NEWBURYPORT	MA	01950	3867	00	None	42.814386	-70.8910785	Essex County
77572	Fee-for-Service	1639706724	1639706724	1	1	ALI, FIZZA MD	7/5/2023	207P00000X	NA	Other	026	PHYSICIANS	186059	None	None	0	In state provider	None	1911 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4131	40	06079	35.27851417	-120.6501092	San Luis Obispo County
77587	Fee-for-Service	1417903436	1417903436	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1751 N SUNRISE WAY	None	PALM SPRINGS	CA	92262	3408	33	06065	33.84576	-116.528208	Riverside County
77598	Fee-for-Service	1326401852	1326401852	1	1	AGAZARYAN, ANDRANIK A MD	12/27/2018	207R00000X	NA	Other	026	PHYSICIANS	155722	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
77612	Fee-for-Service	1114542198	1114542198	1	1	ANTIOCH DUNES HEALTHCARE LLC	6/16/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1210 A STREET	None	ANTIOCH	CA	94509	2327	07	06013	38.009133	-121.8060565	Contra Costa County
77666	Fee-for-Service	1295263002	1295263002	1	1	ADAMSON, TYLER DO	7/23/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18184	08	Family Practice	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
77675	Fee-for-Service	1194011619	1194011619	1	1	ADLER, SARAH M PHD	10/24/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
77684	Fee-for-Service	1306334057	1306334057	1	1	ASSISTIVE HEALTH SYSTEMS INC	10/8/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4540 KEARNY VILLA RD	STE 206	SAN DIEGO	CA	92123	1577	37	06073	32.82260734	-117.144126	San Diego County
77744	Fee-for-Service	1720148638	1720148638	1	1	ADD SMILE HEALTH SVS INC	6/11/2003	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	NEW VALLEY ADHC	1710 S DEL MAR AVE	STE 111-117	SAN GABRIEL	CA	91776	3852	19	06037	34.078212	-118.0995845	Los Angeles County
77748	Fee-for-Service	1417722232	1417722232	1	4	AMG, A PROFESSIONAL MEDICAL	5/31/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ORPORATION	3564 SANTA ANITA AVE	STE A	EL MONTE	CA	91731	2458	19	06037	34.07413975	-118.0415264	Los Angeles County
77754	Fee-for-Service	1689606907	1689606907	1	1	ASARNOW, ROBERT F PHD	2/15/2006	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
77803	Fee-for-Service	1326483603	1326483603	1	1	ASH, MEGAN M MD	10/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133531	01	General Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
77819	Fee-for-Service	1497019806	1497019806	1	1	AHMADI, NASER MD	10/7/2021	2084P0804X	NA	Psychiatry	026	PHYSICIANS	132282	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
77908	Fee-for-Service	1093100463	1093100463	1	1	ARCILLA, JOHN-VINCENT L MD	7/10/2018	207R00000X	NA	Other	026	PHYSICIANS	144114	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
77925	Fee-for-Service	1982167300	1982167300	1	1	ADVENTIST HEALTH PHYSICIANS	10/9/2020	207V00000X	NA	Obstetrics & Gynecology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1100 TRANCAS	STE 250	NAPA	CA	94558	2900	28	06055	38.32316569	-122.2981938	Napa County
77931	Fee-for-Service	1891724670	1891724670	1	1	AVAKUMOV, TIGRAN V MD	9/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84384	05	Anesthesiology	0	In state provider	None	2626 N CALIFORNIA ST	STE G	STOCKTON	CA	95204	5500	39	06077	37.97724966	-121.2917368	San Joaquin County
77950	Fee-for-Service	1851731756	1851731756	1	1	ARIAS-SHAH, ANNAMARIE MD	1/12/2023	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	168184	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
77967	Fee-for-Service	1437248549	1437248549	1	1	ARBOR MEDICAL GROUP	5/14/1987	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1418 E MAIN ST	STE 210	SANTA MARIA	CA	93454	4836	42	06083	34.95286855	-120.4137315	Santa Barbara County
78006	Fee-for-Service	1578004834	1578004834	1	1	ALVAREZ, LISA C MD	8/14/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	157646	None	None	0	In state provider	None	3883 AIRWAY DR	202	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
78011	Fee-for-Service	1043534654	1043534654	1	1	ALDERFER, KAREN B MD	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LANE	STE 100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
78028	Fee-for-Service	1386050805	1386050805	1	1	AVALOS, JONATHAN D MD	3/20/2017	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	139612	-	NOT APPLICABLE	0	In state provider	None	590 W 8TH STREET	None	SAN PEDRO	CA	90731	3120	19	06037	33.73699936	-118.2899621	Los Angeles County
78043	Fee-for-Service	1750696308	1750696308	1	1	ALLIED HEALTH SOLUTIONS MEDI	5/7/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CAL GROUP, A PROFESSIONA	301 N PRAIRIE AVE	SUITE 230	INGLEWOOD	CA	90301	4507	19	06037	33.965712	-118.3439965	Los Angeles County
78051	Fee-for-Service	1538620125	1538620125	1	1	ADVANCED CARE NURSING CORPOR	6/1/2020	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ATION	739 EAST PENNSYLVANIA AV	STE C	ESCONDIDO	CA	92025	3004	37	06073	33.12712182	-117.0727888	San Diego County
78066	Fee-for-Service	1689238560	1689238560	1	1	AHADIAN, DONIA MD	7/24/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178849	None	None	0	In state provider	None	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	37	06073	32.79692047	-117.1567137	San Diego County
78089	Fee-for-Service	1740428580	1740428580	1	1	ADVANCED EYECARE AN	4/1/2009	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRIC CORPORATION	1050 LIVE OAK BLVD	None	YUBA CITY	CA	95991	3630	51	06101	39.14449564	-121.6208323	Sutter County
78102	Fee-for-Service	1417233578	1417233578	1	1	ARZAGA, CHERISE B LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
78144	Fee-for-Service	1518197581	1518197581	1	1	ANDERSON, ALI LMFT	6/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15260 VENTURA BLVD	1200	SHERMAN OAKS	CA	91403	5307	19	06037	34.15370926	-118.4656644	Los Angeles County
78182	Fee-for-Service	1215313457	1215313457	1	1	ALIGA-CABAMUNGAN, SCARLETTE	1/25/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
78209	Fee-for-Service	1558803114	1558803114	1	1	AGUILAR, JENNIFER CCC-SLP	8/30/2019	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3518 JEFFERSON AVE	None	REDWOOD CITY	CA	94062	3136	41	06081	37.46715891	-122.2492205	San Mateo County
78220	Fee-for-Service	1235236662	1235236662	1	1	ABELS, GLORIA B MD	4/30/1994	174400000X	NA	Other	026	PHYSICIANS	64604	41	Internal Medicine	0	In state provider	None	2160 APPIAN WAY	STE 200	PINOLE	CA	94564	2565	07	06013	37.99585174	-122.3021549	Contra Costa County
78233	Fee-for-Service	1518960814	1518960814	1	1	ASPEN VALLEY HOSP DIST	5/29/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	0401 CASTLE CREEK RD	None	ASPEN	CO	81611	1159	00	None	39.190482	-106.839324	Pitkin County
78252	Fee-for-Service	1437248549	1437248549	1	1	ARBOR MEDICAL GROUP	5/14/1987	174400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1418 E MAIN ST	STE 210	SANTA MARIA	CA	93454	4836	42	06083	34.95286855	-120.4137315	Santa Barbara County
78273	Fee-for-Service	1295832277	1295832277	1	1	ABDEL-MALEK, SHAHIRA MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	36609	40	Pediatrics	0	In state provider	INC	3100 E FLORENCE AVE	STE 1	HUNTINGTON PARK	CA	90255	5848	19	06037	33.97277388	-118.2118093	Los Angeles County
78280	Fee-for-Service	1275717258	1275717258	1	1	ARMSTRONG, LINDA MD	3/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91474	40	Pediatrics	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
78282	Fee-for-Service	1285132282	1285132282	1	1	ADVENTIST HEALTH PHYSICIANS	8/20/2019	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1233 PLUMAS ST	STE A	YUBA CITY	CA	95991	3410	51	06101	39.14818027	-121.6175196	Sutter County
78330	Fee-for-Service	1750696308	1750696308	1	1	ALLIED HEALTH SOLUTIONS MEDI	5/7/2012	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CAL GROUP, A PROFESSIONA	301 N PRAIRIE AVE	SUITE 230	INGLEWOOD	CA	90301	4507	19	06037	33.965712	-118.3439965	Los Angeles County
78353	Fee-for-Service	1073773818	1073773818	1	1	ARMENDARIZ, REBECCA T MD	4/1/2022	2081H0002X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	175874	None	None	0	In state provider	None	9888 GENESEE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
78361	Fee-for-Service	1558945022	1558945022	1	1	ABELEDA, PAULA F NP	7/30/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
78365	Fee-for-Service	1538905153	1538905153	1	1	AMERICAN LOGISTICS SERVICES	9/19/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	INC	25120 ALTA VISTA DR	None	MORENO VALLEY	CA	92557	5229	33	06065	33.96059516	-117.2246169	Riverside County
78371	Fee-for-Service	1437157252	1437157252	1	1	AMERICAN MED TRANS INC.	2/22/1999	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	CENTRAL COAST AMB SVS	600 E BEL MAR DR	None	LA SELVA BEACH	CA	95076	6400	44	06087	36.94800105	-121.8423519	Santa Cruz County
78383	Fee-for-Service	1881613420	1881613420	1	1	ANAND, VEERINDER S MD	1/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	39442	01	General Practice	0	In state provider	None	1318 S IMPERIAL AVE	None	EL CENTRO	CA	92243	4201	13	06025	32.78032357	-115.5697347	Imperial County
78386	Fee-for-Service	1043716152	1043716152	1	1	AGARWAL, MONICA MD	3/10/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	183566	None	None	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
78392	Fee-for-Service	1881381663	1881381663	1	1	AMPLA HEALTH	6/13/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	680 COHASSET RD	None	CHICO	CA	95926	2213	04	06007	39.752856	-121.8454685	Butte County
78394	Fee-for-Service	1396767554	1396767554	1	1	AIDS HEALTHCARE FOUNDATION	9/23/2005	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	99 N LA CIENEGA BLVD	STE 200	BEVERLY HILLS	CA	90211	2285	19	06037	34.06736471	-118.3763201	Los Angeles County
78395	Fee-for-Service	1265637672	1265637672	1	1	AUDIOLOGY ASSOCIATES	11/17/1982	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 MARGARET LN	STE D	GRASS VALLEY	CA	95945	4207	29	06057	39.23003572	-121.0469625	Nevada County
78511	Fee-for-Service	1336216290	1336216290	1	1	ARIZ, FARIBA MD	7/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	60312	08	Family Practice	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
78524	Fee-for-Service	1518960814	1518960814	1	1	ASPEN VALLEY HOSP DIST	5/29/2007	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	0401 CASTLE CREEK RD	None	ASPEN	CO	81611	1159	00	None	39.190482	-106.839324	Pitkin County
78529	Fee-for-Service	1962039636	1962039636	1	1	ALI, KOMAIL MUJTABA	10/31/2024	207R00000X	NA	Other	026	PHYSICIANS	185057	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
78642	Fee-for-Service	1730576232	1730576232	1	1	ASMEROM, TARIK T MD	6/1/2022	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
78644	Fee-for-Service	1013089838	1013089838	1	1	ALBERT, METTY B MD	6/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	73674	26	Psychiatry (child)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
78646	Fee-for-Service	1912443268	1912443268	1	1	ARMENTA, GUILLERMO LCSW	10/10/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
78650	Fee-for-Service	1164036596	1164036596	1	1	ANDERSONRX, INC	1/5/2022	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2940 EAST ST	None	ANDERSON	CA	96007	3411	45	06089	40.45107638	-122.2980834	Shasta County
78658	Fee-for-Service	1538604541	1538604541	1	1	AAZAA, INC	10/17/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16915 DEVONSHIRE ST	None	GRANADA HILLS	CA	91344	7407	19	06037	34.25754015	-118.5004161	Los Angeles County
78664	Fee-for-Service	1962024158	1962024158	1	1	AVANT CARE HOSPICE INC	7/21/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6427 W 87TH STREET	None	LOS ANGELES	CA	90045	1000	19	06037	33.95853448	-118.4000007	Los Angeles County
78669	Fee-for-Service	1881613420	1881613420	1	1	ANAND, VEERINDER S MD	1/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	39442	20	Orthopedic Surgery	0	In state provider	None	1318 S IMPERIAL AVE	None	EL CENTRO	CA	92243	4201	13	06025	32.78032357	-115.5697347	Imperial County
78676	Fee-for-Service	1518038421	1518038421	1	1	AUBE, YVONNE MARIE MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44571	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
78705	Fee-for-Service	1578821096	1578821096	1	1	ABU ZAHRA, HILAL S MD	7/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136562	40	Pediatrics	0	In state provider	None	555 TACHEVAH DRIVE	2E107	PALM SPRINGS	CA	92262	5752	33	06065	33.83753681	-116.5424435	Riverside County
78747	Fee-for-Service	1619930179	1619930179	1	1	ADAIR, GINA M MD	3/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	80234	08	Family Practice	0	In state provider	None	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
78752	Fee-for-Service	1972559961	1972559961	1	2	ACCENTCARE HOME HEALTH	5/29/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	BRANCH	140 2ND ST	SUITE 320	PETALUMA	CA	94952	3097	49	06097	38.23344142	-122.6372797	Sonoma County
78768	Fee-for-Service	1780646331	1780646331	1	1	ALEXANIAN, LUKAS MD	6/12/2000	2084P0800X	NA	Psychiatry	026	PHYSICIANS	56238	36	Psychiatry	0	In state provider	None	1560 E CHEVY CHASE DR	STE 130	GLENDALE	CA	91206	4140	19	06037	34.15290734	-118.2302295	Los Angeles County
78803	Fee-for-Service	1700964301	1700964301	1	1	ANDERSON, KARL A MD	8/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36107	34	Urology and Urological Surgery	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
78817	Fee-for-Service	1265604631	1265604631	1	1	AYENDU DANQUAH, GRACE MD	4/24/2008	208600000X	NA	General Surgery	026	PHYSICIANS	97084	02	General Surgery	0	In state provider	None	500 S SEVENTH AVE	SUITE C	BARSTOW	CA	92311	3057	36	06071	34.894449	-117.019677	San Bernardino County
78854	Fee-for-Service	1104169655	1104169655	1	1	ATALLAH, HANI MD	6/20/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	132530	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
78856	Fee-for-Service	1265700157	1265700157	1	2	ALLIANCE URGENT CARE INC	10/11/2018	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3853 W STETSON AVE	STE 100	HEMET	CA	92545	9674	33	06065	33.7293005	-117.011457	Riverside County
78873	Fee-for-Service	1144324351	1144324351	1	1	AFSARI, KHOSROW MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	30573	41	Internal Medicine	0	In state provider	None	2089 VALE RD	STE 21	SAN PABLO	CA	94806	3849	07	06013	37.95396781	-122.3375393	Contra Costa County
78894	Fee-for-Service	1700013448	1700013448	1	1	AHMADZIA, AHMAD S MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124249	41	Internal Medicine	0	In state provider	None	1205 EAST NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
78907	Fee-for-Service	1295900504	1295900504	1	1	AGUIRRE, FRANCISCO MD	1/15/2021	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	165450	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
78927	Fee-for-Service	1417056391	1417056391	1	1	AMADPOUR, MOE MD INC	7/20/2010	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	81182	10	Gastroenterology (M.D. only)	0	In state provider	None	2796 SYCAMORE DR	STE 204	SIMI VALLEY	CA	93065	1549	56	06111	34.28595701	-118.7437588	Ventura County
78953	Fee-for-Service	1245340231	1245340231	1	1	ARTHRITIS & OSTEOPOROSIS	10/27/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	MEDICAL CENTER INC	2063 S ATLANTIC BLVD	STE 300	MONTEREY PARK	CA	91754	0000	19	06037	34.04029716	-118.1422905	Los Angeles County
78963	Fee-for-Service	1518038421	1518038421	1	1	AUBE, YVONNE MARIE MD	9/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	44571	25	Physical Medicine and Rehabilitation	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
78967	Fee-for-Service	1962024158	1962024158	1	1	AVANT CARE HOSPICE INC	7/21/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6427 W 87TH STREET	None	LOS ANGELES	CA	90045	1000	19	06037	33.95853448	-118.4000007	Los Angeles County
78983	Fee-for-Service	1528144920	1528144920	1	1	ASIAN NETWORK HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	212 9TH ST	STE 204	OAKLAND	CA	94607	4428	01	06001	37.79871855	-122.2677469	Alameda County
78991	Fee-for-Service	1942588983	1942588983	1	1	ATIF ZAFAR	9/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
79006	Fee-for-Service	1881153609	1881153609	1	1	ARBOLEDA, ALEJANDRO MD	6/8/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	182489	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
79026	Fee-for-Service	1316205776	1316205776	1	1	AZIZI, SAMEEN MD	5/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128839	40	Pediatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
79034	Fee-for-Service	1952315608	1952315608	3	1	ADVANCE MEDICAL SUPPLY, INC	2/6/2018	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	7416 UNIVERSITY AVE	None	LA MESA	CA	91942	0505	37	06073	32.75744508	-117.0378742	San Diego County
79084	Fee-for-Service	1659551703	1659551703	1	1	ALTHEA'S INC	1/1/1997	335E00000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	DEBORAH GATES	2320 E MAIN ST	None	VENTURA	CA	93003	2602	56	06111	34.27632946	-119.264983	Ventura County
79103	Fee-for-Service	1376777524	1376777524	1	1	ABOSAIDA, ALLADDIN M E MD	5/12/2009	2080P0214X	NA	Pulmonology	026	PHYSICIANS	94001	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
79150	Fee-for-Service	1922167501	1922167501	1	1	ALEXANDRAKIS, GEORGE MD	5/17/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74492	18	Ophthalmology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
79159	Fee-for-Service	1144259946	1144259946	1	1	ALBERT, SHLOMI MD	11/14/2007	208800000X	NA	Other	026	PHYSICIANS	99515	34	Urology and Urological Surgery	0	In state provider	None	575 E HARDY ST	STE 215	INGLEWOOD	CA	90301	4041	19	06037	33.94909392	-118.3477665	Los Angeles County
79166	Fee-for-Service	1013168749	1013168749	1	1	ANUNTIYO, JEREMY MD INC	11/21/2008	207R00000X	NA	Other	026	PHYSICIANS	94526	41	Internal Medicine	0	In state provider	None	1360 W 6TH STREET	STE # 310N	SAN PEDRO	CA	90732	3599	19	06037	33.73886546	-118.3075065	Los Angeles County
79191	Fee-for-Service	1104034123	1104034123	1	1	AMRANI, ISRAEL MFT	12/1/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	21152	-	NOT APPLICABLE	0	In state provider	None	1926 W BEVERLY BLVD	None	LOS ANGELES	CA	90057	2402	19	06037	34.06588198	-118.2686209	Los Angeles County
79215	Fee-for-Service	1366511628	1366511628	1	1	ACEVES, SEEMA S MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74305	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
79217	Fee-for-Service	1871745653	1871745653	1	2	ACTIVE FEET, INC.	2/10/2023	332B00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5490 COMPLEX ST	SUITE 605	SAN DIEGO	CA	92123	1126	37	06073	32.83431986	-117.1344569	San Diego County
79259	Fee-for-Service	1528144920	1528144920	1	1	ASIAN NETWORK HOSPICE	5/23/2002	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	212 9TH ST	STE 204	OAKLAND	CA	94607	4428	01	06001	37.79871855	-122.2677469	Alameda County
79268	Fee-for-Service	1548211436	1548211436	1	1	ADIBI, KAMI MD	8/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	64723	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
79273	Fee-for-Service	1295129740	1295129740	1	1	ALEXANDER, JESSICA PT	6/26/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11205 KNOTT AVE	SUITE E	CYPRESS	CA	90630	5489	30	06059	33.8006025	-118.0111199	Orange County
79309	Fee-for-Service	1912772336	1912772336	1	1	AMELIE WAGNER, M.D.	7/29/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	40700 CALIFORNIA OAKS RD	STE 208	MURRIETA	CA	92562	5789	33	06065	33.57067363	-117.2045035	Riverside County
79347	Fee-for-Service	1457425050	1457425050	1	1	AKINS, VICTORIA MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	63270	40	Pediatrics	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
79380	Fee-for-Service	1346471372	1346471372	1	1	ALL DAY HEALTHCARE INC	9/9/2013	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	2820 N FIGUEROA ST	None	LOS ANGELES	CA	90065	1524	19	06037	34.08528359	-118.2205117	Los Angeles County
79386	Fee-for-Service	1609465442	1609465442	1	1	AA FAMILY HOSPICE INC	4/28/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	239 E ALAMEDA AVE	STE 101	BURBANK	CA	91502	1557	19	06037	34.17541398	-118.2988703	Los Angeles County
79392	Fee-for-Service	1396186565	1396186565	1	1	ARGISHTI, NARINE MD	1/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131308	41	Internal Medicine	0	In state provider	None	1818 N ORANGE GROVE AVE	#202	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
79393	Fee-for-Service	1730142670	1730142670	1	1	ADDINGTON-WHITE, JOAN F MD	11/28/2018	207R00000X	NA	Other	026	PHYSICIANS	159042	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
79395	Fee-for-Service	1851838379	1851838379	1	1	ARDENT CARE LLC	11/17/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1665 SOUTH BROOKHURST ST	None	ANAHEIM	CA	92804	6000	30	06059	33.806646	-117.9589595	Orange County
79398	Fee-for-Service	1962951780	1962951780	1	1	ADVANCED SLEEP MEDICINE SRVS	7/3/2018	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	105 N HILL AVE	STE 206	PASADENA	CA	91106	1934	19	06037	34.147827	-118.121406	Los Angeles County
79428	Fee-for-Service	1730291287	1730291287	1	1	AGUILAR, DAVID G MD	6/10/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	66921	40	Pediatrics	0	In state provider	None	7705 SEVILLE AVE	STE D	HUNTINGTON PARK	CA	90255	6315	19	06037	33.96866534	-118.2224746	Los Angeles County
79431	Fee-for-Service	1710009121	1710009121	1	1	ARIZAGA PEVERINI, SILVIA C	8/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	55466	41	Internal Medicine	0	In state provider	MD	3000 Q ST	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
79433	Fee-for-Service	1558952523	1558952523	1	1	ASSISTING HANDS PALLIATIVE	5/24/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	12500 RIVERSIDE DR	SUITE 209	VALLEY VILLAGE	CA	91607	3423	19	06037	34.15758653	-118.4056605	Los Angeles County
79442	Fee-for-Service	1649589243	1649589243	1	1	AHMAD, EHATSHAM MD	8/19/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	114008	None	None	0	In state provider	None	2437 FENTON ST	STE A	CHULA VISTA	CA	91914	3517	37	06073	32.65259485	-116.9605449	San Diego County
79447	Fee-for-Service	1184889420	1184889420	1	1	ARREGUIN, SONIA LCSW	5/9/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2615 ASHBY AVE	None	BERKELEY	CA	94705	2200	01	06001	37.85685511	-122.2547897	Alameda County
79453	Fee-for-Service	1013168749	1013168749	1	1	ANUNTIYO, JEREMY MD INC	11/21/2008	207R00000X	NA	Other	026	PHYSICIANS	94526	83	Rheumatology	0	In state provider	None	1360 W 6TH STREET	STE # 310N	SAN PEDRO	CA	90732	3599	19	06037	33.73886546	-118.3075065	Los Angeles County
79504	Fee-for-Service	1235600925	1235600925	1	1	ARDENT HOME HEALTH CARE INC	7/2/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1933 DAVIS ST	STE 320	SAN LEANDRO	CA	94577	1259	01	06001	37.71755975	-122.1809904	Alameda County
79508	Fee-for-Service	1003372715	1003372715	1	1	AHMED, ADIL DO	5/9/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	20737	None	None	0	In state provider	None	625 S FAIR OAKS AVE	227, 240, 280, 285	PASADENA	CA	91105	2613	19	06037	34.134894	-118.1504155	Los Angeles County
79586	Fee-for-Service	1871078964	1871078964	1	1	AT-CARE MEDICAL TRANSPORT, L	4/5/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LC	4535 MISSOURI FLAT RD.	200E	PLACERVILLE	CA	95667	6846	09	06017	38.69980395	-120.8227032	El Dorado County
79627	Fee-for-Service	1306239918	1306239918	1	1	ADNAN, MOHAMMAD MD	7/19/2023	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	186470	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
79631	Fee-for-Service	1477501799	1477501799	1	1	AZER, WAGEH F MD	11/28/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66892	41	Internal Medicine	0	In state provider	None	1230 W 3RD ST	None	LOS ANGELES	CA	90017	1408	19	06037	34.05723342	-118.259093	Los Angeles County
79644	Fee-for-Service	1053428128	1053428128	1	1	ANTONIO ANZUETO, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
79647	Fee-for-Service	1447444625	1447444625	1	1	ALTOS OAKS MEDICAL GROUP	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2485 HOSPITAL DR	STE 330	MOUNTAIN VIEW	CA	94040	4103	43	06085	37.368918	-122.081761	Santa Clara County
79664	Fee-for-Service	1093803447	1093803447	1	1	APPLEGATE, MITCHELL MD	11/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	58030	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
79675	Fee-for-Service	1609465442	1609465442	1	1	AA FAMILY HOSPICE INC	4/28/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	239 E ALAMEDA AVE	STE 101	BURBANK	CA	91502	1557	19	06037	34.17541398	-118.2988703	Los Angeles County
79699	Fee-for-Service	1326698887	1326698887	1	1	AEGIS TREATMENT CENTERS, LLC	7/15/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2107 1ST STREET	None	EUREKA	CA	95501	0840	12	06023	40.80718153	-124.14897	Humboldt County
79705	Fee-for-Service	1154484129	1154484129	1	1	ARIF, SABREENA MD	9/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110770	41	Internal Medicine	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
79719	Fee-for-Service	1710009121	1710009121	1	1	ARIZAGA PEVERINI, SILVIA C	8/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	55466	38	Geriatrics	0	In state provider	MD	3000 Q ST	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
79720	Fee-for-Service	1558952523	1558952523	1	1	ASSISTING HANDS PALLIATIVE	5/24/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	12500 RIVERSIDE DR	SUITE 209	VALLEY VILLAGE	CA	91607	3423	19	06037	34.15758653	-118.4056605	Los Angeles County
79722	Fee-for-Service	1811057912	1811057912	1	1	ALVARADO, MARIO G DO	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	10288	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
79760	Fee-for-Service	1750575213	1750575213	2	1	AKHAVON, FARIBA MD	7/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	112198	08	Family Practice	0	In state provider	None	1437 E PROSPERITY AVE	None	TULARE	CA	93274	8051	54	06107	36.2257887	-119.3253162	Tulare County
79770	Fee-for-Service	1457810061	1457810061	1	1	ALAVANZA, LUMINITA D NP	5/26/2019	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1307 WEST SIXTH STREET	105	CORONA	CA	92882	3294	33	06065	33.87790309	-117.589666	Riverside County
79771	Fee-for-Service	1609313931	1609313931	1	1	ADCOCK, EMILY AU	1/27/2025	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2717 EL CAMINO AVE	None	SACRAMENTO	CA	95821	5903	34	06067	38.611188	-121.3988535	Sacramento County
79797	Fee-for-Service	1659419828	1659419828	1	1	ADDICTION RESEARCH AND TREAT	6/1/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	TREATMENT, INC	539 N VAN NESS AVENUE	None	FRESNO	CA	93728	3419	10	06019	36.751158	-119.7989285	Fresno County
79817	Fee-for-Service	1730250556	1730250556	1	1	ASSIL, KERRY K MD, INC	8/31/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	ASSIL EYE INSTITUTE	450 N ROXBURY DR	FL 3	BEVERLY HILLS	CA	90210	4232	19	06037	34.06820793	-118.4070317	Los Angeles County
79849	Fee-for-Service	1992786495	1992786495	4	1	ACARIAHEALTH PHARMACY 13 INC	5/6/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3302 GARFIELD AVE	None	COMMERCE	CA	90040	3102	19	06037	33.98511112	-118.1397201	Los Angeles County
79859	Fee-for-Service	1942571146	1942571146	1	2	ACUTE MEDICAL PROVIDERS INC	1/27/2012	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	15630 18TH AVE	None	CLEARLAKE	CA	95422	6710	17	06033	38.93612361	-122.6201499	Lake County
79874	Fee-for-Service	1407993264	1407993264	1	1	ALNIMRI, MUNA AF MD	10/27/2008	390200000X	NA	Other	026	PHYSICIANS	104037	45	Nephrology (Renal-Kidney)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
79877	Fee-for-Service	1396772844	1396772844	1	1	ALVARADO, PATRICIA M MD	1/31/1991	174400000X	NA	Other	026	PHYSICIANS	44552	45	Nephrology (Renal-Kidney)	0	In state provider	None	111 W BEVERLY BLVD	# 200	MONTEBELLO	CA	90640	4312	19	06037	34.01572372	-118.0991599	Los Angeles County
79938	Fee-for-Service	1902847726	1902847726	1	1	AQEEL, RUBINA MD INC	9/1/2000	207RE0101X	NA	Endocrinology	026	PHYSICIANS	53565	08	Family Practice	0	In state provider	None	1183 E FOOTHILL BLVD	STE 260	UPLAND	CA	91786	8305	36	06071	34.10724648	-117.6359175	San Bernardino County
79952	Fee-for-Service	1336433820	1336433820	1	1	ABOU-ARAB, ALAA OT	10/24/2018	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
79956	Fee-for-Service	1265790083	1265790083	1	1	ACHESON, DEAN PHD	6/21/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DRIVE	STE 8201	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
79966	Fee-for-Service	1114460250	1114460250	1	1	ANGELENO HOME HEALTH CARE	10/8/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	4730 WOODMAN AVE	SUITE 460	SHERMAN OAKS	CA	91423	2400	19	06037	34.156701	-118.4312045	Los Angeles County
79988	Fee-for-Service	1326698887	1326698887	1	1	AEGIS TREATMENT CENTERS, LLC	7/15/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2107 1ST STREET	None	EUREKA	CA	95501	0840	12	06023	40.80718153	-124.14897	Humboldt County
79998	Fee-for-Service	1629140439	1629140439	1	1	ALEXANDER, SHANNON N MD	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87679	40	Pediatrics	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
80002	Fee-for-Service	1265656417	1265656417	1	1	AMANI, FARIBA MD	7/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118253	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1801 COLORADO AVE	STE 250	TURLOCK	CA	95382	2710	50	06099	37.50941613	-120.8353105	Stanislaus County
80021	Fee-for-Service	1598383739	1598383739	1	2	ALLWISE CARE COMPANION INC	2/2/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	9995 GENEVA AVE	None	MONTCLAIR	CA	91763	3206	36	06071	34.072308	-117.6947735	San Bernardino County
80028	Fee-for-Service	1073614574	1073614574	1	1	ANDERSON, NEVILLE W MD	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91281	40	Pediatrics	0	In state provider	None	133 N ALTADENA DR	FLOOR 2	PASADENA	CA	91107	7325	19	06037	34.14843	-118.0986385	Los Angeles County
80030	Fee-for-Service	1497077663	1497077663	1	1	ASHLOCK, BECKY J CRNA	2/18/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13562 CANTARA ST	None	PANORAMA CITY	CA	91402	5427	19	06037	34.2197697	-118.4282426	Los Angeles County
80049	Fee-for-Service	1467563387	1467563387	1	2	AMI CARDIAC MONITORING INC	7/2/2019	193400000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	2	Out of state provider	None	1803 RESEARCH BLVD	STE 600	ROCKVILLE	MD	20850	3175	00	None	39.09825241	-77.18111353	Montgomery County
80063	Fee-for-Service	1285685719	1285685719	1	1	ADAMS, JASON H MD	2/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52541	66	Emergency Medicine (Urgent Care)	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
80086	Fee-for-Service	1346491651	1346491651	1	1	AMU, JAVIER MD	5/20/2009	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORPORATION	1093 11TH STREET	None	REEDLEY	CA	93654	2950	10	06019	36.60074456	-119.4445203	Fresno County
80129	Fee-for-Service	1225649353	1225649353	1	1	AARON J EPSTEIN MD INC	4/6/2022	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	50 ALESSANDRO PL	STE 210	PASADENA	CA	91105	3187	19	06037	34.13101049	-118.151532	Los Angeles County
80139	Fee-for-Service	1477737187	1477737187	1	1	AGWANI, SUFIAN M MD	9/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107669	36	Psychiatry	0	In state provider	None	1660 E ROSEVILLE PARKWAY	BUILDING C	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
80162	Fee-for-Service	1396772844	1396772844	1	1	ALVARADO, PATRICIA M MD	1/31/1991	174400000X	NA	Other	026	PHYSICIANS	44552	41	Internal Medicine	0	In state provider	None	111 W BEVERLY BLVD	# 200	MONTEBELLO	CA	90640	4312	19	06037	34.01572372	-118.0991599	Los Angeles County
80186	Fee-for-Service	1609494822	1609494822	1	1	AVE HOSPICE CARE INC	11/3/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	13749 VICTORY BLVD C	None	VAN NUYS	CA	91401	2348	19	06037	34.18670153	-118.4329305	Los Angeles County
80189	Fee-for-Service	1528393287	1528393287	1	1	ALKHOURY, DINA S PSYD	7/10/2020	101Y00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	250 E HACIENDA AVE	None	CAMPBELL	CA	95008	6617	43	06085	37.26846327	-121.9547306	Santa Clara County
80227	Fee-for-Service	1902847726	1902847726	1	1	AQEEL, RUBINA MD INC	9/1/2000	207RE0101X	NA	Endocrinology	026	PHYSICIANS	53565	41	Internal Medicine	0	In state provider	None	1183 E FOOTHILL BLVD	STE 260	UPLAND	CA	91786	8305	36	06071	34.10724648	-117.6359175	San Bernardino County
80233	Fee-for-Service	1699760769	1699760769	1	1	ASKEW, EZELL JR MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90462	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
80250	Fee-for-Service	1801336680	1801336680	2	1	ALTEK DRUGS INC	7/30/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13085 CENTRAL AVE	STE 2	CHINO	CA	91710	4184	36	06071	34.015761	-117.6891735	San Bernardino County
80253	Fee-for-Service	1467730051	1467730051	1	1	AKHIGBE, OYINADE NP	11/8/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
80280	Fee-for-Service	1700091378	1700091378	1	1	ABDOUSH, PHILIP MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	118674	41	Internal Medicine	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
80283	Fee-for-Service	1932214657	1932214657	1	9	AJAY G. MEKA M.D. INC.	9/12/2019	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	17822 BEACH BLVD	SUITE 215	HUNTINGTON BEACH	CA	92647	7101	30	06059	33.70331388	-117.9890471	Orange County
80285	Fee-for-Service	1467580456	1467580456	2	1	ABILITY PATHWAYS	6/19/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED	9714 LA TUNA CANYON RD	None	SUN VALLEY	CA	91352	2234	19	06037	34.23522828	-118.3426828	Los Angeles County
80310	Fee-for-Service	1902260334	1902260334	1	1	AGHILI, NELLY S NP	6/11/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	SUITE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
80324	Fee-for-Service	1750857975	1750857975	1	1	AUTHENTIC HOSPICE CARE, INC	12/14/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2667 N MOORPARK RD	STE 205	THOUSAND OAKS	CA	91360	3011	56	06111	34.21703362	-118.8684249	Ventura County
80346	Fee-for-Service	1457317547	1457317547	1	1	ALI, MICHAEL MD	10/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95471	08	Family Practice	0	In state provider	None	1310 HANNA AVE	None	CORCORAN	CA	93212	2314	16	06031	36.09975818	-119.5641426	Kings County
80389	Fee-for-Service	1760458533	1760458533	1	1	AOYAMA, LINDA MD	4/5/2024	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	65993	None	None	0	In state provider	None	7677 CENTER AVE	STE 214	HUNTINGTON BEACH	CA	92647	9102	30	06059	33.736257	-117.995535	Orange County
80395	Fee-for-Service	1922368745	1922368745	1	2	ADESINA, JOYCE O MD	12/10/2024	207RS0012X	NA	Other	026	PHYSICIANS	126640	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
80406	Fee-for-Service	1598878324	1598878324	1	1	ARONOW, DANIEL S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	63273	41	Internal Medicine	0	In state provider	None	3838 SHERMAN DR	STE 204	RIVERSIDE	CA	92503	4060	33	06065	33.92678822	-117.4368632	Riverside County
80408	Fee-for-Service	1457886723	1457886723	1	1	ALLEN, SAMANTHA E MD	7/5/2022	2084E0001X	NA	Neurology	026	PHYSICIANS	173356	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
80421	Fee-for-Service	1841454758	1841454758	1	1	ALAYO, ERICK H MD	3/31/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	107506	41	Internal Medicine	0	In state provider	None	435 H STREET	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
80439	Fee-for-Service	1073917126	1073917126	1	1	ALAMEDA HEALTH PARTNERS INC	2/26/2018	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
80463	Fee-for-Service	1972534147	1972534147	1	1	AW PATHOLOGY MEDICAL	11/16/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP, INC	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
80472	Fee-for-Service	1609494822	1609494822	1	1	AVE HOSPICE CARE INC	11/3/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	13749 VICTORY BLVD C	None	VAN NUYS	CA	91401	2348	19	06037	34.18670153	-118.4329305	Los Angeles County
80482	Fee-for-Service	1750675492	1750675492	1	1	ADAM, DANE LCSW	1/12/2012	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	4720 WILSON AVE	None	SAN DIEGO	CA	92116	2406	37	06073	32.763879	-117.1162365	San Diego County
80513	Fee-for-Service	1902847726	1902847726	1	1	AQEEL, RUBINA MD INC	9/1/2000	207RE0101X	NA	Endocrinology	026	PHYSICIANS	53565	67	Endocrinology	0	In state provider	None	1183 E FOOTHILL BLVD	STE 260	UPLAND	CA	91786	8305	36	06071	34.10724648	-117.6359175	San Bernardino County
80562	Fee-for-Service	1154016145	1154016145	1	1	ALTHEA ENTERPRISE, LLC.	12/4/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	RTATION	5050 PALO VERDE ST STE L	L103	MONTCLAIR	CA	91763	2329	36	06071	34.08145549	-117.69516	San Bernardino County
80575	Fee-for-Service	1932214657	1932214657	1	9	AJAY G. MEKA M.D. INC.	9/12/2019	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	17822 BEACH BLVD	SUITE 215	HUNTINGTON BEACH	CA	92647	7101	30	06059	33.70331388	-117.9890471	Orange County
80584	Fee-for-Service	1992149447	1992149447	1	1	ADAMI, REBECCA R MD	7/24/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	149389	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
80590	Fee-for-Service	1285997627	1285997627	1	1	ALKTAIFI, ALI M MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132183	41	Internal Medicine	0	In state provider	None	47111 MONROE STREET	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
80594	Fee-for-Service	1114409679	1114409679	1	1	ABRAHAM, SUNITHA RCP	10/26/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
80608	Fee-for-Service	1750857975	1750857975	1	1	AUTHENTIC HOSPICE CARE, INC	12/14/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2667 N MOORPARK RD	STE 205	THOUSAND OAKS	CA	91360	3011	56	06111	34.21703362	-118.8684249	Ventura County
80622	Fee-for-Service	1588665301	1588665301	1	1	ADAMS,WAYNE D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4401 HARRISON BLVD	None	OGDEN	UT	84403	0000	00	None	41.18328	-111.9536955	Weber County
80634	Fee-for-Service	1457317547	1457317547	1	1	ALI, MICHAEL MD	10/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95471	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1310 HANNA AVE	None	CORCORAN	CA	93212	2314	16	06031	36.09975818	-119.5641426	Kings County
80636	Fee-for-Service	1013156850	1013156850	1	1	AZARI, SORAYA N MD	4/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106392	None	None	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
80664	Fee-for-Service	1831481639	1831481639	1	1	ADHIKARI, RANJITA MD	12/4/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	167719	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
80678	Fee-for-Service	1184235459	1184235459	1	1	AUDIOLOGY AND INTEGRATED PRO	4/9/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	17768 WIKA RD	200	APPLE VALLEY	CA	92307	1200	36	06071	34.53985879	-117.2757466	San Bernardino County
80710	Fee-for-Service	1699206250	1699206250	1	1	ASFAW, ELIZABETH K MD	5/5/2020	207R00000X	NA	Other	026	PHYSICIANS	159728	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
80725	Fee-for-Service	1184191470	1184191470	1	1	AIR FOR LIFE LLC	9/27/2023	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	39817 PASEO PADRE PKWY	None	FREMONT	CA	94538	2974	01	06001	37.5475703	-121.9697203	Alameda County
80730	Fee-for-Service	1073917126	1073917126	1	1	ALAMEDA HEALTH PARTNERS INC	5/18/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
80740	Fee-for-Service	1285964759	1285964759	1	1	ANURADHA, REDDY MD	5/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107146	41	Internal Medicine	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
80748	Fee-for-Service	1316387251	1316387251	1	1	AMBER FAAST	3/22/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 NE NEFF RD	None	BEND	OR	97701	6015	00	None	44.067735	-121.268187	Deschutes County
80749	Fee-for-Service	1184067720	1184067720	1	2	AARONSON, ADAM LMFT	7/23/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	572 RIO LINDO AVE	SUITE 104C	CHICO	CA	95926	1851	04	06007	39.75508407	-121.8487933	Butte County
80812	Fee-for-Service	1699034199	1699034199	1	1	AHMED, AMINA MD	8/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129822	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
80825	Fee-for-Service	1558470286	1558470286	2	1	AMAX PHARMACY INC	8/23/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	120 W HELLMAN AVE	STE 102	MONTEREY PARK	CA	91754	1209	19	06037	34.06972847	-118.124154	Los Angeles County
80837	Fee-for-Service	1558765511	1558765511	1	1	ALMENDAREZ, ELIZABETH G LMFT	8/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
80848	Fee-for-Service	1033166632	1033166632	1	1	ALAN R SILVERMAN MD INC	12/23/1987	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	19845 LAKE CHABOT RD	STE 301	CASTRO VALLEY	CA	94546	4055	01	06001	37.69995352	-122.087795	Alameda County
80893	Fee-for-Service	1932478872	1932478872	1	1	ANDERSON, ERIK S MD	10/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125943	None	None	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
80900	Fee-for-Service	1427225986	1427225986	1	1	ANDREI BALANDIN	2/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	18701 N 67TH AVE	None	GLENDALE	AZ	85308	7100	00	None	33.655734	-112.201416	Maricopa County
80908	Fee-for-Service	1558367789	1558367789	1	1	AIZPURU,RICHARD N MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 THOMPSON ST	None	ST PAUL	MN	55102	2370	00	None	44.94428014	-93.10733608	Ramsey County
80920	Fee-for-Service	1285875542	1285875542	1	1	AYAD, INGY N MD	6/16/2009	207R00000X	NA	Other	026	PHYSICIANS	106297	08	Family Practice	0	In state provider	None	2811 H STREET	None	BAKERSFIELD	CA	93301	1913	15	06029	35.38526604	-119.021172	Kern County
80968	Fee-for-Service	1437164399	1437164399	1	1	ASELO V LAYAWEN MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
80971	Fee-for-Service	1053469940	1053469940	1	1	ACUNA-COBURN, MARY B NP	2/27/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	325 W HOSPITALITY LN	STE 312	SAN BERNARDINO	CA	92408	3243	36	06071	34.0658995	-117.29034	San Bernardino County
81003	Fee-for-Service	1497938039	1497938039	2	1	AFROOZ, IMAN MD	11/13/2023	207R00000X	NA	Other	026	PHYSICIANS	104989	None	None	0	In state provider	None	1900 SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2725	19	06037	33.9891357	-118.2389609	Los Angeles County
81020	Fee-for-Service	1073917126	1073917126	1	1	ALAMEDA HEALTH PARTNERS INC	5/18/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
81025	Fee-for-Service	1568906667	1568906667	1	1	ALEJANDRO, FRANCESCA J NP	5/17/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
81069	Fee-for-Service	1699937771	1699937771	1	1	ASHRAF, GOHAR MD	9/8/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	180508	None	None	0	In state provider	None	2497 HERNDON AVE	SUITE 101	CLOVIS	CA	93611	8907	10	06019	36.83742549	-119.6667225	Fresno County
81101	Fee-for-Service	1457687204	1457687204	1	1	ATALLA, MARTA MD	9/1/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	121879	None	None	0	In state provider	None	557 N. MACLAY AVE	None	SAN FERNANDO	CA	91340	2424	19	06037	34.28872206	-118.4339388	Los Angeles County
81105	Fee-for-Service	1831266345	1831266345	1	1	AKMAN, MITCHELL S MD	7/12/1996	174400000X	NA	Other	026	PHYSICIANS	54308	67	Endocrinology	0	In state provider	None	1555 EAST ST	STE 300	REDDING	CA	96001	1153	45	06089	40.58440354	-122.3880021	Shasta County
81194	Fee-for-Service	1386029783	1386029783	1	1	ACUPUNCTURE ONE CENTER INC	5/3/2016	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	18031 US HIGHWAY 18	SUITE D	APPLE VALLEY	CA	92307	2152	36	06071	34.54008717	-117.2706344	San Bernardino County
81199	Fee-for-Service	1275179327	1275179327	2	1	A & T INC	3/4/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5961 LAUREL CANYON BLVD	UNIT 2	VALLEY VILLAGE	CA	91607	0000	19	06037	34.17928424	-118.3965993	Los Angeles County
81202	Fee-for-Service	1063924777	1063924777	1	1	ALVAREZ, AMY L LMFT	9/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CES	25020 LAS BRISAS	STE 208	MURRIETA	CA	92562	4064	33	06065	33.57370977	-117.1829111	Riverside County
81217	Fee-for-Service	1861681447	1861681447	1	1	ADVANI, SONAL MD	1/11/2008	207R00000X	NA	Other	026	PHYSICIANS	98866	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
81229	Fee-for-Service	1588651236	1588651236	1	1	ATKINS, DAVID MD	7/3/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	49226	30	Radiology	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
81235	Fee-for-Service	1598108912	1598108912	1	1	ARCHEUS PSYCHOLOGICAL ASSOCI	12/10/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ATES, INC.	22330 HAWTHORNE BLVD.	207	TORRANCE	CA	90505	5388	19	06037	33.824763	-118.350914	Los Angeles County
81245	Fee-for-Service	1073135174	1073135174	1	1	ADAMS, REBECCA	8/2/2023	208M00000X	NA	Other	026	PHYSICIANS	180335	None	None	0	In state provider	None	450 E ROMIE LN	None	SALINAS	CA	93901	4029	27	06053	36.65983988	-121.6458041	Monterey County
81247	Fee-for-Service	1801976642	1801976642	1	1	ALLEN, CELESTE L MD	5/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89183	40	Pediatrics	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
81249	Fee-for-Service	1598056533	1598056533	1	1	ANTOINE, HEATHER DO	3/30/2024	208M00000X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
81267	Fee-for-Service	1932214657	1932214657	1	3	AJAY G. MEKA M.D. INC.	10/5/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1510 E 7TH ST	None	LONG BEACH	CA	90813	5002	19	06037	33.77531254	-118.1728263	Los Angeles County
81270	Fee-for-Service	1801898044	1801898044	1	1	ACHARYA, JOYDEV MD	10/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96042	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1401 SPANOS CT	STE 230	MODESTO	CA	95355	2816	50	06099	37.66975543	-120.9724048	Stanislaus County
81276	Fee-for-Service	1629639828	1629639828	1	1	AH KIONG, AURA LEE CCC-SP	5/3/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3200 E GUASTI RD	100	ONTARIO	CA	91761	8661	36	06071	34.06518	-117.5822055	San Bernardino County
81277	Fee-for-Service	1316559438	1316559438	1	1	ADNER, EMILY S NP	11/8/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
81299	Fee-for-Service	1518329382	1518329382	1	1	ALTMAN, ALEXANDER J MD	4/17/2020	207R00000X	NA	Other	026	PHYSICIANS	150622	41	Internal Medicine	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
81306	Fee-for-Service	1073917126	1073917126	1	1	ALAMEDA HEALTH PARTNERS INC	5/18/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
81323	Fee-for-Service	1104112440	1104112440	1	1	AKHTAR, SABA MD	5/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127950	41	Internal Medicine	0	In state provider	None	26800 CROWN VALLEY PKWY	SUITE 30	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
81340	Fee-for-Service	1902224538	1902224538	1	1	ARBONIES, CHRISTO X MD	11/30/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	167947	None	None	0	In state provider	None	18460 ROSCOE BLVD	FL 2	NORTHRIDGE	CA	91325	4107	19	06037	34.22071454	-118.5357375	Los Angeles County
81396	Fee-for-Service	1427481522	1427481522	1	1	ADAMCZYK, PETER MD INC	9/20/2013	2084N0400X	NA	Neurology	026	PHYSICIANS	98461	13	Neurology (M.D. only)	0	In state provider	None	20055 LAKE CHABOT ROAD	SUITE 300	CASTRO VALLEY	CA	94546	5334	01	06001	37.69836512	-122.0873587	Alameda County
81400	Fee-for-Service	1780092262	1780092262	1	7	ASHER SHAHZAD MD PC	11/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
81410	Fee-for-Service	1861738742	1861738742	1	1	ANAHEIM HOSPICE INC	4/4/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2301 W LINCOLN AVE	STE 124C	ANAHEIM	CA	92801	5135	30	06059	33.8325463	-117.9637271	Orange County
81413	Fee-for-Service	1669644571	1669644571	1	1	ANGEL, JOEL R MD	9/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116371	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
81439	Fee-for-Service	1356896013	1356896013	1	1	ARIWODO, ODOCHI NP	6/4/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
81508	Fee-for-Service	1033209713	1033209713	1	1	ALEXANDER WISEMAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13199 E MONTVIEW BLVD	PO BOX 111719	AURORA	CO	80042	1719	00	None	39.748041	-104.834673	Adams County
81539	Fee-for-Service	1932264082	1932264082	1	5	ARVIN UNION SCHOOL DIST	10/17/2011	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	300 FRANKLIN ST	None	ARVIN	CA	93203	1913	15	06029	35.20183593	-118.826895	Kern County
81554	Fee-for-Service	1699118281	1699118281	1	1	ALANIS, LOURDES MD	4/22/2019	390200000X	NA	Other	026	PHYSICIANS	148390	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
81559	Fee-for-Service	1932214657	1932214657	1	3	AJAY G. MEKA M.D. INC.	10/5/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1510 E 7TH ST	None	LONG BEACH	CA	90813	5002	19	06037	33.77531254	-118.1728263	Los Angeles County
81617	Fee-for-Service	1720013006	1720013006	1	1	ADVANCED HEART CARE	12/1/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	ASSOCIATES-PLON SPACCAVE	4275 BURNHAM AVE	SUITE 220	LAS VEGAS	NV	89119	5400	00	None	36.111699	-115.1238165	Clark County
81660	Fee-for-Service	1710376819	1710376819	1	1	ARMAO, CATHERINE LCSW	12/7/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
81697	Fee-for-Service	1861738742	1861738742	1	1	ANAHEIM HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2301 W LINCOLN AVE	STE 124C	ANAHEIM	CA	92801	5135	30	06059	33.8325463	-117.9637271	Orange County
81702	Fee-for-Service	1780092262	1780092262	1	7	ASHER SHAHZAD MD PC	11/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	77	Infectious Disease	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
81717	Fee-for-Service	1114588456	1114588456	1	1	ANDERSON, LORREN D CRNA	7/21/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
81720	Fee-for-Service	1942445622	1942445622	1	1	ANDERSON, JAMES M LMFT	5/6/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	33	06065	33.51993406	-117.1641955	Riverside County
81721	Fee-for-Service	1144333436	1144333436	1	1	ALTENAU, LANCE L MD	4/22/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	38631	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
81731	Fee-for-Service	1447890116	1447890116	1	1	ALKHARAFI, HUSSAH PSYD	5/15/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	940 S COAST DR STE 225	None	COSTA MESA	CA	92626	7757	30	06059	33.68993791	-117.8953504	Orange County
81735	Fee-for-Service	1831353986	1831353986	1	1	AGGARWAL, EKTHA LCSW	8/10/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5479 E ABBEYFIELD ST	STE 3	LONG BEACH	CA	90815	3050	19	06037	33.79388819	-118.1261825	Los Angeles County
81746	Fee-for-Service	1699775007	1699775007	1	1	ANGGELIS,CONNIE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	201 ABRAHAM FLEXNER WY	STE 1101	LOUISVILLE	KY	40202	0000	00	None	38.24934554	-85.75086392	Jefferson County
81755	Fee-for-Service	1336793405	1336793405	1	1	ACCESSIBLE DBT, A CORPORATIO	12/16/2024	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9008 ELK GROVE BLVD	SUITE 20	ELK GROVE	CA	95624	1945	34	06067	38.408832	-121.3665345	Sacramento County
81788	Fee-for-Service	1215258280	1215258280	1	1	ARUCAN, ARICA LCSW	11/22/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
81789	Fee-for-Service	1770832362	1770832362	1	1	ACCURATE CARE TRANSPORTATION	10/12/2012	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	INC	2920 E INLAND EMPIRE BLV	#103	ONTARIO	CA	91764	5564	36	06071	34.069419	-117.5893515	San Bernardino County
81851	Fee-for-Service	1588743637	1588743637	1	1	ANDREWS, MARC J MD	9/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95828	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
81883	Fee-for-Service	1841552676	1841552676	1	1	ARCEGA, RAMIR S JR DO	7/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	13230	22	Pathology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	ROOM 3719	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
81946	Fee-for-Service	1861849663	1861849663	1	1	AUGUST, MARIAN DO	10/3/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	21553	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
81988	Fee-for-Service	1326785999	1326785999	1	1	AUDI TRANSPORTS LLC	6/3/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	970 ROOSEVELT	STE 200	IRVINE	CA	92620	4118	30	06059	33.69372462	-117.7652125	Orange County
81998	Fee-for-Service	1811936982	1811936982	1	1	ALBAUGH, GREGORY K DO	9/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	8760	33	Thoracic Surgery	0	In state provider	None	1700 N ROSE AVE	# 425	OXNARD	CA	93030	3790	56	06111	34.21746	-119.155545	Ventura County
82001	Fee-for-Service	1730128935	1730128935	1	1	ANDERSON, PATRIC N. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7301 ROGERS AVE	None	FORT SMITH	AR	72903	4100	00	None	35.35551	-94.35276	Sebastian County
82009	Fee-for-Service	1144333436	1144333436	1	1	ALTENAU, LANCE L MD	4/22/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	38631	14	Neurological Surgery	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
82026	Fee-for-Service	1275538530	1275538530	2	1	ADVENTIST HEALTH MEDICAL	8/1/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER TEHACHAPI	1100 MAGELLAN DR	None	TEHACHAPI	CA	93561	1380	15	06029	35.14690796	-118.4506925	Kern County
82027	Fee-for-Service	1669674719	1669674719	1	1	APNECARE INC	4/9/2018	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1000 TRUXTUN AVE	SUITE C	BAKERSFIELD	CA	93301	4715	15	06029	35.37343849	-119.0133405	Kern County
82053	Fee-for-Service	1356370712	1356370712	1	1	ARDAYA, DAVID C OD	7/18/2006	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11245 WASHINGTON BLVD	None	WHITTIER	CA	90606	3111	19	06037	33.97192651	-118.0711359	Los Angeles County
82076	Fee-for-Service	1972523009	1972523009	1	1	ARPILLEDA, JOYCE C MD	7/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	61745	40	Pediatrics	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
82082	Fee-for-Service	1609893189	1609893189	1	1	ARTHUR NAOKI WESTOVER, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
82084	Fee-for-Service	1770304867	1770304867	1	1	ANGELS HEART AND HANDS DOULA	10/27/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
82085	Fee-for-Service	1124058177	1124058177	1	1	ANESTHESIA CONSULT OF	2/4/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	FRESNO	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
82120	Fee-for-Service	1215507983	1215507983	1	1	ANDERSON, JACK B	9/1/2023	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	CAL TRANSPORTATION	879 190TH ST	400	GARDENA	CA	90248	4220	19	06037	33.85927671	-118.2896516	Los Angeles County
82149	Fee-for-Service	1932214657	1932214657	1	12	AJAY G. MEKA M.D. INC.	10/19/2020	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1066 ATLANTIC AVE	SUITE B	LONG BEACH	CA	90813	3400	19	06037	33.78015	-118.1850225	Los Angeles County
82157	Fee-for-Service	1518996040	1518996040	1	1	AMERICAN HOSPITAL MANAGEMENT	3/15/1974	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CORP	3800 JANES RD	None	ARCATA	CA	95521	4788	12	06023	40.89645172	-124.0930637	Humboldt County
82179	Fee-for-Service	1306323266	1306323266	1	1	ASHFAQ, AMMAR ALI MD	2/6/2024	208M00000X	NA	Other	026	PHYSICIANS	192571	None	None	0	In state provider	None	100 MISSION BLVD	STE 2800	JACKSON	CA	95642	2536	03	06005	38.35163001	-120.7670107	Amador County
82218	Fee-for-Service	1326246059	1326246059	1	1	ALVAREZ, MARCOS N MD	4/15/2008	2085R0204X	NA	Other	026	PHYSICIANS	100374	30	Radiology	0	In state provider	None	105 N BASCOM AVE	STE 104	SAN JOSE	CA	95128	1811	43	06085	37.325853	-121.932068	Santa Clara County
82220	Fee-for-Service	1659928109	1659928109	2	1	ARNARDOTTIR, SVANFRIDUR LPC	12/29/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12628 ASHBROOK CT	None	VICTORVILLE	CA	92395	5123	36	06071	34.48062332	-117.2651972	San Bernardino County
82233	Fee-for-Service	1659041986	1659041986	1	1	ARMA HOME HEALTH CARE INC	10/25/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7344 VAN NUYS BLVD	SUITE 9	VAN NUYS	CA	91405	1932	19	06037	34.203906	-118.4487245	Los Angeles County
82272	Fee-for-Service	1548288491	1548288491	1	1	AUTAR, JAI C MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99944	40	Pediatrics	0	In state provider	None	780 EAST WASHINGTON BLVD	#202	CRESCENT CITY	CA	95531	0000	08	06015	41.775246	-124.194447	Del Norte County
82315	Fee-for-Service	1275538530	1275538530	2	1	ADVENTIST HEALTH MEDICAL	8/1/2016	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER TEHACHAPI	1100 MAGELLAN DR	None	TEHACHAPI	CA	93561	1380	15	06029	35.14690796	-118.4506925	Kern County
82348	Fee-for-Service	1659714574	1659714574	1	1	ABOUD, ORWA MD	8/25/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	169942	13	Neurology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
82363	Fee-for-Service	1972523009	1972523009	1	1	ARPILLEDA, JOYCE C MD	7/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	61745	66	Emergency Medicine (Urgent Care)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
82371	Fee-for-Service	1124058177	1124058177	1	1	ANESTHESIA CONSULT OF	8/27/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	FRESNO	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
82392	Fee-for-Service	1285837708	1285837708	1	1	AZIZ, HUMA MD	2/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118181	41	Internal Medicine	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
82418	Fee-for-Service	1184656613	1184656613	1	1	AYYANAR, KANYALAKSHMI MD	4/23/2024	163WP0218X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
82432	Fee-for-Service	1366438764	1366438764	1	1	AZIMI, NASSIR A MD	10/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91478	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
82437	Fee-for-Service	1932214657	1932214657	1	12	AJAY G. MEKA M.D. INC.	10/19/2020	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1066 ATLANTIC AVE	SUITE B	LONG BEACH	CA	90813	3400	19	06037	33.78015	-118.1850225	Los Angeles County
82445	Fee-for-Service	1518996040	1518996040	1	1	AMERICAN HOSPITAL MANAGEMENT	3/15/1974	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CORP	3800 JANES RD	None	ARCATA	CA	95521	4788	12	06023	40.89645172	-124.0930637	Humboldt County
82491	Fee-for-Service	1932616869	1932616869	1	1	ALCALA, ANA M	1/8/2018	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3838 COCINA LANE	None	PALMDALE	CA	93551	2685	19	06037	34.61743113	-118.1989674	Los Angeles County
82498	Fee-for-Service	1609549757	1609549757	1	2	ATTENTIVE TRANSPORTATION LLC	2/15/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3353 BRADSHAW RD	213	SACRAMENTO	CA	95827	2607	34	06067	38.562822	-121.335534	Sacramento County
82499	Fee-for-Service	1497011902	1497011902	1	1	ADONGO, ANNA A MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128836	05	Anesthesiology	0	In state provider	None	1798 N GAREY AVENUE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
82500	Fee-for-Service	1528146131	1528146131	1	1	ANGEJA, ALEA C MD	11/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79340	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
82507	Fee-for-Service	1336336411	1336336411	1	1	AGGARWAL, SONAL MD	11/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	101426	01	General Practice	0	In state provider	None	1450 TREAT BLVD	SUITE 160	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
82521	Fee-for-Service	1649285321	1649285321	1	1	ALLMOND, LEONARD R MD	4/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	80273	05	Anesthesiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
82529	Fee-for-Service	1467611558	1467611558	1	1	ACCESS EYE INSTITUTE	6/10/2016	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	199 WEST HILLCREST DRIVE	None	THOUSAND OAKS	CA	91360	7892	56	06111	34.18092428	-118.8811584	Ventura County
82541	Fee-for-Service	1811006836	1811006836	1	1	APRIA HEALTHCARE LLC	1/23/2001	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4295 BUSINESS DR	None	SHINGLE SPRINGS	CA	95682	7217	09	06017	38.65065346	-120.9510068	El Dorado County
82547	Fee-for-Service	1780863134	1780863134	1	1	ARRIOLA, CARMEN L MD	6/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	63500	01	General Practice	0	In state provider	None	3000 Q ST	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
82550	Fee-for-Service	1154736734	1154736734	1	1	ANDREWS, SEAN C DO	6/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14461	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 LAS TABLAS	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
82552	Fee-for-Service	1750592887	1750592887	1	1	AMBATI, SREEKANTH R MD	6/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149837	41	Internal Medicine	0	In state provider	None	222 WEST 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
82564	Fee-for-Service	1598793374	1598793374	1	1	ABREU, MARIA T MD	2/4/2025	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	74326	10	Gastroenterology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
82582	Fee-for-Service	1871790717	1871790717	1	1	ATTIA, NADER N DO	8/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12778	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3770 ELIZABETH STREET	None	RIVERSIDE	CA	92506	2527	33	06065	33.95899507	-117.3917212	Riverside County
82585	Fee-for-Service	1427273358	1427273358	1	1	ALBADER, RUBINA LMFT	9/10/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19742 MACARTHUR BLVD	STE 125	IRVINE	CA	92612	2432	30	06059	33.65738766	-117.8625556	Orange County
82589	Fee-for-Service	1083815872	1083815872	1	1	ALAMEDA CO MEDICAL CTR	6/12/2008	No Taxonomy Provided	NA	None	060	COUNTY HOSPITAL INPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
82592	Fee-for-Service	1659546893	1659546893	1	1	ANSARI, SAQIB S MD	8/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113196	01	General Practice	0	In state provider	None	815 BAY AVE	SUITE B	CAPITOLA	CA	95010	2186	44	06087	36.98097987	-121.9554791	Santa Cruz County
82601	Fee-for-Service	1093274508	1093274508	1	1	ADVENTIST HEALTH CLEARLAKE	5/3/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	6300 E HIGHWAY 20	None	LUCERNE	CA	95458	0000	17	06033	39.08645757	-122.7925572	Lake County
82623	Fee-for-Service	1003866914	1003866914	1	2	ADVANCED IMAGING OF	7/25/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	514 N PROSPECT AVE	None	REDONDO BEACH	CA	90277	3036	19	06037	33.85253987	-118.3796668	Los Angeles County
82634	Fee-for-Service	1013019017	1013019017	1	1	ALDRICH, PETER D MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	76399	01	General Practice	0	In state provider	None	10666 N TORREY PINES RD	# MS317	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
82661	Fee-for-Service	1447578331	1447578331	1	1	ADALUMO, DUNNI A MD	8/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117661	08	Family Practice	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
82710	Fee-for-Service	1013137603	1013137603	1	1	ADAM, CARRICK J MD	1/13/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	63883	-	NOT APPLICABLE	0	In state provider	None	105 N LINCOLN	None	SANTA MARIA	CA	93458	4319	42	06083	34.9535882	-120.4374049	Santa Barbara County
82720	Fee-for-Service	1366438764	1366438764	1	1	AZIMI, NASSIR A MD	10/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91478	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
82745	Fee-for-Service	1275587685	1275587685	3	1	ADVANCED HOME MEDICAL	11/20/2014	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	312 PASEO TESORO	None	WALNUT	CA	91789	2725	19	06037	34.01337752	-117.8571288	Los Angeles County
82770	Fee-for-Service	1588132732	1588132732	1	2	ARTHUR MONTES, LICENSED CLIN	10/12/2022	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5000 BIRCH ST	WEST TOWER STE 3000	NEWPORT BEACH	CA	92660	2127	30	06059	33.66605605	-117.8586733	Orange County
82780	Fee-for-Service	1932616869	1932616869	1	1	ALCALA, ANA M	1/8/2018	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3838 COCINA LANE	None	PALMDALE	CA	93551	2685	19	06037	34.61743113	-118.1989674	Los Angeles County
82784	Fee-for-Service	1437216090	1437216090	1	1	ARZUMANOVA, KARINA G MD	10/15/1999	207R00000X	NA	Other	026	PHYSICIANS	70022	41	Internal Medicine	0	In state provider	None	2299 POST ST	STE 203	SAN FRANCISCO	CA	94115	3473	38	06075	37.78434298	-122.4392033	San Francisco County
82802	Fee-for-Service	1164581864	1164581864	1	1	ANTON, TERRY L CRNA	10/26/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
82862	Fee-for-Service	1366093338	1366093338	1	1	ALVA FAMILY SPECIALIST, INC	7/21/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2248 D ST	None	LA VERNE	CA	91750	5403	19	06037	34.10030594	-117.7702602	Los Angeles County
82870	Fee-for-Service	1871790717	1871790717	1	1	ATTIA, NADER N DO	8/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12778	41	Internal Medicine	0	In state provider	None	3770 ELIZABETH STREET	None	RIVERSIDE	CA	92506	2527	33	06065	33.95899507	-117.3917212	Riverside County
82874	Fee-for-Service	1801951389	1801951389	1	1	ATASCADERO UNIFIED SCHOOL	12/28/1997	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	5601 WEST MALL	None	ATASCADERO	CA	93422	4234	40	06079	35.49267517	-120.6653066	San Luis Obispo County
82879	Fee-for-Service	1083815872	1083815872	1	1	ALAMEDA CO MEDICAL CTR	7/1/1971	No Taxonomy Provided	NA	None	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
82888	Fee-for-Service	1093274508	1093274508	1	1	ADVENTIST HEALTH CLEARLAKE	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	6300 E HIGHWAY 20	None	LUCERNE	CA	95458	0000	17	06033	39.08645757	-122.7925572	Lake County
82889	Fee-for-Service	1538699152	1538699152	1	1	AUSTIN, MARK MD	9/17/2021	207L00000X	NA	Other	026	PHYSICIANS	173011	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
82896	Fee-for-Service	1366587339	1366587339	1	1	ALBERT P THOMPSON, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	38505 BROOTEN RD	STE A	PACIFIC CITY	OR	97135	8049	00	None	45.17909482	-123.9261598	Tillamook County
82908	Fee-for-Service	1093806747	1093806747	1	1	ARTHUR COOPER	5/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	506 LENOX AVE	None	NEW YORK	NY	10037	1802	00	None	40.814352	-73.94031	New York County
82921	Fee-for-Service	1427118108	1427118108	1	1	AMBLER, CHERYL K PHD	3/4/2011	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
82940	Fee-for-Service	1336366293	1336366293	1	1	ABDALLAH AZOUZ	2/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	877 JEFFERSON AVE	None	MEMPHIS	TN	38103	2807	00	None	35.14259562	-90.03187321	Shelby County
82962	Fee-for-Service	1053635698	1053635698	1	1	ATTAR, NASEEM A MD INC	10/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	55323	02	General Surgery	0	In state provider	None	4646 BROCKTON AVE	STE 302	RIVERSIDE	CA	92506	0172	33	06065	33.9760171	-117.3860626	Riverside County
82992	Fee-for-Service	1295097897	1295097897	1	1	ARCH HEALTH PARTNERS	11/2/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	16918 DOVE CANYON RD	SUITE 100	SAN DIEGO	CA	92127	3455	37	06073	33.01707634	-117.1112373	San Diego County
83009	Fee-for-Service	1508105024	1508105024	1	1	ADAPTIVE BIOTECHNOLOGIES COR	7/26/2019	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	PORATION	1165 EASTLAKE AVE	None	SEATTLE	WA	98109	4456	00	None	47.63043929	-122.3278452	King County
83032	Fee-for-Service	1598951873	1598951873	1	1	AGNIHOTRI, NEERAJ MD	6/24/2011	207RH0003X	NA	Oncology	026	PHYSICIANS	113667	78	Neoplastic Diseases/Oncology	0	In state provider	None	44105 15TH ST W	STE 207	LANCASTER	CA	93534	4090	19	06037	34.684218	-118.1568465	Los Angeles County
83048	Fee-for-Service	1063625374	1063625374	1	1	AMINI, LINA MD	6/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139587	18	Ophthalmology	0	In state provider	None	1400 E PALOMAR STREET	None	CHULA VISTA	CA	91913	1800	37	06073	32.62382113	-116.9960539	San Diego County
83052	Fee-for-Service	1780092262	1780092262	1	1	ASHER SHAHZAD MD PC	11/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	77	Infectious Disease	1	Border provider	None	2900 W HORIZON RIDGE PKW	100	HENDERSON	NV	89052	5013	00	None	35.9989055	-115.1132668	Clark County
83057	Fee-for-Service	1588008775	1588008775	1	1	ARMSTRONG, PATRICK A L MD	10/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137103	07	Dermatology	0	In state provider	None	26800 CROWN VALLEY PKWY	SUITE 275	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
83061	Fee-for-Service	1982650487	1982650487	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3901 CRENSHAW BLVD	None	BALDWIN HILLS	CA	90008	2522	19	06037	34.014087	-118.3351265	Los Angeles County
83108	Fee-for-Service	1518078963	1518078963	1	1	ALADE, KIYETTA H MD	5/1/2022	2080P0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
83116	Fee-for-Service	1467906180	1467906180	1	1	ARBEIT, ALEXIS G CRNA	12/30/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
83126	Fee-for-Service	1487083655	1487083655	1	1	ABASSI, HANGAMA NP	2/22/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
83146	Fee-for-Service	1679990063	1679990063	1	1	ARMSTRONG, TERESSA LMFT	4/20/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2918 WEBSTER ST	STE 1B	SAN FRANCISCO	CA	94123	4006	38	06075	37.79753373	-122.4338593	San Francisco County
83151	Fee-for-Service	1235736737	1235736737	1	1	ALTO PHARMACY, LLC	6/18/2021	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2360 QUME DRIVE	SUITE A	SAN JOSE	CA	95131	1838	43	06085	37.39769561	-121.8885324	Santa Clara County
83153	Fee-for-Service	1386849347	1386849347	1	1	ARTRY, SELENE Y RN	6/26/2007	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	874 W MARTIN LUTHER KING	None	LOS ANGELES	CA	90037	1205	19	06037	34.01092167	-118.2898462	Los Angeles County
83177	Fee-for-Service	1861838518	1861838518	1	1	AKHTAR, RADEEB MD	12/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134451	01	General Practice	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
83186	Fee-for-Service	1437440138	1437440138	1	3	APIGIAN, AIMIE K MD	8/2/2018	2083P0901X	NA	Adult Primary Care	026	PHYSICIANS	136587	01	General Practice	0	In state provider	None	1117 E DEVONSHIRE AVE	None	MENIFEE	CA	92585	9658	33	06065	0	0	None
83187	Fee-for-Service	1699317644	1699317644	1	1	AVICENNA CRITICAL CARE, PC	10/14/2020	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	8665 LA MESA	None	LA MESA	CA	91942	9503	37	06073	32.76948516	-117.0108365	San Diego County
83240	Fee-for-Service	1417259649	1417259649	1	1	ANTUNA, JAIME R MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118739	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
83253	Fee-for-Service	1154984482	1154984482	1	1	AKARI, DEEMA B MD	9/15/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	179082	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
83266	Fee-for-Service	1134206162	1134206162	1	1	ADLER, DAVID H MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71479	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
83278	Fee-for-Service	1417722232	1417722232	1	1	AMG, A PROFESSIONAL MEDICAL	3/29/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CORPORATION	4528 SLAUSON AVE	None	MAYWOOD	CA	90270	2934	19	06037	33.98692688	-118.1846183	Los Angeles County
83280	Fee-for-Service	1265773030	1265773030	1	1	AITA, TRICIA K PT	5/23/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4760 SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09811852	-118.293408	Los Angeles County
83281	Fee-for-Service	1295097897	1295097897	1	1	ARCH HEALTH PARTNERS	11/2/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	16918 DOVE CANYON RD	SUITE 100	SAN DIEGO	CA	92127	3455	37	06073	33.01707634	-117.1112373	San Diego County
83287	Fee-for-Service	1205518636	1205518636	1	1	ALEX NEMT LLC	9/6/2023	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	530 TECHNOLOGY DR	100	IRVINE	CA	92618	1349	30	06059	33.67298341	-117.7592217	Orange County
83302	Fee-for-Service	1770731390	1770731390	1	1	ASCENCIO, SANDRA G LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
83309	Fee-for-Service	1568509065	1568509065	1	1	ARSHAD, SYED T MD	1/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112821	13	Neurology (M.D. only)	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
83315	Fee-for-Service	1396199550	1396199550	1	1	ALI, SANA Z DO	8/29/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16030	08	Family Practice	0	In state provider	None	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70554251	-121.873005	Alameda County
83321	Fee-for-Service	1598951873	1598951873	1	1	AGNIHOTRI, NEERAJ MD	6/24/2011	207RH0003X	NA	Oncology	026	PHYSICIANS	113667	68	Hematology	0	In state provider	None	44105 15TH ST W	STE 207	LANCASTER	CA	93534	4090	19	06037	34.684218	-118.1568465	Los Angeles County
83329	Fee-for-Service	1811007172	1811007172	1	1	ATALLA, LILY R MD	6/30/1995	2084N0400X	NA	Neurology	026	PHYSICIANS	49798	13	Neurology (M.D. only)	0	In state provider	None	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
83331	Fee-for-Service	1396728564	1396728564	1	1	ARIF, MUHAMMAD MD	5/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87726	08	Family Practice	0	In state provider	None	821 TEXAS AVE	None	LOS BANOS	CA	93635	3453	24	06047	37.06376226	-120.860675	Merced County
83335	Fee-for-Service	1356940704	1356940704	1	2	AMERICAN UNITED TRANSIT	4/5/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3166 E. PALMDALE BLVD	None	PALMDALE	CA	93550	5037	19	06037	34.58019152	-118.072485	Los Angeles County
83342	Fee-for-Service	1780092262	1780092262	1	1	ASHER SHAHZAD MD PC	11/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2900 W HORIZON RIDGE PKW	100	HENDERSON	NV	89052	5013	00	None	35.9989055	-115.1132668	Clark County
83355	Fee-for-Service	1316993942	1316993942	1	1	ANTHONY, CRYSTAL C PT	12/16/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25150 HANCOCK AVE	STE 100	MURRIETA	CA	92562	5987	33	06065	33.56635084	-117.1823956	Riverside County
83366	Fee-for-Service	1710930326	1710930326	1	1	ADAMINA, ELI A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 N 4TH AVE	None	PASCO	WA	99301	5257	00	None	46.23532579	-119.0946579	Franklin County
83370	Fee-for-Service	1538859939	1538859939	1	1	A SISTER BY YOUR SIDE LLC	5/10/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
83380	Fee-for-Service	1497746598	1497746598	1	1	AMMAR, SHERIF M MD	2/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52571	04	Otology, Laryngology, Rhinology	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
83406	Fee-for-Service	1912039777	1912039777	1	1	ANDERSON, KARYN A LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17777 VENTURA BLVD	STE 105	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
83413	Fee-for-Service	1326162561	1326162561	1	1	ADAMS, JASMINE M LCSW	6/4/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3711 LONG BEACH BLVD	STE 5039	LONG BEACH	CA	90807	3315	19	06037	33.824583	-118.1893785	Los Angeles County
83489	Fee-for-Service	1700149663	1700149663	1	1	AZURIN, ROBERT A MD	5/2/2018	261QP2300X	NA	Other	026	PHYSICIANS	132890	08	Family Practice	0	In state provider	None	4075 TWEEDY BLVD	None	SOUTH GATE	CA	90280	6146	19	06037	33.94364315	-118.2003203	Los Angeles County
83541	Fee-for-Service	1295855641	1295855641	1	1	ARCEBAL, EILEEN R L	5/5/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1900 E LAMBERT RD	None	BREA	CA	92821	4371	30	06059	33.92526172	-117.8762995	Orange County
83553	Fee-for-Service	1134206162	1134206162	1	1	ADLER, DAVID H MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71479	01	General Practice	0	In state provider	None	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
83564	Fee-for-Service	1417722232	1417722232	1	1	AMG, A PROFESSIONAL MEDICAL	2/21/2025	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	4528 SLAUSON AVE	None	MAYWOOD	CA	90270	2934	19	06037	33.98692688	-118.1846183	Los Angeles County
83580	Fee-for-Service	1003080243	1003080243	1	1	ARUNASRI, KELLETI MD	6/6/2008	174400000X	NA	Other	026	PHYSICIANS	99796	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	91529	1561	43	06085	37.313433	-121.9318385	Santa Clara County
83586	Fee-for-Service	1023003001	1023003001	1	1	AJIT, AMIRTHA MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	56179	41	Internal Medicine	0	In state provider	SHIRDI MEDICAL CORP	1751 W ROMNEYA DR	STE F	ANAHEIM	CA	92801	1815	30	06059	33.85068001	-117.9438835	Orange County
83599	Fee-for-Service	1780795963	1780795963	1	1	ANILE, PAUL A DO	12/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	6110	01	General Practice	0	In state provider	None	100 OCEANGATE	STE P245	LONG BEACH	CA	90802	4349	19	06037	33.76655046	-118.1989306	Los Angeles County
83608	Fee-for-Service	1598951873	1598951873	1	1	AGNIHOTRI, NEERAJ MD	6/24/2011	207RH0003X	NA	Oncology	026	PHYSICIANS	113667	41	Internal Medicine	0	In state provider	None	44105 15TH ST W	STE 207	LANCASTER	CA	93534	4090	19	06037	34.684218	-118.1568465	Los Angeles County
83620	Fee-for-Service	1699931386	1699931386	1	1	ATTIA, TAMER A M MD	9/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151323	05	Anesthesiology	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3723	56	06111	34.21700406	-119.1582582	Ventura County
83634	Fee-for-Service	1023734357	1023734357	1	1	AHMADIAN, NATASHA NP	3/29/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
83648	Fee-for-Service	1336375021	1336375021	1	1	ASHKAN, MARK MD	7/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128351	30	Radiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
83672	Fee-for-Service	1083459556	1083459556	1	1	AUSTIN, JULIETTE PT	8/16/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	177 NORTH REINO RD	None	NEWBURY PARK	CA	91320	3710	56	06111	34.18076257	-118.9529104	Ventura County
83680	Fee-for-Service	1518370303	1518370303	1	1	ALLEN, SHYLANDER	7/7/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	56590 EL DORADO DRIVE	None	YUCCA VALLEY	CA	92284	4233	36	06071	34.09950364	-116.4295801	San Bernardino County
83731	Fee-for-Service	1114955994	1114955994	1	1	ARAUJO, DAVID MD	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55818	08	Family Practice	0	In state provider	None	1289 D ST	None	MERCED	CA	95340	6247	24	06047	37.29248985	-120.474035	Merced County
83740	Fee-for-Service	1649777897	1649777897	1	1	ALI, SYED M MD	7/1/2021	208M00000X	NA	Other	026	PHYSICIANS	163679	None	None	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
83746	Fee-for-Service	1235541814	1235541814	1	1	AMALOU, HAYET MD	5/4/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	151679	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
83798	Fee-for-Service	1689679581	1689679581	1	1	ALLE-KISKI MEDICAL CENTER	9/8/2014	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1301 CARLISLE ST	None	NATRONA HEIGHTS	PA	15065	1152	00	None	40.61771073	-79.73643087	Allegheny County
83830	Fee-for-Service	1891804043	1891804043	1	1	ARATOW, MICHAEL	3/2/1987	207P00000X	NA	Other	026	PHYSICIANS	59653	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
83831	Fee-for-Service	1891992525	1891992525	1	1	AMINI M MAZIYAR MD	9/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	100096	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
83835	Fee-for-Service	1225276827	1225276827	1	1	ASSAF, L DO	5/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14514	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
83836	Fee-for-Service	1700151206	1700151206	1	1	ALDAZ, MARISOL LMFT	5/4/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	202 E. AIRPORT DRIVE	120	SAN BERNARDINO	CA	92408	3404	36	06071	34.06737938	-117.2834702	San Bernardino County
83852	Fee-for-Service	1417722232	1417722232	1	1	AMG, A PROFESSIONAL MEDICAL	3/29/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CORPORATION	4528 SLAUSON AVE	None	MAYWOOD	CA	90270	2934	19	06037	33.98692688	-118.1846183	Los Angeles County
83868	Fee-for-Service	1932264082	1932264082	1	2	ARVIN UNION SCHOOL DIST	10/17/2011	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	341 HAVEN DR	None	ARVIN	CA	93203	1998	15	06029	35.20541378	-118.8270326	Kern County
83881	Fee-for-Service	1720164551	1720164551	1	1	AMANI-YAZDI, RAMBOD MD CORP	10/10/2013	193400000X	NA	Other	026	PHYSICIANS	70521	67	Endocrinology	0	In state provider	None	1330 WEST COVINA BLVD	STE 206	SAN DIMAS	CA	91773	3200	19	06037	34.09894509	-117.8340464	Los Angeles County
83899	Fee-for-Service	1881023968	1881023968	1	1	ACUTE RESPONSE TEAM CORP	4/24/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6061 BANBURY ST	None	SAN DIEGO	CA	92139	3624	37	06073	32.6710696	-117.0601576	San Diego County
83908	Fee-for-Service	1093310997	1093310997	1	1	AGUIRRE, JOSEPH NP	11/15/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
83946	Fee-for-Service	1548623622	1548623622	1	1	ALTSHULER, PETER J MD	7/7/2023	208600000X	NA	General Surgery	026	PHYSICIANS	187361	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
83967	Fee-for-Service	1518370303	1518370303	1	1	ALLEN, SHYLANDER	7/7/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	56590 EL DORADO DRIVE	None	YUCCA VALLEY	CA	92284	4233	36	06071	34.09950364	-116.4295801	San Bernardino County
84000	Fee-for-Service	1912343930	1912343930	1	1	ADDAMS, ERIN F LMFT	4/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
84016	Fee-for-Service	1114955994	1114955994	1	1	ARAUJO, DAVID MD	4/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55818	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1289 D ST	None	MERCED	CA	95340	6247	24	06047	37.29248985	-120.474035	Merced County
84023	Fee-for-Service	1265468946	1265468946	1	1	ALVARADO HOSPITAL LLC	6/1/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
84033	Fee-for-Service	1124257118	1124257118	1	1	A G MEDICAL SUPPLY INC	10/13/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	A G MEDICAL SUPPLY INC	4020 W MAGNOLIA BLVD	UNIT C	BURBANK	CA	91505	2828	19	06037	34.16656815	-118.3507978	Los Angeles County
84034	Fee-for-Service	1649584426	1649584426	1	1	AHUJA, MEENA T MD	9/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129156	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
84055	Fee-for-Service	1134565740	1134565740	2	1	AEGIS TREATMENT CENTERS LLC	11/1/2016	261QR0405X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	955 W CENTER STREET	1, 12A, 12B & 14	MANTECA	CA	95337	7300	39	06077	37.79916144	-121.2300132	San Joaquin County
84067	Fee-for-Service	1063477750	1063477750	1	1	ARENSON, RONALD L MD	3/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	72743	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
84086	Fee-for-Service	1689679581	1689679581	1	1	ALLE-KISKI MEDICAL CENTER	9/8/2014	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1301 CARLISLE ST	None	NATRONA HEIGHTS	PA	15065	1152	00	None	40.61771073	-79.73643087	Allegheny County
84104	Fee-for-Service	1972629020	1972629020	1	1	ALLEN, JEAN M DO MD	4/27/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	12566	08	Family Practice	0	In state provider	None	2100 SOLAR DR	STE 100	OXNARD	CA	93036	0647	56	06111	34.22156515	-119.14488	Ventura County
84119	Fee-for-Service	1891804043	1891804043	1	1	ARATOW, MICHAEL	3/2/1987	207P00000X	NA	Other	026	PHYSICIANS	59653	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
84122	Fee-for-Service	1295749802	1295749802	1	1	AULT, GLENN T MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	54651	02	General Surgery	0	In state provider	None	1441 EASTLAKE AVE	STE 7418	LOS ANGELES	CA	90089	0178	19	06037	34.06169385	-118.2044698	Los Angeles County
84135	Fee-for-Service	1518482637	1518482637	1	1	ARMAS, VANESSA M LMFT	9/22/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
84141	Fee-for-Service	1417722232	1417722232	1	1	AMG, A PROFESSIONAL MEDICAL	3/29/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	CORPORATION	4528 SLAUSON AVE	None	MAYWOOD	CA	90270	2934	19	06037	33.98692688	-118.1846183	Los Angeles County
84144	Fee-for-Service	1841911773	1841911773	1	2	ARRAE HEALTH	11/22/2023	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	3655 RAMON RD	None	PALM SPRINGS	CA	92264	1150	33	06065	33.81585702	-116.5066057	Riverside County
84145	Fee-for-Service	1710638952	1710638952	1	1	ALEXANDER, KARINA PT	4/22/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3989 STETSON	105	HEMET	CA	92545	9695	33	06065	33.72929866	-117.0132375	Riverside County
84160	Fee-for-Service	1164799425	1164799425	1	1	APEX HEALTHCARE MEDICAL	10/1/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	85422	45	Nephrology (Renal-Kidney)	0	In state provider	CENTER INC	1515 W FLORIDA AVE	None	HEMET	CA	92543	3817	33	06065	33.74738653	-116.9879535	Riverside County
84163	Fee-for-Service	1144768862	1144768862	1	1	ARIZONA EM-I MEDICAL SERVICE	2/22/2024	207P00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	1	Border provider	S PC	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
84166	Fee-for-Service	1710084959	1710084959	1	1	AIYEGBUSI & BRAIMAH AMC	8/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3661 TORRANCE BLVD	#103	TORRANCE	CA	90503	4812	19	06037	33.83762646	-118.351116	Los Angeles County
84171	Fee-for-Service	1720164551	1720164551	1	1	AMANI-YAZDI, RAMBOD MD CORP	10/10/2013	193400000X	NA	Other	026	PHYSICIANS	70521	41	Internal Medicine	0	In state provider	None	1330 WEST COVINA BLVD	STE 206	SAN DIMAS	CA	91773	3200	19	06037	34.09894509	-117.8340464	Los Angeles County
84179	Fee-for-Service	1083978100	1083978100	1	1	ABSOLUTE CARE HEALTH SYSTEMS	3/20/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	7940 SILVERTON AVE	STE 202	SAN DIEGO	CA	92126	6341	37	06073	32.89081884	-117.149988	San Diego County
84184	Fee-for-Service	1609858257	1609858257	1	2	ADAMS, AUTHER E JR MD	4/27/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	40262	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2740 S ELM AVE	None	FRESNO	CA	93706	5435	10	06019	36.70101129	-119.7908643	Fresno County
84211	Fee-for-Service	1629339809	1629339809	1	1	ALHAMBRA HEALTHCARE	6/1/2012	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	& WELLNESS CENTRE LP	415 S GARFIELD AVE	None	ALHAMBRA	CA	91801	3838	19	06037	34.09058841	-118.1236963	Los Angeles County
84219	Fee-for-Service	1972590610	1972590610	1	1	ADAMSON, GREGORY MD	11/27/2024	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	58923	20	Orthopedic Surgery	0	In state provider	None	289 W. HUNTINGTON DR.	104	ARCADIA	CA	91007	3495	19	06037	34.13549119	-118.0419175	Los Angeles County
84257	Fee-for-Service	1255350351	1255350351	1	3	AMPLA HEALTH	3/1/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE UNIT	355 SAMUEL DRIVE	None	YUBA CITY	CA	95991	6324	51	06101	39.12322541	-121.6100736	Sutter County
84260	Fee-for-Service	1003230038	1003230038	1	2	APLA HEALTH & WELLNESS	1/16/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	5901 W OLYMPIC BLVD	SUITE 500	LOS ANGELES	CA	90036	4670	19	06037	34.05764121	-118.3603115	Los Angeles County
84265	Fee-for-Service	1700910114	1700910114	1	1	ARRINGTON, CAMMON B MD	8/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129861	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	725 WELCH RD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
84268	Fee-for-Service	1174751622	1174751622	1	1	ABOU, JANET J MD	7/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117194	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
84281	Fee-for-Service	1285054106	1285054106	3	1	ADVENTIST HEALTH CLEARLAKE	4/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	155 SOLANO ST	None	CORNING	CA	96021	3511	52	06103	39.92779745	-122.1687508	Tehama County
84286	Fee-for-Service	1679582829	1679582829	1	1	ADVANCE CARE AAA MEDICAL GRO	9/17/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	UP INC	1330 S. FULLERTON RD	204-206	ROWLAND HEIGHTS	CA	91748	1246	19	06037	33.99338632	-117.9052035	Los Angeles County
84314	Fee-for-Service	1265468946	1265468946	1	1	ALVARADO HOSPITAL LLC	6/1/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
84345	Fee-for-Service	1134565740	1134565740	2	1	AEGIS TREATMENT CENTERS LLC	11/1/2016	261QR0405X	NA	Other	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	955 W CENTER STREET	1, 12A, 12B & 14	MANTECA	CA	95337	7300	39	06077	37.79916144	-121.2300132	San Joaquin County
84354	Fee-for-Service	1629297122	1629297122	1	1	ANTIOCH ICF, INC	5/24/2004	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1228 PUTNAM ST	None	ANTIOCH	CA	94509	5412	07	06013	37.98962359	-121.8279056	Contra Costa County
84364	Fee-for-Service	1518221928	1518221928	1	1	AMLANI, BARKHA V MD	8/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155990	83	Rheumatology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
84375	Fee-for-Service	1790277135	1790277135	1	1	AXIOM ANESTHESIA GROUP INC	8/6/2018	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
84385	Fee-for-Service	1598877607	1598877607	1	1	ADVANCED PROFESSIONAL	3/28/2023	261QR0200X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IMAGING MEDICAL GROUP	6800 LINCOLN AVE	None	BUENA PARK	CA	90620	4163	30	06059	33.83178874	-118.0144022	Orange County
84391	Fee-for-Service	1184115438	1184115438	1	1	ATTALLA, MADONNA M MD	9/22/2022	207R00000X	NA	Other	026	PHYSICIANS	175856	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
84394	Fee-for-Service	1194004309	1194004309	1	1	AGUILUZ, CESAR E DO	3/20/2019	2086S0122X	NA	General Surgery	026	PHYSICIANS	11848	24	Plastic Surgery	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
84430	Fee-for-Service	1841911773	1841911773	1	2	ARRAE HEALTH	11/22/2023	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3655 RAMON RD	None	PALM SPRINGS	CA	92264	1150	33	06065	33.81585702	-116.5066057	Riverside County
84435	Fee-for-Service	1154642031	1154642031	1	2	AMBULIFE AMBULANCE, INC.	2/4/2022	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	6644 1/2 VAN NUYS BLVD	SUITE B	VAN NUYS	CA	91405	4617	19	06037	34.1920589	-118.4487205	Los Angeles County
84436	Fee-for-Service	1649093097	1649093097	1	1	ATLANTIC COVE MEDICAL GROUP	3/3/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	22141 VENTURA BLVD	309	WOODLAND HILLS	CA	91364	5734	19	06037	34.16866225	-118.6095572	Los Angeles County
84449	Fee-for-Service	1144768862	1144768862	1	1	ARIZONA EM-I MEDICAL SERVICE	2/22/2024	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	1	Border provider	S PC	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
84451	Fee-for-Service	1841503968	1841503968	1	1	AGHAEI LASBOO, ANAHITA MD	12/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128727	13	Neurology (M.D. only)	0	In state provider	None	275 HOSPITAL PKWAY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
84484	Fee-for-Service	1922148790	1922148790	1	1	ALLEVATO, JOSEPH	10/20/2020	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	68267	-	NOT APPLICABLE	0	In state provider	None	10953 RAMONA BLVD	RM#1293, 1295A, 1160	EL MONTE	CA	91731	2629	19	06037	34.07205148	-118.0372365	Los Angeles County
84490	Fee-for-Service	1821256090	1821256090	1	1	ADVANCED CENTER FOR UROLOGY	4/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	72957	None	None	0	In state provider	INC	12555 GARDEN GROVE BLVD	SUITE 405	GARDEN GROVE	CA	92843	1904	30	06059	33.77450946	-117.913041	Orange County
84519	Fee-for-Service	1386403020	1386403020	1	1	ADAMS, KIMBERLEE K CNP	6/18/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2826 HARRIS ST	None	EUREKA	CA	95503	4809	12	06023	40.78047614	-124.1355056	Humboldt County
84546	Fee-for-Service	1255350351	1255350351	1	3	AMPLA HEALTH	3/1/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MOBILE UNIT	355 SAMUEL DRIVE	None	YUBA CITY	CA	95991	6324	51	06101	39.12322541	-121.6100736	Sutter County
84550	Fee-for-Service	1003230038	1003230038	1	2	APLA HEALTH & WELLNESS	1/16/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	5901 W OLYMPIC BLVD	SUITE 500	LOS ANGELES	CA	90036	4670	19	06037	34.05764121	-118.3603115	Los Angeles County
84552	Fee-for-Service	1689600553	1689600553	1	1	AFZAL, MUHAMMAD MD	8/1/1997	207RP1001X	NA	Pulmonology	026	PHYSICIANS	63133	41	Internal Medicine	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
84568	Fee-for-Service	1285054106	1285054106	3	1	ADVENTIST HEALTH CLEARLAKE	4/1/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	155 SOLANO ST	None	CORNING	CA	96021	3511	52	06103	39.92779745	-122.1687508	Tehama County
84569	Fee-for-Service	1477938009	1477938009	1	1	ANNA SZWEDO	11/24/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
84576	Fee-for-Service	1659507259	1659507259	1	1	ARUNAMATA, ALISA A MD	6/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113223	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
84581	Fee-for-Service	1811681133	1811681133	1	1	ALHAMBRA SENIOR VILLA LLC	6/20/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1 E COMMONWEALTH AVE	None	ALHAMBRA	CA	91801	3823	19	06037	34.09236674	-118.1242505	Los Angeles County
84586	Fee-for-Service	1730720681	1730720681	1	1	ATTENTIVE HOME HEALTH INC	7/30/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	19634 VENTURA BLVD	STE 111	TARZANA	CA	91356	2919	19	06037	34.17264197	-118.5613482	Los Angeles County
84606	Fee-for-Service	1134151236	1134151236	1	1	ALPHA PAIN MANAGEMENT	7/13/2006	208VP0014X	NA	Other	026	PHYSICIANS	92212	None	None	0	In state provider	A PROFESSIONAL CORPORATI	41210 11TH ST WEST	STE K	PALMDALE	CA	93551	1447	19	06037	34.631649	-118.150154	Los Angeles County
84608	Fee-for-Service	1912134966	1912134966	1	1	AURORA V BARRIGA OD A PROF	1/7/2010	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	CORP	715-A JACKSON ST	None	RED BLUFF	CA	96080	3771	52	06103	40.17524703	-122.2405638	Tehama County
84618	Fee-for-Service	1285733261	1285733261	1	1	ACCURATE MEDICAL SUPPLY	1/1/1995	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	AND EQUIPMENT INC	4738 BROOKS ST	STE 45	MONTCLAIR	CA	91763	4724	36	06071	34.0616733	-117.7017587	San Bernardino County
84636	Fee-for-Service	1932214657	1932214657	1	13	AJAY G. MEKA M.D. INC.	12/27/2020	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	12923 INGLEWOOD AVE	STE. 1	HAWTHORNE	CA	90250	5573	19	06037	33.914961	-118.3613055	Los Angeles County
84640	Fee-for-Service	1508316217	1508316217	1	1	AWAN, NAZEELA S MD	9/20/2021	390200000X	NA	Other	026	PHYSICIANS	174576	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
84643	Fee-for-Service	1194875799	1194875799	1	1	ALTA LOMA SCHOOL DISTRICT	8/25/2005	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	9390 BASELINE RD	None	ALTA LOMA	CA	91701	5839	36	06071	34.12156347	-117.600165	San Bernardino County
84651	Fee-for-Service	1518221928	1518221928	1	1	AMLANI, BARKHA V MD	8/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155990	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
84674	Fee-for-Service	1285156109	1285156109	1	1	ANGELS TRANS, INC.	11/21/2018	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1201 S VICTORY BLVD	200	BURBANK	CA	91502	2552	19	06037	34.16527115	-118.3059384	Los Angeles County
84684	Fee-for-Service	1669429775	1669429775	1	1	AL-DARSANI, HUSSAIN MD	9/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	68782	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
84710	Fee-for-Service	1740492214	1740492214	2	1	ABU GHALYOUN, BADER MD	7/2/2020	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	169074	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1801 E MARCH LN	STE D400	STOCKTON	CA	95210	6629	39	06077	38.00315652	-121.2868715	San Joaquin County
84727	Fee-for-Service	1649093097	1649093097	1	1	ATLANTIC COVE MEDICAL GROUP	3/3/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	22141 VENTURA BLVD	309	WOODLAND HILLS	CA	91364	5734	19	06037	34.16866225	-118.6095572	Los Angeles County
84737	Fee-for-Service	1417521113	1417521113	1	1	A AND N HOME HEALTH CARE	2/20/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3857 FOOTHILL BLVD	STE 17	GLENDALE	CA	91214	1658	19	06037	34.23893612	-118.263699	Los Angeles County
84759	Fee-for-Service	1619594074	1619594074	1	1	ALVAREZ MELO, ESTEFANIA	8/7/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
84762	Fee-for-Service	1265507156	1265507156	1	1	A ROSHNI DASQUPTA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
84774	Fee-for-Service	1669508073	1669508073	1	1	ALSAN, BURAK H MD	9/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126971	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
84788	Fee-for-Service	1851741136	1851741136	1	1	AMADOR, OLGA L LMFT	10/7/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1338 CENTER COURT DR	STE 107	COVINA	CA	91724	3681	19	06037	34.0724419	-117.8624967	Los Angeles County
84825	Fee-for-Service	1477624377	1477624377	1	1	ARAMBULO, CELESTINE J DO	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	7401	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
84841	Fee-for-Service	1689600553	1689600553	1	1	AFZAL, MUHAMMAD MD	8/1/1997	207RP1001X	NA	Pulmonology	026	PHYSICIANS	63133	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
84859	Fee-for-Service	1619472693	1619472693	1	1	AL-OBEIDI, EBAA MD	7/26/2024	390200000X	NA	Other	026	PHYSICIANS	164569	68	Hematology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
84860	Fee-for-Service	1285054106	1285054106	3	1	ADVENTIST HEALTH CLEARLAKE	3/21/2021	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	155 SOLANO ST	None	CORNING	CA	96021	3511	52	06103	39.92779745	-122.1687508	Tehama County
84864	Fee-for-Service	1265518740	1265518740	1	1	ABDULKARIM, SEIFEDIN MD	10/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	50245	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
84895	Fee-for-Service	1912017120	1912017120	1	1	APRIA HEALTHCARE LLC	9/24/1998	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	990 KLAMATH LN	STE 11	YUBA CITY	CA	95993	8978	51	06101	39.13992431	-121.6517328	Sutter County
84922	Fee-for-Service	1932214657	1932214657	1	13	AJAY G. MEKA M.D. INC.	12/27/2020	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	12923 INGLEWOOD AVE	STE. 1	HAWTHORNE	CA	90250	5573	19	06037	33.914961	-118.3613055	Los Angeles County
84924	Fee-for-Service	1447836432	1447836432	1	1	ADHIKARI, PRAGYAN MD	8/12/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
84928	Fee-for-Service	1780227025	1780227025	1	1	AMBION, EVELYN B	10/29/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	7016 RAWLEY WAY	None	ELK GROVE	CA	95757	4039	34	06067	38.405583	-121.4220645	Sacramento County
84934	Fee-for-Service	1629525050	1629525050	1	1	ANDERSON, TRE'NISE LCSW	1/28/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
84943	Fee-for-Service	1467626341	1467626341	1	1	AGARWAL, NAMITA A MD	1/1/2001	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	61479	40	Pediatrics	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
84982	Fee-for-Service	1689840076	1689840076	1	1	ARIF RAHMAN M.D.	7/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5171 W OLIVE AVE	None	GLENDALE	AZ	85302	4204	00	None	33.567093	-112.1719365	Maricopa County
84985	Fee-for-Service	1871186023	1871186023	1	1	ASCENSION HOME HEALTH CARE	4/3/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	800 CHARCOT AVENUE	SUITE 106	SAN JOSE	CA	95131	2211	43	06085	37.38625759	-121.9076666	Santa Clara County
85007	Fee-for-Service	1235676388	1235676388	1	1	AQA, KAMILAH LCSW	5/25/2020	101YP2500X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
85008	Fee-for-Service	1689125965	1689125965	1	1	ALFEGO, DANIELLE E NP	2/20/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
85010	Fee-for-Service	1649093097	1649093097	1	1	ATLANTIC COVE MEDICAL GROUP	3/3/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	22141 VENTURA BLVD	309	WOODLAND HILLS	CA	91364	5734	19	06037	34.16866225	-118.6095572	Los Angeles County
85031	Fee-for-Service	1992873947	1992873947	1	1	ARDMORE MEDICAL GROUP INC	9/3/2003	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4528 SLAUSON AVE	None	MAYWOOD	CA	90270	2934	19	06037	33.98692688	-118.1846183	Los Angeles County
85045	Fee-for-Service	1124655162	1124655162	1	1	ANGELS PROTECTION HOSPICE	3/26/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	1616 VICTORY BLVD	STE 103	GLENDALE	CA	91201	2956	19	06037	34.16022036	-118.2989479	Los Angeles County
85063	Fee-for-Service	1669508073	1669508073	1	1	ALSAN, BURAK H MD	9/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126971	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
85070	Fee-for-Service	1144302993	1144302993	1	1	ASHIKU, SIMON K MD	3/18/2010	208600000X	NA	General Surgery	026	PHYSICIANS	87964	33	Thoracic Surgery	0	In state provider	None	1515 NEWWEL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	0	0	None
85089	Fee-for-Service	1932617644	1932617644	1	1	AMES-COTTO, CHRISTINA E LMFT	5/17/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	132030	-	NOT APPLICABLE	0	In state provider	None	1365 AND 1385 N. JOHNSON	111, 112, 113, 102, AND	EL CAJON	CA	92020	1649	37	06073	32.813847	-116.970981	San Diego County
85091	Fee-for-Service	1831836857	1831836857	1	1	ARTHEON MEDICAL LLC	12/6/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	1107 E JACKSON ST	# 206	TAMPA	FL	33602	4115	00	None	27.94939432	-82.4503747	Hillsborough County
85092	Fee-for-Service	1588860159	1588860159	1	1	ASANDRA, AMY MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	108663	30	Radiology	0	In state provider	None	1601 YGNACIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
85101	Fee-for-Service	1205603800	1205603800	1	1	AHCS SPECIALTY CARE SACRAMEN	10/1/2024	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	TO	1820 TRIBUTE RD	SUITE G	SACRAMENTO	CA	95815	4307	34	06067	38.599578	-121.444326	Sacramento County
85110	Fee-for-Service	1720285604	1720285604	1	1	ALEJANDRO DE LA TORRE	11/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
85156	Fee-for-Service	1396292009	1396292009	1	1	ANDERSON, MARY LMFT	9/26/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
85159	Fee-for-Service	1477014959	1477014959	1	1	AFZAL, SARAH Y MD	6/13/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	178707	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
85218	Fee-for-Service	1699960815	1699960815	1	1	ALLAPARTHI, SATYA B MD	10/21/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	156485	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
85219	Fee-for-Service	1780227025	1780227025	1	1	AMBION, EVELYN B	10/29/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	7016 RAWLEY WAY	None	ELK GROVE	CA	95757	4039	34	06067	38.405583	-121.4220645	Sacramento County
85244	Fee-for-Service	1760649644	1760649644	1	1	ANAMOS, PAUL G CRNA	10/26/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
85283	Fee-for-Service	1699374280	1699374280	1	1	AA CARE HOSPICE	12/17/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	303 N GLENOAKS BLVD	STE 217	BURBANK	CA	91502	1116	19	06037	34.18486122	-118.308553	Los Angeles County
85314	Fee-for-Service	1912234436	1912234436	1	1	ARTHUR, SUSAN	1/11/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	38	06075	0	0	None
85328	Fee-for-Service	1104818715	1104818715	1	1	ADVANCED CARDIOTHORACIC	10/20/2003	208G00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	SURGERY MEDICAL GROUP	1245 WILSHIRE BLVD	STE 606	LOS ANGELES	CA	90017	4806	19	06037	34.05362775	-118.2661889	Los Angeles County
85332	Fee-for-Service	1124655162	1124655162	1	1	ANGELS PROTECTION HOSPICE	3/26/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	1616 VICTORY BLVD	STE 103	GLENDALE	CA	91201	2956	19	06037	34.16022036	-118.2989479	Los Angeles County
85338	Fee-for-Service	1952518482	1952518482	1	1	ASHRATI, GHYZAL	7/6/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVENUE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
85354	Fee-for-Service	1750650982	1750650982	1	4	APEX RADIOLOGY MEDICAL GROUP	5/8/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	15248 11TH STREET	None	VICTORVILLE	CA	92395	3704	36	06071	34.52825401	-117.2925587	San Bernardino County
85356	Fee-for-Service	1376102988	1376102988	1	1	AUDET, MEGAN A MD	8/22/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
85368	Fee-for-Service	1366949315	1366949315	1	1	AMERICAN ALL CARE SERVICES	10/16/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	LLC	10737 LAUREL STREET	SUITE 245	RANCHO CUCAMONGA	CA	91730	3837	36	06071	34.10515337	-117.570867	San Bernardino County
85373	Fee-for-Service	1336749100	1336749100	1	1	ADULT NEUROLOGY SPECIALISTS	3/11/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	None	None	None	0	In state provider	INC	729 SUNRISE AVE	616	ROSEVILLE	CA	95661	4548	31	06061	38.73444822	-121.2720033	Placer County
85388	Fee-for-Service	1205203510	1205203510	1	1	ANAND, SUSHIL MD FAAP	9/28/2015	261QP2300X	NA	Other	026	PHYSICIANS	110593	None	None	0	In state provider	None	304 WEST F STREET	None	ONTARIO	CA	91762	3206	36	06071	34.069563	-117.6538005	San Bernardino County
85399	Fee-for-Service	1497356885	1497356885	1	1	ADCOX, COURTNEY LCSW	4/4/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
85405	Fee-for-Service	1801874144	1801874144	1	1	ANDERSON, ROBERT L MD	10/7/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49374	04	Otology, Laryngology, Rhinology	0	In state provider	None	1017 2ND ST	None	SANTA ROSA	CA	95404	6608	49	06097	38.442753	-122.7056805	Sonoma County
85406	Fee-for-Service	1043509953	1043509953	1	1	ARCH, ALLISON E MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136785	13	Neurology (M.D. only)	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
85430	Fee-for-Service	1528426053	1528426053	1	1	ALLERGY ASTHMA SINUSITIS	3/27/2017	207KA0200X	NA	Other	026	PHYSICIANS	42411	03	Allergy	0	In state provider	MEDICAL CLINIC INC	11832 E ROSECRANS AVE	SUITE 200	NORWALK	CA	90650	4107	19	06037	33.90211977	-118.0813129	Los Angeles County
85439	Fee-for-Service	1912369927	1912369927	1	1	ALIFANO, JESSE A DO	2/5/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	275 W HERNDON AVE	None	CLOVIS	CA	93612	0204	10	06019	36.83766747	-119.715174	Fresno County
85455	Fee-for-Service	1275988248	1275988248	1	1	AMURAO, MIGUEL C MD	12/6/2021	208M00000X	NA	Other	026	PHYSICIANS	173257	None	None	0	In state provider	None	1595 SOQUEL DR	STE 400	SANTA CRUZ	CA	95065	1724	44	06087	36.98879599	-121.9826354	Santa Cruz County
85465	Fee-for-Service	1104169564	1104169564	1	1	ALQAHTANI, EMAN MD	6/28/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	138391	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
85511	Fee-for-Service	1366491623	1366491623	1	1	AMSTER, JAMES L MD	7/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	49317	None	None	0	In state provider	None	510 N PROSPECT AVE	SUITE 101	REDONDO BEACH	CA	90277	3028	19	06037	33.85259344	-118.379739	Los Angeles County
85529	Fee-for-Service	1912223496	1912223496	1	1	ARRIETA, NOEMI J MD	9/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11153	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
85537	Fee-for-Service	1780328062	1780328062	1	1	AIR EVAC EMS, INC.	7/21/2022	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	910 W HOBBS ST	None	ATHENS	AL	35611	1412	00	None	34.80486056	-86.97962404	Limestone County
85553	Fee-for-Service	1861654204	1861654204	1	1	AFSHAR-SHAHIDI, NAHAL MD	12/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97491	08	Family Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
85561	Fee-for-Service	1053685644	1053685644	1	1	AXELROD, AHLAM H LMFT	4/17/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15431 ANACAPA RD	STE D	VICTORVILLE	CA	92392	2458	36	06071	34.50544107	-117.3250832	San Bernardino County
85572	Fee-for-Service	1699374280	1699374280	1	1	AA CARE HOSPICE	12/17/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	303 N GLENOAKS BLVD	STE 217	BURBANK	CA	91502	1116	19	06037	34.18486122	-118.308553	Los Angeles County
85614	Fee-for-Service	1104818715	1104818715	1	1	ADVANCED CARDIOTHORACIC	10/20/2003	208G00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	SURGERY MEDICAL GROUP	1245 WILSHIRE BLVD	STE 606	LOS ANGELES	CA	90017	4806	19	06037	34.05362775	-118.2661889	Los Angeles County
85616	Fee-for-Service	1700494762	1700494762	1	1	AUTHORIZED HOME HEALTH CARE	8/8/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12410 BURBANK BLVD	STE 200	VALLEY VILLAGE	CA	91607	4732	19	06037	34.17210753	-118.403775	Los Angeles County
85627	Fee-for-Service	1710294343	1710294343	1	1	ANDREWS, CAITLIN L PSYD	12/2/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	4633	07	06013	38.00771973	-122.1331484	Contra Costa County
85655	Fee-for-Service	1366949315	1366949315	1	1	AMERICAN ALL CARE SERVICES	10/16/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	LLC	10737 LAUREL STREET	SUITE 245	RANCHO CUCAMONGA	CA	91730	3837	36	06071	34.10515337	-117.570867	San Bernardino County
85658	Fee-for-Service	1043895436	1043895436	1	1	ASHLEY, SARAH LMFT	6/12/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6276 N 1ST ST	103	FRESNO	CA	93710	5400	10	06019	36.82794977	-119.7721574	Fresno County
85695	Fee-for-Service	1134475171	1134475171	1	1	AL-FADLY, WALEED S MD INC	5/17/2017	261QP2300X	NA	Other	026	PHYSICIANS	20545	01	General Practice	0	In state provider	None	16000 S VERMONT AVE	None	GARDENA	CA	90247	4552	19	06037	33.88597446	-118.2914079	Los Angeles County
85709	Fee-for-Service	1245356807	1245356807	1	1	ASIJA, RITU MD	6/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	85487	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
85715	Fee-for-Service	1801253323	1801253323	1	1	ACTIVE LIFE WOUND CLINIC, A	10/22/2018	163WW0000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	PROFESSIONAL NURSING COR	87 SCRIPPS DR	None	SACRAMENTO	CA	95825	6379	34	06067	38.572092	-121.410261	Sacramento County
85720	Fee-for-Service	1366098279	1366098279	1	1	ASKARI, NILI LMFT	4/8/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
85756	Fee-for-Service	1346823838	1346823838	1	1	ARCHER, JENNIFER DO	8/15/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22839	08	Family Practice	0	In state provider	None	17615 MORO RD	None	SALINAS	CA	93907	8541	27	06053	36.80320219	-121.663727	Monterey County
85785	Fee-for-Service	1154044931	1154044931	1	1	ALL FOR HEALTH, HEALTH FOR	7/1/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ALL, INC.	25500 RANCHO NIGUEL ROAD	SUITE 250	LAGUNA NIGUEL	CA	92677	7306	30	06059	33.55578198	-117.6849338	Orange County
85786	Fee-for-Service	1164000295	1164000295	1	1	AKINS, DELVIN	8/30/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
85796	Fee-for-Service	1003866914	1003866914	1	3	ADVANCED IMAGING OF	6/12/2015	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1300 W 7TH STREET	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
85813	Fee-for-Service	1578597803	1578597803	2	1	AMERICAN MEDICAL RESPONSE	1/13/2017	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	WEST	4846 STRATOS WAY	None	MODESTO	CA	95356	9266	50	06099	37.71023901	-121.0001817	Stanislaus County
85827	Fee-for-Service	1982853370	1982853370	1	1	ANDERSON, MARY E PHD	11/8/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
85842	Fee-for-Service	1841270584	1841270584	1	1	ARFAEI, ASGHAR MD	12/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102199	41	Internal Medicine	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
85872	Fee-for-Service	1386271682	1386271682	1	1	AL-RABADI, DINA DO	3/24/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20813	08	Family Practice	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
85906	Fee-for-Service	1518474774	1518474774	1	1	ALIKHAN, MIRZA N LMFT	2/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8939 S SEPULVEDA BLVD	SUITE #200	LOS ANGELES	CA	90045	3631	19	06037	33.95485856	-118.3962461	Los Angeles County
85966	Fee-for-Service	1619980638	1619980638	1	1	ASRAT, TAMEROU MD	1/30/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	55588	01	General Practice	0	In state provider	None	3325 PALO VERDE AVE	STE 105	LONG BEACH	CA	90808	4132	19	06037	33.81701249	-118.1078791	Los Angeles County
85970	Fee-for-Service	1881023927	1881023927	1	1	ADVANCED DERMATOLOGY AND SKI	10/14/2024	207N00000X	NA	Dermatology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	N CANCER SPECIALISTS	31720 S TEMECULA PARKWAY	203	TEMECULA	CA	92592	2034	33	06065	33.4799323	-117.1033702	Riverside County
85975	Fee-for-Service	1023173135	1023173135	2	1	AEGIS TREATMENT CENTERS, LLC	3/27/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1050 N GAREY AVE	None	POMONA	CA	91767	3808	19	06037	34.06832944	-117.7520793	Los Angeles County
85998	Fee-for-Service	1245356807	1245356807	1	1	ASIJA, RITU MD	6/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	85487	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
86001	Fee-for-Service	1801253323	1801253323	1	1	ACTIVE LIFE WOUND CLINIC, A	10/22/2018	163WW0000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL NURSING COR	87 SCRIPPS DR	None	SACRAMENTO	CA	95825	6379	34	06067	38.572092	-121.410261	Sacramento County
86010	Fee-for-Service	1942969530	1942969530	1	1	A PLUS CARE NON-EMERGENCY ME	5/17/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	DICAL TRANSPORTATION LLC	530 BELLEVUE RD	B	ATWATER	CA	95301	2339	24	06047	37.3604007	-120.5980638	Merced County
86019	Fee-for-Service	1831298389	1831298389	1	1	AGUIRRE, RICARDO J MD	10/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87157	05	Anesthesiology	0	In state provider	None	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
86052	Fee-for-Service	1942704424	1942704424	1	1	ALJILANI, SALMAN DO	2/17/2025	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	23106	25	Physical Medicine and Rehabilitation	0	In state provider	None	16311 VENTURA BLVD	SUITE #1150	ENCINO	CA	91436	4386	19	06037	34.15706864	-118.4885978	Los Angeles County
86073	Fee-for-Service	1154044931	1154044931	1	1	ALL FOR HEALTH, HEALTH FOR	7/1/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	ALL, INC.	25500 RANCHO NIGUEL ROAD	SUITE 250	LAGUNA NIGUEL	CA	92677	7306	30	06059	33.55578198	-117.6849338	Orange County
86092	Fee-for-Service	1700266210	1700266210	1	2	ADDICTION RESEARCH AND TREAT	10/21/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1701 ZONAL AVE.	None	LOS ANGELES	CA	90033	1065	19	06037	34.06219051	-118.2106555	Los Angeles County
86093	Fee-for-Service	1801852900	1801852900	1	1	ADAMS, JOHN D JR DO	1/1/1982	207R00000X	NA	Other	026	PHYSICIANS	4561	41	Internal Medicine	0	In state provider	None	121 S LONG BEACH BLVD	None	COMPTON	CA	90221	3423	19	06037	33.89475493	-118.2080292	Los Angeles County
86104	Fee-for-Service	1497016653	1497016653	1	1	AUDD, LEE M MD	9/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141009	05	Anesthesiology	0	In state provider	None	FRESNO & R STREET	None	FRESNO	CA	93721	1365	10	06019	36.741663	-119.7841005	Fresno County
86107	Fee-for-Service	1578848529	1578848529	1	1	ART, JACOB M LMFT	1/17/2017	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	459 FULTON ST	SUITE 107	SAN FRANCISCO	CA	94102	4364	38	06075	37.77858939	-122.4243874	San Francisco County
86113	Fee-for-Service	1578583365	1578583365	1	1	AGRAN, PHYLLIS F MD	2/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	37725	10	Gastroenterology (M.D. only)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
86124	Fee-for-Service	1841270584	1841270584	1	1	ARFAEI, ASGHAR MD	12/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102199	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
86137	Fee-for-Service	1861887945	1861887945	1	1	ACKERMAN, EMILY K MD	11/14/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	146938	None	None	0	In state provider	None	415 W ROUTE 66	STE 202	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
86149	Fee-for-Service	1548821523	1548821523	1	1	ACOPIANS, LINA DO	2/8/2023	208M00000X	NA	Other	026	PHYSICIANS	19568	None	None	0	In state provider	None	10 CONGRESS ST	STE 208	PASADENA	CA	91105	3027	19	06037	34.13396893	-118.1528162	Los Angeles County
86204	Fee-for-Service	1457694747	1457694747	1	1	AGOURA NEUROFEEDBACK, INC.	10/18/2024	103TB0200X	NA	Mental Health Outpatient Services	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	28632 ROADSIDE DR	210	AGOURA HILLS	CA	91301	6091	19	06037	34.14375168	-118.7497422	Los Angeles County
86222	Fee-for-Service	1962113035	1962113035	1	1	ABEL, KRISTY CRNA	7/21/2023	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
86242	Fee-for-Service	1962681676	1962681676	1	1	ALI, YUSUF MD	12/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	73465	40	Pediatrics	0	In state provider	None	203 WALKER ST	STE 3	ORLAND	CA	95963	1450	11	06021	39.74734953	-122.1918345	Glenn County
86253	Fee-for-Service	1619980638	1619980638	1	1	ASRAT, TAMEROU MD	1/30/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	55588	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3325 PALO VERDE AVE	STE 105	LONG BEACH	CA	90808	4132	19	06037	33.81701249	-118.1078791	Los Angeles County
86258	Fee-for-Service	1881023927	1881023927	1	1	ADVANCED DERMATOLOGY AND SKI	9/24/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	N CANCER SPECIALISTS	31720 S TEMECULA PARKWAY	203	TEMECULA	CA	92592	2034	33	06065	33.4799323	-117.1033702	Riverside County
86263	Fee-for-Service	1023173135	1023173135	2	1	AEGIS TREATMENT CENTERS, LLC	1/11/2014	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1050 N GAREY AVE	None	POMONA	CA	91767	3808	19	06037	34.06832944	-117.7520793	Los Angeles County
86279	Fee-for-Service	1366623746	1366623746	1	1	ABRAMS, EDWARD MD, INC	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	16243 COLORADO AVE	None	PARAMOUNT	CA	90723	5009	19	06037	33.88601256	-118.1614385	Los Angeles County
86295	Fee-for-Service	1619278181	1619278181	1	1	ANGEL MEDICAL TRANSPORTATION	12/16/2012	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	INC	1323 W WEST COVINA PKWY	STE F	WEST COVINA	CA	91790	2802	19	06037	34.06866964	-117.9368217	Los Angeles County
86317	Fee-for-Service	1164502233	1164502233	1	1	ANDERSEN, BOGI MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	48338	67	Endocrinology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
86321	Fee-for-Service	1427716737	1427716737	1	1	AQUA HOME HEALTH CARE	1/16/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5535 N BALBOA BLVD	SUITE 103	ENCINO	CA	91316	1575	19	06037	34.171632	-118.5011955	Los Angeles County
86371	Fee-for-Service	1710046594	1710046594	1	1	ADAMS, PETER J PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
86376	Fee-for-Service	1639706211	1639706211	1	1	ASFAHAN, JOEY MD	7/26/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	185623	08	Family Practice	0	In state provider	None	1330 W COVINA BLVD	102	SAN DIMAS	CA	91773	3200	19	06037	34.09894509	-117.8340464	Los Angeles County
86388	Fee-for-Service	1679942270	1679942270	1	1	AIR EVAC EMS, INC.	8/10/2021	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	2205 S EXECUTIVE AIRPORT	None	ARDMORE	OK	73401	2101	00	None	34.144605	-97.120008	Carter County
86404	Fee-for-Service	1578583365	1578583365	1	1	AGRAN, PHYLLIS F MD	2/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	37725	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
86486	Fee-for-Service	1063523819	1063523819	1	1	ALLEN, DANIEL B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	71411	24	Plastic Surgery	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
86491	Fee-for-Service	1457694747	1457694747	1	1	AGOURA NEUROFEEDBACK, INC.	2/7/2024	103TB0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	28632 ROADSIDE DR	210	AGOURA HILLS	CA	91301	6091	19	06037	34.14375168	-118.7497422	Los Angeles County
86495	Fee-for-Service	1881169209	1881169209	1	1	ALVAREZ, AMY LCSW	3/26/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12440 FIRESTONE BLVD	3001	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
86513	Fee-for-Service	1932544657	1932544657	1	1	ATAIE, YALDA MD	9/30/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139509	01	General Practice	0	In state provider	None	34900 PASEO PADRE PARKWA	None	FREMONT	CA	94538	2310	01	06001	37.576947	-122.0267208	Alameda County
86515	Fee-for-Service	1992394811	1992394811	1	1	ALEXANDER GENG INC	3/5/2021	2085R0001X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
86542	Fee-for-Service	1619980638	1619980638	1	1	ASRAT, TAMEROU MD	1/30/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	55588	05	Anesthesiology	0	In state provider	None	3325 PALO VERDE AVE	STE 105	LONG BEACH	CA	90808	4132	19	06037	33.81701249	-118.1078791	Los Angeles County
86550	Fee-for-Service	1124737192	1124737192	1	1	ANAHEIM COMPOUNDING LLC	12/16/2022	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CY	500 S ANAHEIM HILLS RD	STE. 100	ANAHEIM	CA	92807	4780	30	06059	33.8427954	-117.7772895	Orange County
86566	Fee-for-Service	1043694847	1043694847	1	1	AUTUMN KEISER	10/3/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 E 10TH ST	None	ATLANTIC	IA	50022	1936	00	None	41.4020555	-94.99122928	Cass County
86588	Fee-for-Service	1164813788	1164813788	1	1	AMIRPASHA EHSAN MD, INC	4/27/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	None	None	0	In state provider	None	5501 STOCKDALE HWY	SUITE 10746	BAKERSFIELD	CA	93309	2503	15	06029	35.35416451	-119.063223	Kern County
86592	Fee-for-Service	1376824854	1376824854	1	2	AARON K TRAN MD INC	4/25/2019	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1955 LOMITA BLVD	None	LOMITA	CA	95240	5118	39	06077	33.79977654	-118.3137675	Los Angeles County
86610	Fee-for-Service	1255385886	1255385886	1	1	ASHLEY, ROBERT V MD	5/15/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77225	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	0000	19	06037	34.07067	-118.4432445	Los Angeles County
86631	Fee-for-Service	1508011958	1508011958	1	2	AGARWAL, MEGHA MD	10/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	110288	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
86645	Fee-for-Service	1609094804	1609094804	2	1	ART HOME HEALTH CARE INC	9/1/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	16661 VENTURA BLVD	STE 404A	ENCINO	CA	91436	1914	19	06037	34.15820737	-118.496492	Los Angeles County
86670	Fee-for-Service	1477105005	1477105005	1	1	AVENTUS HOME HEALTH CARE INC	5/7/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	428 SOUTH ROSEMEAD BLVD	None	PASADENA	CA	91107	4980	19	06037	34.139277	-118.073202	Los Angeles County
86672	Fee-for-Service	1699441352	1699441352	1	1	ARDEN HOME HEALTH INC	5/17/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	327 ARDEN AVE	STE 204	GLENDALE	CA	91203	4035	19	06037	34.15851787	-118.2592388	Los Angeles County
86673	Fee-for-Service	1740507367	1740507367	1	1	ADOR-DIONISIO, SWEETHEART T	12/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122235	41	Internal Medicine	0	In state provider	MD	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
86684	Fee-for-Service	1255489068	1255489068	1	1	AGRESS, MICHAEL MD	12/31/1982	2084P0800X	NA	Psychiatry	026	PHYSICIANS	39059	36	Psychiatry	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
86685	Fee-for-Service	1700043320	1700043320	1	1	AROUS, LINDA R MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124389	08	Family Practice	0	In state provider	None	43839 N 15TH STREET WEST	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
86733	Fee-for-Service	1235336595	1235336595	1	1	AZAR MD INC	1/27/2012	207L00000X	NA	Other	026	PHYSICIANS	79191	05	Anesthesiology	0	In state provider	None	14662 NEWPORT AVENUE	None	TUSTIN	CA	92780	6064	30	06059	33.73088521	-117.8293385	Orange County
86738	Fee-for-Service	1972658540	1972658540	1	1	ALCANTAR, JUAN M MD	7/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	93796	41	Internal Medicine	0	In state provider	None	191 S BUENA VISTA ST	STE 440	BURBANK	CA	91505	4551	19	06037	34.15872557	-118.3283863	Los Angeles County
86772	Fee-for-Service	1326785999	1326785999	1	2	AUDI TRANSPORTS LLC	10/16/2023	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	970 ROOSEVELT	200	IRVINE	CA	92620	3664	30	06059	33.69372462	-117.7652125	Orange County
86774	Fee-for-Service	1336264860	1336264860	1	1	AHMED, SYED N MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76752	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
86775	Fee-for-Service	1063523819	1063523819	1	1	ALLEN, DANIEL B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	71411	02	General Surgery	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
86778	Fee-for-Service	1083769566	1083769566	1	1	AMBACH, MARY A MD	11/2/2010	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	108622	25	Physical Medicine and Rehabilitation	0	In state provider	None	3636 NOBEL DR	STE 401	SAN DIEGO	CA	92122	1042	37	06073	32.86846743	-117.2279063	San Diego County
86779	Fee-for-Service	1457694747	1457694747	1	1	AGOURA NEUROFEEDBACK, INC.	2/7/2024	103TB0200X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	28632 ROADSIDE DR	210	AGOURA HILLS	CA	91301	6091	19	06037	34.14375168	-118.7497422	Los Angeles County
86780	Fee-for-Service	1427240456	1427240456	1	1	ANTHONY ANTONOLPOS	1/29/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10500 MONTGOMERY RD	None	CINCINNATI	OH	45242	4402	00	None	39.252267	-84.3413535	Hamilton County
86862	Fee-for-Service	1972897346	1972897346	1	2	ALDEA, INC	4/14/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	RVICES	4820 BUSINESS CENTER DRI	210	FAIRFIELD	CA	94534	9600	48	06095	38.22055392	-122.1386622	Solano County
86863	Fee-for-Service	1669673448	1669673448	1	1	ANANTHAPANYASUT, WANWARAT M	1/13/2021	207RN0300X	NA	Nephrology	026	PHYSICIANS	106780	None	None	0	In state provider	D	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
86877	Fee-for-Service	1508498650	1508498650	1	1	ADVANCED FAMILY COUNSELING O	9/23/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	F SAN DIEGO PC	16496 BERNARDO CENTER DR	201	SAN DIEGO	CA	92128	2524	37	06073	33.01375281	-117.0777466	San Diego County
86905	Fee-for-Service	1518423839	1518423839	1	1	AREVALO, MICHAEL A PSYD	12/9/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
86925	Fee-for-Service	1952326977	1952326977	1	1	AMISUB SAINT FRANCIS	2/15/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL INC	5959 PARK AVE	None	MEMPHIS	TN	38119	5200	00	None	35.09992047	-89.8632855	Shelby County
86940	Fee-for-Service	1710249693	1710249693	1	1	AGUILAR-JAKTHONG, JOSEPHINE	6/17/2021	207ZP0102X	NA	Other	026	PHYSICIANS	140238	None	None	0	In state provider	MD	300 SIERRA COLLEGE DR	STE 105	GRASS VALLEY	CA	95945	5084	29	06057	39.23625806	-121.054471	Nevada County
86944	Fee-for-Service	1497071443	1497071443	1	1	ABESA, MARIA REGINA A MD	9/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124305	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
86952	Fee-for-Service	1487046231	1487046231	1	1	ADVOCARE HOSPICE, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	12419 LEWIS STREET	SUITE 106	GARDEN GROVE	CA	92840	4655	30	06059	33.78299909	-117.8978174	Orange County
86957	Fee-for-Service	1720762735	1720762735	1	1	ALTAMIRANO, ISMARI OT	7/8/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	275 W HOSPITALITY LN	103	SAN BERNARDINO	CA	92408	3249	36	06071	34.0659135	-117.289215	San Bernardino County
86966	Fee-for-Service	1841387214	1841387214	1	1	ACUTE CARE ASSOCIATES	7/17/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INPATIENT MEDICAL GROUP	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
86995	Fee-for-Service	1851592737	1851592737	1	1	ARYAI, ARMAN MD	3/25/2008	207R00000X	NA	Other	026	PHYSICIANS	94416	41	Internal Medicine	0	In state provider	None	9921 SIERRA AVE	None	FONTANA	CA	92335	3720	36	06071	34.07362663	-117.4356118	San Bernardino County
87016	Fee-for-Service	1629768965	1629768965	1	1	AMARE, MESERET ABERA	6/20/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5904 ISAAC WAY	None	ELK GROVE	CA	95757	5954	34	06067	38.392335	-121.4339085	Sacramento County
87021	Fee-for-Service	1164581641	1164581641	1	1	AHUJA, NEERA K MD	12/1/2009	207R00000X	NA	Other	026	PHYSICIANS	53175	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
87044	Fee-for-Service	1750465472	1750465472	1	1	ANDERSEN, BETH MD	8/10/2023	208800000X	NA	Other	026	PHYSICIANS	186314	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
87060	Fee-for-Service	1689840076	1689840076	1	2	ARIF RAHMAN M.D.	7/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	18951 N MEMORIAL DR	None	HUMBLE	TX	77338	4217	00	None	29.99481341	-95.2753651	Harris County
87073	Fee-for-Service	1093277683	1093277683	1	1	ALLAN, CHRISTIE L LMFT	2/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
87102	Fee-for-Service	1750325817	1750325817	1	1	AYRIAN, EUGENIA MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	66671	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
87105	Fee-for-Service	1992742738	1992742738	1	1	AREVALO, ELVIA D MD	12/10/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79728	05	Anesthesiology	0	In state provider	None	507 S ATLANTIC BLVD	None	LOS ANGELES	CA	90022	2621	19	06037	34.0269721	-118.1553658	Los Angeles County
87121	Fee-for-Service	1952388852	1952388852	1	1	ABDEL-MALEK, MICHAEL MD	8/2/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72463	41	Internal Medicine	0	In state provider	None	1258 CONCANNON BLVD	None	LIVERMORE	CA	94550	6002	01	06001	37.6609605	-121.7789055	Alameda County
87139	Fee-for-Service	1225017098	1225017098	1	1	AUSTIN JOHN MARK MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 THOMPSON ST	None	ST PAUL	MN	55102	2370	00	None	44.94428014	-93.10733608	Ramsey County
87158	Fee-for-Service	1801220165	1801220165	1	1	ADL BEST CARE LLC	11/1/2016	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5433 MONROE ST	None	HOLLYWOOD	CA	90038	4059	19	06037	34.08579352	-118.312479	Los Angeles County
87159	Fee-for-Service	1285162834	1285162834	1	1	AV HOLDING, INC	3/1/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	4836 W WASHINGTON BLVD	None	LOS ANGELES	CA	90016	1519	19	06037	34.03980872	-118.3448235	Los Angeles County
87163	Fee-for-Service	1194750539	1194750539	1	1	AMY BETH CORLISS M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	KAUAI MEDICAL CLINIC	3-3420 KUHIO HIGHWAY	None	LIHUE	HI	96766	1099	00	None	21.98560043	-159.3663628	Kauai County
87168	Fee-for-Service	1194391417	1194391417	1	1	ALLSTAR HOSPICE CARE INC	9/22/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2626 FOOTHILL BLVD	STE 203	LA CRESCENTA	CA	91214	3574	19	06037	34.22187547	-118.2363189	Los Angeles County
87171	Fee-for-Service	1235286436	1235286436	1	1	AKHAVAN, PARVIZ DO	2/22/2010	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	7522	02	General Surgery	0	In state provider	None	723 E MANCHESTER AVENUE	None	LOS ANGELES	CA	90001	3632	19	06037	33.96015588	-118.2621099	Los Angeles County
87173	Fee-for-Service	1326058777	1326058777	1	1	ATREYA, CHLOE E MD	6/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104445	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
87188	Fee-for-Service	1265410187	1265410187	1	1	ALMANZA, MONICA Y MD	3/10/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73586	41	Internal Medicine	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
87193	Fee-for-Service	1053794180	1053794180	1	1	AVIV, RACHEL M MD	11/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147322	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
87214	Fee-for-Service	1760427579	1760427579	2	1	ALLEN, EUGENE DO	7/15/2011	207P00000X	NA	Other	026	PHYSICIANS	6802	66	Emergency Medicine (Urgent Care)	0	In state provider	None	701 E 28TH ST	STE 401	LONG BEACH	CA	90806	4923	19	06037	33.80803441	-118.1847137	Los Angeles County
87215	Fee-for-Service	1952326977	1952326977	1	1	AMISUB SAINT FRANCIS	2/15/2006	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL INC	5959 PARK AVE	None	MEMPHIS	TN	38119	5200	00	None	35.09992047	-89.8632855	Shelby County
87224	Fee-for-Service	1558502963	1558502963	1	1	ACE MEDICAL SERVICES, INC.	7/31/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ACE MED EQUIP SUPPLY CO	248 E HIGHLAND AVE	STE 2	SAN BERNARDINO	CA	92404	3710	36	06071	34.13596553	-117.281088	San Bernardino County
87228	Fee-for-Service	1164689972	1164689972	1	1	ARREDONDO, ANTHONY F MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111910	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365,120,420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
87239	Fee-for-Service	1487046231	1487046231	1	1	ADVOCARE HOSPICE, INC	11/16/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	12419 LEWIS STREET	SUITE 106	GARDEN GROVE	CA	92840	4655	30	06059	33.78299909	-117.8978174	Orange County
87253	Fee-for-Service	1841387214	1841387214	1	1	ACUTE CARE ASSOCIATES	12/27/2016	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	INPATIENT MEDICAL GROUP	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
87267	Fee-for-Service	1255542601	1255542601	1	1	ALTAMED MEDICAL & DENTAL	3/17/2004	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	GROUP, WHITTIER WEST	3945 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2440	19	06037	34.02394552	-118.187748	Los Angeles County
87271	Fee-for-Service	1588897045	1588897045	1	1	AFTAB, UNBER MD	5/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137317	41	Internal Medicine	0	In state provider	None	8540 S SEPULVEDA BLVD	STE 818-A	LOS ANGELES	CA	90045	3808	19	06037	33.96022076	-118.3961982	Los Angeles County
87273	Fee-for-Service	1497203806	1497203806	1	1	ALLETAG, DANIELLE NP	12/16/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	15	06029	35.3687456	-119.1106561	Kern County
87276	Fee-for-Service	1972527414	1972527414	1	1	ABEMAYOR, ELLIOT MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	46780	84	Surgery-Head and Neck	0	In state provider	None	10833 LE CONTE AVE	# 62-132	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
87288	Fee-for-Service	1457481772	1457481772	1	1	ALCANTAR, VICTOR LMFT	3/13/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	41174	-	NOT APPLICABLE	0	In state provider	None	21545 CNTRE POINTE PRKWY	None	SANTA CLARITA	CA	91350	2947	19	06037	34.413021	-118.514534	Los Angeles County
87290	Fee-for-Service	1962059857	1962059857	1	1	ALPHA PLUS HOSPICE	1/21/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1102 SAN FERNANDO RD	SUITE 205	SAN FERNANDO	CA	91340	3299	19	06037	34.28299646	-118.4418413	Los Angeles County
87303	Fee-for-Service	1629768965	1629768965	1	1	AMARE, MESERET ABERA	6/20/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5904 ISAAC WAY	None	ELK GROVE	CA	95757	5954	34	06067	38.392335	-121.4339085	Sacramento County
87308	Fee-for-Service	1164581641	1164581641	1	1	AHUJA, NEERA K MD	12/1/2009	207R00000X	NA	Other	026	PHYSICIANS	53175	40	Pediatrics	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
87320	Fee-for-Service	1720435084	1720435084	1	1	AUJLA, GURPREET K LMFT	12/9/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
87323	Fee-for-Service	1760740286	1760740286	1	1	ATTARI, HUMA Y MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143463	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
87345	Fee-for-Service	1770688640	1770688640	1	1	ABDALI, GHEZAL OD	11/30/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	516 E PALMDALE BLVD	None	PALMDALE	CA	93550	4603	19	06037	34.57961309	-118.1198918	Los Angeles County
87369	Fee-for-Service	1174106306	1174106306	1	1	ALISO RIDGE BEHAVIORAL	8/25/2022	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	HEALTH LLC	200 FREEDOM LANE	None	ALISO VIEJO	CA	92656	5876	30	06059	33.56235125	-117.7282117	Orange County
87401	Fee-for-Service	1871362186	1871362186	1	1	ANTEDAR PSYCHIATRIC NURSING	12/17/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	PROFESSIONAL SERVICES, I	710 N EUCLID ST	STE 208	ANAHEIM	CA	92801	4132	30	06059	33.8420837	-117.9415765	Orange County
87420	Fee-for-Service	1174977102	1174977102	1	1	ALI, SAIF MD	1/3/2023	207R00000X	NA	Other	026	PHYSICIANS	161008	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
87424	Fee-for-Service	1033144704	1033144704	1	2	ABRAHAM, GIZEL A MD	10/19/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	53854	40	Pediatrics	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
87455	Fee-for-Service	1194391417	1194391417	1	1	ALLSTAR HOSPICE CARE INC	9/22/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2626 FOOTHILL BLVD	STE 203	LA CRESCENTA	CA	91214	3574	19	06037	34.22187547	-118.2363189	Los Angeles County
87470	Fee-for-Service	1780092262	1780092262	1	6	ASHER SHAHZAD MD PC	11/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	77	Infectious Disease	1	Border provider	None	2075 E FLAMINGO ROAD	None	LAS VEGAS	NV	89119	5188	00	None	36.112671	-115.1248725	Clark County
87474	Fee-for-Service	1265410187	1265410187	1	1	ALMANZA, MONICA Y MD	3/10/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73586	30	Radiology	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
87479	Fee-for-Service	1528352499	1528352499	1	1	ARUK KANNAPPAN	2/13/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
87485	Fee-for-Service	1578780797	1578780797	1	1	AHARON-EZER, JANICE M LMFT	1/21/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
87487	Fee-for-Service	1619067238	1619067238	1	1	ABEL, EVAN D MD	11/30/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	180511	None	None	0	In state provider	None	1245 16TH STREET	303	SANTA MONICA	CA	90404	1265	19	06037	34.02726451	-118.4857138	Los Angeles County
87495	Fee-for-Service	1043442197	1043442197	1	1	AYODELE, MARANATHA O MD	5/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115049	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	SUITE B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
87515	Fee-for-Service	1164689972	1164689972	1	1	ARREDONDO, ANTHONY F MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111910	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365,120,420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
87517	Fee-for-Service	1023593530	1023593530	1	1	ABBOTT, DANA H OT	3/26/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1922 HACIENDA DR	None	VISTA	CA	92081	0000	37	06073	33.1855682	-117.2834788	San Diego County
87542	Fee-for-Service	1841387214	1841387214	1	1	ACUTE CARE ASSOCIATES	7/17/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	INPATIENT MEDICAL GROUP	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
87551	Fee-for-Service	1265510978	1265510978	1	1	AUZA, JOHN C MD	3/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89286	36	Psychiatry	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
87560	Fee-for-Service	1255542601	1255542601	1	1	ALTAMED MEDICAL & DENTAL	1/5/2005	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	GROUP, WHITTIER WEST	3945 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2440	19	06037	34.02394552	-118.187748	Los Angeles County
87577	Fee-for-Service	1962059857	1962059857	1	1	ALPHA PLUS HOSPICE	1/21/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1102 SAN FERNANDO RD	SUITE 205	SAN FERNANDO	CA	91340	3299	19	06037	34.28299646	-118.4418413	Los Angeles County
87585	Fee-for-Service	1538883681	1538883681	1	1	AVILA, IMELDA LCSW	1/10/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
87592	Fee-for-Service	1093196214	1093196214	1	1	AM-PM HOSPICE SERVICES INC	1/30/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1155 N CENTRAL AVE	STE 104	GLENDALE	CA	91202	2527	19	06037	34.16347353	-118.2569192	Los Angeles County
87603	Fee-for-Service	1275698615	1275698615	2	1	AEGIS TREATMENT CENTERS LLC	3/27/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	125 WEST F ST	SUITE 101	ONTARIO	CA	91762	3201	36	06071	34.069302	-117.652158	San Bernardino County
87625	Fee-for-Service	1548220551	1548220551	1	1	ACOSTA, LUIS MD	8/14/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	72214	08	Family Practice	0	In state provider	None	222 W EULALIA ST	STE 201	GLENDALE	CA	91204	2851	19	06037	34.12653215	-118.257121	Los Angeles County
87630	Fee-for-Service	1386960904	1386960904	1	1	ALLEE, TINA M MD	9/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109503	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
87638	Fee-for-Service	1194020073	1194020073	1	1	ADVANCED HOME HEALTH	7/12/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	AND HOSPICE INC	4362 AUBURN BLVD	None	SACRAMENTO	CA	95841	4107	34	06067	38.645712	-121.3612425	Sacramento County
87655	Fee-for-Service	1164486395	1164486395	1	1	ALEXANDER BAXTER	5/17/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 FIRST AVENUE 27TH ST	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
87683	Fee-for-Service	1568980472	1568980472	1	1	APPLEGET, JOSEPH M CRNA	3/30/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
87757	Fee-for-Service	1780092262	1780092262	1	6	ASHER SHAHZAD MD PC	11/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2075 E FLAMINGO ROAD	None	LAS VEGAS	NV	89119	5188	00	None	36.112671	-115.1248725	Clark County
87761	Fee-for-Service	1861525511	1861525511	1	1	ALEMI, FARZAD MD	6/29/2020	208600000X	NA	General Surgery	026	PHYSICIANS	103262	02	General Surgery	0	In state provider	None	1505 WILSON TER STE 150	150	GLENDALE	CA	91206	4076	19	06037	34.14960934	-118.2313491	Los Angeles County
87762	Fee-for-Service	1265410187	1265410187	1	1	ALMANZA, MONICA Y MD	3/10/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	73586	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
87777	Fee-for-Service	1730321589	1730321589	1	1	AMIN, ANISH MD	2/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152861	66	Emergency Medicine (Urgent Care)	0	In state provider	None	275 MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
87841	Fee-for-Service	1255542601	1255542601	1	1	ALTAMED MEDICAL & DENTAL	3/17/2004	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	GROUP, WHITTIER WEST	3945 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2440	19	06037	34.02394552	-118.187748	Los Angeles County
87849	Fee-for-Service	1720136716	1720136716	1	1	AUYEUNG, YANYING MD	5/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64525	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
87878	Fee-for-Service	1093196214	1093196214	1	1	AM-PM HOSPICE SERVICES INC	1/30/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1155 N CENTRAL AVE	STE 104	GLENDALE	CA	91202	2527	19	06037	34.16347353	-118.2569192	Los Angeles County
87881	Fee-for-Service	1962676627	1962676627	1	1	AMIRI, JULIANA LMFT	2/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
87894	Fee-for-Service	1275698615	1275698615	2	1	AEGIS TREATMENT CENTERS LLC	1/11/2014	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	125 WEST F ST	SUITE 101	ONTARIO	CA	91762	3201	36	06071	34.069302	-117.652158	San Bernardino County
87895	Fee-for-Service	1730263617	1730263617	1	1	ALTER, MARK D MD	7/8/2023	2084P0804X	NA	Psychiatry	026	PHYSICIANS	161292	None	None	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
87899	Fee-for-Service	1811755861	1811755861	1	1	ALFARO, JESSICA L LMFT	4/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
87926	Fee-for-Service	1194020073	1194020073	1	1	ADVANCED HOME HEALTH	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	AND HOSPICE INC	4362 AUBURN BLVD	None	SACRAMENTO	CA	95841	4107	34	06067	38.645712	-121.3612425	Sacramento County
87936	Fee-for-Service	1932229291	1932229291	1	1	ANDOLSEN, RICHARD J MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	31940	08	Family Practice	0	In state provider	A PROFESSIONAL CORP	465 MARCH AVE	STE A	HEALDSBURG	CA	95448	3371	49	06097	38.62593845	-122.8639725	Sonoma County
87970	Fee-for-Service	1114126646	1114126646	1	1	ANDERSEN, ROBIN M NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
87988	Fee-for-Service	1598740177	1598740177	1	1	AIDS HEALTHCARE FOUNDATION	3/10/1994	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	4835 VAN NUYS BLVD	STE 200	SHERMAN OAKS	CA	91403	2139	19	06037	34.1587068	-118.4487394	Los Angeles County
88048	Fee-for-Service	1538607049	1538607049	1	1	AMIGO BABY THERAPY SERVICES	3/20/2020	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	1901 N RICE AVE	SUITE 170 & 180	OXNARD	CA	93030	7912	56	06111	34.21960355	-119.1421345	Ventura County
88079	Fee-for-Service	1619397031	1619397031	1	1	ALIMONOS, LYSISTRATI A	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14919	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	823 GATEWAY CTR WAY	None	SAN DIEGO	CA	92102	4541	37	06073	32.71503452	-117.1134945	San Diego County
88107	Fee-for-Service	1295014710	1295014710	1	1	ABUABA, ROMANO MD	2/9/2021	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1550 S POTOMAC ST	SUITE 110	AURORA	CO	80012	5414	00	None	39.689235	-104.830335	Arapahoe County
88123	Fee-for-Service	1275841629	1275841629	2	1	ADVENTIST HEALTH MEDICAL	11/1/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER TEHACHAPI	105 WEST E STREET	None	TEHACHAPI	CA	93561	1607	15	06029	35.13003699	-118.4481914	Kern County
88124	Fee-for-Service	1164803300	1164803300	1	1	ALPERSTEIN, ADAM S MD	7/6/2021	207RC0200X	NA	Other	026	PHYSICIANS	171103	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
88143	Fee-for-Service	1225399231	1225399231	1	1	ASSESSMENT CONSULTATION	11/9/2018	193400000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	COUNSELING AND EDUCATION	27268 VIA INDUSTRIA	None	TEMECULA	CA	92590	3751	33	06065	33.50883542	-117.1833694	Riverside County
88151	Fee-for-Service	1679626436	1679626436	2	1	AZUL MEDICAL CLINIC INC	10/14/2014	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	6517 EASTERN AVE	None	BELL GARDENS	CA	90201	3003	19	06037	33.97370784	-118.1640782	Los Angeles County
88169	Fee-for-Service	1871543702	1871543702	1	1	AHERN, KRISTINE V MD	3/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	69488	07	Dermatology	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
88194	Fee-for-Service	1598292435	1598292435	1	1	AEVUM HOME HEALTH INC.	2/8/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	461B HILL ST	None	SAN LUIS OBISPO	CA	93405	2325	40	06079	35.28436098	-120.6699746	San Luis Obispo County
88195	Fee-for-Service	1518505759	1518505759	1	1	ALEJOS, GABRIELA A LCSW	6/8/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
88207	Fee-for-Service	1629456553	1629456553	1	1	ATTENELLO, JOHN D MD	7/24/2020	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	166979	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
88220	Fee-for-Service	1124653126	1124653126	1	1	AU HOMES INC	11/4/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7036 VAN BUREN WAY	None	BUENA PARK	CA	90620	3832	30	06059	33.83821736	-118.0104138	Orange County
88228	Fee-for-Service	1063465557	1063465557	1	2	A&T HEALTHCARE SERVICES INC	9/17/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12440 FIRESTONE BLVD	STE 240	NORWALK	CA	90650	4339	19	06037	33.90523023	-118.0681168	Los Angeles County
88251	Fee-for-Service	1902257868	1902257868	1	1	ALMAHMOUD, MOHANAD MD	5/1/2023	2084A2900X	NA	Neurology	026	PHYSICIANS	185587	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
88261	Fee-for-Service	1295955938	1295955938	1	1	ALI, ALIJA DO	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	6561	41	Internal Medicine	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
88269	Fee-for-Service	1144088436	1144088436	1	1	ADVENTIST HEALTH PHYSICIANS	10/9/2024	207V00000X	NA	Obstetrics & Gynecology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1220 LAS TABLAS RD	1418	TEMPLETON	CA	93465	9756	40	06079	35.55442452	-120.7211175	San Luis Obispo County
88270	Fee-for-Service	1487766176	1487766176	1	1	ASK, MIHRAN N MD	9/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	42159	41	Internal Medicine	0	In state provider	None	1454 E 2ND STREET	None	SAN BERNARDINO	CA	92408	0118	36	06071	34.1035953	-117.2563723	San Bernardino County
88348	Fee-for-Service	1932762341	1932762341	1	1	AJIB, FAYEZ DO	1/12/2023	207P00000X	NA	Other	026	PHYSICIANS	19600	None	None	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
88378	Fee-for-Service	1205107653	1205107653	1	1	AHARONIAN, HAIG H MD	7/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124502	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
88383	Fee-for-Service	1235250234	1235250234	1	1	AMPLEX HEARING CENTERS	1/1/1979	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	GRADY MAGURES	1139 GRAY AVE	None	YUBA CITY	CA	95991	3208	51	06101	39.145338	-121.6301835	Sutter County
88387	Fee-for-Service	1134384779	1134384779	1	1	AQUINO, FEMA B MD	9/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	6900 N DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
88410	Fee-for-Service	1275841629	1275841629	2	1	ADVENTIST HEALTH MEDICAL	11/1/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER TEHACHAPI	105 WEST E STREET	None	TEHACHAPI	CA	93561	1607	15	06029	35.13003699	-118.4481914	Kern County
88413	Fee-for-Service	1336472638	1336472638	1	1	AAA HEALTHCARE PRODUCTS INC	10/25/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	18529 ROSCOE BLVD	None	NORTHRIDGE	CA	91324	4632	19	06037	34.22075552	-118.5373395	Los Angeles County
88415	Fee-for-Service	1902919160	1902919160	1	1	AUSMAN, JAMES I MD	12/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	30374	14	Neurological Surgery	0	In state provider	None	300 MEDICAL PLAZA	STE 200	LOS ANGELES	CA	90024	0000	19	06037	34.06473399	-118.445865	Los Angeles County
88428	Fee-for-Service	1194057190	1194057190	1	1	ALFARO, JOSE O LMFT	8/16/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1805 W AVE K	STE 203C	LANCASTER	CA	93534	5856	19	06037	34.67503146	-118.163763	Los Angeles County
88489	Fee-for-Service	1861796161	1861796161	1	1	ARLINGTON PHYSICIANS CHOICE	3/30/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	A MEDICAL CORPORATION	8151 ARLINGTON AVE	STE U-V	RIVERSIDE	CA	92503	0437	33	06065	33.946337	-117.4592707	Riverside County
88503	Fee-for-Service	1306452008	1306452008	1	1	AMAZING GRACE CARE SERVICES	6/1/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	43 SITARA STREET	None	BEAUMONT	CA	92223	6833	33	06065	33.92035775	-116.9502654	Riverside County
88511	Fee-for-Service	1861169237	1861169237	1	1	ACEVES SANTIAGO, ANTONIO M L	1/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
88515	Fee-for-Service	1609332493	1609332493	1	1	AMD ALTERNATIVE CARE	3/19/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SERVICES LLC	2639 SHEPPARD WAY	None	ANTIOCH	CA	94509	4354	07	06013	37.99927527	-121.855469	Contra Costa County
88563	Fee-for-Service	1245755586	1245755586	1	1	ABDELMALAK, SAMEH LMFT	1/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	100 N BRAND BLVD	STE 223	GLENDALE	CA	91203	2641	19	06037	34.14652066	-118.2549229	Los Angeles County
88572	Fee-for-Service	1508148685	1508148685	1	1	ALSTON-STEPNITZ, KIMBERLY C	4/2/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
88620	Fee-for-Service	1851306401	1851306401	1	1	ARPAWONG, KUMTORN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	32210	05	Anesthesiology	0	In state provider	CHINO GENERAL HOSP	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
88651	Fee-for-Service	1356499156	1356499156	1	1	ARNOLD, CHRISTOPHER D DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	8181	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	2438 N PONDEROSA DR	STE 213	CAMARILLO	CA	93010	2374	56	06111	34.24219545	-119.0227012	Ventura County
88700	Fee-for-Service	1275841629	1275841629	2	1	ADVENTIST HEALTH MEDICAL	11/1/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CENTER TEHACHAPI	105 WEST E STREET	None	TEHACHAPI	CA	93561	1607	15	06029	35.13003699	-118.4481914	Kern County
88709	Fee-for-Service	1265172266	1265172266	1	2	AE URGENT CARE - VAN NUYS	4/22/2024	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	14614 VICTORY BLVD.	None	VAN NUYS	CA	91411	1621	19	06037	34.18663148	-118.451421	Los Angeles County
88720	Fee-for-Service	1649358318	1649358318	1	1	AWAN, TAYYIBA MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	26641	None	None	0	In state provider	UCD PROF SVCS GRP	2233 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.555946	-121.45743	Sacramento County
88777	Fee-for-Service	1083857742	1083857742	1	1	ALLERGY ASTHMA SINUS MEDICAL	11/8/2010	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	CENTER	4644 LINCOLN BLVD	STE 410	MARINA DEL REY	CA	90292	6390	19	06037	33.98210351	-118.4405172	Los Angeles County
88781	Fee-for-Service	1770116618	1770116618	1	1	ANDERSONRX, INC	3/23/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2940 EAST ST	None	ANDERSON	CA	96007	3411	45	06089	40.45107638	-122.2980834	Shasta County
88807	Fee-for-Service	1336446236	1336446236	1	1	ABDEL AZIZ, HALA M MD	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128658	22	Pathology (M.D. only)	0	In state provider	None	18300 HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
88816	Fee-for-Service	1669845442	1669845442	1	1	ALLERGY AND ASTHMA SPECIALTY	5/9/2016	193400000X	NA	Other	026	PHYSICIANS	9958	03	Allergy	0	In state provider	CENTER INC	9220 HAVEN AVE	STE 101	RANCHO CUCAMONGA	CA	91730	8551	36	06071	34.08525	-117.5758875	San Bernardino County
88889	Fee-for-Service	1013996370	1013996370	1	1	ALLARI, TIMOTHY W MD	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	60077	41	Internal Medicine	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
88916	Fee-for-Service	1720168016	1720168016	1	1	ANDREWS, KEITH A MD	9/1/1998	207R00000X	NA	Other	026	PHYSICIANS	55248	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
88931	Fee-for-Service	1194187609	1194187609	1	1	A&M MIRACLE HOME HEALTH CARE	11/7/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	10523 BURBANK BLVD	SUITE 203	NORTH HOLLYWOOD	CA	91601	2233	19	06037	34.17216449	-118.36017	Los Angeles County
88940	Fee-for-Service	1356499156	1356499156	1	1	ARNOLD, CHRISTOPHER D DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	8181	08	Family Practice	0	In state provider	INC	2438 N PONDEROSA DR	STE 213	CAMARILLO	CA	93010	2374	56	06111	34.24219545	-119.0227012	Ventura County
88957	Fee-for-Service	1831618040	1831618040	1	1	ABBOT HOSPICE INC	9/16/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11010 ARROW ROUTE	SUITE 102	RANCHO CUCAMONGA	CA	91730	4851	36	06071	34.09911651	-117.563661	San Bernardino County
88986	Fee-for-Service	1467557363	1467557363	1	1	AHMAD, TARIQ E MD	2/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83784	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
88997	Fee-for-Service	1265172266	1265172266	1	2	AE URGENT CARE - VAN NUYS	4/22/2024	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	14614 VICTORY BLVD.	None	VAN NUYS	CA	91411	1621	19	06037	34.18663148	-118.451421	Los Angeles County
89043	Fee-for-Service	1184324014	1184324014	1	2	ABAT, NEFRETIRI B NP	2/21/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95024411	-	NOT APPLICABLE	0	In state provider	None	510 EAST MAGNOLIA ST	100	STOCKTON	CA	95202	1812	39	06077	37.96446348	-121.2872245	San Joaquin County
89050	Fee-for-Service	1023402310	1023402310	1	1	ARTENSTEIN, DANIEL MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143978	34	Urology and Urological Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
89066	Fee-for-Service	1134513500	1134513500	1	1	ALCON, ANDRE MD	8/11/2023	208200000X	NA	General Surgery	026	PHYSICIANS	145806	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
89070	Fee-for-Service	1881950632	1881950632	1	2	ASHER, AVA MD	12/13/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	127049	-	NOT APPLICABLE	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
89095	Fee-for-Service	1457646978	1457646978	1	1	ASANTE-ACKUAYI, LINDA A MD	11/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116723	26	Psychiatry (child)	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
89099	Fee-for-Service	1225874035	1225874035	1	1	ANUSHREE GUPTA, M.D., INC.	11/16/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	6850 BROCKTON AVE STE 10	None	RIVERSIDE	CA	92506	3814	33	06065	33.9493261	-117.3967206	Riverside County
89115	Fee-for-Service	1841473618	1841473618	1	1	AWAI, HANNAH I MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112363	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
89127	Fee-for-Service	1962504654	1962504654	1	1	ALLCARE MED SUPPLY CORP	9/24/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ALLCARE MED SUPPLY CORP	8937 S. WESTERN AVENUE	None	LOS ANGELES	CA	90047	3549	19	06037	33.955254	-118.309048	Los Angeles County
89150	Fee-for-Service	1083233654	1083233654	1	1	ALL IN ONE CLINIC INC	5/31/2022	261QP2300X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	11843 WHITTIER BLVD	None	WHITTIER	CA	90601	3941	19	06037	33.98063769	-118.0503687	Los Angeles County
89171	Fee-for-Service	1861250847	1861250847	1	1	AYUCARE INFUSION LLC	3/25/2024	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16029 ARROW HWY STE C	None	IRWINDALE	CA	91706	2066	19	06037	34.10708536	-117.9318828	Los Angeles County
89202	Fee-for-Service	1720168016	1720168016	1	1	ANDREWS, KEITH A MD	9/1/1998	207R00000X	NA	Other	026	PHYSICIANS	55248	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
89221	Fee-for-Service	1386662575	1386662575	1	1	ARORA, BHAVANA K MD	11/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78311	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
89242	Fee-for-Service	1518127521	1518127521	1	1	AHMADZIA, SHAYIQ MD	11/12/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	445 EATON AVE	None	TRACY	CA	95376	3420	39	06077	37.74351322	-121.417915	San Joaquin County
89249	Fee-for-Service	1083154074	1083154074	1	1	ALSO HOME HEALTH CARE INC	12/20/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	224 E OLIVE AVE	STE 305	BURBANK	CA	91502	1251	19	06037	34.18109046	-118.3084839	Los Angeles County
89250	Fee-for-Service	1831618040	1831618040	1	1	ABBOT HOSPICE INC	9/16/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11010 ARROW ROUTE	SUITE 102	RANCHO CUCAMONGA	CA	91730	4851	36	06071	34.09911651	-117.563661	San Bernardino County
89264	Fee-for-Service	1861792442	1861792442	1	1	ANASTOPOULOS, PETER H MD	3/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119178	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 MALL DR	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
89272	Fee-for-Service	1467557363	1467557363	1	1	AHMAD, TARIQ E MD	2/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	83784	67	Endocrinology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
89282	Fee-for-Service	1144768862	1144768862	1	2	ARIZONA EM-I MEDICAL SERVICE	2/22/2024	207P00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	1	Border provider	S PC	11351 FRONTAGE RD	None	YUMA	AZ	85367	7862	00	None	32.67083959	-114.4379033	Yuma County
89289	Fee-for-Service	1194943944	1194943944	1	1	ALBA-VALENCIA, NICOLE R MD	10/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	94404	-	NOT APPLICABLE	0	In state provider	None	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	43	06085	37.34293689	-121.9270392	Santa Clara County
89313	Fee-for-Service	1669622361	1669622361	1	1	AVALOS, LISA L MD	2/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105152	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
89318	Fee-for-Service	1649478314	1649478314	1	1	AMMAR, TAREK MD	9/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	10	Gastroenterology (M.D. only)	1	Border provider	None	3006 S MARYLAND PKWY	STE 315	LAS VEGAS	NV	89109	6205	00	None	36.135288	-115.1368705	Clark County
89320	Fee-for-Service	1407046881	1407046881	1	1	ADVANCED DYNAMIC THERAPIES	3/24/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORP	644 E REGENTS STREET	SUITE 101	INGLEWOOD	CA	90301	1439	19	06037	33.96448447	-118.345059	Los Angeles County
89321	Fee-for-Service	1457442949	1457442949	1	1	ASGHARZADEH, SHAHAB MD	12/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74401	68	Hematology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
89322	Fee-for-Service	1386183721	1386183721	1	1	ALLEN-DUREN, EVETTE LMFT	10/21/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
89342	Fee-for-Service	1386722114	1386722114	1	1	AUNG, KYAW MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	56289	41	Internal Medicine	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
89346	Fee-for-Service	1073892477	1073892477	1	1	AHN, SANGMIN MD	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141480	25	Physical Medicine and Rehabilitation	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
89404	Fee-for-Service	1841473618	1841473618	1	1	AWAI, HANNAH I MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	112363	01	General Practice	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
89434	Fee-for-Service	1033506688	1033506688	1	1	ACHILIKE, SAVIOUR MD	8/28/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	166880	13	Neurology (M.D. only)	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
89463	Fee-for-Service	1407924475	1407924475	1	1	AHART, SUSAN L MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80538	36	Psychiatry	0	In state provider	None	509 7TH ST	None	SANTA ROSA	CA	95401	5265	49	06097	38.442258	-122.717124	Sonoma County
89467	Fee-for-Service	1912203787	1912203787	1	1	ALTURAS, SHANNON O OD A PC	5/16/2011	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3658 S NOGALES ST	None	WEST COVINA	CA	91792	2714	19	06037	34.0113478	-117.8866414	Los Angeles County
89494	Fee-for-Service	1790921872	1790921872	1	1	ARMENTA, AMALIA A MD APC	10/6/2009	207R00000X	NA	Other	026	PHYSICIANS	80646	41	Internal Medicine	0	In state provider	None	1808 VERDUGO BLVD	STE 408	GLENDALE	CA	91208	1488	19	06037	34.2056211	-118.2154553	Los Angeles County
89497	Fee-for-Service	1679962443	1679962443	1	1	ALMEIDA, BECKY R LMFT	8/10/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3 N COLLEGE ST	None	WOODLAND	CA	95695	3243	57	06113	38.684898	-121.774626	Yolo County
89512	Fee-for-Service	1396779732	1396779732	1	1	ARTZNER, THOMAS H MD	7/19/1988	207P00000X	NA	Other	026	PHYSICIANS	25670	66	Emergency Medicine (Urgent Care)	0	In state provider	None	316 FLUME ST	None	CHICO	CA	95928	5429	04	06007	39.73065032	-121.837428	Butte County
89525	Fee-for-Service	1285234302	1285234302	1	1	ANGELES FAMILY HOSPICE CARE	10/12/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	2505 FOOTHILL BLVD	STE E	LA CRESCENTA	CA	91214	4556	19	06037	34.21999881	-118.2330708	Los Angeles County
89555	Fee-for-Service	1114018694	1114018694	1	1	ABDEL-AZIM, HISHAM M MD	4/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79947	78	Neoplastic Diseases/Oncology	0	In state provider	None	4650 SUNSET BLVD	MS #62	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
89568	Fee-for-Service	1144768862	1144768862	1	2	ARIZONA EM-I MEDICAL SERVICE	2/22/2024	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	1	Border provider	S PC	11351 FRONTAGE RD	None	YUMA	AZ	85367	7862	00	None	32.67083959	-114.4379033	Yuma County
89583	Fee-for-Service	1538155932	1538155932	1	1	ARELLANO, ALVIN OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1909 W MALVERN AVE	None	FULLERTON	CA	92833	2177	30	06059	33.87730432	-117.9629117	Orange County
89609	Fee-for-Service	1457442949	1457442949	1	1	ASGHARZADEH, SHAHAB MD	12/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74401	78	Neoplastic Diseases/Oncology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
89614	Fee-for-Service	1962426825	1962426825	1	1	ALI, SYED D MD	1/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56104	41	Internal Medicine	0	In state provider	None	8110 LAGUNA BLVD	None	ELK GROVE	CA	95758	7904	34	06067	38.421306	-121.408173	Sacramento County
89689	Fee-for-Service	1306006655	1306006655	1	1	A-ONE MEDICAL GROUP INC APC	9/23/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	7715	08	Family Practice	0	In state provider	None	2705 S DIAMOND BAR BLVD	SUITE 100	DIAMOND BAR	CA	91765	3557	19	06037	33.97580639	-117.8361676	Los Angeles County
89716	Fee-for-Service	1760865208	1760865208	1	1	AUF DER SPRINGE, JENNIFER M	4/8/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144989	None	None	0	In state provider	D	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
89755	Fee-for-Service	1790757441	1790757441	1	1	ABDOLI, ABOLGHASEM MD	1/31/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	49572	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3555 ARMY ST	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.7479947	-122.4209132	San Francisco County
89784	Fee-for-Service	1972878072	1972878072	1	1	AHEARN, PATRICK C MD	4/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129551	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
89798	Fee-for-Service	1396779732	1396779732	1	1	ARTZNER, THOMAS H MD	7/19/1988	207P00000X	NA	Other	026	PHYSICIANS	25670	01	General Practice	0	In state provider	None	316 FLUME ST	None	CHICO	CA	95928	5429	04	06007	39.73065032	-121.837428	Butte County
89812	Fee-for-Service	1285234302	1285234302	1	1	ANGELES FAMILY HOSPICE CARE	10/12/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	2505 FOOTHILL BLVD	STE E	LA CRESCENTA	CA	91214	4556	19	06037	34.21999881	-118.2330708	Los Angeles County
89821	Fee-for-Service	1942830898	1942830898	1	1	ANGEL STORM HOSPICE CARE	10/5/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	5761 WHITNALL HWY	STE E	NORTH HOLLYWOOD	CA	91601	2101	19	06037	34.17572844	-118.3619999	Los Angeles County
89822	Fee-for-Service	1053355305	1053355305	1	1	ARIZONA CVS STORES LLC	1/19/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	1	Border provider	CVS PHARMACY #08802	131 W RIVERSIDE DR	None	PARKER	AZ	85344	5221	00	None	34.15561562	-114.2767301	La Paz County
89829	Fee-for-Service	1699806232	1699806232	1	1	ARKOSY, THOMAS L LMFT	8/13/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3831 HUGHES AVE	SUITE 708	CULVER CITY	CA	90232	6842	19	06037	34.02243278	-118.3981492	Los Angeles County
89843	Fee-for-Service	1114018694	1114018694	1	1	ABDEL-AZIM, HISHAM M MD	4/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79947	68	Hematology	0	In state provider	None	4650 SUNSET BLVD	MS #62	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
89875	Fee-for-Service	1306839543	1306839543	1	1	ALAN D SAVOY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10150 SE 32ND AVE	None	MILWAUKIE	OR	97222	6516	00	None	45.44944836	-122.6297748	Clackamas County
89890	Fee-for-Service	1003415613	1003415613	1	1	ANTELOPE VALLEY OUTPATIENT I	6/4/2021	2085R0202X	NA	Mammography/MRI Provider	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	MAGING CENTER, LLC	38925 TRADE CENTER DR	UNIT E	PALMDALE	CA	93551	3655	19	06037	34.59028112	-118.1433053	Los Angeles County
89893	Fee-for-Service	1609867506	1609867506	1	1	AUGUST, LAWRENCE N MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	27303	18	Ophthalmology	0	In state provider	None	520 N PROSPECT AVE	STE 206	REDONDO BEACH	CA	90277	3042	19	06037	33.8529819	-118.3802954	Los Angeles County
89919	Fee-for-Service	1588713184	1588713184	1	1	ALBRIGHT, ROSS A MD	1/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	932 RYLAND STREET	None	RENO	NV	89502	1605	00	None	39.52380293	-119.7998835	Washoe County
89939	Fee-for-Service	1295930782	1295930782	1	1	ADVANTAGE EYE CARE OPTOMETRY	4/20/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	1751 HARTNELL AVE	STE 1	REDDING	CA	96002	2219	45	06089	40.56370348	-122.3388585	Shasta County
89974	Fee-for-Service	1710091327	1710091327	1	1	AEROMEDEVAC, INC	6/7/1996	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1860 JOE CROSSON DR	HANGER I	EL CAJON	CA	92020	1227	37	06073	32.82394659	-116.9697869	San Diego County
90004	Fee-for-Service	1952475493	1952475493	1	1	ANGWIN COMMUNITY AMBULAN	1/1/1979	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	P O BOX 947	275 COLLEGE AVE	None	ANGWIN	CA	94508	9722	28	06055	38.5759044	-122.4444618	Napa County
90020	Fee-for-Service	1144265455	1144265455	1	1	AIKAWA, TARO MD	12/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101626	30	Radiology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
90037	Fee-for-Service	1407352883	1407352883	1	1	ARREDONDO, FELIPE O MD	8/18/2021	207R00000X	NA	Other	026	PHYSICIANS	167251	None	None	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
90040	Fee-for-Service	1790757441	1790757441	1	1	ABDOLI, ABOLGHASEM MD	1/31/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	49572	40	Pediatrics	0	In state provider	None	3555 ARMY ST	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.7479947	-122.4209132	San Francisco County
90041	Fee-for-Service	1679921241	1679921241	1	2	ADDICTION RESEARCH AND TREAT	10/27/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	89 E. MILL AVENUE	None	PORTERVILLE	CA	93257	3808	54	06107	36.06877628	-119.014426	Tulare County
90062	Fee-for-Service	1164447876	1164447876	1	1	ASUDANI, RUCHITA MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	105266	41	Internal Medicine	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
90090	Fee-for-Service	1255366837	1255366837	1	1	AUNG, MYO	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	44476	None	None	0	In state provider	None	1300 N VERMONT AVE	STE 600	LOS ANGELES	CA	90027	6098	19	06037	34.0956033	-118.2916918	Los Angeles County
90108	Fee-for-Service	1942830898	1942830898	1	1	ANGEL STORM HOSPICE CARE	10/5/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	5761 WHITNALL HWY	STE E	NORTH HOLLYWOOD	CA	91601	2101	19	06037	34.17572844	-118.3619999	Los Angeles County
90123	Fee-for-Service	1689142101	1689142101	1	1	AGUAYO, JAIME RCP	1/7/2025	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
90132	Fee-for-Service	1114018694	1114018694	1	1	ABDEL-AZIM, HISHAM M MD	4/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79947	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	MS #62	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
90143	Fee-for-Service	1295700474	1295700474	1	1	ACCURATE HOME HLTH CARE	5/26/2007	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	3505 HART AVE	SUITE 102	ROSEMEAD	CA	91770	2061	19	06037	34.07294437	-118.0687952	Los Angeles County
90146	Fee-for-Service	1104094531	1104094531	1	1	ALI, MOHSIN MD AMC	1/1/1982	193400000X	NA	Other	026	PHYSICIANS	36319	None	None	0	In state provider	None	5451 LA PALMA AVE	STE 16	LA PALMA	CA	90623	1729	30	06059	33.84643146	-118.038843	Orange County
90180	Fee-for-Service	1962180570	1962180570	1	1	ARINGO, CALLEB ONYANGO	9/6/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2452 DONATELLO STREET	None	MANTECA	CA	95337	8403	39	06077	37.78158218	-121.2598781	San Joaquin County
90261	Fee-for-Service	1144233370	1144233370	1	1	ABBOTT, DAVID S MD	12/1/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	65817	40	Pediatrics	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
90290	Fee-for-Service	1821144403	1821144403	1	1	ARJAL, RUSS R MD	9/1/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	171402	None	None	0	In state provider	None	1255 LAS TABLAS RD	STE 201	TEMPLETON	CA	93465	9750	40	06079	35.55437053	-120.721806	San Luis Obispo County
90300	Fee-for-Service	1801122767	1801122767	1	1	AUSTIN, MONTEITH D MD INC	11/19/2009	208600000X	NA	General Surgery	026	PHYSICIANS	98715	02	General Surgery	0	In state provider	None	470 N GREENFIELD AVE	STE 202	HANFORD	CA	93230	3589	16	06031	36.32996137	-119.6580167	Kings County
90346	Fee-for-Service	1982778585	1982778585	1	1	ALLY, RASHEEDA N MD	1/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92355	40	Pediatrics	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
90383	Fee-for-Service	1215565379	1215565379	1	1	ABUEG, MICHELLE R MD	9/24/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187190	08	Family Practice	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
90390	Fee-for-Service	1639225121	1639225121	1	1	ADVANI, RANJANA MD	9/30/1995	207RH0003X	NA	Oncology	026	PHYSICIANS	44422	None	None	0	In state provider	None	2680 HANOVER ST	STE 100	PALO ALTO	CA	94304	1117	43	06085	37.41744418	-122.1474815	Santa Clara County
90408	Fee-for-Service	1952326811	1952326811	1	2	AMPLA HEALTH	12/27/2021	261QF0400X	Both NEMT & NMT Provider	Federally Qualified Health Center	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	935 MARKET ST	STE B	YUBA CITY	CA	95991	4210	51	06101	39.145482	-121.614471	Sutter County
90413	Fee-for-Service	1225194582	1225194582	1	1	AMIT PANDYA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	REGENTS OF THE UNIVER	1500 E MEDICAL CENTER DR	None	ANN ARBOR	MI	48109	5000	00	None	42.28391347	-83.72716554	Washtenaw County
90422	Fee-for-Service	1376762088	1376762088	1	2	AKHBARATI, LAILA H	10/26/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	109333	-	NOT APPLICABLE	0	In state provider	None	5 MAREBLU	STE 100, 200, 250	ALISO VIEJO	CA	92656	3014	30	06059	33.57250566	-117.7027366	Orange County
90427	Fee-for-Service	1932180494	1932180494	1	1	ALEMAN-MARTIN, MARGIE F	5/31/1995	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	81236	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2299 MOWRY AVE	STE 3C	FREMONT	CA	94538	1621	01	06001	37.55671415	-121.9817758	Alameda County
90432	Fee-for-Service	1194357590	1194357590	1	1	ALLEN, ALEISHA L	12/12/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
90454	Fee-for-Service	1558997452	1558997452	1	2	AMASYALI, AKIN S MD	6/3/2022	208800000X	NA	Other	026	PHYSICIANS	178796	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2050	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
90470	Fee-for-Service	1962180570	1962180570	1	1	ARINGO, CALLEB ONYANGO	9/6/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2452 DONATELLO STREET	None	MANTECA	CA	95337	8403	39	06077	37.78158218	-121.2598781	San Joaquin County
90473	Fee-for-Service	1457302762	1457302762	1	1	ARTHRITIS ASSOC OF	2/27/1995	207RR0500X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	REDDING	2510 AIRPARK DR	STE 305	REDDING	CA	96001	2462	45	06089	40.57119566	-122.4016582	Shasta County
90478	Fee-for-Service	1336429000	1336429000	1	1	ADKINS SINGH, ASHVIND N PHD	7/16/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5100 E THE TOLEDO	None	LONG BEACH	CA	90803	5539	19	06037	33.76321266	-118.1338252	Los Angeles County
90491	Fee-for-Service	1992730709	1992730709	1	1	AZER, MAGED F MD	6/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53477	01	General Practice	0	In state provider	None	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	19	06037	34.0309884	-118.2642142	Los Angeles County
90495	Fee-for-Service	1275611352	1275611352	1	1	AMATO, MALENA M MD	10/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	65150	18	Ophthalmology	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
90542	Fee-for-Service	1649697947	1649697947	1	1	ALTMAN, ASHLEY C MD	11/21/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	160157	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
90545	Fee-for-Service	1699029306	1699029306	1	1	ASSESSMENT, CONSULTATION & T	6/10/2018	103K00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	REATMENT	2700 EAST FOOTHILL BLVD.	SUITE #100	PASADENA	CA	91107	7100	19	06037	34.14985464	-118.0947535	Los Angeles County
90558	Fee-for-Service	1487043329	1487043329	1	1	ADAMS-NERDAHL, TAMMI LMFT	5/11/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
90568	Fee-for-Service	1033179676	1033179676	1	1	ADILI-KHAMS, NAZITA MD	11/19/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	53969	01	General Practice	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
90606	Fee-for-Service	1396213302	1396213302	1	1	AMAZING GRACE OASIS II	3/16/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	8708 BRIDGEPORT AVE	None	HESPERIA	CA	92344	5562	36	06071	34.40865572	-117.3734349	San Bernardino County
90612	Fee-for-Service	1659852648	1659852648	1	1	ALLEN, JEFFERY K LPCC	4/15/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
90618	Fee-for-Service	1568809226	1568809226	1	2	AHN, RICHARD S MD	9/1/2019	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	162729	46	Hand Surgery	0	In state provider	None	3828 SCHAUFELE AVE	STE 320	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
90643	Fee-for-Service	1235185737	1235185737	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8440 E CHAPMAN AVE	None	ORANGE	CA	92869	2459	30	06059	33.7927103	-117.7632194	Orange County
90688	Fee-for-Service	1467561563	1467561563	1	1	APRIA HEALTHCARE LLC	12/1/1998	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2476 VERNA CT	None	SAN LEANDRO	CA	94577	4223	01	06001	37.70706742	-122.1716507	Alameda County
90699	Fee-for-Service	1598225062	1598225062	1	1	ASSALI, THOMAS S DO	11/14/2022	208M00000X	NA	Other	026	PHYSICIANS	19758	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
90702	Fee-for-Service	1740346303	1740346303	1	2	AEGIS TREATMENT CENTERS, LLC	5/15/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1825 E THELBORN STREET	None	WEST COVINA	CA	91791	1442	19	06037	34.07731718	-117.9071155	Los Angeles County
90706	Fee-for-Service	1376762088	1376762088	1	1	AKHBARATI, LAILA H MD	12/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109333	36	Psychiatry	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
90711	Fee-for-Service	1407102338	1407102338	1	1	ABDYRAKOV, ALMAZ	4/5/2022	207R00000X	NA	Other	026	PHYSICIANS	174653	None	None	0	In state provider	None	300 WEST HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
90729	Fee-for-Service	1447229851	1447229851	1	1	ARANO, SILVERIO P MD	6/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87306	08	Family Practice	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
90755	Fee-for-Service	1669462115	1669462115	1	1	ASFAHA, NIGIST MD	4/2/2008	207L00000X	NA	Other	026	PHYSICIANS	52081	05	Anesthesiology	0	In state provider	None	6601 WHITE FEATHER ROAD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
90761	Fee-for-Service	1457302762	1457302762	1	1	ARTHRITIS ASSOC OF	3/18/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	REDDING	2510 AIRPARK DR	STE 305	REDDING	CA	96001	2462	45	06089	40.57119566	-122.4016582	Shasta County
90779	Fee-for-Service	1992730709	1992730709	1	1	AZER, MAGED F MD	6/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53477	41	Internal Medicine	0	In state provider	None	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	19	06037	34.0309884	-118.2642142	Los Angeles County
90815	Fee-for-Service	1396936217	1396936217	1	1	ARDALAN, MARYAM MD	11/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102198	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	99 N LA CIENEGA	None	BEVERLY HILLS	CA	90211	2222	19	06037	34.06736471	-118.3763201	Los Angeles County
90831	Fee-for-Service	1699029306	1699029306	1	1	ASSESSMENT, CONSULTATION & T	6/10/2018	103K00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	REATMENT	2700 EAST FOOTHILL BLVD.	SUITE #100	PASADENA	CA	91107	7100	19	06037	34.14985464	-118.0947535	Los Angeles County
90853	Fee-for-Service	1538492830	1538492830	1	1	AWHC LLC CA LIMITED LIAB CO	10/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	240 HOSPITAL CIRCLE	None	WESTMINSTER	CA	92683	3953	30	06059	33.76421351	-117.99477	Orange County
90857	Fee-for-Service	1861592610	1861592610	1	1	ARROWHEAD RADIOLOGY	9/1/2004	2085N0904X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	MEDICAL GROUP INC	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
90867	Fee-for-Service	1215485305	1215485305	1	1	ADAL HEART2HEART PSYCHOTHERA	2/19/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PY SERVICES, INC.	27201 TOURNEY ROAD	SUITE 201	VALENCIA	CA	91355	5393	19	06037	34.41741018	-118.5770409	Los Angeles County
90879	Fee-for-Service	1982728960	1982728960	1	1	ABREU, ANEL M DO	11/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14556	20	Orthopedic Surgery	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
90908	Fee-for-Service	1568809226	1568809226	1	2	AHN, RICHARD S MD	9/1/2019	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	162729	20	Orthopedic Surgery	0	In state provider	None	3828 SCHAUFELE AVE	STE 320	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
90948	Fee-for-Service	1821540063	1821540063	1	1	ALEMI, AREZU LCSW	8/2/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
90953	Fee-for-Service	1528655438	1528655438	1	1	ANDREWS, JAMES NP	7/12/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3500 5TH AVE	103	SAN DIEGO	CA	92103	5020	37	06073	32.74173	-117.1604085	San Diego County
90961	Fee-for-Service	1841911773	1841911773	1	1	ARRAE HEALTH	10/13/2022	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	802 MAGNOLIA AVE	STE 205	CORONA	CA	92879	3144	33	06065	33.8596449	-117.5529774	Riverside County
90980	Fee-for-Service	1437268695	1437268695	1	1	ALAPATI, VENKATA SAMPATH K	4/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	53211	30	Radiology	0	In state provider	MD	1720 ESPLANADE	None	CHICO	CA	95926	3315	04	06007	39.74490068	-121.8505328	Butte County
90992	Fee-for-Service	1740346303	1740346303	1	2	AEGIS TREATMENT CENTERS, LLC	5/15/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1825 E THELBORN STREET	None	WEST COVINA	CA	91791	1442	19	06037	34.07731718	-117.9071155	Los Angeles County
91018	Fee-for-Service	1447229851	1447229851	1	1	ARANO, SILVERIO P MD	6/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87306	01	General Practice	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
91023	Fee-for-Service	1871575282	1871575282	1	1	ALPHA & OMEGA HEALTH INC	2/1/2005	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	DIAMOND MEDICAL SUPPLY	18919 COLIMA RD	None	ROWLAND HEIGHTS	CA	91748	2942	19	06037	33.98767704	-117.8912613	Los Angeles County
91048	Fee-for-Service	1073623492	1073623492	1	1	ACTON, DANIELLE O MD	1/1/1993	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55746	08	Family Practice	0	In state provider	None	212 SAN JOSE ST	STE 301	SALINAS	CA	93901	3928	27	06053	36.65853377	-121.6476066	Monterey County
91049	Fee-for-Service	1457302762	1457302762	1	1	ARTHRITIS ASSOC OF	3/18/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	REDDING	2510 AIRPARK DR	STE 305	REDDING	CA	96001	2462	45	06089	40.57119566	-122.4016582	Shasta County
91064	Fee-for-Service	1578384046	1578384046	1	1	ARMSTRONG, COURTNEY PHD	10/29/2024	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
91065	Fee-for-Service	1992730709	1992730709	1	1	AZER, MAGED F MD	6/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53477	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	19	06037	34.0309884	-118.2642142	Los Angeles County
91144	Fee-for-Service	1770149213	1770149213	1	1	AMBARTSUMYAN, TIRAN LMFT	2/10/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	138 N BRAND BLVD	STE 303	GLENDALE	CA	91203	4621	19	06037	34.147755	-118.2549335	Los Angeles County
91154	Fee-for-Service	1437430790	1437430790	1	1	ADULT CARE HOME HEALTH	3/18/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY INC	1007 S CENTRAL AVE	SUITE 103	GLENDALE	CA	91204	3970	19	06037	34.13452405	-118.2579006	Los Angeles County
91166	Fee-for-Service	1124349774	1124349774	1	1	AMIN, ARTI J MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130755	None	None	0	In state provider	None	3626 RUFFIN ROAD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
91176	Fee-for-Service	1427728815	1427728815	1	1	ANANDA ANALYTICAL LABORATORI	3/27/2023	291U00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	ES LLC	101 S 1ST ST	STE 1000	BURBANK	CA	91502	1928	19	06037	34.17942444	-118.3096895	Los Angeles County
91198	Fee-for-Service	1477815801	1477815801	1	1	ALLEN, CARRIE E LCSW	7/19/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	162 N SANTA FE ST	None	HEMET	CA	92543	4451	33	06065	33.74923371	-116.9629676	Riverside County
91202	Fee-for-Service	1750650982	1750650982	1	3	APEX RADIOLOGY MEDICAL GROUP	5/8/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	28400 MCCALL BLVD	None	SUN CITY	CA	92585	9658	33	06065	33.71805454	-117.1672547	Riverside County
91208	Fee-for-Service	1689203093	1689203093	1	1	AZAM, FAROOQUE	4/20/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
91210	Fee-for-Service	1609202308	1609202308	1	1	ALDAHHAN, NADINE DO	2/27/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	14150	01	General Practice	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
91246	Fee-for-Service	1669930723	1669930723	1	1	ADVENTIST HEALTH PHYSICIANS	11/30/2022	207RN0300X	NA	Nephrology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	111 RALEY BLVD	SUITE 160	CHICO	CA	95928	8351	04	06007	39.71601447	-121.790817	Butte County
91249	Fee-for-Service	1881677995	1881677995	2	1	AIR EVAC EMS INC	9/24/2023	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	54 MEDICAL CENTER DR	None	JACKSON	TN	38301	3947	00	None	35.63729246	-88.82922535	Madison County
91267	Fee-for-Service	1366777336	1366777336	1	1	AJAMIAN, LENA H MD	11/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108950	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
91298	Fee-for-Service	1346255254	1346255254	1	1	ABUBAKER, FIRAS MD	7/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	101953	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4834	36	06071	34.13502	-117.2758635	San Bernardino County
91302	Fee-for-Service	1700891900	1700891900	1	1	AGARWAL, MANOJ MD	3/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53155	78	Neoplastic Diseases/Oncology	0	In state provider	None	1020 29TH STREET	STE 680	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
91306	Fee-for-Service	1962447896	1962447896	1	1	AMENT, MARVIN E MD	1/1/1995	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	11555	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
91321	Fee-for-Service	1629205125	1629205125	1	1	ADVANCE MEDICAL EQUIPMENT	4/11/2011	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INC	8340 VAN NUYS BLVD	SUITE G	PANORAMA CITY	CA	91402	3608	19	06037	34.22300853	-118.4487264	Los Angeles County
91324	Fee-for-Service	1184856916	1184856916	1	1	AHMED, MOHAMMED M MD	7/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124696	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1908 SWEETWATER RD	None	NATIONAL CITY	CA	91950	7628	37	06073	32.66119079	-117.0786584	San Diego County
91373	Fee-for-Service	1568555225	1568555225	1	1	ABRAVESH, SUE MD INC	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	70930	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	600 CORPORATE DR	STE 100	LADERA RANCH	CA	92694	2107	30	06059	33.55834891	-117.6292039	Orange County
91418	Fee-for-Service	1912553090	1912553090	1	1	ADVENTIST HEALTH PHYSICIANS	1/2/2020	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	225 SPRUCE ST	None	GRIDLEY	CA	95948	2215	04	06007	39.36695351	-121.68954	Butte County
91437	Fee-for-Service	1144659491	1144659491	2	2	ALLERGY PARTNERS OF CALIFORN	1/12/2022	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	OUNTY	4050 BARRANCA PARKWAY,	SUITE 110	IRVINE	CA	92604	1723	30	06059	33.68293726	-117.8067799	Orange County
91463	Fee-for-Service	1326232513	1326232513	1	1	ARON, JONATHAN H MD	8/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101330	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RAOD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
91466	Fee-for-Service	1609808427	1609808427	1	1	AUSTIN, TODD A MD	12/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94630	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
91468	Fee-for-Service	1053146175	1053146175	1	1	ANAND M.D. MEDICAL CORP.	9/30/2024	193400000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	3250 SEPULVEDA BLVD	None	TORRANCE	CA	90505	2719	19	06037	33.82491629	-118.3437278	Los Angeles County
91470	Fee-for-Service	1114038064	1114038064	1	1	ATKINSON, NATHAN D MD	2/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110712	08	Family Practice	0	In state provider	None	7600 OLD DOMINION CT	None	APTOS	CA	95003	3821	44	06087	36.97913818	-121.9099818	Santa Cruz County
91478	Fee-for-Service	1710564570	1710564570	1	1	ANKU, BERTHA E MD	10/21/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
91496	Fee-for-Service	1871671453	1871671453	1	1	ACHARYA, MALATHI MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64136	None	None	0	In state provider	None	2800 BENEDICT DR	None	SAN LEANDRO	CA	94577	6840	01	06001	37.71593435	-122.131151	Alameda County
91499	Fee-for-Service	1972559961	1972559961	1	1	ACCENTCARE HOME HEALTH	5/11/1998	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA, INC	3170 CROW CANYON PL	STE 270	SAN RAMON	CA	94583	1157	07	06013	37.77547298	-121.9719797	Contra Costa County
91512	Fee-for-Service	1699775734	1699775734	1	1	AHMED, EJAZ MD	7/25/2014	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	63679	40	Pediatrics	0	In state provider	None	1510 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74228609	-121.8485808	Butte County
91542	Fee-for-Service	1063238525	1063238525	1	1	AGEKYAN, GAYANE CNP	1/30/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	511 N HOLLYWOOD WAY	None	BURBANK	CA	91505	3406	19	06037	34.15985598	-118.3431272	Los Angeles County
91561	Fee-for-Service	1225656572	1225656572	1	1	AMIT BAWA MD INC	7/13/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1836 GOLD ST	None	REDDING	CA	96001	1817	45	06089	40.57840961	-122.3946308	Shasta County
91563	Fee-for-Service	1417581711	1417581711	1	1	ANDREA KULBERG PHD	3/24/2022	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	225 E CARRILLO ST	304	SANTA BARBARA	CA	93101	2121	42	06083	34.42430069	-119.6989389	Santa Barbara County
91575	Fee-for-Service	1134793532	1134793532	1	1	ARAVA HOME HEALTH CARE, INC.	3/23/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	595 E COLORADO BLVD	SUITE 614A	PASADENA	CA	91101	2015	19	06037	34.14588202	-118.1380722	Los Angeles County
91576	Fee-for-Service	1225304942	1225304942	1	1	ASPEN MEDICAL GROUP INC	3/15/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	341 MAGNOLIA AVE	STE 201	CORONA	CA	92879	3332	33	06065	33.85291987	-117.5664344	Riverside County
91577	Fee-for-Service	1467626432	1467626432	1	1	ANDERSON, LESLIE K PHD	9/12/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
91579	Fee-for-Service	1053604918	1053604918	1	1	ALSHUWAYKH, HARITH H MD	8/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130669	41	Internal Medicine	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
91592	Fee-for-Service	1700891900	1700891900	1	1	AGARWAL, MANOJ MD	3/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53155	41	Internal Medicine	0	In state provider	None	1020 29TH STREET	STE 680	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
91596	Fee-for-Service	1619058237	1619058237	1	2	AGUILAR, CHRISTINE MD	4/1/2013	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	47 SAN BENANCIO ROAD	None	SALINAS	CA	93908	9133	27	06053	36.57635318	-121.7169598	Monterey County
91609	Fee-for-Service	1578805537	1578805537	1	1	AVESAR, MICHAEL MD	4/1/2018	2080P0203X	NA	Other	026	PHYSICIANS	141521	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
91700	Fee-for-Service	1760979678	1760979678	1	1	ALIKOZAI, FARHAD DO	1/20/2025	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
91703	Fee-for-Service	1386933349	1386933349	1	1	ANAHEIM-BUENA PARK REGIONAL	6/19/2024	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	DIALYSIS CENTER	3356 W BALL RD	SUITE 110	ANAHEIM	CA	92804	3702	30	06059	33.81726453	-118.007451	Orange County
91726	Fee-for-Service	1083608541	1083608541	1	1	AFFILIATES IN IMAGING	1/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	3012 SUMMIT ST	None	OAKLAND	CA	94609	3480	01	06001	37.81947101	-122.264516	Alameda County
91729	Fee-for-Service	1922234293	1922234293	1	1	ARCE, TYRONE MD INC	4/7/2009	207R00000X	NA	Other	026	PHYSICIANS	56377	41	Internal Medicine	0	In state provider	TYRONE ARCE MD INC	121 S MAIN ST	None	LAKE ELSINORE	CA	92530	4108	33	06065	33.66767673	-117.327843	Riverside County
91736	Fee-for-Service	1124106968	1124106968	1	1	ARROYO, FLORDELINA O MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71042	40	Pediatrics	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
91740	Fee-for-Service	1225156888	1225156888	1	1	AURORA HEALTH CARE SOUTH	9/14/2008	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	10400 75TH ST	None	KENOSHA	WI	53142	7884	00	None	42.56982	-87.935364	Kenosha County
91766	Fee-for-Service	1336207778	1336207778	1	1	ALTMAN, DAVID E MD	2/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	34377	08	Family Practice	0	In state provider	None	20 CONSTITUTION DR	STE B	CHICO	CA	95973	4906	04	06007	39.77160609	-121.8743484	Butte County
91780	Fee-for-Service	1578611547	1578611547	1	1	AZAD, AZITA MD	5/31/1995	207R00000X	NA	Other	026	PHYSICIANS	81656	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
91801	Fee-for-Service	1154373454	1154373454	1	1	ANDERSON, GARY D MD	4/28/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	52512	40	Pediatrics	0	In state provider	None	1615 HILL RD	STE 2	NOVATO	CA	94947	4304	21	06041	38.09764686	-122.5787662	Marin County
91817	Fee-for-Service	1386245694	1386245694	2	1	ALLEN, MIKO LCSW	11/6/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	22572 LITTLE JOHN RD	None	TWAIN HARTE	CA	95383	9998	55	06109	38.03176917	-120.2226307	Tuolumne County
91828	Fee-for-Service	1801580477	1801580477	1	1	ALTUN, TAYLOR M NP	7/23/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1330 N INDIAN CANYON DR	STE F	PALM SPRINGS	CA	92262	4880	33	06065	33.84144	-116.5455715	Riverside County
91849	Fee-for-Service	1700174398	1700174398	1	1	AUGUSTUS, JERMAINE S MD	9/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135168	05	Anesthesiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
91852	Fee-for-Service	1417581711	1417581711	1	1	ANDREA KULBERG PHD	3/24/2022	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	225 E CARRILLO ST	304	SANTA BARBARA	CA	93101	2121	42	06083	34.42430069	-119.6989389	Santa Barbara County
91853	Fee-for-Service	1003317926	1003317926	1	1	AHN, AMY CCC-SLP	6/21/2019	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
91870	Fee-for-Service	1326132945	1326132945	1	1	AZURIN, NARCISO M MD	4/23/1984	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36302	08	Family Practice	0	In state provider	None	4075 TWEEDY BLVD	None	SOUTH GATE	CA	90280	6146	19	06037	33.94364315	-118.2003203	Los Angeles County
91902	Fee-for-Service	1750360426	1750360426	1	1	ANAND, SUDHIR K	3/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	24827	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
91957	Fee-for-Service	1467081216	1467081216	1	1	ADAMS, CONNOR T PSYD	11/30/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
92002	Fee-for-Service	1205268588	1205268588	1	1	ALSAID ALKHREISAT, MUSTAFA A	1/13/2025	207R00000X	NA	Other	026	PHYSICIANS	183202	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
92018	Fee-for-Service	1588002737	1588002737	1	1	ASCHERMAN, JOSHUA J LMFT	3/25/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3 GOVERNORS LN	A	CHICO	CA	95926	5503	04	06007	39.75542195	-121.8587226	Butte County
92028	Fee-for-Service	1336449024	1336449024	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1018 CASITAS PASS RD	None	CARPINTERIA	CA	93013	2109	42	06083	34.395972	-119.5130879	Santa Barbara County
92030	Fee-for-Service	1225156888	1225156888	1	1	AURORA HEALTH CARE SOUTH	9/14/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	10400 75TH ST	None	KENOSHA	WI	53142	7884	00	None	42.56982	-87.935364	Kenosha County
92042	Fee-for-Service	1578553277	1578553277	1	1	ADAMS, JAMES R MD	8/8/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	28429	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
92048	Fee-for-Service	1891327573	1891327573	1	1	ADYA HOSPICE & PALLIATIVE	3/5/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE LLC	1652 W TEXAS ST	SUITE 207	FAIRFIELD	CA	94533	6080	48	06095	38.24929745	-122.0578065	Solano County
92099	Fee-for-Service	1619523131	1619523131	1	1	ASHLEY JERVE CNP	3/8/2022	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	824 N 11TH ST	None	MONTEVIDEO	MN	56265	1629	00	None	44.95361546	-95.7135587	Chippewa County
92101	Fee-for-Service	1962840322	1962840322	1	1	ARMIJO, ERICK MD	5/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125945	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
92103	Fee-for-Service	1255329736	1255329736	2	1	ANACAPA PROSTHETICS & ORTHOT	10/11/2023	335E00000X	NA	Other	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	ICS LAB, INC	4517 MARKET STREET	SUITE 4	VENTURA	CA	93003	7841	56	06111	34.25728623	-119.2321419	Ventura County
92138	Fee-for-Service	1255542601	1255542601	1	5	ALTAMED MEDICAL & DENTAL	11/21/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	RAMONA GARDENS	1424 CRUSADO LANE	#168	LOS ANGELES	CA	90033	1512	19	06037	34.05790991	-118.1953725	Los Angeles County
92140	Fee-for-Service	1639198757	1639198757	1	1	AHN, TAEJOON MD	9/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67062	08	Family Practice	0	In state provider	None	1455 MONTEGO	STE 205	WALNUT CREEK	CA	94598	2957	07	06013	37.91046956	-122.0418669	Contra Costa County
92192	Fee-for-Service	1851529879	1851529879	1	1	ANG, LAWRENCE W MD	2/6/2017	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	115926	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
92200	Fee-for-Service	1174794309	1174794309	1	1	AGGARWAL, RAHUL R MD	5/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	102876	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
92202	Fee-for-Service	1790783447	1790783447	2	1	AAMH PHARMACEUTICAL INC	12/14/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	110 W HARVARD BLVD	#H	SANTA PAULA	CA	93060	3874	56	06111	34.34617726	-119.0723365	Ventura County
92241	Fee-for-Service	1821592940	1821592940	1	1	ADAMOVICH, IRINA P	11/4/2021	172A00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1100 MELODY LANE	SUITE 219	ROSEVILLE	CA	95678	5207	31	06061	38.72518759	-121.2912717	Placer County
92259	Fee-for-Service	1164668125	1164668125	1	1	ADVANCED THERAPY SERVICES	4/16/2013	193200000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2648 MAIN STREET	SUITE B AND C	CHULA VISTA	CA	91911	4664	37	06073	32.5948443	-117.0761526	San Diego County
92266	Fee-for-Service	1649615733	1649615733	1	1	AUDEN, ANNIE-LAURIE MD	8/3/2020	207P00000X	NA	Other	026	PHYSICIANS	143568	66	Emergency Medicine (Urgent Care)	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
92275	Fee-for-Service	1730420068	1730420068	1	1	AUSTIN, DANIELLE B MFT	6/20/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	86392	-	NOT APPLICABLE	0	In state provider	None	15305 RAYEN STREET	None	NORTH HILLS	CA	91343	5117	19	06037	34.23191048	-118.4657625	Los Angeles County
92277	Fee-for-Service	1447958673	1447958673	1	1	ALL COMFORT BOARD AND CARE	3/2/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	INC	18757 GAULT STREET	None	RESEDA	CA	91335	4026	19	06037	34.19931412	-118.5424056	Los Angeles County
92338	Fee-for-Service	1891327573	1891327573	1	1	ADYA HOSPICE & PALLIATIVE	3/5/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE LLC	1652 W TEXAS ST	SUITE 207	FAIRFIELD	CA	94533	6080	48	06095	38.24929745	-122.0578065	Solano County
92352	Fee-for-Service	1932563210	1932563210	1	1	AWAD, KYRILLOS DO	9/7/2022	208600000X	NA	General Surgery	026	PHYSICIANS	20096	None	None	0	In state provider	None	1325 CHURCH ST	STE 202	SANTA MARIA	CA	93454	5909	42	06083	34.95209265	-120.4147348	Santa Barbara County
92405	Fee-for-Service	1649870080	1649870080	1	1	ALCANTARA, KEVIN PT	3/15/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	5730	27	06053	36.57482436	-121.8101797	Monterey County
92425	Fee-for-Service	1255542601	1255542601	1	5	ALTAMED MEDICAL & DENTAL	11/21/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	RAMONA GARDENS	1424 CRUSADO LANE	#168	LOS ANGELES	CA	90033	1512	19	06037	34.05790991	-118.1953725	Los Angeles County
92479	Fee-for-Service	1821319658	1821319658	1	1	ALCONCEL, FRANKLIN P DO	10/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12001	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
92488	Fee-for-Service	1174794309	1174794309	1	1	AGGARWAL, RAHUL R MD	5/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	102876	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
92495	Fee-for-Service	1568659985	1568659985	1	1	ALAM, MAHMUDA A MD	3/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95563	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
92500	Fee-for-Service	1609163179	1609163179	1	1	AVILES-LEE, CARLA I MD	9/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122996	36	Psychiatry	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
92510	Fee-for-Service	1225648751	1225648751	1	1	ANDRESEN, SEAN MD	3/11/2025	390200000X	NA	Other	026	PHYSICIANS	192130	30	Radiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
92542	Fee-for-Service	1427198696	1427198696	1	1	ADVENTIST HEALTH PET CT	4/3/2006	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	RCOA ADVENTIST HLTH LLC	5974 PENTZ RD	None	PARADISE	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
92543	Fee-for-Service	1528146016	1528146016	1	1	AGRAWAL, ATUL MD	12/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87707	83	Rheumatology	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
92548	Fee-for-Service	1164668125	1164668125	1	1	ADVANCED THERAPY SERVICES	4/16/2013	193200000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2648 MAIN STREET	SUITE B AND C	CHULA VISTA	CA	91911	4664	37	06073	32.5948443	-117.0761526	San Diego County
92583	Fee-for-Service	1992759187	1992759187	1	1	ALPHONSO, NELSON O MD	4/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90383	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
92585	Fee-for-Service	1356521678	1356521678	2	2	AEON MEDICAL EQUIPMENT & SUP	8/30/2021	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	PLIES, INC.	1518 ARROW HIGHWAY	SUITE J	LA VERNE	CA	91750	5330	19	06037	34.10011235	-117.7808362	Los Angeles County
92596	Fee-for-Service	1841633880	1841633880	1	1	ACCURATE HEARING AID CENTERS	4/8/2024	237600000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	, INC.	16783 BEACH BLVD	None	HUNTINGTON BEACH	CA	92647	4848	30	06059	33.7187932	-117.9892699	Orange County
92629	Fee-for-Service	1851444376	1851444376	2	2	AEGIS TREATMENT CENTERS, LLC	6/2/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	(DBA: HEALTHY CONNECTIO	1839 S EL DORADO STREET	None	STOCKTON	CA	95206	2025	39	06077	37.93316949	-121.2845192	San Joaquin County
92634	Fee-for-Service	1457638512	1457638512	1	1	ABOUELSOOD, JEANNY A MD	10/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123417	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
92647	Fee-for-Service	1033165162	1033165162	1	1	APTER, ROBERT L MD	1/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 SOUTH AVE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
92652	Fee-for-Service	1952547036	1952547036	1	1	AZER, BERNARD DO INC	10/21/2009	174400000X	NA	Other	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	3810 KATELLA AVENUE	None	LOS ALAMITOS	CA	90720	3302	30	06059	33.80299148	-118.0666755	Orange County
92655	Fee-for-Service	1871889675	1871889675	1	1	ALTSCHULER, JUSTIN A MD	10/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122737	01	General Practice	0	In state provider	None	1500 21ST STREET	None	SACRAMENTO	CA	95811	5216	34	06067	38.570553	-121.481325	Sacramento County
92672	Fee-for-Service	1669645099	1669645099	2	1	ALISSA RALSTON	1/24/2022	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 TOWSON AVE	None	FORT SMITH	AR	72901	4921	00	None	35.374455	-94.42107	Sebastian County
92718	Fee-for-Service	1922118041	1922118041	1	1	ARCHIE, CAROL L	5/31/1989	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	60046	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	924 WESTWOOD BLVD	STE 335	LOS ANGELES	CA	90024	2929	19	06037	34.06309787	-118.4452763	Los Angeles County
92732	Fee-for-Service	1437448511	1437448511	1	1	AMAN, EDRIS MD	6/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122467	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
92778	Fee-for-Service	1174794309	1174794309	1	1	AGGARWAL, RAHUL R MD	5/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	102876	68	Hematology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
92797	Fee-for-Service	1164075545	1164075545	1	1	ALVAREZ, JONATHAN NP	3/15/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
92825	Fee-for-Service	1942252788	1942252788	1	1	ALI, HALA H MD	12/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	52640	41	Internal Medicine	0	In state provider	None	1375 SUTTER ST	#308	SAN FRANCISCO	CA	94109	5466	38	06075	37.78738239	-122.4229066	San Francisco County
92833	Fee-for-Service	1740713882	1740713882	1	1	ABRAHAM, RAHUL K DPM	1/19/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	29826 HAUN RD	SUITE 200	MENIFEE	CA	92586	6547	33	06065	33.68719818	-117.1748757	Riverside County
92854	Fee-for-Service	1730488479	1730488479	1	1	ALIPIO, KAREN M B MD	4/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141664	40	Pediatrics	0	In state provider	None	260 SAN JOSE STREET	None	SALINAS	CA	93901	3901	27	06053	36.65808446	-121.6456618	Monterey County
92855	Fee-for-Service	1083164180	1083164180	1	1	AMERIA HOSPICE CARE, INC	3/15/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6819 SEPULVEDA BLVD	SUITE 212	VAN NUYS	CA	91405	4440	19	06037	34.194564	-118.4662195	Los Angeles County
92907	Fee-for-Service	1366951568	1366951568	1	1	AYERS-CLUFF, HEATHER E LCSW	10/11/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 MEDICAL PLAZA	530	PASADENA	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
92914	Fee-for-Service	1154193597	1154193597	1	1	ACOSTA, ANNA NP	1/8/2024	363LN0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
92918	Fee-for-Service	1851444376	1851444376	2	2	AEGIS TREATMENT CENTERS, LLC	6/2/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	(DBA: HEALTHY CONNECTIO	1839 S EL DORADO STREET	None	STOCKTON	CA	95206	2025	39	06077	37.93316949	-121.2845192	San Joaquin County
92931	Fee-for-Service	1336208255	1336208255	1	2	ASIAN PACIFIC HEALTH	3/18/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	9960 BALDWIN PL	None	EL MONTE	CA	91731	2204	19	06037	34.07140294	-118.0516061	Los Angeles County
92962	Fee-for-Service	1740295419	1740295419	1	1	AW, THAN A MD	3/4/2010	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	53206	41	Internal Medicine	0	In state provider	None	2636 N BLACKSTONE AVE	None	FRESNO	CA	93703	1704	10	06019	36.774837	-119.790444	Fresno County
92977	Fee-for-Service	1548324536	1548324536	1	1	ANGTUACO, MARIETA G C MD	11/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	37063	01	General Practice	0	In state provider	None	101 SOUTH SAN MATEO DR	SUITE 115	SAN MATEO	CA	94401	3840	41	06081	37.56590481	-122.325549	San Mateo County
92983	Fee-for-Service	1194708917	1194708917	1	2	AIR EVAC EMS INC	2/17/2024	No Taxonomy Provided	NA	None	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	1873 AIRPORT LOOP	None	KERRVILLE	TX	78028	9696	00	None	29.97463597	-99.08291664	Kerr County
92985	Fee-for-Service	1235725128	1235725128	1	1	ABDELMALEK, PAVLY H LMFT	8/1/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
93008	Fee-for-Service	1821000100	1821000100	1	1	ARNSTEIN, MICHAEL R MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	80314	24	Plastic Surgery	0	In state provider	None	22930 CRENSHAW BLVD	STE D	TORRANCE	CA	90505	3048	19	06037	33.817599	-118.3280235	Los Angeles County
93059	Fee-for-Service	1609137066	1609137066	2	1	AUSTIN, VANESSA LCSW	4/24/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13781 ROSWELL AVE	SUITE C	CHINO	CA	91710	5475	36	06071	34.00240379	-117.721769	San Bernardino County
93068	Fee-for-Service	1841303054	1841303054	1	1	ANDERSON, TRACEY NP	11/26/2019	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25150 HANCOCK AVENUE	SUITE 210	MURRIETA	CA	92562	5989	33	06065	33.56635084	-117.1823956	Riverside County
93086	Fee-for-Service	1932121498	1932121498	1	1	ALI, NAZISH N MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	63271	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
93116	Fee-for-Service	1922685981	1922685981	1	1	AIYAR, SHREYA MD	2/20/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
93138	Fee-for-Service	1053460261	1053460261	1	1	ALAMEDA COUNTY CCS	10/1/2002	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	WEST OAKLAND MTU	1240 18TH ST	None	OAKLAND	CA	94607	2223	01	06001	37.81299883	-122.2868933	Alameda County
93143	Fee-for-Service	1083164180	1083164180	1	1	AMERIA HOSPICE CARE, INC	3/15/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6819 SEPULVEDA BLVD	SUITE 212	VAN NUYS	CA	91405	4440	19	06037	34.194564	-118.4662195	Los Angeles County
93153	Fee-for-Service	1215768494	1215768494	1	1	AHAVA PHARMACY INC	11/6/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15517 DEVONSHIRE ST	None	MISSION HILLS	CA	91345	2620	19	06037	34.2573693	-118.4703903	Los Angeles County
93154	Fee-for-Service	1598159006	1598159006	1	1	ARRUDA, JENNA M MD	8/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143736	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
93159	Fee-for-Service	1235692773	1235692773	1	1	ALBERT, KATHERINE M LCSW	11/25/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
93169	Fee-for-Service	1952759359	1952759359	1	1	ALCAM MEDICAL INC.	11/12/2020	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1533 S GRAND AVE	None	SANTA ANA	CA	92705	4410	30	06059	33.7275	-117.8504131	Orange County
93188	Fee-for-Service	1750557534	1750557534	1	1	AYERS, CATHERINE R PHD	10/11/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
93201	Fee-for-Service	1104941616	1104941616	1	1	ARASTU, VASEEMA S MD	9/3/2011	207R00000X	NA	Other	026	PHYSICIANS	44428	40	Pediatrics	0	In state provider	None	12675 LA MIRADA BLVD	STE 400	LA MIRADA	CA	90638	2236	19	06037	33.91589551	-118.0119734	Los Angeles County
93219	Fee-for-Service	1336208255	1336208255	1	2	ASIAN PACIFIC HEALTH	8/8/2023	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	9960 BALDWIN PL	None	EL MONTE	CA	91731	2204	19	06037	34.07140294	-118.0516061	Los Angeles County
93229	Fee-for-Service	1659894988	1659894988	1	1	AMAYA, JESSICA P NP	1/3/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
93231	Fee-for-Service	1467006676	1467006676	1	1	AGUILAR, JAMI R CCC-SLP	7/11/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	600 CENTRAL AVE	SUITE F	LAKE ELSINORE	CA	92530	6976	33	06065	33.689503	-117.340376	Riverside County
93235	Fee-for-Service	1851765549	1851765549	1	1	AHMED, SHALLA CNP	12/7/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1197 E ARQUES AVE	None	SUNNYVALE	CA	94085	3904	43	06085	37.38051652	-121.9964175	Santa Clara County
93251	Fee-for-Service	1740295419	1740295419	1	1	AW, THAN A MD	3/4/2010	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	53206	38	Geriatrics	0	In state provider	None	2636 N BLACKSTONE AVE	None	FRESNO	CA	93703	1704	10	06019	36.774837	-119.790444	Fresno County
93301	Fee-for-Service	1093071367	1093071367	1	1	ABBOTT, LAURA H MD	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123655	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1515 NEWELL AVE	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
93319	Fee-for-Service	1770006728	1770006728	1	1	ALTAMED HEALTH SERVICES	4/16/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	972 GOODRICH BLVD	None	COMMERCE	CA	90022	4114	19	06037	34.01786727	-118.1546159	Los Angeles County
93354	Fee-for-Service	1871679399	1871679399	1	1	ABEL, THOMAS MD	4/1/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	29287	83	Rheumatology	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
93373	Fee-for-Service	1396990412	1396990412	1	1	AYALA, GLADYS P MD	6/17/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	154677	10	Gastroenterology (M.D. only)	0	In state provider	None	1100 TRANCAS ST	STE 350	NAPA	CA	94558	2959	28	06055	38.32316569	-122.2981938	Napa County
93378	Fee-for-Service	1932121498	1932121498	1	1	ALI, NAZISH N MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	63271	41	Internal Medicine	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
93398	Fee-for-Service	1962635045	1962635045	1	1	ADLER, PHILIP S PSYD	7/25/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	7101 BAIRD AVENUE	None	RESEDA	CA	91335	4150	19	06037	34.1995012	-118.5373824	Los Angeles County
93473	Fee-for-Service	1831439231	1831439231	1	1	AHMED, OMAR I MD	9/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122695	05	Anesthesiology	0	In state provider	None	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
93502	Fee-for-Service	1053702159	1053702159	1	1	ADANZA, IVORY NP	1/5/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
93507	Fee-for-Service	1336208255	1336208255	1	2	ASIAN PACIFIC HEALTH	3/18/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	9960 BALDWIN PL	None	EL MONTE	CA	91731	2204	19	06037	34.07140294	-118.0516061	Los Angeles County
93521	Fee-for-Service	1922299023	1922299023	1	1	ALEX ZAND MD A PROFESSIONAL	3/23/2009	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CORPORATION	1010 W LA VETA AVE	STE 610	ORANGE	CA	92868	4306	30	06059	33.78028244	-117.8635552	Orange County
93590	Fee-for-Service	1487648929	1487648929	1	1	AFABLE, JESSICA G MD	10/19/2018	207R00000X	NA	Other	026	PHYSICIANS	62534	01	General Practice	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
93602	Fee-for-Service	1477575272	1477575272	1	1	ALPERT, TERI L OD	9/1/1981	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	28601 MARGUERITE PKWY	STE 3	MISSION VIEJO	CA	92692	3729	30	06059	33.54857376	-117.6707062	Orange County
93604	Fee-for-Service	1356743975	1356743975	1	1	ANDERSON, ALLISON N LMFT	1/11/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
93607	Fee-for-Service	1770006728	1770006728	1	1	ALTAMED HEALTH SERVICES	10/24/2018	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	972 GOODRICH BLVD	None	COMMERCE	CA	90022	4114	19	06037	34.01786727	-118.1546159	Los Angeles County
93610	Fee-for-Service	1629003447	1629003447	1	1	ALLEN, MICHAEL D OD	6/9/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8800 MING AVE	None	BAKERSFIELD	CA	93301	1308	15	06029	35.33987154	-119.1000429	Kern County
93624	Fee-for-Service	1457313017	1457313017	1	1	ASSASSA-SOLH, GHADA M MD	12/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	50196	30	Radiology	0	In state provider	INC	210 W SAN BERNARDINO RD	None	COVINA	CA	91723	1515	19	06037	34.088004	-117.893475	Los Angeles County
93648	Fee-for-Service	1891239653	1891239653	1	1	ARROW NON-EMERGENCY MEDICAL	12/17/2018	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TRANSPORTATION, INC.	1130 EAST GREEN STREET	SUITE 112	PASADENA	CA	91106	2500	19	06037	34.14455149	-118.127106	Los Angeles County
93661	Fee-for-Service	1396990412	1396990412	1	1	AYALA, GLADYS P MD	6/17/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	154677	41	Internal Medicine	0	In state provider	None	1100 TRANCAS ST	STE 350	NAPA	CA	94558	2959	28	06055	38.32316569	-122.2981938	Napa County
93760	Fee-for-Service	1184624744	1184624744	1	1	ASTRAN, MELINDA MD	12/10/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163169	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
93773	Fee-for-Service	1699204271	1699204271	1	1	ASOKAN, ISHAN MD	7/27/2021	207R00000X	NA	Other	026	PHYSICIANS	163061	None	None	0	In state provider	None	1250 16TH STREET	2100	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
93819	Fee-for-Service	1427583996	1427583996	1	1	AU, EMILY MD	6/2/2020	207P00000X	NA	Other	026	PHYSICIANS	167400	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
93856	Fee-for-Service	1306326426	1306326426	1	1	ANTOLIN, CRYSTAL LMFT	1/28/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14500 ROSCOE BLVD.	400	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
93862	Fee-for-Service	1184885659	1184885659	1	1	ASKARI, SHAHRAM DPM	8/17/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	18151 BEAR VALLEY RD	None	HESPERIA	CA	92345	4907	36	06071	34.47084429	-117.2672208	San Bernardino County
93869	Fee-for-Service	1700964533	1700964533	1	1	ARIYASU, LAURENCE MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	55466	01	General Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
93884	Fee-for-Service	1609090026	1609090026	1	1	ANDERSON, DONALD R MD	5/31/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	177815	None	None	0	In state provider	None	29101 HOSPITAL ROAD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
93887	Fee-for-Service	1801082706	1801082706	1	1	ABRAMS, ALEXANDRA K MD	3/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	105049	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
93895	Fee-for-Service	1770006728	1770006728	1	1	ALTAMED HEALTH SERVICES	4/16/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	972 GOODRICH BLVD	None	COMMERCE	CA	90022	4114	19	06037	34.01786727	-118.1546159	Los Angeles County
93900	Fee-for-Service	1821072943	1821072943	1	1	AIDS HEALTH FOUNDATION	5/4/1993	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1400 S GRAND AVE	STE 801	LOS ANGELES	CA	90015	3068	19	06037	34.03692236	-118.2655238	Los Angeles County
93911	Fee-for-Service	1730570615	1730570615	1	1	AGAPE HEALTHCARE INC.	2/27/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	15501 SAN FERNANDO MISSI	SUITE 311	MISSION HILLS	CA	91345	1359	19	06037	34.27189979	-118.4695266	Los Angeles County
93913	Fee-for-Service	1457313017	1457313017	1	1	ASSASSA-SOLH, GHADA M MD	12/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	50196	42	Nuclear Medicine	0	In state provider	INC	210 W SAN BERNARDINO RD	None	COVINA	CA	91723	1515	19	06037	34.088004	-117.893475	Los Angeles County
93937	Fee-for-Service	1699034942	1699034942	1	1	ARMBRUSTER, STANLEY R LMFT	10/29/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1111 E TAHQUITZ CYN WAY	STE 121	PALM SPRINGS	CA	92262	0102	33	06065	33.8230345	-116.5331835	Riverside County
93944	Fee-for-Service	1326196148	1326196148	1	1	ASKREN, MISHA MD	4/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	40736	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
93945	Fee-for-Service	1255350351	1255350351	1	4	AMPLA HEALTH	8/19/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	100 INDEPENDENCE CIRCLE	None	CHICO	CA	95973	0258	04	06007	39.77251462	-121.8734088	Butte County
93960	Fee-for-Service	1588600548	1588600548	1	1	ARCHANA,LAROIA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
93971	Fee-for-Service	1316016587	1316016587	1	1	ARMERDING, MARK D MD	11/19/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	74399	-	NOT APPLICABLE	0	In state provider	None	1450 MAIN ST	None	WEAVERVILLE	CA	96093	1640	53	06105	40.72339821	-122.9297505	Trinity County
93992	Fee-for-Service	1790876282	1790876282	1	1	ATTINASI, MUNDI L MD	9/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91476	None	None	0	In state provider	None	4650 W SUNSET BLVD	MS#113	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
94013	Fee-for-Service	1518161439	1518161439	1	1	ADDINGTON, TIFFANY N. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2210 CANTERBURY DR	None	HAYS	KS	67601	2370	00	None	38.87856402	-99.29924822	Ellis County
94021	Fee-for-Service	1073541512	1073541512	1	1	ALAM, SYED M MD	10/28/2005	207RP1001X	NA	Pulmonology	026	PHYSICIANS	53309	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3805 SAN DIMAS ST	STE B	BAKERSFIELD	CA	93301	5725	15	06029	35.39508529	-119.0082516	Kern County
94058	Fee-for-Service	1720221708	1720221708	2	1	ATG REHAB SPECIALISTS INC	8/12/2015	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4010 N CHESTNUT AVE	SUITE 108	FRESNO	CA	93726	4706	10	06019	36.79082608	-119.7288129	Fresno County
94094	Fee-for-Service	1003992371	1003992371	1	1	ANNE-MARIE ELIZABETH AMIES	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4245 ROOSEVELT WAY	NE MS359110	SEATTLE	WA	98105	6008	00	None	47.65883901	-122.3177928	King County
94105	Fee-for-Service	1669685251	1669685251	1	1	ATWAL, SUKHVIR S MD	7/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	96047	45	Nephrology (Renal-Kidney)	0	In state provider	None	568 E HERNDON AVENUE	SUITE 201	FRESNO	CA	93720	2989	10	06019	36.83752653	-119.7776433	Fresno County
94144	Fee-for-Service	1699339903	1699339903	1	1	AMERICAN WHEELCHAIR, INC	4/1/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	8305 VICKERS ST	106, 108, 110	SAN DIEGO	CA	92111	2111	37	06073	32.82723948	-117.1470015	San Diego County
94157	Fee-for-Service	1417035270	1417035270	1	1	AGEE, ROBERT E MD	9/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	64137	08	Family Practice	0	In state provider	None	199 W SHIELDS AVE	None	FRESNO	CA	93705	4102	10	06019	36.77936354	-119.8139535	Fresno County
94167	Fee-for-Service	1710917513	1710917513	1	1	ASTON, EDWARD E MD INC	3/17/2009	207N00000X	NA	Dermatology	026	PHYSICIANS	19019	01	General Practice	0	In state provider	None	333 W BASTANCHURY RD	STE 110	FULLERTON	CA	92835	3433	30	06059	33.89358012	-117.9327635	Orange County
94177	Fee-for-Service	1801082706	1801082706	1	1	ABRAMS, ALEXANDRA K MD	3/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	105049	68	Hematology	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
94200	Fee-for-Service	1447659206	1447659206	1	1	ADVANCED MEDTRANS INC	8/13/2018	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	8949 RESEDA BLVD	STE 224	NORTHRIDGE	CA	91324	3916	19	06037	34.233255	-118.536109	Los Angeles County
94223	Fee-for-Service	1841847548	1841847548	1	1	ANZALONE, DONALD M NP	10/29/2020	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
94235	Fee-for-Service	1255350351	1255350351	1	4	AMPLA HEALTH	8/19/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	100 INDEPENDENCE CIRCLE	None	CHICO	CA	95973	0258	04	06007	39.77251462	-121.8734088	Butte County
94256	Fee-for-Service	1437440138	1437440138	1	1	APIGIAN, AIMIE K MD	7/11/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	136587	-	NOT APPLICABLE	0	In state provider	None	11959 MARIPOSA ROAD	SUITE 101, 103, & 104	HESPERIA	CA	92345	1622	36	06071	34.46792706	-117.3463089	San Bernardino County
94261	Fee-for-Service	1104301258	1104301258	1	1	ACCELERATE PHYSICAL THERAPY,	7/2/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 DOVE ST.	100	NEWPORT BEACH	CA	92660	2438	30	06059	33.66447676	-117.8660248	Orange County
94272	Fee-for-Service	1457895856	1457895856	1	1	ALLAN, BETH C NP	2/27/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
94304	Fee-for-Service	1073541512	1073541512	1	1	ALAM, SYED M MD	10/28/2005	207RP1001X	NA	Pulmonology	026	PHYSICIANS	53309	41	Internal Medicine	0	In state provider	None	3805 SAN DIMAS ST	STE B	BAKERSFIELD	CA	93301	5725	15	06029	35.39508529	-119.0082516	Kern County
94359	Fee-for-Service	1831569904	1831569904	1	1	ANTONYAN, LUSINE	5/13/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	614 SOUTH STREET	None	GLENDALE	CA	91502	0000	19	06037	34.16258769	-118.2698577	Los Angeles County
94389	Fee-for-Service	1275794034	1275794034	1	1	AKBARI, YAMA MD	5/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	104076	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
94390	Fee-for-Service	1609258383	1609258383	2	1	ADVANCED PHARMACY GROUP INC	4/9/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15555 MAIN ST	STE D8	HESPERIA	CA	92345	3423	36	06071	34.42475918	-117.3236171	San Bernardino County
94409	Fee-for-Service	1982299657	1982299657	1	1	ABHISHEK CHOUDHARY MD, GASTR	3/25/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	None	None	0	In state provider	OENTEROLOGY, PC	734 MOWRY AVE	None	FREMONT	CA	94536	4115	01	06001	37.56635225	-121.9749284	Alameda County
94436	Fee-for-Service	1437539301	1437539301	1	1	ALL IN ONE HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14553 DELANO STR	STE 317	VAN NUYS	CA	91411	2897	19	06037	34.18266949	-118.450629	Los Angeles County
94453	Fee-for-Service	1710917513	1710917513	1	1	ASTON, EDWARD E MD INC	3/17/2009	207N00000X	NA	Dermatology	026	PHYSICIANS	19019	07	Dermatology	0	In state provider	None	333 W BASTANCHURY RD	STE 110	FULLERTON	CA	92835	3433	30	06059	33.89358012	-117.9327635	Orange County
94463	Fee-for-Service	1801082706	1801082706	1	1	ABRAMS, ALEXANDRA K MD	3/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	105049	78	Neoplastic Diseases/Oncology	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
94468	Fee-for-Service	1003866914	1003866914	1	1	ADVANCED IMAGING OF	6/26/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
94489	Fee-for-Service	1659327658	1659327658	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1505 E VALLEY PKWY	None	ESCONDIDO	CA	92027	2315	37	06073	33.13315672	-117.0611565	San Diego County
94495	Fee-for-Service	1891564340	1891564340	1	1	ANAND GANDHI MD INC	6/18/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	16003 TUSCOLA RD	SUITE H	APPLE VALLEY	CA	92307	0825	36	06071	34.54197921	-117.2692581	San Bernardino County
94519	Fee-for-Service	1902253362	1902253362	1	1	ALBERT, MICHAEL H MD	10/4/2019	207R00000X	NA	Other	026	PHYSICIANS	154477	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
94527	Fee-for-Service	1245231174	1245231174	1	1	ALTAVAS, VALERIE C MD	6/28/2019	207R00000X	NA	Other	026	PHYSICIANS	52243	41	Internal Medicine	0	In state provider	None	655 EUCLID AVE	209	NATIONAL CITY	CA	91950	2970	37	06073	32.68353398	-117.082625	San Diego County
94538	Fee-for-Service	1497308613	1497308613	1	2	A & E TRANSIT, INC.	7/29/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	110 S GARFIELD AVE	210	MONTEBELLO	CA	90640	3810	19	06037	34.01405646	-118.1301633	Los Angeles County
94584	Fee-for-Service	1437215803	1437215803	1	1	AXLINE, STANTON G MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	23954	01	General Practice	0	In state provider	None	2001 SANTA MONICA BLVD	STE 655W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
94606	Fee-for-Service	1104260702	1104260702	1	1	ANAYA, YOHUALLI B MD	6/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135425	01	General Practice	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	3414	19	06037	34.02564555	-118.477319	Los Angeles County
94633	Fee-for-Service	1528566528	1528566528	1	1	ADVENTIST HEALTH PHYSICIANS	8/20/2019	208600000X	NA	General Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	481 PLUMAS BLVD	STE 202	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
94634	Fee-for-Service	1881761443	1881761443	1	1	ACKER, BRIAN J MD INC	3/31/1981	208600000X	NA	General Surgery	026	PHYSICIANS	35691	02	General Surgery	0	In state provider	None	2650 ELM AVE	STE 318	LONG BEACH	CA	90806	1600	19	06037	33.805521	-118.1882945	Los Angeles County
94647	Fee-for-Service	1831569904	1831569904	1	1	ANTONYAN, LUSINE	5/13/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	614 SOUTH STREET	None	GLENDALE	CA	91502	0000	19	06037	34.16258769	-118.2698577	Los Angeles County
94710	Fee-for-Service	1568674927	1568674927	1	1	ACEVEDO, ALBERTO L MD	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	41834	01	General Practice	0	In state provider	None	1205 GARCES HWY	STE 205	DELANO	CA	93215	3658	15	06029	35.76144147	-119.2400687	Kern County
94713	Fee-for-Service	1457501926	1457501926	1	1	ARNOLD, DON C MD	7/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116527	34	Urology and Urological Surgery	0	In state provider	None	11370 ANDERSON ST	STE 1100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
94725	Fee-for-Service	1437539301	1437539301	1	1	ALL IN ONE HOSPICE CARE INC	1/31/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14553 DELANO STR	STE 317	VAN NUYS	CA	91411	2897	19	06037	34.18266949	-118.450629	Los Angeles County
94746	Fee-for-Service	1982814745	1982814745	1	1	ALTAMED COMM HEALTH CLIN	5/22/1995	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	EL MONTE	10418 VALLEY BLVD	STE B	EL MONTE	CA	91731	2402	19	06037	34.07647884	-118.0458956	Los Angeles County
94751	Fee-for-Service	1962071118	1962071118	1	1	ARNOLD, JOSEFINA NP	10/17/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	140 CENTENNIAL WAY	None	TUSTIN	CA	92780	3711	30	06059	33.74496	-117.818857	Orange County
94758	Fee-for-Service	1073680997	1073680997	1	1	AVILA, RICARDO MD	3/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89723	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
94780	Fee-for-Service	1891564340	1891564340	1	1	ANAND GANDHI MD INC	6/18/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	None	67	Endocrinology	0	In state provider	None	16003 TUSCOLA RD	SUITE H	APPLE VALLEY	CA	92307	0825	36	06071	34.54197921	-117.2692581	San Bernardino County
94801	Fee-for-Service	1730781113	1730781113	1	1	ASANA RECOVERY	7/5/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	9612 INDIAN WELLS CIR	None	HUNTINGTON BEACH	CA	92646	7577	30	06059	33.6526365	-117.960066	Orange County
94812	Fee-for-Service	1073602314	1073602314	1	1	ARTHER MEDICAL CORP	5/19/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	851 W FOOTHILL BLVD	STE 101	RIALTO	CA	92376	4731	36	06071	34.10672307	-117.3864948	San Bernardino County
94816	Fee-for-Service	1831143775	1831143775	1	1	AYRONS, KEITH A MD	1/27/2021	207RH0003X	NA	Oncology	026	PHYSICIANS	151371	41	Internal Medicine	0	In state provider	None	1325 E CHURCH ST	STE 301	SANTA MARIA	CA	93454	5915	42	06083	34.95209265	-120.4147348	Santa Barbara County
94893	Fee-for-Service	1932264082	1932264082	1	4	ARVIN UNION SCHOOL DIST	10/17/2011	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1501 HOOD ST	None	ARVIN	CA	93203	1635	15	06029	35.20355955	-118.839528	Kern County
94924	Fee-for-Service	1881761443	1881761443	1	1	ACKER, BRIAN J MD INC	3/31/1981	208600000X	NA	General Surgery	026	PHYSICIANS	35691	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2650 ELM AVE	STE 318	LONG BEACH	CA	90806	1600	19	06037	33.805521	-118.1882945	Los Angeles County
94932	Fee-for-Service	1982104998	1982104998	1	1	AGUILAR, ALINE S LMFT	3/28/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	876 N MOUNTAIN AVE STE 2	None	UPLAND	CA	91786	4166	36	06071	34.10485371	-117.6701493	San Bernardino County
94945	Fee-for-Service	1730377649	1730377649	1	1	ABBEY, RICHARD D PHD	11/9/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
94948	Fee-for-Service	1679654800	1679654800	1	1	ABULSEOUD, OSAMA A MD	12/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89395	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
95034	Fee-for-Service	1982814745	1982814745	1	1	ALTAMED COMM HEALTH CLIN	5/22/1995	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	EL MONTE	10418 VALLEY BLVD	STE B	EL MONTE	CA	91731	2402	19	06037	34.07647884	-118.0458956	Los Angeles County
95049	Fee-for-Service	1689707259	1689707259	1	1	AZINGE-OBASI, MEZIA O MD	9/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53449	01	General Practice	0	In state provider	None	3450 W 43RD ST	STE 106	LOS ANGELES	CA	90008	4944	19	06037	34.00569618	-118.3330634	Los Angeles County
95073	Fee-for-Service	1861002453	1861002453	1	1	ACTIVE LIGHT HOME HEALTH INC	8/18/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	8123 SAN FERNANDO RD	SUITE B	SUN VALLEY	CA	91252	4005	19	06037	34.21806737	-118.3675198	Los Angeles County
95096	Fee-for-Service	1730373994	1730373994	1	1	AGGARWAL, VINAY MD	11/25/2008	207R00000X	NA	Other	026	PHYSICIANS	100787	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1809	36	06071	34.073505	-117.3505995	San Bernardino County
95101	Fee-for-Service	1073602314	1073602314	1	1	ARTHER MEDICAL CORP	5/19/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	851 W FOOTHILL BLVD	STE 101	RIALTO	CA	92376	4731	36	06071	34.10672307	-117.3864948	San Bernardino County
95111	Fee-for-Service	1659326825	1659326825	1	1	ASSISTED HOME CARE, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	ASSISTED HOME HOSPICE	4450 WESTINGHOUSE STREET	#103	VENTURA	CA	93003	5787	56	06111	34.25886329	-119.2335372	Ventura County
95116	Fee-for-Service	1942293279	1942293279	1	1	AXMINSTER MEDICAL GROUP	12/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INC	11539 HAWTHORNE BLVD	FL 6	HAWTHORNE	CA	90250	2325	19	06037	33.929352	-118.352747	Los Angeles County
95121	Fee-for-Service	1245205483	1245205483	1	1	AUGUSTINE, WYNETTE C OD	1/31/1987	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	790 E WILLOW ST	None	LONG BEACH	CA	90806	2703	19	06037	33.80426489	-118.1825796	Los Angeles County
95180	Fee-for-Service	1184324014	1184324014	1	1	ABAT, NEFRETIRI B NP	11/30/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
95190	Fee-for-Service	1639598329	1639598329	1	1	AKATEH, CLIFFORD MD	8/10/2021	208600000X	NA	General Surgery	026	PHYSICIANS	174347	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
95235	Fee-for-Service	1295197317	1295197317	1	1	ATHAVALE, JANHAVI	11/6/2019	207R00000X	NA	Other	026	PHYSICIANS	152776	41	Internal Medicine	0	In state provider	None	2500 GRANT ROAD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
95237	Fee-for-Service	1023192846	1023192846	1	1	AIROLA, JILL J MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	50973	40	Pediatrics	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
95253	Fee-for-Service	1245791276	1245791276	1	1	ASHFAQ, SAMEED MD	8/27/2023	207P00000X	NA	Other	026	PHYSICIANS	20637	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
95282	Fee-for-Service	1700842507	1700842507	1	1	ARCADIA OUTPT SURGERY	12/1/1977	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	614 W DUARTE RD	None	ARCADIA	CA	91007	7601	19	06037	34.12649917	-118.0516649	Los Angeles County
95293	Fee-for-Service	1366635609	1366635609	1	1	APPLE SURGERY CENTER INC	9/5/2008	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	9870 BRIMHALL ROAD	STE 200	BAKERSFIELD	CA	93312	2798	15	06029	35.36881694	-119.1119759	Kern County
95301	Fee-for-Service	1184398489	1184398489	1	1	ASATO, KIANA	10/17/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3601 MARCONI AVE	None	SACRAMENTO	CA	95821	5309	34	06067	38.618109	-121.380255	Sacramento County
95319	Fee-for-Service	1750598504	1750598504	1	1	AQUINO, CHRISTOPHER B MD	10/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120449	30	Radiology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
95323	Fee-for-Service	1982814745	1982814745	1	1	ALTAMED COMM HEALTH CLIN	1/7/2021	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	EL MONTE	10418 VALLEY BLVD	STE B	EL MONTE	CA	91731	2402	19	06037	34.07647884	-118.0458956	Los Angeles County
95336	Fee-for-Service	1689707259	1689707259	1	1	AZINGE-OBASI, MEZIA O MD	9/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53449	22	Pathology (M.D. only)	0	In state provider	None	3450 W 43RD ST	STE 106	LOS ANGELES	CA	90008	4944	19	06037	34.00569618	-118.3330634	Los Angeles County
95357	Fee-for-Service	1396958237	1396958237	1	1	AYOUB, ROBBY T MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	102841	None	None	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
95403	Fee-for-Service	1659326825	1659326825	1	1	ASSISTED HOME CARE, INC	10/10/2000	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	ASSISTED HOME HOSPICE	4450 WESTINGHOUSE STREET	#103	VENTURA	CA	93003	5787	56	06111	34.25886329	-119.2335372	Ventura County
95419	Fee-for-Service	1225010218	1225010218	1	1	ANG, CESAR K MD	4/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	50396	41	Internal Medicine	0	In state provider	None	1095 MARSHALL WAY	None	PLACERVILLE	CA	95667	5722	09	06017	38.7257686	-120.7910663	El Dorado County
95436	Fee-for-Service	1346377736	1346377736	1	1	AFFLACK, PHABILLIA MD	11/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55443	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MEDICAL PLAZA	SUITE 430	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
95440	Fee-for-Service	1659707826	1659707826	1	1	ATTRAPLSI, SHADA M MD	9/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146466	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	STE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
95468	Fee-for-Service	1508860412	1508860412	1	1	ARROYO, MANUEL MD	3/13/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48417	08	Family Practice	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
95489	Fee-for-Service	1326521626	1326521626	1	1	AVERY GARDEN ASSISTED LIVING	5/21/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	INC	5377 FULMER CT	None	JURUPA VALLEY	CA	91752	4475	33	06065	33.98779024	-117.5422901	Riverside County
95502	Fee-for-Service	1194211151	1194211151	1	1	ALMONTE, JENELYN NP	11/7/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1800 N. WESTERN AVE	SUITE 204	SAN BERNARDINO	CA	92411	1353	36	06071	34.1315778	-117.3182453	San Bernardino County
95520	Fee-for-Service	1811131741	1811131741	1	1	ARENSON, KENNETH J MD IN	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	28845	18	Ophthalmology	0	In state provider	None	7301 MEDICAL CENTER DR	STE 410	WEST HILLS	CA	91307	1994	19	06037	34.20285756	-118.6294575	Los Angeles County
95524	Fee-for-Service	1023192846	1023192846	1	1	AIROLA, JILL J MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	50973	66	Emergency Medicine (Urgent Care)	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
95530	Fee-for-Service	1649298738	1649298738	1	1	AVELINO, CHRISTOPHER F	7/18/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	63008	41	Internal Medicine	0	In state provider	None	23838 VALENCIA BLVD	None	VALENCIA	CA	91355	5319	19	06037	34.41337791	-118.5520369	Los Angeles County
95539	Fee-for-Service	1144287061	1144287061	1	1	ANDERSON, SEAN F MD	9/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94875	05	Anesthesiology	0	In state provider	None	700 MOUNTAIN RANCH RD	STE C	SAN ANDREAS	CA	95249	9707	05	06009	38.18960347	-120.6719165	Calaveras County
95577	Fee-for-Service	1336208255	1336208255	1	3	ASIAN PACIFIC HEALTH	6/15/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3939 TRACY ST	None	LOS ANGELES	CA	90027	3207	19	06037	34.10836346	-118.278765	Los Angeles County
95585	Fee-for-Service	1619979614	1619979614	1	1	ATKINSON, BRANDON S DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	7613	08	Family Practice	0	In state provider	None	6189 LA PALMA AVE	None	BUENA PARK	CA	90620	2858	30	06059	33.84662776	-118.0247919	Orange County
95628	Fee-for-Service	1578989448	1578989448	1	1	ACUNA, MARIA LCSW	10/28/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
95629	Fee-for-Service	1689707259	1689707259	1	1	AZINGE-OBASI, MEZIA O MD	9/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53449	08	Family Practice	0	In state provider	None	3450 W 43RD ST	STE 106	LOS ANGELES	CA	90008	4944	19	06037	34.00569618	-118.3330634	Los Angeles County
95632	Fee-for-Service	1114367174	1114367174	1	1	AABICA MEDICAL INC	7/15/2013	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3354 MATHER FIELD RD	None	RANCHO CORDOVA	CA	95670	5966	34	06067	38.574027	-121.303692	Sacramento County
95668	Fee-for-Service	1922686112	1922686112	1	1	ANDERSON, CHARLES DO	12/21/2024	207P00000X	NA	Other	026	PHYSICIANS	20552	None	None	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
95692	Fee-for-Service	1184380651	1184380651	1	1	ANGEL WINGS CARE HOME INC	8/22/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5420 SAN MARTIN WAY	None	ANTIOCH	CA	94531	8506	07	06013	37.95761936	-121.7576112	Contra Costa County
95705	Fee-for-Service	1326025396	1326025396	1	1	ANDERSON, JOSEPH M. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3100 CHANNING WAY	None	IDAHO FALLS	ID	83404	7533	00	None	43.470198	-111.9901955	Bonneville County
95776	Fee-for-Service	1295453272	1295453272	1	1	AASHRO MEDS LLC	2/5/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2304 COLUMBUS ST	None	BAKERSFIELD	CA	93306	2608	15	06029	35.39764435	-118.9670636	Kern County
95816	Fee-for-Service	1770562134	1770562134	1	1	AGHIGHI, BAHAR MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	61454	67	Endocrinology	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
95841	Fee-for-Service	1932262144	1932262144	1	1	ARYA, SATYA P MD	3/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	31908	04	Otology, Laryngology, Rhinology	0	In state provider	None	2011 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	5012	15	06029	35.37326947	-119.0251935	Kern County
95867	Fee-for-Service	1336208255	1336208255	1	3	ASIAN PACIFIC HEALTH	6/15/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3939 TRACY ST	None	LOS ANGELES	CA	90027	3207	19	06037	34.10836346	-118.278765	Los Angeles County
95875	Fee-for-Service	1902361678	1902361678	1	1	ABBASI, DAVOUD OD	9/13/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12100 WILSHIRE BLVD.	SUITE 1275	LOS ANGELES	CA	90025	7143	19	06037	34.04370122	-118.4678993	Los Angeles County
95894	Fee-for-Service	1043812274	1043812274	1	1	ALLEN, JESSE S LMFT	7/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
95902	Fee-for-Service	1184790396	1184790396	1	1	AGUILAR, TRINIDAD MD	7/20/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	79465	41	Internal Medicine	0	In state provider	None	4314 W VICTORY BLVD	None	BURBANK	CA	91505	1334	19	06037	34.18483654	-118.3581315	Los Angeles County
95943	Fee-for-Service	1740478338	1740478338	1	1	ARSI, KIMBERLY A DO	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	9768	08	Family Practice	0	In state provider	None	6226 E SPRING ST	STE 100 & 175	LONG BEACH	CA	90815	1442	19	06037	33.81040053	-118.1102715	Los Angeles County
95954	Fee-for-Service	1821012345	1821012345	1	2	AIDS HEALTHCARE FOUNDATION	10/14/2020	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4940 VAN NUYS BLVD	SUITE 200	SHERMAN OAKS	CA	91403	1741	19	06037	34.160589	-118.4486715	Los Angeles County
95966	Fee-for-Service	1508887845	1508887845	1	1	ANGFONTE, GLORIETTA Z MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	32200	41	Internal Medicine	0	In state provider	None	500 E REMINGTON DR	STE 29	SUNNYVALE	CA	94087	2612	43	06085	37.35898474	-122.0281716	Santa Clara County
95995	Fee-for-Service	1932214657	1932214657	1	1	AJAY G. MEKA M.D. INC.	7/1/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2740 S BRISTOL ST	STE 208	SANTA ANA	CA	92704	6233	30	06059	33.70999696	-117.8854626	Orange County
96006	Fee-for-Service	1154434983	1154434983	1	1	AESTHETIC EYE PLASTIC	2/16/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	SURGEONS MEDICAL CORPORA	8920 WILSHIRE BLVD	STE 426	BEVERLY HILLS	CA	90211	2012	19	06037	34.06703599	-118.3863456	Los Angeles County
96033	Fee-for-Service	1891728515	1891728515	1	1	ACTION MED EQUIP & SUPPL	7/17/2007	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	11801 INGLEWOOD AVE	STE 3	HAWTHORNE	CA	90250	2701	19	06037	33.927039	-118.361338	Los Angeles County
96073	Fee-for-Service	1982619359	1982619359	1	1	ASSOMULL, VINOD M MD INC	10/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	31336	45	Nephrology (Renal-Kidney)	0	In state provider	None	14935 RINALDI ST	STE 509	MISSION HILLS	CA	91345	1206	19	06037	34.27904221	-118.4583902	Los Angeles County
96080	Fee-for-Service	1417722232	1417722232	1	3	AMG, A PROFESSIONAL MEDICAL	5/30/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	ORPORATION	3500 WHITTIER BLVD	SUITE 105	LOS ANGELES	CA	90023	1746	19	06037	34.02656881	-118.1982818	Los Angeles County
96084	Fee-for-Service	1134367568	1134367568	1	1	ADAMS, JASON Y MD	1/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101954	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
96093	Fee-for-Service	1972593788	1972593788	1	1	ADVENTIST HEALTH CLEARLAKE	3/6/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	21337 BUSH ST	None	MIDDLETOWN	CA	95461	9304	17	06033	38.74858031	-122.6176566	Lake County
96104	Fee-for-Service	1770562134	1770562134	1	1	AGHIGHI, BAHAR MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	61454	41	Internal Medicine	0	In state provider	None	2525 STOCKTON BLVD	STE 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
96156	Fee-for-Service	1245635705	1245635705	1	1	AYALA, LINDSEY	11/21/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
96177	Fee-for-Service	1871961839	1871961839	1	1	ARCEO, ALEJANDRA LCSW	7/21/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
96182	Fee-for-Service	1972998706	1972998706	1	1	AMEENA, SYEDA MD	12/28/2018	207R00000X	NA	Other	026	PHYSICIANS	153093	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
96200	Fee-for-Service	1306815196	1306815196	1	1	ANN MANN MD	1/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6001 E WOODMEN RD	RM 3111	COLORADO SPGS	CO	80923	2601	00	None	38.938365	-104.7168315	El Paso County
96230	Fee-for-Service	1295252138	1295252138	1	1	AUSTIN, DANIELLE LCSW	11/27/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18888 US HIGHWAY 18	SUITE 106	APPLE VALLEY	CA	92307	2315	36	06071	34.53770988	-117.252322	San Bernardino County
96241	Fee-for-Service	1932264082	1932264082	1	6	ARVIN UNION SCHOOL DIST	10/17/2011	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	633 WALNUT RD	None	ARVIN	CA	93203	0000	15	06029	35.20282835	-118.8376553	Kern County
96253	Fee-for-Service	1508887845	1508887845	1	1	ANGFONTE, GLORIETTA Z MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	32200	83	Rheumatology	0	In state provider	None	500 E REMINGTON DR	STE 29	SUNNYVALE	CA	94087	2612	43	06085	37.35898474	-122.0281716	Santa Clara County
96254	Fee-for-Service	1073676730	1073676730	2	1	ARDEN DRUGS, INC	10/31/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	435 ARDEN AVENUE	SUITE 110	GLENDALE	CA	91203	1130	19	06037	34.15848148	-118.2628845	Los Angeles County
96316	Fee-for-Service	1902014574	1902014574	1	1	AMIRTHARAJAH, MOHANA MD	12/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105922	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
96336	Fee-for-Service	1003056680	1003056680	1	1	ATEIA, MAGGIE J PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	415 W ROUTE 66	STE 202	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
96337	Fee-for-Service	1710528369	1710528369	1	1	ADK HOME HEALTH INC	9/22/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	8300 TAMPA AVE	STE F	NORTHRIDGE	CA	91324	4267	19	06037	34.220709	-118.5534835	Los Angeles County
96346	Fee-for-Service	1609928803	1609928803	1	1	ANDERSON, DENNIS K MD	6/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	13673	24	Plastic Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
96364	Fee-for-Service	1982619359	1982619359	1	1	ASSOMULL, VINOD M MD INC	10/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	31336	41	Internal Medicine	0	In state provider	None	14935 RINALDI ST	STE 509	MISSION HILLS	CA	91345	1206	19	06037	34.27904221	-118.4583902	Los Angeles County
96367	Fee-for-Service	1417722232	1417722232	1	3	AMG, A PROFESSIONAL MEDICAL	5/30/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	ORPORATION	3500 WHITTIER BLVD	SUITE 105	LOS ANGELES	CA	90023	1746	19	06037	34.02656881	-118.1982818	Los Angeles County
96383	Fee-for-Service	1972593788	1972593788	1	1	ADVENTIST HEALTH CLEARLAKE	1/31/2011	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	21337 BUSH ST	None	MIDDLETOWN	CA	95461	9304	17	06033	38.74858031	-122.6176566	Lake County
96406	Fee-for-Service	1568545317	1568545317	1	1	AHMED, ANEELA MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69356	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
96457	Fee-for-Service	1942509385	1942509385	1	2	ASSAF, SULEIMAN H DO	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14746	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
96474	Fee-for-Service	1528539996	1528539996	1	1	AGUIRRE, KRISTINE RCP	7/25/2020	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
96534	Fee-for-Service	1841427226	1841427226	1	1	ANGELES, JEFFREY T MD	3/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126731	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
96554	Fee-for-Service	1285146977	1285146977	1	1	ADRIANO, MAE KHRISTINE U NP	3/15/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
96576	Fee-for-Service	1730248394	1730248394	1	1	ALAVERDIAN, ALLEN MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69689	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
96603	Fee-for-Service	1972016087	1972016087	1	1	ANDREW, JENNECA R PT	3/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	31515 RANCHO PUEBLO RD	SUITE 101	TEMECULA	CA	92592	0000	33	06065	33.47922478	-117.1107757	Riverside County
96648	Fee-for-Service	1841365129	1841365129	1	1	ASSOCIATED PATHOLGY MED	4/15/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	GROUP INC	75 NIELSON ST	None	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7937089	Santa Cruz County
96653	Fee-for-Service	1184661811	1184661811	1	1	ALLISON, KIMBERLY H MD	2/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	55708	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
96657	Fee-for-Service	1417722232	1417722232	1	3	AMG, A PROFESSIONAL MEDICAL	5/30/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ORPORATION	3500 WHITTIER BLVD	SUITE 105	LOS ANGELES	CA	90023	1746	19	06037	34.02656881	-118.1982818	Los Angeles County
96669	Fee-for-Service	1972593788	1972593788	1	1	ADVENTIST HEALTH CLEARLAKE	3/6/2002	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	21337 BUSH ST	None	MIDDLETOWN	CA	95461	9304	17	06033	38.74858031	-122.6176566	Lake County
96699	Fee-for-Service	1568984417	1568984417	1	1	ALDAIMALANI, SARAH LCSW	4/11/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3825 HOPYARD	STE 140	PLEASANTON	CA	94588	8530	01	06001	37.683009	-121.9036935	Alameda County
96710	Fee-for-Service	1962430967	1962430967	1	1	ALBANI, SALVATORE MD	1/5/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64991	83	Rheumatology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
96713	Fee-for-Service	1740369727	1740369727	1	1	ALMAZAN, MARIETTA MD	3/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	46443	36	Psychiatry	0	In state provider	None	6600 MERCY CT	STE 290	FAIR OAKS	CA	95628	3190	34	06067	38.666565	-121.309857	Sacramento County
96722	Fee-for-Service	1306881164	1306881164	1	1	AUBURN SURGICAL CENTER, LP	11/27/1996	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3123 PROFESSIONAL DR	STE 100	AUBURN	CA	95603	2400	31	06061	38.9412	-121.100888	Placer County
96755	Fee-for-Service	1992712806	1992712806	1	1	ABU-ZAINEH, MOHAMMED MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	37792	05	Anesthesiology	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
96757	Fee-for-Service	1225142375	1225142375	1	1	ARORA, MONICA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6901 N 72ND ST	None	OMAHA	NE	68122	1709	00	None	41.32103124	-96.02114037	Douglas County
96775	Fee-for-Service	1265545321	1265545321	1	2	ANEES, NASR N MD	3/1/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	52690	01	General Practice	0	In state provider	None	200 S WELLS RD	SUITE 100	VENTURA	CA	93004	1378	56	06111	34.29321532	-119.1597424	Ventura County
96784	Fee-for-Service	1205113313	1205113313	1	1	ASEF, DANIELLE DO	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	11977	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
96821	Fee-for-Service	1023276367	1023276367	1	1	AGUILERA, LUZ A MD	10/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105941	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
96822	Fee-for-Service	1841427226	1841427226	1	1	ANGELES, JEFFREY T MD	3/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126731	38	Geriatrics	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
96823	Fee-for-Service	1447653787	1447653787	2	1	ALTAMED HEALTH SERVICES CORP	1/25/2024	3336C0002X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1855 N FAIR OAKS AVE	#100	PASADENA	CA	91103	1620	19	06037	34.177806	-118.1507985	Los Angeles County
96867	Fee-for-Service	1427022284	1427022284	2	1	ARROYO, MICHAEL A MD	12/21/2022	207ZP0102X	NA	Other	026	PHYSICIANS	64993	None	None	0	In state provider	None	2374 E PACIFICA PLACE	None	RANCHO DOMINGUEZ	CA	90220	6214	19	06037	33.84864797	-118.2240829	Los Angeles County
96937	Fee-for-Service	1720039639	1720039639	1	1	ASHISH SHARMA MD	7/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
96946	Fee-for-Service	1417722232	1417722232	1	3	AMG, A PROFESSIONAL MEDICAL	2/21/2025	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ORPORATION	3500 WHITTIER BLVD	SUITE 105	LOS ANGELES	CA	90023	1746	19	06037	34.02656881	-118.1982818	Los Angeles County
96973	Fee-for-Service	1548273758	1548273758	1	1	ABIDI, NICHOLAS A MD	7/1/2000	207XX0004X	NA	Orthopedic Surgery	026	PHYSICIANS	85551	20	Orthopedic Surgery	0	In state provider	None	1662 DOMINICAN WAY	None	SANTA CRUZ	CA	95065	1522	44	06087	36.99033079	-121.9816507	Santa Cruz County
96981	Fee-for-Service	1467647529	1467647529	2	1	ALGOS INC., A MEDICAL CORPOR	9/30/2020	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	9808 VENICE BLVD	STE 706	CULVER CITY	CA	90232	2732	19	06037	34.0236396	-118.3980847	Los Angeles County
96989	Fee-for-Service	1962430967	1962430967	1	1	ALBANI, SALVATORE MD	1/5/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64991	40	Pediatrics	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
97009	Fee-for-Service	1629561170	1629561170	1	1	AREVALO, JOHN B MD	9/11/2022	207PH0002X	NA	Other	026	PHYSICIANS	174705	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
97010	Fee-for-Service	1699083089	1699083089	1	1	AYODEJI, ABISOLA A MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136975	05	Anesthesiology	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
97053	Fee-for-Service	1669996245	1669996245	1	1	AWCY, LLC	9/1/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1449 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	4101	07	06013	37.91244951	-122.044666	Contra Costa County
97079	Fee-for-Service	1770773251	1770773251	1	1	ALLAPARTHI, SAILAJA MD	11/30/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	156167	08	Family Practice	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
97111	Fee-for-Service	1376076406	1376076406	1	1	AL QAYSI, NADA MD	12/7/2022	390200000X	NA	Other	026	PHYSICIANS	183120	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
97112	Fee-for-Service	1003310293	1003310293	1	1	ANOUSHIRAVANI, AFSHIN MD	7/8/2024	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
97154	Fee-for-Service	1689611923	1689611923	1	1	ABAD-PELSANG, ELMA MD	9/26/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	46584	05	Anesthesiology	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	7079	38	06075	37.7738933	-122.4544685	San Francisco County
97157	Fee-for-Service	1790753358	1790753358	1	1	ADIAR COUNTY HELATH CENTER	10/1/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1401 W LOCUST ST	None	STILWELL	OK	74960	3217	00	None	35.80856644	-94.64321622	Adair County
97165	Fee-for-Service	1851713838	1851713838	1	1	ALVARADO, NERY LCSW	1/14/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	87875	-	NOT APPLICABLE	0	In state provider	None	180 MISSION	None	POMONA	CA	91766	1843	19	06037	34.05510524	-117.7491982	Los Angeles County
97176	Fee-for-Service	1083933766	1083933766	1	1	AUNG, MA MON MON MD	9/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123189	38	Geriatrics	0	In state provider	None	43112 15TH ST WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
97177	Fee-for-Service	1255878252	1255878252	1	1	ADAPA, PRIYANKA S MD	10/7/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	181828	None	None	0	In state provider	None	2008 MORSE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
97211	Fee-for-Service	1598192478	1598192478	1	1	ASIA PACIFIC COMPREHENSIVE	7/22/2014	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	STROKE NETWORK	1798 N GAREY AVE	2ND FLOOR CATH LAB	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
97265	Fee-for-Service	1568792729	1568792729	1	1	AJAY D'MELLO	1/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
97267	Fee-for-Service	1467647529	1467647529	2	1	ALGOS INC., A MEDICAL CORPOR	9/30/2020	103TB0200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9808 VENICE BLVD	STE 706	CULVER CITY	CA	90232	2732	19	06037	34.0236396	-118.3980847	Los Angeles County
97289	Fee-for-Service	1518410018	1518410018	1	1	ARCEO, MONIQUE LCSW	5/14/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
97293	Fee-for-Service	1821650318	1821650318	1	1	ALVARADO OLMEDO, CYNTHIA C L	7/29/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CSW	39159 PASEO PADRE PKWY	STE 121	FREMONT	CA	94538	1600	01	06001	37.5531875	-121.9805141	Alameda County
97436	Fee-for-Service	1417117771	1417117771	1	1	AHMAD, SOHA MD	6/4/2019	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	129915	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 E BEVERLY BLVD	# 103	MONTEBELLO	CA	90640	4314	19	06037	34.01556395	-118.0983878	Los Angeles County
97441	Fee-for-Service	1811970833	1811970833	1	1	APONTE, LEONARDO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1238 S 16TH ST	None	MILWAUKEE	WI	53204	2267	00	None	43.01812602	-87.93301314	Milwaukee County
97443	Fee-for-Service	1831127570	1831127570	1	1	AURANGZEB, IMRAN MD	9/6/2006	207RC0200X	NA	Other	026	PHYSICIANS	96003	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2 MEDICAL PLAZA DR	STE 100	ROSEVILLE	CA	95661	3042	31	06061	38.76507948	-121.2477476	Placer County
97469	Fee-for-Service	1467555359	1467555359	1	1	AIRES, DANIEL J MD	5/10/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	166853	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
97480	Fee-for-Service	1063616217	1063616217	1	1	ALI, SHAZIA MD	8/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108661	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
97493	Fee-for-Service	1306856513	1306856513	1	1	ABBASI, ELHAM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	920 MEDICAL PLAZA DR	STE 140	SHENANDOAH	TX	77380	3256	00	None	30.17283687	-95.45254904	Montgomery County
97513	Fee-for-Service	1982086914	1982086914	1	1	ALPHA HOSPITALIST GROUP INC	1/22/2021	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
97529	Fee-for-Service	1477535714	1477535714	1	1	AMIRI, JODI M MD	7/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	93387	02	General Surgery	0	In state provider	None	2800 L ST	STE 200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
97535	Fee-for-Service	1316116221	1316116221	1	1	ALTAMED HEALTH SERVICES CORP	2/11/2008	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	ORANGE, CHAPMAN	4010 E CHAPMAN AVE	None	ORANGE	CA	92869	3990	30	06059	33.7877325	-117.8109675	Orange County
97569	Fee-for-Service	1306518121	1306518121	1	1	AGING & ADULT RESOURCES AND	6/30/2023	No Taxonomy Provided	NA	None	093	CARE COORDINATOR AGENCIES (CCA)	-	-	NOT APPLICABLE	0	In state provider	PLACEMENT GROUP LLC	1601 H ST	SUITE 102	BAKERSFIELD	CA	93301	5812	15	06029	35.372646	-119.021228	Kern County
97578	Fee-for-Service	1750650982	1750650982	1	2	APEX RADIOLOGY MEDICAL GROUP	5/8/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	1001 N TUSTIN AVE	None	HEMET	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
97590	Fee-for-Service	1417279316	1417279316	1	1	ANDERSON, CAROLYN LPCC	12/24/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
97629	Fee-for-Service	1639104037	1639104037	1	1	ALAN B WILLIAMS M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 HERITAGE WAY	STE 2100	KALISPELL	MT	59901	0000	00	None	48.216645	-114.324948	Flathead County
97651	Fee-for-Service	1104362268	1104362268	1	1	ABAWI, WALI DO	7/1/2019	390200000X	NA	Other	026	PHYSICIANS	15952	41	Internal Medicine	0	In state provider	None	30230 RANCHO VIEJO RD	STE 200	SAN JUAN CAPISTRA	CA	92675	1585	30	06059	33.52397575	-117.6652094	Orange County
97672	Fee-for-Service	1205443512	1205443512	1	1	ABLETO LICENSED CLINICAL SOC	5/4/2021	251S00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	IAL WORKER SERVICES PC	595 MARKET ST	23RD FLOOR	SAN FRANCISCO	CA	94105	2802	38	06075	37.78940904	-122.4011441	San Francisco County
97703	Fee-for-Service	1568951903	1568951903	1	1	AIRMID HOME HEALTH CARE INC	12/10/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	412 WEST BROADWAY	STE 208	GLENDALE	CA	91204	1297	19	06037	34.14682413	-118.261622	Los Angeles County
97713	Fee-for-Service	1447528609	1447528609	1	1	ANTIOCH UNIFIED SCHOOL	7/1/2011	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	510 G STREET	None	ANTIOCH	CA	94509	1259	07	06013	38.01440454	-121.8137911	Contra Costa County
97770	Fee-for-Service	1063616217	1063616217	1	1	ALI, SHAZIA MD	8/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	108661	10	Gastroenterology (M.D. only)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
97771	Fee-for-Service	1245641521	1245641521	1	1	AVOL, HAYLEY A	2/6/2018	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	140156	40	Pediatrics	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
97824	Fee-for-Service	1316116221	1316116221	1	1	ALTAMED HEALTH SERVICES CORP	2/13/2008	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	ORANGE, CHAPMAN	4010 E CHAPMAN AVE	None	ORANGE	CA	92869	3990	30	06059	33.7877325	-117.8109675	Orange County
97841	Fee-for-Service	1861721672	1861721672	1	1	AJLOUNY, KIM L PSYD	5/13/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
97870	Fee-for-Service	1457674525	1457674525	1	1	ACUNA, CHRISTINE A MD	4/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115624	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
97871	Fee-for-Service	1316111230	1316111230	1	1	ARELLANO, NATALIA LCSW	8/19/2022	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
97873	Fee-for-Service	1174531263	1174531263	1	1	AMIN, JANKI P MD	11/16/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	77083	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 400	SACRAMENTO	CA	95816	5243	34	06067	38.570076	-121.4657145	Sacramento County
97882	Fee-for-Service	1093368953	1093368953	1	1	ANDERSON, MAKAYLA V	1/24/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	13079 VAN NUYS BLVD	STE 1	PACOIMA	CA	91320	1144	19	06037	34.26908885	-118.4180507	Los Angeles County
97913	Fee-for-Service	1972807261	1972807261	1	1	AYALA, JESSICA C LCSW	11/30/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
97953	Fee-for-Service	1629307434	1629307434	1	1	ARAGON, IZETTE Z LCSW	1/25/2019	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12440 FIRESTONE BLVD	SUITE 201	NORWALK	CA	90650	9323	19	06037	33.90523023	-118.0681168	Los Angeles County
97959	Fee-for-Service	1205443512	1205443512	1	1	ABLETO LICENSED CLINICAL SOC	3/31/2022	251S00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	IAL WORKER SERVICES PC	595 MARKET ST	23RD FLOOR	SAN FRANCISCO	CA	94105	2802	38	06075	37.78940904	-122.4011441	San Francisco County
98002	Fee-for-Service	1447528609	1447528609	1	1	ANTIOCH UNIFIED SCHOOL	3/12/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	510 G STREET	None	ANTIOCH	CA	94509	1259	07	06013	38.01440454	-121.8137911	Contra Costa County
98018	Fee-for-Service	1689396293	1689396293	1	1	AMAN, SIMA NP	10/18/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
98032	Fee-for-Service	1538115571	1538115571	1	1	ASLAN, ALEX A MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	62211	10	Gastroenterology (M.D. only)	0	In state provider	None	365 LENNON LANE	SUITE 250	WALNUT CREEK	CA	94598	5915	07	06013	37.92784983	-122.0301444	Contra Costa County
98050	Fee-for-Service	1811158967	1811158967	1	1	AWWAD, REEM	4/5/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	142086	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
98069	Fee-for-Service	1124231139	1124231139	1	1	ARGUIJA, ANTHONY F DO	8/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9716	41	Internal Medicine	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
98077	Fee-for-Service	1558476440	1558476440	1	1	ANDJELA T. DRINCIC M.D.	10/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
98107	Fee-for-Service	1407546690	1407546690	1	1	ALVARADO, CHARLYNE DOULA	5/22/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
98112	Fee-for-Service	1316116221	1316116221	1	1	ALTAMED HEALTH SERVICES CORP	4/20/2009	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	ORANGE, CHAPMAN	4010 E CHAPMAN AVE	None	ORANGE	CA	92869	3990	30	06059	33.7877325	-117.8109675	Orange County
98123	Fee-for-Service	1295732410	1295732410	1	1	AZIZ, SHEHZAD MD	10/23/1998	207RH0003X	NA	Oncology	026	PHYSICIANS	66796	68	Hematology	0	In state provider	None	505 E ROMIE LN	STE A	SALINAS	CA	93901	4031	27	06053	36.65998191	-121.6461895	Monterey County
98186	Fee-for-Service	1366419517	1366419517	1	2	ANTELOPE VALLEY HEALTHCARE	12/1/1977	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
98215	Fee-for-Service	1023173135	1023173135	2	2	AEGIS TREATMENT CENTERS, LLC	6/5/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1050 N GAREY AVE	None	POMONA	CA	91767	3802	19	06037	34.06832944	-117.7520793	Los Angeles County
98242	Fee-for-Service	1992740187	1992740187	1	1	AHARONIAN, ARTIN MD	8/1/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	162198	30	Radiology	0	In state provider	None	225 N JACKSON AVE	ATTN RADIOLOGY DEPT	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
98247	Fee-for-Service	1205443512	1205443512	1	1	ABLETO LICENSED CLINICAL SOC	6/1/2022	251S00000X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	IAL WORKER SERVICES PC	595 MARKET ST	23RD FLOOR	SAN FRANCISCO	CA	94105	2802	38	06075	37.78940904	-122.4011441	San Francisco County
98278	Fee-for-Service	1922146661	1922146661	1	1	ANTELOPE VALLEY CARDIOLGY	6/5/2007	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	ASSOCIATES	43723 20TH ST WEST	STE 101	LANCASTER	CA	93534	4784	19	06037	34.67746837	-118.1657415	Los Angeles County
98280	Fee-for-Service	1639261795	1639261795	1	1	ASIAN COMMUNITY CENTER	4/29/1987	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	OF SAC VALLEY, INC	7801 RUSH RIVER DR	None	SACRAMENTO	CA	95831	4602	34	06067	38.484333	-121.525515	Sacramento County
98284	Fee-for-Service	1629047147	1629047147	1	1	ARMAS, OCTAVIO A MD	1/1/1996	207ZC0500X	NA	Other	026	PHYSICIANS	76309	22	Pathology (M.D. only)	0	In state provider	None	5550 UNIVERSITY AVE	None	SAN DIEGO	CA	92105	2307	37	06073	32.74809744	-117.0773303	San Diego County
98319	Fee-for-Service	1215356241	1215356241	1	1	ALEXANDER J ABRAMOWICZ	2/13/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
98321	Fee-for-Service	1700293214	1700293214	1	1	ALDRIDGE, NICHOLAS R MD	10/5/2018	207P00000X	NA	Other	026	PHYSICIANS	138680	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
98345	Fee-for-Service	1861420630	1861420630	1	1	ANDERSON, JANE E MD	11/30/1991	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	33011	40	Pediatrics	0	In state provider	PEDIATRICS ASOCIATES	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
98355	Fee-for-Service	1780177709	1780177709	1	1	AQUINO, MARIA KRISTINA CCC-	10/25/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	SLP	8265 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10330723	-117.5642502	San Bernardino County
98368	Fee-for-Service	1780610105	1780610105	1	1	ARKFELD, DANIEL G MD	2/28/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	61240	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
98392	Fee-for-Service	1396733713	1396733713	1	1	ALI, SYED MD	2/7/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	166984	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
98401	Fee-for-Service	1316116221	1316116221	1	1	ALTAMED HEALTH SERVICES CORP	2/11/2008	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ORANGE, CHAPMAN	4010 E CHAPMAN AVE	None	ORANGE	CA	92869	3990	30	06059	33.7877325	-117.8109675	Orange County
98409	Fee-for-Service	1295732410	1295732410	1	1	AZIZ, SHEHZAD MD	10/23/1998	207RH0003X	NA	Oncology	026	PHYSICIANS	66796	78	Neoplastic Diseases/Oncology	0	In state provider	None	505 E ROMIE LN	STE A	SALINAS	CA	93901	4031	27	06053	36.65998191	-121.6461895	Monterey County
98448	Fee-for-Service	1235577982	1235577982	1	1	ARUTYUNYAN, VARDUI MD INC	11/26/2014	261QP2300X	NA	Other	026	PHYSICIANS	70072	01	General Practice	0	In state provider	None	1030 S GLENDALE AVE	STE 308	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
98503	Fee-for-Service	1023173135	1023173135	2	2	AEGIS TREATMENT CENTERS, LLC	6/5/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1050 N GAREY AVE	None	POMONA	CA	91767	3802	19	06037	34.06832944	-117.7520793	Los Angeles County
98528	Fee-for-Service	1851819577	1851819577	1	1	AGAZARYAN, EDWARD OT	6/25/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1855 E COCHRAN STREET	109	SIMI VALLEY	CA	93065	2263	56	06111	34.27906738	-118.7628635	Ventura County
98530	Fee-for-Service	1366086563	1366086563	1	1	AMIRYAN, LILIT LPCC	8/25/2024	103TC1900X	NA	Mental Health Outpatient Services	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7170 N FINANCIAL DR.	STE 110	FRESNO	CA	93720	2939	10	06019	36.84000952	-119.7711439	Fresno County
98555	Fee-for-Service	1952728099	1952728099	1	1	ASHLOCK, BRITTANY M MD	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139748	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
98567	Fee-for-Service	1922146661	1922146661	1	1	ANTELOPE VALLEY CARDIOLGY	6/5/2007	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ASSOCIATES	43723 20TH ST WEST	STE 101	LANCASTER	CA	93534	4784	19	06037	34.67746837	-118.1657415	Los Angeles County
98606	Fee-for-Service	1194923813	1194923813	1	1	AHN, GRACE G MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100922	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2000 VALE RD	None	SAN PABLO	CA	94806	3808	07	06013	37.95393251	-122.3375029	Contra Costa County
98614	Fee-for-Service	1164005336	1164005336	1	1	ALLEN, JOHN M CPO	6/2/2021	222Z00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	711 D ST	SUITE 108	SAN RAFAEL	CA	94901	3707	21	06041	37.97088061	-122.5324469	Marin County
98627	Fee-for-Service	1124596556	1124596556	1	1	ARTHRITIS AND RHEUMATIC CARE	5/22/2019	207RR0500X	NA	Other	026	PHYSICIANS	None	83	Rheumatology	0	In state provider	CLINIC, INC.	1401 N PALM CANYON DR	STE 103	PALM SPRINGS	CA	92262	4434	33	06065	33.841269	-116.546807	Riverside County
98642	Fee-for-Service	1467688994	1467688994	1	2	A1 UNLIMITED HOME HEALTH	11/1/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INCORPORATED	4430 SANTA MONICA BLVD	SUITE 203	LOS ANGELES	CA	90029	2014	19	06037	34.09083952	-118.285731	Los Angeles County
98658	Fee-for-Service	1871507293	1871507293	1	1	ANESTHESIA CONSULTANTS	4/23/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OF SACRAMENTO A MED GRP	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
98663	Fee-for-Service	1205002417	1205002417	1	1	AKASHI, MARC K MD	10/21/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123922	40	Pediatrics	0	In state provider	None	769 MEDICAL CENTER COURT	STE 300	CHULA VISTA	CA	91911	6600	37	06073	32.619186	-117.0200925	San Diego County
98674	Fee-for-Service	1396452868	1396452868	1	1	AHMED, EMILYN P LMFT	9/18/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
98680	Fee-for-Service	1871513663	1871513663	1	1	ARAJ, RAMSEY A MD	3/14/1996	208600000X	NA	General Surgery	026	PHYSICIANS	49298	33	Thoracic Surgery	0	In state provider	GEARHART/ARAJ SURGEONS	2147 MOWRY AVE	STE D3	FREMONT	CA	94538	1724	01	06001	37.55758233	-121.9810516	Alameda County
98685	Fee-for-Service	1124880232	1124880232	1	1	ANUNCIADO, ALLYSON PT	4/22/2024	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	275 W HOSPITALITY LANE	100	SAN BERNARDINO	CA	92408	3238	36	06071	34.0659135	-117.289215	San Bernardino County
98703	Fee-for-Service	1144485459	1144485459	1	1	ALLADAWI, AYMAN MD	8/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	96862	None	None	0	In state provider	None	11525 BROOKSHIRE AVE	STE 105	DOWNEY	CA	90241	4982	19	06037	33.93544635	-118.1318321	Los Angeles County
98729	Fee-for-Service	1780092262	1780092262	1	2	ASHER SHAHZAD MD PC	11/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	77	Infectious Disease	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
98792	Fee-for-Service	1396108403	1396108403	1	1	AVOCADO MEDICAL CLINIC PROFE	12/10/2021	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SSIONAL CORP	126 AVOCADO AVE	SUITE 106	PERRIS	CA	92571	2605	33	06065	33.8102395	-117.2244465	Riverside County
98820	Fee-for-Service	1528146321	1528146321	1	1	AYE, SEIN S MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53723	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
98828	Fee-for-Service	1780897066	1780897066	1	1	ARRUDA, ALISON E CSW	7/25/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LTING	2769 ELMHURST CIRCLE	None	FAIRFIELD	CA	94533	1237	48	06095	38.2806685	-122.0321413	Solano County
98834	Fee-for-Service	1003878240	1003878240	1	1	ALTA EAST BAY PATHOLOGY	4/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	INC	2450 ASHBY AVE	None	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
98843	Fee-for-Service	1306157037	1306157037	1	1	AMAN, MUAZZUM MD	1/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136647	01	General Practice	0	In state provider	None	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	4418	50	06099	37.66508443	-120.9962589	Stanislaus County
98845	Fee-for-Service	1083954390	1083954390	1	1	AVERA, LEIGH E DO	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13561	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
98847	Fee-for-Service	1952326811	1952326811	1	1	AMPLA HEALTH	9/15/2009	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	931 MARKET ST	None	YUBA CITY	CA	95991	4210	51	06101	39.14489165	-121.6144546	Sutter County
98855	Fee-for-Service	1932687670	1932687670	1	1	ARBA HOME HEALTHCARE INC	11/22/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5958 VINELAND AVE	STE H	NORTH HOLLYWOOD	CA	91601	1329	19	06037	34.179174	-118.370272	Los Angeles County
98896	Fee-for-Service	1386006278	1386006278	1	1	ANDERSON, MARK J MD	7/22/2021	208600000X	NA	General Surgery	026	PHYSICIANS	172690	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
98899	Fee-for-Service	1760518591	1760518591	1	1	ALBERT LIN MD	3/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3200 S WATER ST	None	PITTSBURGH	PA	15203	2307	00	None	40.42483376	-79.95936389	Allegheny County
98929	Fee-for-Service	1265844799	1265844799	1	1	AKAZAWA, STACY H MD	7/22/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	156284	08	Family Practice	0	In state provider	None	899 VALENCIA ST	GROUND FLOOR	SAN FRANCISCO	CA	94110	1736	38	06075	37.75867161	-122.4212468	San Francisco County
98969	Fee-for-Service	1871513663	1871513663	1	1	ARAJ, RAMSEY A MD	3/14/1996	208600000X	NA	General Surgery	026	PHYSICIANS	49298	02	General Surgery	0	In state provider	GEARHART/ARAJ SURGEONS	2147 MOWRY AVE	STE D3	FREMONT	CA	94538	1724	01	06001	37.55758233	-121.9810516	Alameda County
99020	Fee-for-Service	1780092262	1780092262	1	2	ASHER SHAHZAD MD PC	11/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
99079	Fee-for-Service	1396108403	1396108403	1	1	AVOCADO MEDICAL CLINIC PROFE	5/24/2022	261Q00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	SSIONAL CORP	126 AVOCADO AVE	SUITE 106	PERRIS	CA	92571	2605	33	06065	33.8102395	-117.2244465	Riverside County
99091	Fee-for-Service	1881665933	1881665933	1	2	ARGUELLO, JUAN C DO	3/18/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	9233	-	NOT APPLICABLE	0	In state provider	None	10877 CONDUCTOR BLVD	STE 300	SUTTER CREEK	CA	95685	9687	03	06005	38.36440771	-120.8174749	Amador County
99104	Fee-for-Service	1932441359	1932441359	1	1	ALLEN, REBECCA M MD	7/31/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	143449	40	Pediatrics	0	In state provider	None	1401 AVOCADO AVE	709	NEWPORT BEACH	CA	92660	8714	30	06059	33.61235015	-117.8704573	Orange County
99112	Fee-for-Service	1790935419	1790935419	1	1	ANDERSON, MEGHAN H NP	11/6/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY STREET	SUITE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
99135	Fee-for-Service	1952326811	1952326811	1	1	AMPLA HEALTH	10/1/2002	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	931 MARKET ST	None	YUBA CITY	CA	95991	4210	51	06101	39.14489165	-121.6144546	Sutter County
99156	Fee-for-Service	1861907594	1861907594	1	1	ADIBZADEH, RICCI P NP	2/6/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
99188	Fee-for-Service	1962412643	1962412643	1	1	A DE LA PENA AMG INC	2/27/2007	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	139 S ALVARADO ST	None	LOS ANGELES	CA	90057	2201	19	06037	34.06566774	-118.271006	Los Angeles County
99193	Fee-for-Service	1205367349	1205367349	1	1	AL TAI, ZEENA Z MD	9/2/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	170443	None	None	0	In state provider	None	200 S WELLS ROAD	100	VENTURA	CA	93004	1378	56	06111	34.29321532	-119.1597424	Ventura County
99205	Fee-for-Service	1831318229	1831318229	1	1	ANDERSON, JENNIFER L MD	4/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55027	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
99229	Fee-for-Service	1508890831	1508890831	3	1	AMERICAN MEDICAL RESPONSE	1/10/2018	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	WEST	1101 FEE DR	None	SACRAMENTO	CA	95815	3909	34	06067	38.600829	-121.441914	Sacramento County
99230	Fee-for-Service	1285665364	1285665364	1	1	AYARS, NATALIE M MD	12/31/1996	2084P0800X	NA	Psychiatry	026	PHYSICIANS	71647	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
99240	Fee-for-Service	1407066624	1407066624	1	1	ANGELL, RANDY L MD	8/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119993	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
99241	Fee-for-Service	1194003277	1194003277	3	1	ANGEL'S SMILE HOSPICE INC	2/14/2017	251G00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2252 BEVERLY BLVD	SUITE 210	LOS ANGELES	CA	90057	2225	19	06037	34.06771646	-118.2728448	Los Angeles County
99255	Fee-for-Service	1134206436	1134206436	1	2	ANGEL FAMILY PRACTICE MEDICA	10/31/1991	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	L GROUP INC	2015 E FLORENCE AVE	None	LOS ANGELES	CA	90001	2754	19	06037	33.9747873	-118.2353874	Los Angeles County
99267	Fee-for-Service	1073576757	1073576757	1	1	ACADEMIC OB/GYN PHYS	3/24/1988	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	A MEDICAL GROUP	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
99270	Fee-for-Service	1689803223	1689803223	1	1	ASKIM, KELLY M DO	2/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11013	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	2001 FOURTH AVENUE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
99386	Fee-for-Service	1164538765	1164538765	1	1	ADMIRAL HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4010 WATSON PLAZA DR	STE 120	LAKEWOOD	CA	90712	4035	19	06037	33.83123565	-118.1550195	Los Angeles County
99399	Fee-for-Service	1760682868	1760682868	1	1	AGGARWAL, ASHISH K MD	2/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131211	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	16542 VENTURA BLVD	STE 402	ENCINO	CA	91436	4562	19	06037	34.15773086	-118.493868	Los Angeles County
99419	Fee-for-Service	1679008569	1679008569	2	1	AL-MSHHDANI, AYSER S MD	2/4/2025	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	172929	15	Obstetrics (D.O. only)	0	In state provider	NI MD	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	37	06073	32.750523	-117.100927	San Diego County
99424	Fee-for-Service	1952326811	1952326811	1	1	AMPLA HEALTH	10/1/2002	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	931 MARKET ST	None	YUBA CITY	CA	95991	4210	51	06101	39.14489165	-121.6144546	Sutter County
99457	Fee-for-Service	1881941409	1881941409	1	1	ALESSANDRO MEDICAL	1/28/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	PROFESSIONAL CORPORATION	13925 INDIAN ST	None	MORENO VALLEY	CA	92553	5718	33	06065	33.91832269	-117.2350208	Riverside County
99470	Fee-for-Service	1669535621	1669535621	1	1	AUSTIN, MARIA PSYD	12/23/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
99494	Fee-for-Service	1811286347	1811286347	1	1	ALSOFROM, JESSICA S MD	6/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145533	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
99499	Fee-for-Service	1437412814	1437412814	1	1	ALHEJILY, WESAM A MD FACC	8/7/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	183257	None	None	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
99500	Fee-for-Service	1780016071	1780016071	1	1	AGUILAR GARCIA, JIMMY S LMFT	7/14/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
99505	Fee-for-Service	1548749922	1548749922	1	1	ATKINS, AARON A PT	2/25/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25495 MEDICAL CENTER DR.	SUITE 304	MURRIETA	CA	92562	0000	33	06065	33.55804188	-117.1834064	Riverside County
99527	Fee-for-Service	1194003277	1194003277	3	1	ANGEL'S SMILE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2252 BEVERLY BLVD	SUITE 210	LOS ANGELES	CA	90057	2225	19	06037	34.06771646	-118.2728448	Los Angeles County
99534	Fee-for-Service	1841467099	1841467099	1	1	ANDERSON, GREGORY S MD	7/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	90018	30	Radiology	0	In state provider	None	501 WASHINGTON STREET	SUITE 510	SAN DIEGO	CA	92103	2231	37	06073	32.74986289	-117.1599343	San Diego County
99568	Fee-for-Service	1104319771	1104319771	1	1	ABDALI, ABDUL S MD	10/1/2021	208M00000X	NA	Other	026	PHYSICIANS	173436	None	None	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
99591	Fee-for-Service	1104028000	1104028000	1	1	ANDALIB, PEYMAN MD	9/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101868	13	Neurology (M.D. only)	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
99641	Fee-for-Service	1477521789	1477521789	1	1	ABOU EL KHEIR, TAREK A MD	1/17/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	54454	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	210 SOUTH PALISADE DRIVE	STE 102	SANTA MARIA	CA	93454	8901	42	06083	34.95169604	-120.4120907	Santa Barbara County
99673	Fee-for-Service	1164538765	1164538765	1	1	ADMIRAL HOSPICE CARE INC	6/11/2007	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4010 WATSON PLAZA DR	STE 120	LAKEWOOD	CA	90712	4035	19	06037	33.83123565	-118.1550195	Los Angeles County
99696	Fee-for-Service	1295907301	1295907301	1	1	ADHIKARI, SUSHIL MD	6/6/2021	207R00000X	NA	Other	026	PHYSICIANS	171400	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
99711	Fee-for-Service	1679008569	1679008569	2	1	AL-MSHHDANI, AYSER S MD	2/4/2025	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	172929	09	Gynecology (D.O. only)	0	In state provider	NI MD	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	37	06073	32.750523	-117.100927	San Diego County
99729	Fee-for-Service	1598116915	1598116915	1	1	AL-AZAWI, HIND MD	5/11/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	166421	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
99735	Fee-for-Service	1437287505	1437287505	1	1	AURAN, MICHELLE R MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88351	40	Pediatrics	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
99741	Fee-for-Service	1457628760	1457628760	1	1	AARONSON, ALISTAIR J MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119264	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
99746	Fee-for-Service	1881941409	1881941409	1	1	ALESSANDRO MEDICAL	1/28/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	PROFESSIONAL CORPORATION	13925 INDIAN ST	None	MORENO VALLEY	CA	92553	5718	33	06065	33.91832269	-117.2350208	Riverside County
99782	Fee-for-Service	1235738154	1235738154	1	1	AROUND THE CLOCK HOSPICE	5/17/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1525 W MAGNOLIA BLVD	STE B	BURBANK	CA	91506	1835	19	06037	34.17521731	-118.3252399	Los Angeles County
99795	Fee-for-Service	1962716498	1962716498	1	1	AGS MANAGEMENT SERVICES INC	6/1/2011	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	12040 FOOTHILL BLVD	#110-115	LAKE VIEW TERRACE	CA	91342	6440	19	06037	34.27753839	-118.3983691	Los Angeles County
99847	Fee-for-Service	1467759415	1467759415	1	1	ADVENTIST HEALTH PHYSICIANS	3/30/2011	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	935 TRANCAS ST	STE 4B	NAPA	CA	94558	2943	28	06055	38.32367324	-122.294977	Napa County
99855	Fee-for-Service	1134237993	1134237993	1	2	ADVANCED WOMEN'S HEALTHCARE,	5/22/2023	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MEDICAL CORPORATION	1180 NORTH INDIAN CANYON	SUITE W300	PALM SPRINGS	CA	92262	4809	33	06065	33.839505	-116.5455735	Riverside County
99924	Fee-for-Service	1780694232	1780694232	2	1	APRIA HEALTHCARE LLC	3/21/2005	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	APRIA HEALTHCARE INC	610 S DOUGLAS ST	None	EL SEGUNDO	CA	90245	4811	19	06037	33.90752428	-118.3836533	Los Angeles County
99948	Fee-for-Service	1720289945	1720289945	1	1	ANNA NICOLE RINEWALT MD	12/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	None	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
99973	Fee-for-Service	1649298852	1649298852	1	1	ASCIUTO, THOMAS J MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	53904	01	General Practice	0	In state provider	None	701 E 28TH ST	STE 318	LONG BEACH	CA	90806	2785	19	06037	33.80803441	-118.1847137	Los Angeles County
99992	Fee-for-Service	1245565928	1245565928	1	1	ANDERSON, ADAM S LCSW	6/23/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
99993	Fee-for-Service	1689349094	1689349094	1	2	ANGEL TRANSPORTATION SERVICE	11/29/2021	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	4326 VAUGHN AVE	None	MERCED	CA	95341	9759	24	06047	37.29884436	-120.5653581	Merced County
100029	Fee-for-Service	1790958262	1790958262	1	1	AL-DARSANI, HUSSAIN MD APC	4/2/2009	207R00000X	NA	Other	026	PHYSICIANS	68782	41	Internal Medicine	0	In state provider	None	13193 CENTRAL AVENUE	S#110	CHINO	CA	91710	4173	36	06071	34.01406506	-117.6891684	San Bernardino County
100032	Fee-for-Service	1881941409	1881941409	1	1	ALESSANDRO MEDICAL	1/28/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	PROFESSIONAL CORPORATION	13925 INDIAN ST	None	MORENO VALLEY	CA	92553	5718	33	06065	33.91832269	-117.2350208	Riverside County
100045	Fee-for-Service	1053667386	1053667386	1	1	AVILA, GABRIELA L OD	8/9/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	36891 COOK ST	STE 7	PALM DESERT	CA	92211	6109	33	06065	33.77991452	-116.3558533	Riverside County
100070	Fee-for-Service	1235738154	1235738154	1	1	AROUND THE CLOCK HOSPICE	5/17/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1525 W MAGNOLIA BLVD	STE B	BURBANK	CA	91506	1835	19	06037	34.17521731	-118.3252399	Los Angeles County
100090	Fee-for-Service	1154494599	1154494599	1	1	ADDISON, THOMAS E MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	36097	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
100094	Fee-for-Service	1639219462	1639219462	1	1	ALTA BATES SUMMIT	1/1/2011	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	MED CTR-SUMMIT CAMPUS	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
100108	Fee-for-Service	1154977882	1154977882	1	1	ATHARA TOUSSAIN,NP	3/3/2022	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3950 AUSTELL RD	None	AUSTELL	GA	30106	1121	00	None	33.857235	-84.605022	Cobb County
100137	Fee-for-Service	1790833739	1790833739	1	1	AMZOYAN, MANUSHAK MD	7/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72173	24	Plastic Surgery	0	In state provider	None	1510 SAN PABLO ST	STE 514	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
100141	Fee-for-Service	1073780714	1073780714	1	2	APFEL, BRIGITTE A MD	12/23/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	101833	-	NOT APPLICABLE	0	In state provider	None	734 RUSS STREET	SUITES 104,106,107,110	EUREKA	CA	95501	4540	12	06023	40.7819667	-124.1609055	Humboldt County
100146	Fee-for-Service	1134237993	1134237993	1	2	ADVANCED WOMEN'S HEALTHCARE,	5/22/2023	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	MEDICAL CORPORATION	1180 NORTH INDIAN CANYON	SUITE W300	PALM SPRINGS	CA	92262	4809	33	06065	33.839505	-116.5455735	Riverside County
100152	Fee-for-Service	1710533740	1710533740	1	1	AMERIBEST HOSPICE INC	5/4/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14015 VAN NESS AVE	UNIT 4	GARDENA	CA	90249	2937	19	06037	33.904017	-118.3178875	Los Angeles County
100194	Fee-for-Service	1790914919	1790914919	1	1	ABOUL HOSN, ALAA MD	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139101	01	General Practice	0	In state provider	None	26357 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.41257644	-118.5597683	Los Angeles County
100212	Fee-for-Service	1609315811	1609315811	1	1	ANOSIKE, CHRISTINA N LMFT	6/15/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
100219	Fee-for-Service	1518267186	1518267186	1	1	ASSAAD, PAUL E MD	4/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	113739	41	Internal Medicine	0	In state provider	None	26800 CROWN VALLEY PKWY	SUITE 305	MISSION VIEJO	CA	92691	8033	30	06059	33.56286021	-117.6673449	Orange County
100230	Fee-for-Service	1558393900	1558393900	1	1	AKHLAGHI, IRAJ MD INC	1/1/1979	193400000X	NA	Other	026	PHYSICIANS	21222	41	Internal Medicine	0	In state provider	None	4201 TORRANCE BLVD	STE 730	TORRANCE	CA	90503	4566	19	06037	33.8375955	-118.358748	Los Angeles County
100266	Fee-for-Service	1538345160	1538345160	1	1	AUSTERLITZ, MICHAEL A MD INC	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	25290	41	Internal Medicine	0	In state provider	None	4588 WHITTIER BLVD	None	LOS ANGELES	CA	90022	2430	19	06037	34.02268096	-118.1682101	Los Angeles County
100270	Fee-for-Service	1043414220	1043414220	1	1	AFTAB, WAQAS MD	7/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99485	41	Internal Medicine	0	In state provider	None	1180 E SHAW AVE	STE 101	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
100299	Fee-for-Service	1083715379	1083715379	1	1	AMERIOX, INC	5/24/2005	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14140 VENTURA BLVD	STE 308	SHERMAN OAKS	CA	91423	2774	19	06037	34.14968092	-118.4413738	Los Angeles County
100335	Fee-for-Service	1790283273	1790283273	1	1	ALLURE HOMECARE INC	12/18/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	315 ARDEN AVE	SUITE 12	GLENDALE	CA	91203	1155	19	06037	34.15852735	-118.2587759	Los Angeles County
100346	Fee-for-Service	1124004387	1124004387	1	1	ALTER, GARY J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	27611	34	Urology and Urological Surgery	0	In state provider	None	416 N BEDFORD DR	STE 400	BEVERLY HILLS	CA	90210	4318	19	06037	34.06819809	-118.4052828	Los Angeles County
100362	Fee-for-Service	1730398595	1730398595	1	1	ANTONIO, NICOLE M MD	6/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	103315	40	Pediatrics	0	In state provider	None	11175 CAMPUS ST	CP-A1121	LOMA LINDA	CA	92354	3450	36	06071	34.05060717	-117.2656018	San Bernardino County
100370	Fee-for-Service	1336195700	1336195700	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2291 W MALVERN AVE	None	FULLERTON	CA	92833	2106	30	06059	33.87773823	-117.9660324	Orange County
100374	Fee-for-Service	1326156282	1326156282	1	1	ANDREW JAMES HILL MD	2/20/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
100379	Fee-for-Service	1154494599	1154494599	1	1	ADDISON, THOMAS E MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	36097	41	Internal Medicine	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
100408	Fee-for-Service	1912989773	1912989773	1	1	ALAPATI, RAVINDRA MD	12/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45634	10	Gastroenterology (M.D. only)	0	In state provider	None	18335 VALLEY BLVD	None	LA PUENTE	CA	91744	5968	19	06037	34.00550085	-117.9026349	Los Angeles County
100425	Fee-for-Service	1780080754	1780080754	1	1	AARON, SAGIV MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133119	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
100441	Fee-for-Service	1710533740	1710533740	1	1	AMERIBEST HOSPICE INC	5/4/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14015 VAN NESS AVE	UNIT 4	GARDENA	CA	90249	2937	19	06037	33.904017	-118.3178875	Los Angeles County
100446	Fee-for-Service	1619011863	1619011863	1	1	ASHLOCK, TRACY L OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3747 SUNSET LN	None	ANTIOCH	CA	94509	6101	07	06013	37.98340082	-121.8048051	Contra Costa County
100451	Fee-for-Service	1104806355	1104806355	1	1	ALEXANDER, DARLICIA D MD	10/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
100457	Fee-for-Service	1487188116	1487188116	1	1	ATANELOV, ZAZA U MD	7/21/2020	207P00000X	NA	Other	026	PHYSICIANS	161432	None	None	0	In state provider	None	7901 WALKER STREET	None	LA PALMA	CA	90623	1722	30	06059	33.84755382	-118.0373024	Orange County
100525	Fee-for-Service	1548466329	1548466329	1	1	ARAUJO, RICARDO M MD	10/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115076	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
100533	Fee-for-Service	1992162952	1992162952	1	1	ANDERSON, HEATHER D	11/13/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	15315 MAGNOLIA BLVD	SUITE 306	SHERMAN OAKS	CA	91403	1100	19	06037	34.16488161	-118.4666419	Los Angeles County
100540	Fee-for-Service	1154664241	1154664241	1	1	ARCHENBRONN, SARAH R NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
100552	Fee-for-Service	1538345160	1538345160	1	1	AUSTERLITZ, MICHAEL A MD INC	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	25290	45	Nephrology (Renal-Kidney)	0	In state provider	None	4588 WHITTIER BLVD	None	LOS ANGELES	CA	90022	2430	19	06037	34.02268096	-118.1682101	Los Angeles County
100606	Fee-for-Service	1356972798	1356972798	1	1	ANDREW NASSERI MD INC.	3/30/2020	208600000X	NA	General Surgery	026	PHYSICIANS	None	33	Thoracic Surgery	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
100657	Fee-for-Service	1053301127	1053301127	1	1	AUGUSTA HEALTH CARE, INC.	4/28/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	78 MEDICAL CENTER DR	None	FISHERSVILLE	VA	22939	2332	00	None	38.09423877	-78.9866154	Augusta County
100664	Fee-for-Service	1154494599	1154494599	1	1	ADDISON, THOMAS E MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	36097	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
100685	Fee-for-Service	1346721859	1346721859	1	1	ALLEN, AERIAL LMFT	10/14/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16250 VENTURA BLVD	SUITE 465	ENCINO	CA	91436	4620	19	06037	34.15682212	-118.4871886	Los Angeles County
100688	Fee-for-Service	1811365125	1811365125	1	1	ADELSON, DANEN L PSYD	5/13/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
100693	Fee-for-Service	1003980798	1003980798	1	1	ASHE, REBECCA M MD	10/31/1992	207R00000X	NA	Other	026	PHYSICIANS	75669	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1330 CUTTING BLVD	None	RICHMOND	CA	94804	2555	07	06013	37.92518651	-122.3564715	Contra Costa County
100695	Fee-for-Service	1912989773	1912989773	1	1	ALAPATI, RAVINDRA MD	12/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45634	41	Internal Medicine	0	In state provider	None	18335 VALLEY BLVD	None	LA PUENTE	CA	91744	5968	19	06037	34.00550085	-117.9026349	Los Angeles County
100699	Fee-for-Service	1730748807	1730748807	1	1	ASHOURI, BASHAR	4/26/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	199 S MONTE VISTA AVE	STE 2	SAN DIMAS	CA	91773	3142	19	06037	34.10580672	-117.8093786	Los Angeles County
100702	Fee-for-Service	1588726756	1588726756	1	1	ALANIZI, AYAD MD	9/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	44518	08	Family Practice	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
100713	Fee-for-Service	1780080754	1780080754	1	1	AARON, SAGIV MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133119	40	Pediatrics	0	In state provider	None	8501 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3150	19	06037	34.0653985	-118.3769177	Los Angeles County
100780	Fee-for-Service	1831194331	1831194331	1	1	AYENI, AYODEJI A	2/23/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85436	None	None	0	In state provider	None	2101 7TH ST	None	WASCO	CA	93280	1502	15	06029	35.59426049	-119.3498955	Kern County
100782	Fee-for-Service	1942707112	1942707112	2	1	ANGEL, DONNA LMFT	2/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	74225 HWY 111	SUITE C	PALM DESERT	CA	92260	9398	33	06065	33.72116164	-116.3700359	Riverside County
100786	Fee-for-Service	1205847027	1205847027	1	1	ABOYTES, TERRI L	11/29/2005	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
100788	Fee-for-Service	1073640363	1073640363	2	1	ANGEL CARE ENTERPRISES INC	12/5/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6996 COLE AVE	None	HIGHLAND	CA	92346	3134	36	06071	34.126695	-117.211349	San Bernardino County
100801	Fee-for-Service	1639137425	1639137425	1	2	AYOUB, WILLIAM G DPM	9/30/1987	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	8543 BURNS PL	None	STOCKTON	CA	95209	2633	39	06077	38.02775775	-121.3268182	San Joaquin County
100812	Fee-for-Service	1548466329	1548466329	1	1	ARAUJO, RICARDO M MD	10/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115076	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
100833	Fee-for-Service	1548886765	1548886765	1	1	ANGEL'S CARING HANDS HOSPICE	6/30/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE	517 COMMERCIAL ST	STE C	GLENDALE	CA	91203	1509	19	06037	34.15293268	-118.2735546	Los Angeles County
100887	Fee-for-Service	1376510586	1376510586	1	1	ADVENTIST HEALTH CALIF	8/27/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MEDICAL GRP INC	15322 LAKESHORE DR	STE 102	CLEARLAKE	CA	95422	9815	17	06033	38.95045805	-122.6255271	Lake County
100895	Fee-for-Service	1871658641	1871658641	1	1	ARAMBULA, JOAQUIN MD	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89417	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
100902	Fee-for-Service	1376972752	1376972752	1	1	AMBER MCDANIEL	2/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
100912	Fee-for-Service	1285115360	1285115360	1	1	ARABIAN, JAYME L	6/22/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
100931	Fee-for-Service	1396060984	1396060984	1	1	ABBASIAN, NIEKOO MD	3/23/2021	207LP3000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	3333 BURNET AVENUE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
100966	Fee-for-Service	1538486352	1538486352	1	1	AZIZAD-PINTO, PARISA MD	5/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126926	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
100968	Fee-for-Service	1942436597	1942436597	1	1	APOLAYA, PAMELA E MD	10/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148890	41	Internal Medicine	0	In state provider	None	1600 OWENS STREET	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
100979	Fee-for-Service	1386146496	1386146496	1	1	ALLIANCE PSYCHIATRIC GROUP I	3/15/2022	2084P0800X	NA	Psychiatry	022	PHYSICIANS GROUP	-	None	None	0	In state provider	NC A MEDICAL CORPORATION	17601 17TH ST	120	TUSTIN	CA	92780	1946	30	06059	33.75990351	-117.8253082	Orange County
100981	Fee-for-Service	1003980798	1003980798	1	1	ASHE, REBECCA M MD	10/31/1992	207R00000X	NA	Other	026	PHYSICIANS	75669	41	Internal Medicine	0	In state provider	None	1330 CUTTING BLVD	None	RICHMOND	CA	94804	2555	07	06013	37.92518651	-122.3564715	Contra Costa County
100986	Fee-for-Service	1972546240	1972546240	1	1	AHN, JOHAN K MD	10/9/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	84698	30	Radiology	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
100989	Fee-for-Service	1588726756	1588726756	1	1	ALANIZI, AYAD MD	9/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	44518	02	General Surgery	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
100994	Fee-for-Service	1699109306	1699109306	1	1	ADVANTAGE HOSPICE PROVIDERS	7/28/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	1934 W 9TH ST	UNIT B	UPLAND	CA	91786	4366	36	06071	34.09539405	-117.6881437	San Bernardino County
101007	Fee-for-Service	1184903502	1184903502	1	1	ASJ FAMILY COUNSELING CENTER	9/12/2018	251S00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23632 CALABASAS ROAD	SUITE #103	CALABASAS	CA	91302	3774	19	06037	34.15613926	-118.6421933	Los Angeles County
101072	Fee-for-Service	1861954687	1861954687	1	1	AZAR, GEZELLE C MD	3/29/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	178676	None	None	0	In state provider	None	200 FREEDOM LANE	None	ALISO VIEJO	CA	92656	5876	30	06059	33.56235125	-117.7282117	Orange County
101086	Fee-for-Service	1487764783	1487764783	1	1	ASCH, STEVEN M MD	4/7/2020	207RH0002X	NA	Adult Primary Care	026	PHYSICIANS	67484	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
101094	Fee-for-Service	1609253012	1609253012	1	1	AUF DER SPRINGE, AMY	7/3/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
101121	Fee-for-Service	1548886765	1548886765	1	1	ANGEL'S CARING HANDS HOSPICE	6/30/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE	517 COMMERCIAL ST	STE C	GLENDALE	CA	91203	1509	19	06037	34.15293268	-118.2735546	Los Angeles County
101128	Fee-for-Service	1013634609	1013634609	1	1	ADESSO THERAPEUTICS, LLC	5/31/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	None	5365 MAE ANNE AVE	STE B9	RENO	NV	89523	1889	00	None	39.53353931	-119.8693765	Washoe County
101136	Fee-for-Service	1093843005	1093843005	1	2	ARROWHEAD PEDIATRICS	9/9/2019	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1499 E. HIGHLAND AVENUE	None	SAN BERNARDINO	CA	92404	4611	36	06071	34.1358425	-117.25479	San Bernardino County
101141	Fee-for-Service	1578641874	1578641874	1	1	ALB, SIMONA D MD	2/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98085	08	Family Practice	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
101153	Fee-for-Service	1750574034	1750574034	1	1	AZADFAR, ZOHREH MD	10/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98808	08	Family Practice	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
101158	Fee-for-Service	1649512898	1649512898	1	1	ARAFA, AYAH M MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139217	66	Emergency Medicine (Urgent Care)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
101166	Fee-for-Service	1104155258	1104155258	1	1	ALBREKTSON, JOSHUA R MD	4/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120486	None	None	0	In state provider	None	1770 IOWA AVENUE	SUITE 280	RIVERSIDE	CA	92507	7401	33	06065	33.995169	-117.3398115	Riverside County
101169	Fee-for-Service	1699029298	1699029298	1	1	ALTOM, CHASE S MD	1/25/2021	207L00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1093 ROYAL COURT	None	MEDFORD	OR	97504	8383	00	None	42.34017467	-122.8666022	Jackson County
101185	Fee-for-Service	1669480745	1669480745	1	1	AHMED, PARVEEN N MD	12/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	40390	41	Internal Medicine	0	In state provider	None	4511 ROSEMEAD BLVD	None	PICO RIVERA	CA	90660	2032	19	06037	34.0092382	-118.0814466	Los Angeles County
101197	Fee-for-Service	1578717237	1578717237	1	1	ALEXANDER, LYDIA C MD	1/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	100407	01	General Practice	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
101206	Fee-for-Service	1215989009	1215989009	1	1	ALCALA, GLORIA G MD	7/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	78896	40	Pediatrics	0	In state provider	None	1235 HARRISON ST	None	SAN LEANDRO	CA	94577	4515	01	06001	37.72577467	-122.1544541	Alameda County
101226	Fee-for-Service	1740222934	1740222934	1	1	AMERICAN INDIAN HEALTH	2/1/2000	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	AND SERVICES, INC	4141 STATE ST	None	SANTA BARBARA	CA	93110	1814	42	06083	34.4404695	-119.7612045	Santa Barbara County
101244	Fee-for-Service	1235168881	1235168881	1	1	ALEXANDER J KONDOW, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 METROHEALTH DR	None	CLEVELAND	OH	44109	1998	00	None	41.46242416	-81.69888235	Cuyahoga County
101266	Fee-for-Service	1902338122	1902338122	1	1	ARIBINDI, KATYAYINI MD	9/4/2024	207R00000X	NA	Other	026	PHYSICIANS	172090	41	Internal Medicine	0	In state provider	None	2825 J ST	None	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
101273	Fee-for-Service	1164694907	1164694907	1	1	ABDELNUR, DIEGO R MD	5/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95710	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
101274	Fee-for-Service	1205934866	1205934866	1	1	ANDREW FRANK ZIGMAN, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	501 N GRAHAM ST STE 300	None	PORTLAND	OR	97227	2008	00	None	45.54285348	-122.671035	Multnomah County
101282	Fee-for-Service	1699109306	1699109306	1	1	ADVANTAGE HOSPICE PROVIDERS	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	1934 W 9TH ST	UNIT B	UPLAND	CA	91786	4366	36	06071	34.09539405	-117.6881437	San Bernardino County
101287	Fee-for-Service	1326542424	1326542424	1	1	ANDERSON, MALINDA NP	5/30/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
101305	Fee-for-Service	1003010950	1003010950	1	1	ARTHUR, KRISTINE S O MD	7/19/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95013	41	Internal Medicine	0	In state provider	None	11420 WARNER AVE	None	FOUNTAIN VALLEY	CA	92708	2529	30	06059	33.71633952	-117.929061	Orange County
101312	Fee-for-Service	1235281304	1235281304	1	1	ALLEN-SPEES FAMILY	7/1/2013	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	HOME III	286 W SIERRA AVE	None	FRESNO	CA	93704	1228	10	06019	36.83014322	-119.7967093	Fresno County
101328	Fee-for-Service	1093355984	1093355984	1	1	ASPELL, BRIAN D LMFT	2/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	130 N BRAND BLVD	202	GLENDALE	CA	91203	2644	19	06037	34.147521	-118.2549325	Los Angeles County
101334	Fee-for-Service	1013399104	1013399104	1	1	ARANAS, JUDITH MD	11/5/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	155778	08	Family Practice	0	In state provider	None	1701 E FLORIDA AVE	None	HEMET	CA	92544	4632	33	06065	33.74755247	-116.9539875	Riverside County
101341	Fee-for-Service	1720155567	1720155567	1	1	ALBAUGH, CHRISTOPHER G OD	9/10/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	10850 ARROW ROUTE	None	RANCHO CUCAMONGA	CA	91730	4833	36	06071	34.0991609	-117.5680267	San Bernardino County
101365	Fee-for-Service	1861425456	1861425456	1	1	AMENT, JOEL MD	11/5/2024	2080P0203X	NA	Other	026	PHYSICIANS	65706	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
101392	Fee-for-Service	1194104737	1194104737	1	1	ALDEA INC	3/26/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1375 TROWER AVE	None	NAPA	CA	94558	2420	28	06055	38.33438391	-122.3049737	Napa County
101430	Fee-for-Service	1245606102	1245606102	1	1	ADAM, CYNTHIA S NP	3/16/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1650 LOS GAMOS DR	None	SAN RAFAEL	CA	94903	1850	21	06041	38.02105246	-122.5420674	Marin County
101441	Fee-for-Service	1700185667	1700185667	1	1	AGGARWAL, GAUTAM MD	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120485	01	General Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
101451	Fee-for-Service	1033774088	1033774088	1	1	ABC NON-EMERGENCY MEDICAL TR	8/4/2020	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ANSPORTATION,LLC	5627 N FIGARDEN DR	SUITE 105	FRESNO	CA	93722	4692	10	06019	36.82097784	-119.8700567	Fresno County
101474	Fee-for-Service	1902006182	1902006182	1	1	ABIGAIL BODEN SCHLESINGER, M	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3811 OHARA ST	None	PITTSBURGH	PA	15213	2593	00	None	40.44350017	-79.95952606	Allegheny County
101484	Fee-for-Service	1811036825	1811036825	1	1	ANDREW CARLSON	9/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2719	00	None	35.08771808	-106.6192188	Bernalillo County
101508	Fee-for-Service	1740222934	1740222934	1	1	AMERICAN INDIAN HEALTH	2/1/2000	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	AND SERVICES, INC	4141 STATE ST	None	SANTA BARBARA	CA	93110	1814	42	06083	34.4404695	-119.7612045	Santa Barbara County
101548	Fee-for-Service	1629778733	1629778733	1	1	ALBERT D CHAN MD INC	6/28/2023	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	2150 COLORADO AVE	None	TURLOCK	CA	95382	2003	50	06099	37.51248365	-120.8352587	Stanislaus County
101553	Fee-for-Service	1992176267	1992176267	1	1	AVENAL COMMUNITY HEALTH	9/18/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER	20326 MAIN STREET	None	STRATFORD	CA	93266	9742	16	06031	36.18962048	-119.822823	Kings County
101571	Fee-for-Service	1689170573	1689170573	1	1	ARENSON, ALEXANDRA M DO	10/14/2022	207QA0401X	NA	Adult Primary Care	026	PHYSICIANS	17977	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
101586	Fee-for-Service	1720103229	1720103229	1	1	AGOPIAN, VATCHE G MD	5/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	91885	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
101625	Fee-for-Service	1619094281	1619094281	1	1	ASELTINE, ROBYN M LCSW	6/23/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	969 BROADWAY	None	OAKLAND	CA	94607	4017	01	06001	37.80134725	-122.273069	Alameda County
101644	Fee-for-Service	1134639859	1134639859	1	2	ASPIRE NEURO PSYCHOLOGICAL S	1/24/2020	103G00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	ERVICES, INC.	2815 MITCHELL DR	STE 119	WALNUT CREEK	CA	94598	1622	07	06013	37.93129027	-122.0204585	Contra Costa County
101657	Fee-for-Service	1487200143	1487200143	1	1	ACEVEDO, CRISTINA OD	7/22/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	15330 AMAR RD	STE A	LA PUENTE	CA	91744	2001	19	06037	34.03714077	-117.9509701	Los Angeles County
101672	Fee-for-Service	1750917191	1750917191	1	1	ARIAS, RUBY C LCSW	4/4/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
101710	Fee-for-Service	1588892723	1588892723	1	1	ARNERICH, CHRISTI A MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137463	04	Otology, Laryngology, Rhinology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
101713	Fee-for-Service	1558847392	1558847392	2	1	AVENUE HEALTH INC	10/10/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10373 TRADEMARK ST	STE A	RANCHO CUCAMONGA	CA	91730	5862	36	06071	34.08044029	-117.5787029	San Bernardino County
101731	Fee-for-Service	1588953780	1588953780	1	1	ALTAF, ELHAM W MD FACOG	11/11/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	168521	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
101751	Fee-for-Service	1407076276	1407076276	1	1	ANNA GOLD CO, INC	3/1/2003	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	MILLENNIUM CARE ADHC	2150 WINIFRED ST	None	SIMI VALLEY	CA	93063	2934	56	06111	34.274655	-118.7110602	Ventura County
101753	Fee-for-Service	1699738047	1699738047	1	1	ALEXANIAN, RUZANNA MD	8/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53476	41	Internal Medicine	0	In state provider	None	1505 WILSON TER	STE 220	GLENDALE	CA	91206	4074	19	06037	34.14960934	-118.2313491	Los Angeles County
101774	Fee-for-Service	1619058237	1619058237	1	1	AGUILAR, CHRISTINE MD	12/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	60095	None	None	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
101791	Fee-for-Service	1578535084	1578535084	1	1	ADIE, ELIZABETH M MD	6/28/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	72831	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2425 SAMARITAN DRIVE	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
101801	Fee-for-Service	1740222934	1740222934	1	1	AMERICAN INDIAN HEALTH	2/1/2000	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	AND SERVICES, INC	4141 STATE ST	None	SANTA BARBARA	CA	93110	1814	42	06083	34.4404695	-119.7612045	Santa Barbara County
101810	Fee-for-Service	1619961372	1619961372	1	1	AFRIDI, NADEEM MD	11/11/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	175653	None	None	0	In state provider	None	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	33	06065	33.82736911	-116.5109632	Riverside County
101841	Fee-for-Service	1992176267	1992176267	1	1	AVENAL COMMUNITY HEALTH	9/18/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER	20326 MAIN STREET	None	STRATFORD	CA	93266	9742	16	06031	36.18962048	-119.822823	Kings County
101868	Fee-for-Service	1033864525	1033864525	1	1	AGING GRACE SENIOR LIVING	4/28/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	FACILITY	11539 HAWTHORNE AVE	None	HESPERIA	CA	92345	1927	36	06071	34.46033931	-117.3363545	San Bernardino County
101870	Fee-for-Service	1689961310	1689961310	1	1	AYOUB, MARK MD	9/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150352	20	Orthopedic Surgery	0	In state provider	None	290 N WAYTE LANE	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
101892	Fee-for-Service	1700876026	1700876026	1	1	ALLEN, ROBERT H MD	7/1/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	26066	33	Thoracic Surgery	0	In state provider	None	3965 J ST	# 110	SACRAMENTO	CA	95819	3624	34	06067	38.56967099	-121.4533629	Sacramento County
101902	Fee-for-Service	1407397672	1407397672	1	1	ADEDIPE, ADEKEMI NP	9/15/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1700 COFFEE RD	None	MODESTO	CA	95355	2803	50	06099	37.668645	-120.9756715	Stanislaus County
101909	Fee-for-Service	1386993814	1386993814	1	1	AGARIN, TAGHOGHO MD	1/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130398	36	Psychiatry	0	In state provider	None	4445 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
101927	Fee-for-Service	1427212570	1427212570	1	1	APGAR, JOSHUA K DO	4/15/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	22650	30	Radiology	0	In state provider	None	6412 LAUREL AVE	None	MOUNTAIN MESA	CA	93240	9529	15	06029	35.63564004	-118.407037	Kern County
101930	Fee-for-Service	1134639859	1134639859	1	2	ASPIRE NEURO PSYCHOLOGICAL S	1/24/2020	103G00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ERVICES, INC.	2815 MITCHELL DR	STE 119	WALNUT CREEK	CA	94598	1622	07	06013	37.93129027	-122.0204585	Contra Costa County
101945	Fee-for-Service	1043607633	1043607633	1	1	ALLEN, RACHEL C MD	9/1/2020	208600000X	NA	General Surgery	026	PHYSICIANS	146358	02	General Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
101974	Fee-for-Service	1649516154	1649516154	1	1	ANDREWS, LAURA K MD	12/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124033	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
101995	Fee-for-Service	1689840076	1689840076	1	3	ARIF RAHMAN M.D.	7/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7171 S 51ST AVE	None	LAVEEN	AZ	85339	2923	00	None	33.380613	-112.16745	Maricopa County
102001	Fee-for-Service	1063824498	1063824498	1	1	ALLEN, DELHIA MFT	10/16/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	85885	-	NOT APPLICABLE	0	In state provider	None	1001 POTRERO AVE	WARD 93/95	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
102024	Fee-for-Service	1699865170	1699865170	1	1	ARCHER, ROBERT L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 CHILDRENS WAY	None	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
102029	Fee-for-Service	1750390381	1750390381	1	1	AHMED, SAQUIB M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6440 GRAND AVE	STE 203	GURNEE	IL	60031	5258	00	None	42.385887	-87.9623685	Lake County
102050	Fee-for-Service	1144475583	1144475583	1	1	ANUMANDLA, ANIL REDDY MD	1/11/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	176590	None	None	0	In state provider	None	263 PEARSON DR	STE 200	PORTERVILLE	CA	93257	3333	54	06107	36.07050297	-119.0277645	Tulare County
102060	Fee-for-Service	1336167899	1336167899	1	1	ARROYO, JOEL E MD	9/1/1985	207RP1001X	NA	Pulmonology	026	PHYSICIANS	32663	41	Internal Medicine	0	In state provider	None	5305 E BEVERLY BLVD	None	LOS ANGELES	CA	90022	2103	19	06037	34.03066918	-118.1509726	Los Angeles County
102064	Fee-for-Service	1740323328	1740323328	1	1	ABSOLUTE CARE INC	9/12/2006	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	541 N MACLAY AVE	STE 104	SAN FERNANDO	CA	91340	2478	19	06037	34.28849974	-118.4343102	Los Angeles County
102069	Fee-for-Service	1376674689	1376674689	1	1	AHMED, KHAJA R MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	45423	45	Nephrology (Renal-Kidney)	0	In state provider	None	20911 EARL ST	STE 180	TORRANCE	CA	90503	4353	19	06037	33.840459	-118.3580985	Los Angeles County
102085	Fee-for-Service	1609862051	1609862051	1	1	AKHONDI ASL, HOSSEIN MD	9/15/2020	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
102089	Fee-for-Service	1740222934	1740222934	1	1	AMERICAN INDIAN HEALTH	2/1/2000	207Q00000X	NA	Adult Primary Care	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	AND SERVICES, INC	4141 STATE ST	None	SANTA BARBARA	CA	93110	1814	42	06083	34.4404695	-119.7612045	Santa Barbara County
102102	Fee-for-Service	1770767139	1770767139	1	1	AMR, OMAR M MD	3/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102525	66	Emergency Medicine (Urgent Care)	0	In state provider	None	17100 EUCLID	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
102129	Fee-for-Service	1992176267	1992176267	1	1	AVENAL COMMUNITY HEALTH	2/12/2018	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CENTER	20326 MAIN STREET	None	STRATFORD	CA	93266	9742	16	06031	36.18962048	-119.822823	Kings County
102159	Fee-for-Service	1538494794	1538494794	1	1	AZANZA, ROSANNA P LCSW	6/5/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	62048	-	NOT APPLICABLE	0	In state provider	None	323 N PRAIRIE AVE	STE 350	INGELWOOD	CA	90301	4502	19	06037	33.966333	-118.3439975	Los Angeles County
102178	Fee-for-Service	1700876026	1700876026	1	1	ALLEN, ROBERT H MD	7/1/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	26066	02	General Surgery	0	In state provider	None	3965 J ST	# 110	SACRAMENTO	CA	95819	3624	34	06067	38.56967099	-121.4533629	Sacramento County
102182	Fee-for-Service	1134147150	1134147150	2	1	AMERICAN MEDICAL RESPONSE	1/18/2018	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	WEST	3755 N WEST LANE	None	STOCKTON	CA	95204	2431	39	06077	37.98776042	-121.2853308	San Joaquin County
102189	Fee-for-Service	1992458608	1992458608	1	1	AKPENE GBEGNON MD, INC	6/7/2023	208600000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	1680 120TH ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
102236	Fee-for-Service	1295812121	1295812121	1	1	AVARI, SHIVA MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71604	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
102260	Fee-for-Service	1174506430	1174506430	1	1	ABIOG, MICHAEL C MD	6/4/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	103007	None	None	0	In state provider	None	1180 POST ST	None	SAN FRANCISCO	CA	94109	5505	38	06075	37.78672984	-122.4209381	San Francisco County
102270	Fee-for-Service	1104453257	1104453257	1	1	ABDELMESEEH, ERENE Y MD	8/7/2023	208M00000X	NA	Other	026	PHYSICIANS	183860	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
102277	Fee-for-Service	1730248311	1730248311	1	1	ABDALLA, IMAN A MD	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79393	68	Hematology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
102279	Fee-for-Service	1548345200	1548345200	1	1	AGHA, SAMINA MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90995	01	General Practice	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
102284	Fee-for-Service	1306847827	1306847827	1	1	ARAB, MOHAMMAD K MD	9/17/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	39192	04	Otology, Laryngology, Rhinology	0	In state provider	None	516 W ATEN RD	STE 4	IMPERIAL	CA	92251	9805	13	06025	32.82558069	-115.5814237	Imperial County
102318	Fee-for-Service	1679583074	1679583074	1	1	AIKIN, BRUCE M MD	1/4/1999	207P00000X	NA	Other	026	PHYSICIANS	37012	08	Family Practice	0	In state provider	None	5974 PENTZ RD	None	PARADISE	CA	95969	5509	04	06007	39.75705992	-121.572292	Butte County
102322	Fee-for-Service	1629725668	1629725668	1	1	ALOE URGENT CARE PLLC	1/24/2023	261QU0200X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	2	Out of state provider	None	3663 PIONEER PKWY	STE 1	SANTA CLARA	UT	84765	5403	00	None	37.1464764	-113.662731	Washington County
102355	Fee-for-Service	1376674689	1376674689	1	1	AHMED, KHAJA R MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	45423	41	Internal Medicine	0	In state provider	None	20911 EARL ST	STE 180	TORRANCE	CA	90503	4353	19	06037	33.840459	-118.3580985	Los Angeles County
102362	Fee-for-Service	1457731572	1457731572	1	1	ADEYEMO, MOPELOLA A MD	7/13/2021	207R00000X	NA	Other	026	PHYSICIANS	150028	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
102395	Fee-for-Service	1164518189	1164518189	1	1	AMORMINO, GINELLE C PT	7/10/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2842 SEPULVEDA BLVD	None	TORRANCE	CA	90505	2803	19	06037	33.82340521	-118.3361739	Los Angeles County
102431	Fee-for-Service	1033415211	1033415211	1	1	ADVANCED SLEEP MEDICINE SRVS	7/3/2018	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	3975 JACKSON ST	SUITE 304	RIVERSIDE	CA	92503	3950	33	06065	33.92729721	-117.4413503	Riverside County
102454	Fee-for-Service	1942260229	1942260229	1	1	ABRAHAM, JOSEPHINE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	650 E 4500 S	None	SALT LAKE CTY	UT	84107	2900	00	None	40.6742997	-111.873574	Salt Lake County
102474	Fee-for-Service	1922235662	1922235662	1	1	ABEYTA, REINA A NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	44444 20TH ST WEST	None	LANCASTER	CA	93534	2714	19	06037	34.69063406	-118.1656452	Los Angeles County
102479	Fee-for-Service	1477504926	1477504926	1	1	ARNOLD, MATTHEW W MD	6/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81482	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA STE B2	None	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
102515	Fee-for-Service	1639407695	1639407695	1	1	ATTWILL, FRANCIS E DO	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12131	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1250 EAST ALMOND AVENUE	None	MADERA	CA	93637	5696	20	06039	36.94519024	-120.0420086	Madera County
102521	Fee-for-Service	1972199123	1972199123	1	1	AUXILIUM PALLIATIVE HOSPICE	10/28/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	11350 VENTURA BLVD	SUITE 100	STUDIO CITY	CA	91604	3140	19	06037	34.14014506	-118.3774984	Los Angeles County
102536	Fee-for-Service	1063084093	1063084093	1	1	ANVARI, ABTIN PT	8/8/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1280 CORONA POINTE CT	STE 118	CORONA	CA	92879	1770	33	06065	33.87039079	-117.5408442	Riverside County
102566	Fee-for-Service	1730248311	1730248311	1	1	ABDALLA, IMAN A MD	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79393	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
102580	Fee-for-Service	1285667758	1285667758	1	2	AMPLA HEALTH	4/2/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1187 EAST SOUTH STREET	None	ORLAND	CA	95963	9136	11	06021	39.736017	-122.167224	Glenn County
102599	Fee-for-Service	1508058108	1508058108	1	1	AGRAWAL, RANJANI	3/24/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103054	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
102607	Fee-for-Service	1447413802	1447413802	1	1	ATTAYA, HESHAM N MD	11/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144016	30	Radiology	0	In state provider	None	3800 DALE RD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
102614	Fee-for-Service	1851603013	1851603013	1	2	ARGUS HOME HEALTH INC	2/8/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	13746 VICTORY BLVD	SUITE 215	VAN NUYS	CA	91401	6716	19	06037	34.18664551	-118.432764	Los Angeles County
102675	Fee-for-Service	1700843216	1700843216	1	1	AURORA LAS ENCINAS LLC	3/11/2003	283Q00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2900 E DEL MAR BLVD	None	PASADENA	CA	91107	4375	19	06037	34.14213253	-118.090593	Los Angeles County
102696	Fee-for-Service	1114664380	1114664380	1	1	AA HIGH QUALITY HOME INC	11/29/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	13300 ARMINTA ST	None	NORTH HOLLYWOOD	CA	91605	4815	19	06037	34.21339548	-118.422918	Los Angeles County
102698	Fee-for-Service	1245391523	1245391523	1	1	A-1 HEALTHCARE MGMT INC	4/12/2006	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3740 LONG BEACH BLVD	SUITE 201	LONG BEACH	CA	90807	3310	19	06037	33.82551587	-118.1893168	Los Angeles County
102709	Fee-for-Service	1982753521	1982753521	1	1	ARMENIAN, SARO H	11/8/2006	2080P0207X	NA	Hematology	026	PHYSICIANS	8610	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
102729	Fee-for-Service	1912412818	1912412818	1	1	ANDERSON, CAYLA LCSW	2/10/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
102765	Fee-for-Service	1801550637	1801550637	1	1	AREK APO TOULOUMDJIAN MD INC	5/10/2022	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	.	70077 RAMON RD	None	RANCHO MIRAGE	CA	92270	5201	33	06065	33.81587854	-116.4396933	Riverside County
102769	Fee-for-Service	1912312273	1912312273	1	1	AVENAL COMMUNITY HEALTH	7/1/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER	148 E KINGS STREET	None	AVENAL	CA	93204	1529	16	06031	36.00249425	-120.1366109	Kings County
102778	Fee-for-Service	1336670991	1336670991	1	1	AKHETUAMHEN, ADESUWA MD	6/10/2021	207P00000X	NA	Other	026	PHYSICIANS	171950	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
102788	Fee-for-Service	1124252069	1124252069	1	1	ALTAMED HEALTH SERV CORP	5/1/2009	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	2828 N FIGUEROA ST	None	LOS ANGELES	CA	90065	0000	19	06037	34.08528359	-118.2205117	Los Angeles County
102810	Fee-for-Service	1932198256	1932198256	1	1	ARCIA, JOHN M MD	5/15/1996	207RN0300X	NA	Nephrology	026	PHYSICIANS	70558	41	Internal Medicine	0	In state provider	None	255 E ORANGE GROVE AVE	STE D	BURBANK	CA	91502	1240	19	06037	34.18236815	-118.3089281	Los Angeles County
102811	Fee-for-Service	1972199123	1972199123	1	1	AUXILIUM PALLIATIVE HOSPICE	10/28/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	11350 VENTURA BLVD	SUITE 100	STUDIO CITY	CA	91604	3140	19	06037	34.14014506	-118.3774984	Los Angeles County
102815	Fee-for-Service	1285195123	1285195123	1	1	ABARCAR, KARA A MD	7/18/2023	207P00000X	NA	Other	026	PHYSICIANS	185365	None	None	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
102818	Fee-for-Service	1093800617	1093800617	1	1	ANAHEIM CARDIOLOGY MED	8/10/2005	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	1801 W ROMNEYA DR	STE 506	ANAHEIM	CA	92801	1827	30	06059	33.8506615	-117.946413	Orange County
102855	Fee-for-Service	1730248311	1730248311	1	1	ABDALLA, IMAN A MD	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79393	78	Neoplastic Diseases/Oncology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
102876	Fee-for-Service	1003150657	1003150657	1	1	AZHAND, AZIM U MD APC	1/31/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	49621	40	Pediatrics	0	In state provider	None	27450 YNEZ RD	STE 108	TEMECULA	CA	92591	4649	33	06065	33.50684549	-117.1502048	Riverside County
102878	Fee-for-Service	1932311867	1932311867	1	1	ANJANI RAO, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	42557 WOODWARD AVE	STE 200	BLOOMFLD HLS	MI	48304	5206	00	None	42.6002658	-83.26130526	Oakland County
102885	Fee-for-Service	1699021378	1699021378	1	1	ANDOH, HENRY M MD	9/23/2019	2085N0700X	NA	MRI Provider	026	PHYSICIANS	127048	30	Radiology	0	In state provider	None	3161 L ST	None	SACRAMENTO	CA	95816	5234	34	06067	38.570958	-121.4642295	Sacramento County
102922	Fee-for-Service	1134384134	1134384134	1	1	ARON, MANJU MD	6/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114197	22	Pathology (M.D. only)	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
102930	Fee-for-Service	1073806683	1073806683	1	1	ALVAREZ, JUAN F MD	11/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150042	02	General Surgery	0	In state provider	None	7300 N FRESNO STREET	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
102963	Fee-for-Service	1700843216	1700843216	1	1	AURORA LAS ENCINAS LLC	3/11/2003	283Q00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2900 E DEL MAR BLVD	None	PASADENA	CA	91107	4375	19	06037	34.14213253	-118.090593	Los Angeles County
102998	Fee-for-Service	1942567540	1942567540	1	1	AZIM, MANSOOR MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128143	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
103002	Fee-for-Service	1780932996	1780932996	1	1	ARAKERE, PUSHPALATHA MD INC	2/28/2013	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	88072	77	Infectious Disease	0	In state provider	None	7035 N MAPLE AVENUE	SUITE 101	FRESNO	CA	93720	8026	10	06019	36.83856379	-119.7452911	Fresno County
103034	Fee-for-Service	1952580714	1952580714	1	1	ARORA, NEELU MD	7/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98714	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
103058	Fee-for-Service	1912312273	1912312273	1	1	AVENAL COMMUNITY HEALTH	12/1/2015	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CENTER	148 E KINGS STREET	None	AVENAL	CA	93204	1529	16	06031	36.00249425	-120.1366109	Kings County
103059	Fee-for-Service	1558307009	1558307009	1	1	ASHMORE, DIANE L LMFT	1/18/2021	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	264 CLOVIS AVE	SUITE 210	CLOVIS	CA	93612	1115	10	06019	36.8268544	-119.7007055	Fresno County
103068	Fee-for-Service	1649669938	1649669938	1	1	ADVANCED HOME HEALTH SAN	10/1/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	DIEGO INC	8996 MIRAMAR RD	SUITE 220	SAN DIEGO	CA	92126	4451	37	06073	32.8938195	-117.131463	San Diego County
103074	Fee-for-Service	1124252069	1124252069	1	1	ALTAMED HEALTH SERV CORP	5/1/2009	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2828 N FIGUEROA ST	None	LOS ANGELES	CA	90065	0000	19	06037	34.08528359	-118.2205117	Los Angeles County
103090	Fee-for-Service	1528419207	1528419207	1	1	A FAITHFUL HOME, LLC	11/1/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	26642 SALAMANCA DRIVE	None	MISSION VIEJO	CA	92691	1004	30	06059	33.60521626	-117.6654702	Orange County
103156	Fee-for-Service	1417963075	1417963075	1	1	ARNOLD, MUOI M.D.	9/30/1994	207ZP0101X	NA	Other	026	PHYSICIANS	52691	22	Pathology (M.D. only)	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
103187	Fee-for-Service	1932726973	1932726973	1	1	A PLUS HOME HEALTH SERVICES	3/4/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	28310 ROADSIDE DR	STE 239	AGOURA HILLS	CA	91301	4965	19	06037	34.14271418	-118.7432847	Los Angeles County
103216	Fee-for-Service	1861589962	1861589962	1	1	ALBABA, MOHAMMAD MD	12/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	82130	41	Internal Medicine	0	In state provider	None	450 STANYON ST	6TH FLOOR	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
103239	Fee-for-Service	1689096133	1689096133	2	1	ALPHA MEDICAL HEALTH INC	2/27/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	401 N GARFIELD AVE	STE. 101	MONTEREY PARK	CA	91754	1207	19	06037	34.066305	-118.122906	Los Angeles County
103247	Fee-for-Service	1558862946	1558862946	1	1	ASSISTED HOME RECOVERY, INC	3/1/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	115 E MICHELTORENA ST	SUITE 201	SANTA BARBARA	CA	93101	1905	42	06083	34.42766456	-119.7067497	Santa Barbara County
103251	Fee-for-Service	1700843216	1700843216	1	1	AURORA LAS ENCINAS LLC	3/11/2003	283Q00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	2900 E DEL MAR BLVD	None	PASADENA	CA	91107	4375	19	06037	34.14213253	-118.090593	Los Angeles County
103268	Fee-for-Service	1114005816	1114005816	1	1	ATKINS, DAVID A MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65002	36	Psychiatry	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
103309	Fee-for-Service	1093077356	1093077356	1	1	ADDICOTT, BENJAMIN T MD	5/1/2018	390200000X	NA	Other	026	PHYSICIANS	154348	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
103330	Fee-for-Service	1215625116	1215625116	2	1	ARJONA, STEPHANIE CLE	4/30/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	30	06059	0	0	None
103344	Fee-for-Service	1912312273	1912312273	1	1	AVENAL COMMUNITY HEALTH	10/15/2015	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CENTER	148 E KINGS STREET	None	AVENAL	CA	93204	1529	16	06031	36.00249425	-120.1366109	Kings County
103395	Fee-for-Service	1477959393	1477959393	1	1	ALBERO, AMATA LMFT	8/27/2021	171M00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1103 BUTTE HOUSE RD	SUITE E	YUBA CITY	CA	95991	3109	51	06101	39.14536728	-121.6306637	Sutter County
103434	Fee-for-Service	1255891735	1255891735	1	1	ANSHUS, ALEXANDER MD	7/25/2022	207P00000X	NA	Other	026	PHYSICIANS	176929	None	None	0	In state provider	None	2020 GENESEE AVE	None	SAN DIEGO	CA	92123	4219	37	06073	32.7921973	-117.1571251	San Diego County
103443	Fee-for-Service	1356091383	1356091383	1	1	AMEN, SARA MD	7/22/2024	261QU0200X	NA	Other	026	PHYSICIANS	187342	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	37	06073	32.79692047	-117.1567137	San Diego County
103507	Fee-for-Service	1861589962	1861589962	1	1	ALBABA, MOHAMMAD MD	12/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	82130	38	Geriatrics	0	In state provider	None	450 STANYON ST	6TH FLOOR	SAN FRANCISCO	CA	94117	1079	38	06075	37.7738933	-122.4544685	San Francisco County
103530	Fee-for-Service	1962514141	1962514141	1	1	AMR-ELMELIGY, MAHA M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	45082	None	None	0	In state provider	None	25845 BARTON RD	STE F	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
103536	Fee-for-Service	1215349725	1215349725	1	1	ARBOLEDA, VALERIE A MD	8/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140552	22	Pathology (M.D. only)	0	In state provider	None	10833 LE CONTE AVE	RM B186	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
103561	Fee-for-Service	1063980928	1063980928	1	1	ATI, MANISHA NP	12/7/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	44151 15TH ST W	101	LANCASTER	CA	93534	4079	19	06037	34.68551775	-118.1568686	Los Angeles County
103601	Fee-for-Service	1275906208	1275906208	1	1	ALVARADO, HEATHER PSYD	2/16/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
103633	Fee-for-Service	1912312273	1912312273	1	1	AVENAL COMMUNITY HEALTH	7/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER	148 E KINGS STREET	None	AVENAL	CA	93204	1529	16	06031	36.00249425	-120.1366109	Kings County
103669	Fee-for-Service	1578851697	1578851697	1	1	ARBABI, SHERENE A MD	10/1/2018	208M00000X	NA	Other	026	PHYSICIANS	147745	41	Internal Medicine	0	In state provider	None	16200 SAND CANYON AVE	None	IRVINE	CA	92618	3714	30	06059	33.6617581	-117.7736362	Orange County
103780	Fee-for-Service	1477812170	1477812170	1	1	ALLEN, CHRISTOPHER M MD	8/1/2022	207P00000X	NA	Other	026	PHYSICIANS	180202	None	None	0	In state provider	None	2540 EAST ST	None	CONCORD	CA	94520	1906	07	06013	37.98292379	-122.0341876	Contra Costa County
103809	Fee-for-Service	1497923619	1497923619	1	1	AKONI, CHERYL D LMFT	10/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
103827	Fee-for-Service	1821117938	1821117938	1	1	ALLEN, SHAUN J LCSW	4/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	21954	-	NOT APPLICABLE	0	In state provider	None	4211 S AVALON BLVD	None	LOS ANGELES	CA	90011	5622	19	06037	34.007238	-118.2653065	Los Angeles County
103831	Fee-for-Service	1275836371	1275836371	1	1	ANKUR SETH M.D.	2/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	877 JEFFERSON AVE	None	MEMPHIS	TN	38103	2807	00	None	35.14259562	-90.03187321	Shelby County
103848	Fee-for-Service	1407148760	1407148760	1	1	ASIFUDDIN, AMIR MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131642	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
103853	Fee-for-Service	1093840415	1093840415	1	1	ANAND, VEERINDER S MD INC	3/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	39442	None	None	0	In state provider	None	1318 S IMPERIAL AVE	None	EL CENTRO	CA	92243	4201	13	06025	32.78032357	-115.5697347	Imperial County
103858	Fee-for-Service	1588133193	1588133193	1	1	ADVINCULA, JASMIN G CRNA	5/15/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
103865	Fee-for-Service	1881871200	1881871200	1	1	AMAYA, GINA E DO	9/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
103876	Fee-for-Service	1992325039	1992325039	1	1	A LIFE CARE HOSPICE INC	12/3/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10970 ARROW ROUTE	SUITE 213	RANCHO CUCAMONGA	CA	91730	4839	36	06071	34.09912555	-117.5646369	San Bernardino County
103881	Fee-for-Service	1689258238	1689258238	1	2	ART MED TRANS, INC.	12/9/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1510 S CENTRAL AVE	270	GLENDALE	CA	91204	2500	19	06037	34.12709764	-118.2577911	Los Angeles County
103884	Fee-for-Service	1437440138	1437440138	1	2	APIGIAN, AIMIE MD	8/2/2018	2083P0901X	NA	Adult Primary Care	026	PHYSICIANS	136587	01	General Practice	0	In state provider	None	28400 MCCALL BLVD	None	MENIFEE	CA	92585	9658	33	06065	33.71805454	-117.1672547	Riverside County
103897	Fee-for-Service	1669421640	1669421640	2	1	APOTEK GLOBAL	12/16/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2865 E COAST HWY	SUITE 150	CORONA DEL MAR	CA	92625	2236	30	06059	33.59992624	-117.8723954	Orange County
103918	Fee-for-Service	1346289204	1346289204	1	1	ALAN LAORR M.D.	10/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
103927	Fee-for-Service	1831510999	1831510999	1	1	ARDENT HOSPICE & PALLIATIVE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE OF FRESNO INC	2040 N WINERY AVE	STE 102	FRESNO	CA	93703	4814	10	06019	36.76911951	-119.7317313	Fresno County
104007	Fee-for-Service	1689612079	1689612079	1	1	ALTINSAN, SAIDE MD	8/27/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	51069	36	Psychiatry	0	In state provider	None	2830 GLENDESSARY LANE	None	SANTA BARBARA	CA	93105	2960	42	06083	34.44509477	-119.7186392	Santa Barbara County
104008	Fee-for-Service	1437576436	1437576436	1	1	ABUGROUN, ISRA MD	7/23/2020	2080P0205X	NA	Endocrinology	026	PHYSICIANS	167777	67	Endocrinology	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
104025	Fee-for-Service	1700938297	1700938297	1	1	ANSARI, ALTAF H MD	6/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56132	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 MILVIA STREET	None	BERKELEY	CA	94705	2636	01	06001	37.86338897	-122.2698455	Alameda County
104055	Fee-for-Service	1205478252	1205478252	1	1	ARAZ MELKONIAN MD INC	3/16/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
104102	Fee-for-Service	1023011632	1023011632	1	4	ALTURA CENTERS FOR HEALTH	10/4/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE	1101 N CHERRY ST	None	TULARE	CA	93274	2231	54	06107	36.22333808	-119.337575	Tulare County
104115	Fee-for-Service	1568863157	1568863157	1	1	AGAPE HOSPICE & PALLIATIVE	9/8/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE LLC	3711 LOMITA BLVD	SUITE 120	TORRANCE	CA	90505	3877	19	06037	33.81537872	-118.349881	Los Angeles County
104124	Fee-for-Service	1114451663	1114451663	1	1	AKUA BEHAVIORAL HEALTH, INC	1/9/2025	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	10087 TERRA LOMA DR	None	RANCHO CORDOVA	CA	95670	3202	34	06067	38.58408	-121.31775	Sacramento County
104127	Fee-for-Service	1629170261	1629170261	1	1	ADAMS, JAMES W LMFT	12/19/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1990 3RD ST	STE 600	SACRAMENTO	CA	95811	6929	34	06067	38.5722	-121.507677	Sacramento County
104134	Fee-for-Service	1932299930	1932299930	1	1	ANNIE LIM & KHENG LIM MD	12/8/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	INC	9209 COLIMA RD	STE 4200	WHITTIER	CA	90605	1827	19	06037	33.9505367	-118.0054552	Los Angeles County
104162	Fee-for-Service	1992325039	1992325039	1	1	A LIFE CARE HOSPICE INC	12/3/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10970 ARROW ROUTE	SUITE 213	RANCHO CUCAMONGA	CA	91730	4839	36	06071	34.09912555	-117.5646369	San Bernardino County
104170	Fee-for-Service	1679917280	1679917280	1	1	AVETISOV, GREGORY DO	6/6/2024	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	22510	01	General Practice	0	In state provider	None	701 HOWE AVE	SUITE C-5	SACRAMENTO	CA	95825	4604	34	06067	38.578716	-121.416228	Sacramento County
104188	Fee-for-Service	1588210967	1588210967	1	1	AGUILAR, PAUL A	9/4/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1744 CAROM WAY	UNIT 4	CHULA VISTA	CA	91915	2392	37	06073	32.61987992	-116.9600423	San Diego County
104212	Fee-for-Service	1861870354	1861870354	1	1	AMSALEM, DAVID MD	1/21/2020	207P00000X	NA	Other	026	PHYSICIANS	145858	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
104215	Fee-for-Service	1831510999	1831510999	1	1	ARDENT HOSPICE & PALLIATIVE	12/18/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE OF FRESNO INC	2040 N WINERY AVE	STE 102	FRESNO	CA	93703	4814	10	06019	36.76911951	-119.7317313	Fresno County
104218	Fee-for-Service	1730619198	1730619198	1	1	ASHTON, HELEN E MD	11/18/2020	163WG0000X	NA	Other	026	PHYSICIANS	162336	None	None	0	In state provider	None	451 W GONZALES RD	STE 230	OXNARD	CA	93036	0719	56	06111	34.21921445	-119.1816945	Ventura County
104230	Fee-for-Service	1861586364	1861586364	1	1	AGUAS, VILMA R MD	11/24/1982	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	33653	01	General Practice	0	In state provider	None	535 E ROMIE LN	STE 2	SALINAS	CA	93901	4026	27	06053	36.65969283	-121.6449044	Monterey County
104292	Fee-for-Service	1033156765	1033156765	1	1	ASSISTED HOME RECOVERY	6/28/1990	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	8550 BALBOA BLVD	STE 283	NORTHRIDGE	CA	91325	3562	19	06037	34.225713	-118.5026045	Los Angeles County
104296	Fee-for-Service	1437576436	1437576436	1	1	ABUGROUN, ISRA MD	7/23/2020	2080P0205X	NA	Endocrinology	026	PHYSICIANS	167777	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
104345	Fee-for-Service	1104978568	1104978568	2	1	ABDELNABY, MARYAM A MD	3/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	80495	41	Internal Medicine	0	In state provider	None	5353 G ST	None	CHINO	CA	91710	5249	36	06071	34.00987149	-117.6880905	San Bernardino County
104352	Fee-for-Service	1154105690	1154105690	1	1	AFFORDABLE MEDICAL TRANSPORT	3/12/2024	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	6100 GOLDSTONE DR	None	BAKERSFIELD	CA	93313	5330	15	06029	35.29539104	-119.0700669	Kern County
104358	Fee-for-Service	1760610711	1760610711	1	1	ACKERMAN, ANNE L MD	6/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	112910	34	Urology and Urological Surgery	0	In state provider	None	99 N LA CIENEGA BLVD	None	BEVERLY HILLS	CA	90211	2222	19	06037	34.06736471	-118.3763201	Los Angeles County
104363	Fee-for-Service	1932285335	1932285335	1	1	ASIAN NTWK PACIFIC HOME CARE	12/21/1997	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HOME CARE, INC	212 9TH ST	STE 205	OAKLAND	CA	94607	4428	01	06001	37.79871855	-122.2677469	Alameda County
104371	Fee-for-Service	1437224995	1437224995	1	1	AMORTEGUY, ALBERT E MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	27192	13	Neurology (M.D. only)	0	In state provider	A PROFESSIONAL CORP	2833 LOMA VISTA RD	None	VENTURA	CA	93003	1545	56	06111	34.27534273	-119.2580429	Ventura County
104379	Fee-for-Service	1497286256	1497286256	1	1	ANTONUK, CATHERINE D MD	10/13/2021	207P00000X	NA	Other	026	PHYSICIANS	157794	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
104390	Fee-for-Service	1023011632	1023011632	1	4	ALTURA CENTERS FOR HEALTH	10/4/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MOBILE	1101 N CHERRY ST	None	TULARE	CA	93274	2231	54	06107	36.22333808	-119.337575	Tulare County
104404	Fee-for-Service	1568863157	1568863157	1	1	AGAPE HOSPICE & PALLIATIVE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE LLC	3711 LOMITA BLVD	SUITE 120	TORRANCE	CA	90505	3877	19	06037	33.81537872	-118.349881	Los Angeles County
104445	Fee-for-Service	1700964319	1700964319	1	1	ANSARI, MARIA N MD	4/20/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62849	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
104455	Fee-for-Service	1184677346	1184677346	1	1	ADAMS, JEFFREY T. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1050 N JAMES CAMPBELL BL	None	COLUMBIA	TN	38401	2754	00	None	35.62106254	-87.06724507	Maury County
104461	Fee-for-Service	1265879522	1265879522	1	1	AHMAD, ZUBIA S MD	1/24/2018	207R00000X	NA	Other	026	PHYSICIANS	151558	41	Internal Medicine	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
104474	Fee-for-Service	1952531584	1952531584	1	1	ALISOBHANI, AFSANEH K	11/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1101 DOVE ST	165	NEWPORT BEACH	CA	92660	2862	30	06059	33.6602824	-117.8647147	Orange County
104477	Fee-for-Service	1588210967	1588210967	1	1	AGUILAR, PAUL A	9/4/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1744 CAROM WAY	UNIT 4	CHULA VISTA	CA	91915	2392	37	06073	32.61987992	-116.9600423	San Diego County
104504	Fee-for-Service	1154568574	1154568574	1	1	ASIF ANWAR	3/23/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1415 TULANE AVE	None	NEW ORLEANS	LA	70112	2600	00	None	29.95527949	-90.07612766	Orleans Parish
104519	Fee-for-Service	1609924661	1609924661	1	1	AURANG, MIKI MD	8/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61791	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
104575	Fee-for-Service	1710197330	1710197330	1	1	ALVAREZ, EDWIN A MD	4/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78109	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
104594	Fee-for-Service	1487791224	1487791224	1	1	ANGEL VIEW INC	6/26/1996	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HUCKABEE HOUSE	11270 VERBENA DR	None	DESERT HOT SPRING	CA	92240	2721	33	06065	33.96655951	-116.4926365	Riverside County
104637	Fee-for-Service	1497308084	1497308084	1	1	ABUMAALI, ALNASHMI E OD	5/1/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	145 N 2ND ST	None	CHOWCHILLA	CA	93610	2910	20	06039	37.12342437	-120.260796	Madera County
104640	Fee-for-Service	1679988463	1679988463	1	1	ASTHANA, PRIYA	7/14/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	15906	36	Psychiatry	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
104645	Fee-for-Service	1720140072	1720140072	1	1	ARNST, CHARLENE J	9/28/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
104647	Fee-for-Service	1124285150	1124285150	1	1	ALLEN, MIYA E MD	6/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105636	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
104648	Fee-for-Service	1043655996	1043655996	1	1	ANTHEM HOSPICE CARE, INC	7/29/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	20121 VENTURA BLVD	STE 303	WOODLAND HILLS	CA	91364	2546	19	06037	34.17068268	-118.5718406	Los Angeles County
104659	Fee-for-Service	1437224995	1437224995	1	1	AMORTEGUY, ALBERT E MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	27192	41	Internal Medicine	0	In state provider	A PROFESSIONAL CORP	2833 LOMA VISTA RD	None	VENTURA	CA	93003	1545	56	06111	34.27534273	-119.2580429	Ventura County
104679	Fee-for-Service	1083801146	1083801146	1	1	AIREN, PRIYA MD	6/10/2022	207R00000X	NA	Other	026	PHYSICIANS	171989	None	None	0	In state provider	None	7111 N FRESNO ST	STE. 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
104690	Fee-for-Service	1609557982	1609557982	1	1	AFRICANO, NIKO SEBASTIAN B C	3/28/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	RNA	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
104693	Fee-for-Service	1811183585	1811183585	1	1	ANUNTIYO, JEREMY S MD	5/15/2020	207RR0500X	NA	Other	026	PHYSICIANS	94526	None	None	0	In state provider	None	1360 W 6TH STREET	STE # 310N	SAN PEDRO	CA	90732	3599	19	06037	33.73886546	-118.3075065	Los Angeles County
104694	Fee-for-Service	1225611288	1225611288	1	1	AMERICAN MED	5/18/2021	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2216 N CALIFORNIA ST	SUITE B	STOCKTON	CA	95204	5533	39	06077	37.97386974	-121.2903465	San Joaquin County
104715	Fee-for-Service	1477587368	1477587368	1	1	ANTHONY LAWRENCE SEVERT MD	3/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	701 PARK AVE	None	MINNEAPOLIS	MN	55415	1623	00	None	44.97241797	-93.26300044	Hennepin County
104718	Fee-for-Service	1134714744	1134714744	1	1	ADINAMIS, DYAN LMFT	8/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
104726	Fee-for-Service	1619914652	1619914652	1	1	ALPENA GENERAL HOSPITAL	7/28/2007	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1501 W CHISHOLM ST	None	ALPENA	MI	49707	1401	00	None	45.07705464	-83.45088712	Alpena County
104729	Fee-for-Service	1366747636	1366747636	1	2	ALBANO, NICOLE M LMFT	4/26/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	256 CAJON ST.	SUITE E	REDLANDS	CA	92373	4711	36	06071	34.05204454	-117.1802319	San Bernardino County
104761	Fee-for-Service	1386747244	1386747244	1	1	ARON, ELISABETH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
104764	Fee-for-Service	1457527145	1457527145	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1571 SAN ELIJO RD S	None	SAN MARCOS	CA	92078	2044	37	06073	33.09729386	-117.2002867	San Diego County
104765	Fee-for-Service	1912243700	1912243700	1	1	ALIGN CLINIC LLC	4/2/2013	222Z00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	700 SOUTH CLAREMONT ST	#105	SAN MATEO	CA	94402	1447	41	06081	37.56418809	-122.3182004	San Mateo County
104775	Fee-for-Service	1568685477	1568685477	1	1	AHWATUKEE FOOTHILLS PLASTIC	10/31/2008	2086S0122X	NA	General Surgery	026	PHYSICIANS	-	02	General Surgery	2	Out of state provider	SURGERY	15810 S 45TH STREET	SUITE 140	PHOENIX	AZ	85048	7655	00	None	33.303726	-111.987207	Maricopa County
104781	Fee-for-Service	1467763284	1467763284	1	1	ALECK, AMALIA K MD	9/11/2018	207L00000X	NA	Other	026	PHYSICIANS	131231	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
104807	Fee-for-Service	1093742199	1093742199	1	1	ALTERNATIVE FOR BETTER	3/15/2016	261Q00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	LIVING	701 SCHOOL STREET	None	NAPA	CA	94559	2829	28	06055	38.29546482	-122.2880598	Napa County
104815	Fee-for-Service	1235337627	1235337627	1	1	ABI-JAOUDEH, NADINE MD	6/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137011	30	Radiology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
104818	Fee-for-Service	1093055170	1093055170	1	1	ALPHA UROLOGY GROUP, INC.	1/15/2019	208800000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	4244 RIVERWALK PKWY	SUITE 240	RIVERSIDE	CA	92505	8509	33	06065	33.90336622	-117.49394	Riverside County
104829	Fee-for-Service	1962576561	1962576561	1	1	ALMEDOM, MUSSIE H MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95712	41	Internal Medicine	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
104832	Fee-for-Service	1285778233	1285778233	1	1	ACTIVE CARE PHYSICAL THERAPY	10/15/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	& SPORTS MEDICINE, INC	4201 TORRANCE BLVD	SUITE 200	TORRANCE	CA	90503	4504	19	06037	33.8375955	-118.358748	Los Angeles County
104855	Fee-for-Service	1639412166	1639412166	1	1	ARCHIBALD GROUP INC	1/15/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2731 E ARABIAN PLACE	None	ONTARIO	CA	91764	5096	36	06071	34.009911	-117.592938	San Bernardino County
104856	Fee-for-Service	1699845883	1699845883	2	1	ACCESS MEDICAL INC	2/10/2014	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3266 GREY HAWK CT	None	CARLSBAD	CA	92010	6651	37	06073	33.13057169	-117.2365641	San Diego County
104871	Fee-for-Service	1205255288	1205255288	1	1	AGUIRRE, KRISTEN MD	6/20/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	135075	07	Dermatology	0	In state provider	None	3629 VISTA WAY	None	OCEANSIDE	CA	92056	4522	37	06073	33.1814285	-117.3093613	San Diego County
104884	Fee-for-Service	1669008934	1669008934	1	1	ANGENIDA HOSPICE LLC	8/2/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14081 YORBA ST	SUITE 201	TUSTIN	CA	92780	2011	30	06059	33.7582604	-117.8296904	Orange County
104914	Fee-for-Service	1962588376	1962588376	1	1	ALANIS-AMEZCUA, JOSE	5/24/1995	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	54215	66	Emergency Medicine (Urgent Care)	0	In state provider	None	185 W SAN YSIDRO BLVD	None	SAN YSIDRO	CA	92173	2555	37	06073	32.55366791	-117.047635	San Diego County
104941	Fee-for-Service	1043655996	1043655996	1	1	ANTHEM HOSPICE CARE, INC	7/29/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	20121 VENTURA BLVD	STE 303	WOODLAND HILLS	CA	91364	2546	19	06037	34.17068268	-118.5718406	Los Angeles County
104973	Fee-for-Service	1831277466	1831277466	1	1	ANDERSON, JASON L MD	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	67616	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
104984	Fee-for-Service	1831764802	1831764802	1	1	ABLE & AVAILABLE HOME HEALTH	11/16/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	8904 RESEDA BLVD	SUITE 205	NORTHRIDGE	CA	91324	3930	19	06037	34.232058	-118.536062	Los Angeles County
105008	Fee-for-Service	1326297169	1326297169	1	1	ADVANCED VALLEY EYE	10/29/2008	193400000X	NA	Other	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	ASSOCIATES	2035 LYNDELL TERRACE	STE 100	DAVIS	CA	95616	6202	57	06113	38.56303319	-121.7694148	Yolo County
105009	Fee-for-Service	1336208255	1336208255	1	4	ASIAN PACIFIC HEALTH	2/22/2024	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	180 UNION PLACE	None	LOS ANGELES	CA	90026	5715	19	06037	34.06186536	-118.2653898	Los Angeles County
105014	Fee-for-Service	1619914652	1619914652	1	1	ALPENA GENERAL HOSPITAL	7/28/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1501 W CHISHOLM ST	None	ALPENA	MI	49707	1401	00	None	45.07705464	-83.45088712	Alpena County
105016	Fee-for-Service	1114128915	1114128915	1	1	ALAMEDA COUNTY MED CTR	7/1/1998	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	WINTON WELLNESS	24100 AMADOR ST	STE 250	HAYWARD	CA	94544	1273	01	06001	37.65846116	-122.0943585	Alameda County
105029	Fee-for-Service	1538759238	1538759238	1	1	ASHKAN E SEFARADI INC	10/5/2021	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	9808 VENICE BLVD	STE 707	CULVER CITY	CA	90232	6802	19	06037	34.0236396	-118.3980847	Los Angeles County
105066	Fee-for-Service	1720066657	1720066657	1	1	ALICIA CARTAGENA	12/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9201 W THOMAS RD	None	PHOENIX	AZ	85037	3332	00	None	33.47892	-112.2579	Maricopa County
105073	Fee-for-Service	1225221831	1225221831	1	1	AGUIRRE-MIYAMOTO, ERIKA M LC	1/24/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
105130	Fee-for-Service	1801321229	1801321229	1	1	ACEVES, JORGE L MD	7/8/2022	207P00000X	NA	Other	026	PHYSICIANS	176129	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
105157	Fee-for-Service	1780092262	1780092262	1	5	ASHER SHAHZAD MD PC	11/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1050 W GALLERIA DRIVE	None	HENDERSON	NV	89011	4800	00	None	36.07123413	-115.0308684	Clark County
105158	Fee-for-Service	1053334920	1053334920	1	1	ACHARYA, JAISHREE MD	5/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	52653	41	Internal Medicine	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
105169	Fee-for-Service	1669008934	1669008934	1	1	ANGENIDA HOSPICE LLC	8/2/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14081 YORBA ST	SUITE 201	TUSTIN	CA	92780	2011	30	06059	33.7582604	-117.8296904	Orange County
105172	Fee-for-Service	1043455850	1043455850	1	2	ADVANTAGE NEUROPSYCHIATRIC A	12/28/2023	2084P0800X	NA	Psychiatry	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	SSOC	1010 W CHAPMAN AVE	None	ORANGE	CA	92868	2847	30	06059	33.78785047	-117.8631495	Orange County
105191	Fee-for-Service	1740995992	1740995992	1	1	APEX RETINA INSTITUTE INCORP	5/14/2024	207WX0107X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	2880 ATLANTIC AVE	STE 290	LONG BEACH	CA	90806	1716	19	06037	33.809382	-118.185001	Los Angeles County
105201	Fee-for-Service	1962588376	1962588376	1	1	ALANIS-AMEZCUA, JOSE	5/24/1995	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	54215	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	185 W SAN YSIDRO BLVD	None	SAN YSIDRO	CA	92173	2555	37	06073	32.55366791	-117.047635	San Diego County
105202	Fee-for-Service	1811194491	1811194491	1	1	AMSBAUGH, NICOLE L. PA	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 BURDICK EXPY W	None	MINOT	ND	58701	4406	00	None	48.2325845	-101.2938165	Ward County
105287	Fee-for-Service	1740264183	1740264183	1	1	ADKINS, DON A OD	9/26/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	44139 MONTEREY AVE	STE A	PALM DESERT	CA	92260	8700	33	06065	33.728004	-116.3912775	Riverside County
105301	Fee-for-Service	1326301862	1326301862	1	1	AUSTIN-PAGE, LUKAS R MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121721	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
105326	Fee-for-Service	1093450876	1093450876	1	1	ARANETA, MONICA C CNP	6/21/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11103 VENICE BLVD	None	LOS ANGELES	CA	90034	6914	19	06037	34.01379685	-118.4159354	Los Angeles County
105327	Fee-for-Service	1336208255	1336208255	1	4	ASIAN PACIFIC HEALTH	8/4/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	180 UNION PLACE	None	LOS ANGELES	CA	90026	5715	19	06037	34.06186536	-118.2653898	Los Angeles County
105392	Fee-for-Service	1356366991	1356366991	1	1	AULTMAN HOSPITAL	5/5/2012	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2600 SIXTH ST SW	None	CANTON	OH	44710	1799	00	None	40.79684788	-81.40409211	Stark County
105416	Fee-for-Service	1447712062	1447712062	1	1	ALKHIDER, SAAD MD	12/18/2022	207R00000X	NA	Other	026	PHYSICIANS	176779	None	None	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
105421	Fee-for-Service	1417368804	1417368804	1	1	AGHAMOHAMMADI, SARA MD	7/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	112475	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
105427	Fee-for-Service	1891826145	1891826145	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1133 S MISSION RD	None	FALLBROOK	CA	92028	3222	37	06073	33.37248944	-117.2534254	San Diego County
105440	Fee-for-Service	1043508666	1043508666	1	1	AHMAD, DELSHAD MD	9/6/2018	207RH0003X	NA	Oncology	026	PHYSICIANS	157319	68	Hematology	0	In state provider	None	900 S MAIN ST	STE 204	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
105445	Fee-for-Service	1780092262	1780092262	1	5	ASHER SHAHZAD MD PC	11/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	77	Infectious Disease	1	Border provider	None	1050 W GALLERIA DRIVE	None	HENDERSON	NV	89011	4800	00	None	36.07123413	-115.0308684	Clark County
105453	Fee-for-Service	1194351007	1194351007	1	1	AAKHUS, COOPER G MD	6/25/2024	207P00000X	NA	Other	026	PHYSICIANS	184605	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
105464	Fee-for-Service	1770945545	1770945545	1	1	AL-ABDULLAH, AWS MD	10/4/2018	207P00000X	NA	Other	026	PHYSICIANS	152914	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
105465	Fee-for-Service	1043455850	1043455850	1	2	ADVANTAGE NEUROPSYCHIATRIC A	5/8/2023	2084P0800X	NA	Psychiatry	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	SSOC	1010 W CHAPMAN AVE	None	ORANGE	CA	92868	2847	30	06059	33.78785047	-117.8631495	Orange County
105482	Fee-for-Service	1982160669	1982160669	1	1	ABSOLUTE CARE HEALTH SYSTEMS	5/8/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE INC	7940 SILVERTON AVE	SUITE 203	SAN DIEGO	CA	92126	6341	37	06073	32.89081884	-117.149988	San Diego County
105497	Fee-for-Service	1588690648	1588690648	1	1	ALVAREZ, FRANCISCO J MD	8/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81105	41	Internal Medicine	0	In state provider	None	1427 MAGNOLIA AVE	None	CHICO	CA	95926	3226	04	06007	39.74063543	-121.8499003	Butte County
105560	Fee-for-Service	1558502716	1558502716	1	1	ALARCON, J ANTONIO MD	8/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	40197	01	General Practice	0	In state provider	INCORPORATED	2133 W BEVERLY BLVD	STE 200	MONTEBELLO	CA	90640	3901	19	06037	34.0206436	-118.1226229	Los Angeles County
105585	Fee-for-Service	1336208255	1336208255	1	4	ASIAN PACIFIC HEALTH	8/4/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	180 UNION PLACE	None	LOS ANGELES	CA	90026	5715	19	06037	34.06186536	-118.2653898	Los Angeles County
105600	Fee-for-Service	1740531540	1740531540	1	1	ADAMS, CAROLYN L LMFT	3/30/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
105626	Fee-for-Service	1689021354	1689021354	1	1	ALLSTAR HOME HEALTHCARE INC	6/13/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	601 E GLENOAKS BLVD	SUITE 104	GLENDALE	CA	91207	1761	19	06037	34.15833486	-118.2487788	Los Angeles County
105630	Fee-for-Service	1265875215	1265875215	1	1	ANDERSON, DANIELLE	4/23/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	13606	04	Otology, Laryngology, Rhinology	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
105681	Fee-for-Service	1356366991	1356366991	1	1	AULTMAN HOSPITAL	5/5/2012	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2600 SIXTH ST SW	None	CANTON	OH	44710	1799	00	None	40.79684788	-81.40409211	Stark County
105685	Fee-for-Service	1750650982	1750650982	1	5	APEX RADIOLOGY MEDICAL GROUP	5/8/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	27300 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.89552551	-117.186021	Riverside County
105711	Fee-for-Service	1790705671	1790705671	1	1	ALWIS, MIKEL A MD	9/3/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48518	08	Family Practice	0	In state provider	None	716 E. MAIN ST.	None	BARSTOW	CA	92311	2354	36	06071	34.89865642	-117.0187803	San Bernardino County
105730	Fee-for-Service	1043508666	1043508666	1	1	AHMAD, DELSHAD MD	9/6/2018	207RH0003X	NA	Oncology	026	PHYSICIANS	157319	41	Internal Medicine	0	In state provider	None	900 S MAIN ST	STE 204	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
105749	Fee-for-Service	1043455850	1043455850	1	2	ADVANTAGE NEUROPSYCHIATRIC A	5/8/2023	2084P0800X	NA	Psychiatry	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	SSOC	1010 W CHAPMAN AVE	None	ORANGE	CA	92868	2847	30	06059	33.78785047	-117.8631495	Orange County
105770	Fee-for-Service	1982160669	1982160669	1	1	ABSOLUTE CARE HEALTH SYSTEMS	5/8/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE INC	7940 SILVERTON AVE	SUITE 203	SAN DIEGO	CA	92126	6341	37	06073	32.89081884	-117.149988	San Diego County
105802	Fee-for-Service	1427481035	1427481035	1	1	ASLARONA, CHERRY ROSE D LMFT	5/25/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
105804	Fee-for-Service	1124679394	1124679394	1	1	ARLO, JACLYN LMFT	9/3/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
105819	Fee-for-Service	1659663136	1659663136	1	1	ARBUCKLE, ROBERT A MD	9/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114731	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
105841	Fee-for-Service	1629209044	1629209044	1	1	AHMED, EJAZ MD	10/23/2009	207R00000X	NA	Other	026	PHYSICIANS	105775	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
105847	Fee-for-Service	1558502716	1558502716	1	1	ALARCON, J ANTONIO MD	8/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	40197	34	Urology and Urological Surgery	0	In state provider	INCORPORATED	2133 W BEVERLY BLVD	STE 200	MONTEBELLO	CA	90640	3901	19	06037	34.0206436	-118.1226229	Los Angeles County
105898	Fee-for-Service	1376735621	1376735621	1	1	ALAMEDA COUNTY CCS	4/18/2007	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	CESAR CHAVEZ MTU	2825 INTERNATIONAL BLVD	None	OAKLAND	CA	94601	1543	01	06001	37.77996094	-122.2303293	Alameda County
105901	Fee-for-Service	1225398316	1225398316	1	1	ABRUTE, VILIJA NP	3/11/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
105966	Fee-for-Service	1972559599	1972559599	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8800 VALLEY VIEW ST	None	BUENA PARK	CA	90620	3588	30	06059	33.83462951	-118.027233	Orange County
106052	Fee-for-Service	1922116698	1922116698	1	1	ASKARI, ASGHAR MD	1/30/1980	174400000X	NA	Other	026	PHYSICIANS	35822	34	Urology and Urological Surgery	0	In state provider	None	1360 W 6TH ST	STE 160	SAN PEDRO	CA	90732	3537	19	06037	33.73886546	-118.3075065	Los Angeles County
106065	Fee-for-Service	1366997702	1366997702	1	1	ANDREW, MEAGAN PT	12/30/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3142 VISTA WAY	STE 101	OCEANSIDE	CA	92056	3627	37	06073	33.18253858	-117.3252818	San Diego County
106073	Fee-for-Service	1225699697	1225699697	1	1	ALLIED HOSPICE CARE INC	1/9/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	21757 DEVONSHIRE ST	UNIT 12	CHATSWORTH	CA	91311	2960	19	06037	34.25725894	-118.603595	Los Angeles County
106104	Fee-for-Service	1992770655	1992770655	1	1	ALBERTON, LAURA A MD	12/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68700	25	Physical Medicine and Rehabilitation	0	In state provider	None	400 PARNASSUS AVE	FL 2	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
106114	Fee-for-Service	1962783464	1962783464	1	1	AVILA, FERNANDO M PHD	3/3/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
106131	Fee-for-Service	1982814745	1982814745	1	2	ALTAMED COMM HEALTH CLIN	11/21/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	SUNSET	910 S SUNSET AVE	STE 1 & 5	WEST COVINA	CA	91790	3490	19	06037	34.064247	-117.9429166	Los Angeles County
106165	Fee-for-Service	1043376049	1043376049	1	1	AMBURGEY, ROBERT G MD	5/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141538	66	Emergency Medicine (Urgent Care)	0	In state provider	None	815 POLLARD ROAD	None	LOS GATOS	CA	95032	1438	43	06085	37.26214754	-121.9701986	Santa Clara County
106202	Fee-for-Service	1396817763	1396817763	1	1	ALAN JACKS ATKINS MD	3/23/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3050 TWIN RIVERS DR	None	ARKADELPHIA	AR	71923	4218	00	None	34.123185	-93.088503	Clark County
106212	Fee-for-Service	1639285927	1639285927	1	1	ANDERSON, JEFFREY J	2/25/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42755	20	Orthopedic Surgery	0	In state provider	None	333 OCONNOR DR	None	SAN JOSE	CA	95128	1623	43	06085	37.325907	-121.939898	Santa Clara County
106229	Fee-for-Service	1568698298	1568698298	1	1	AGUILA, NOVA R MD	8/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125752	01	General Practice	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
106230	Fee-for-Service	1003846510	1003846510	1	1	ALEXANDER, BROOKE E DO	3/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	7006	01	General Practice	0	In state provider	None	6501 GARFIELD AVENUE	None	BELL GARDENS	CA	90201	1805	19	06037	33.97292523	-118.1475473	Los Angeles County
106267	Fee-for-Service	1285208215	1285208215	1	1	ALTIZER, JEFFREY J CRNA	12/22/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
106317	Fee-for-Service	1699969287	1699969287	1	1	ALJOUDI, HAYTHAM MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150276	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1801 E MARCH LANE	SUITE D400	STOCKTON	CA	95210	6675	39	06077	38.00315652	-121.2868715	San Joaquin County
106321	Fee-for-Service	1922305010	1922305010	1	1	ADVENTIST HEALTH PHYSICIANS	3/30/2011	193400000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	10 WOODLAND RD	STE 502	ST HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
106322	Fee-for-Service	1235695420	1235695420	1	1	AURICLE SOLUTIONS INCORPORAT	7/12/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	None	None	0	In state provider	ED	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
106334	Fee-for-Service	1265933667	1265933667	1	1	ASSISTED HOME RECOVERY, INC	3/1/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1900 W GARVEY AVE S	SUITE 220	WEST COVINA	CA	91790	2660	19	06037	34.07079031	-117.9466404	Los Angeles County
106357	Fee-for-Service	1225699697	1225699697	1	1	ALLIED HOSPICE CARE INC	1/9/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	21757 DEVONSHIRE ST	UNIT 12	CHATSWORTH	CA	91311	2960	19	06037	34.25725894	-118.603595	Los Angeles County
106365	Fee-for-Service	1578713517	1578713517	1	1	ADAM BOBBEY	10/6/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	700 CHILDRENS DR	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
106393	Fee-for-Service	1962732966	1962732966	1	1	ALEXANDRAKIS, GEORGE MD INC	11/17/2009	193400000X	NA	Other	026	PHYSICIANS	74492	18	Ophthalmology	0	In state provider	None	1851 OAK ST	STE B	BAKERSFIELD	CA	93301	3003	15	06029	35.37577414	-119.0386553	Kern County
106403	Fee-for-Service	1831161207	1831161207	1	1	ARYA, SHITAL P MD	8/5/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	82659	40	Pediatrics	0	In state provider	None	133 N ALTADENA DR	2ND FL	PASADENA	CA	91107	7325	19	06037	34.14843	-118.0986385	Los Angeles County
106421	Fee-for-Service	1982814745	1982814745	1	2	ALTAMED COMM HEALTH CLIN	11/21/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	SUNSET	910 S SUNSET AVE	STE 1 & 5	WEST COVINA	CA	91790	3490	19	06037	34.064247	-117.9429166	Los Angeles County
106431	Fee-for-Service	1154437069	1154437069	1	1	AVIDAN, ALON Y MD	4/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	67111	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
106451	Fee-for-Service	1124074638	1124074638	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14201 JEFFREY RD	None	IRVINE	CA	92620	3405	30	06059	33.69506015	-117.7634492	Orange County
106469	Fee-for-Service	1134745110	1134745110	1	1	ANSARI, FAISAL DO	11/18/2024	207R00000X	NA	Other	026	PHYSICIANS	22982	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
106508	Fee-for-Service	1871571141	1871571141	1	1	AWASTHI, SARVAMITRA MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33855	41	Internal Medicine	0	In state provider	INC	324 N VERMONT AVE	None	DINUBA	CA	93618	1631	54	06107	36.54780049	-119.3894155	Tulare County
106568	Fee-for-Service	1750999702	1750999702	1	1	APRICOT MORNINGS INC	3/19/2025	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	248 W VERMONT AVE	None	CLOVIS	CA	93619	3727	10	06019	36.8607898	-119.7164525	Fresno County
106591	Fee-for-Service	1780732651	1780732651	1	1	ADAIR, MICHAEL J MD	5/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	80412	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
106604	Fee-for-Service	1962793737	1962793737	1	1	AHMED, SYED S MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128138	66	Emergency Medicine (Urgent Care)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
106605	Fee-for-Service	1699969287	1699969287	1	1	ALJOUDI, HAYTHAM MD	9/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150276	41	Internal Medicine	0	In state provider	None	1801 E MARCH LANE	SUITE D400	STOCKTON	CA	95210	6675	39	06077	38.00315652	-121.2868715	San Joaquin County
106614	Fee-for-Service	1619979028	1619979028	1	2	ANDERSON, ERIC MD	1/1/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
106626	Fee-for-Service	1801220165	1801220165	1	2	ADL BEST CARE LLC	11/1/2016	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5431 MONROE ST	None	HOLLYWOOD	CA	90038	4059	19	06037	34.08579352	-118.312479	Los Angeles County
106629	Fee-for-Service	1164954574	1164954574	1	1	ABRAHAM, MARK J MD	8/4/2021	207L00000X	NA	Other	026	PHYSICIANS	171988	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
106655	Fee-for-Service	1629240049	1629240049	1	1	ALICAR, AGNES T NP	6/1/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
106665	Fee-for-Service	1790795136	1790795136	1	1	ASPESBERRO, FRANCOIS P MD	6/27/2017	2080P0203X	NA	Other	026	PHYSICIANS	146375	40	Pediatrics	0	In state provider	None	1010 MURRAY STREET	None	SAN LUIS OBISPO	CA	93405	8800	40	06079	35.29101669	-120.6663647	San Luis Obispo County
106695	Fee-for-Service	1437264793	1437264793	1	1	AGARWAL, RITA MD	12/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
106696	Fee-for-Service	1003230038	1003230038	1	1	APLA HEALTH & WELLNESS	4/21/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	DAVID GEFFEN CENTER	611 S KINGSLEY DRIVE	SUITE 301	LOS ANGELES	CA	90005	2309	19	06037	34.06305793	-118.3028813	Los Angeles County
106721	Fee-for-Service	1174975155	1174975155	1	1	AERTS, ILSE LMFT	12/27/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6840 INDIANA AVE	275	RIVERSIDE	CA	92506	4279	33	06065	33.94246965	-117.3926366	Riverside County
106743	Fee-for-Service	1871943894	1871943894	1	1	ASK, KACIE PT	4/14/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1252 BROADWAY	SUITE B	PLACERVILLE	CA	95667	5806	09	06017	38.73128098	-120.7852781	El Dorado County
106768	Fee-for-Service	1831293273	1831293273	1	1	AZIMOV, MICHELLE B MD	4/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	65994	41	Internal Medicine	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
106783	Fee-for-Service	1295052124	1295052124	1	1	AUSTIN, GRACE K MD	8/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145433	04	Otology, Laryngology, Rhinology	0	In state provider	None	23803 MCBEAN PKWY	SUITE 202	VALENCIA	CA	91355	2001	19	06037	34.39750589	-118.552072	Los Angeles County
106792	Fee-for-Service	1023120367	1023120367	1	1	ARMSTRONG, BARBARA J OD	2/28/1990	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	377 E COLORADO BLVD	None	PASADENA	CA	91101	1909	19	06037	34.1459133	-118.142582	Los Angeles County
106794	Fee-for-Service	1871571141	1871571141	1	1	AWASTHI, SARVAMITRA MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33855	38	Geriatrics	0	In state provider	INC	324 N VERMONT AVE	None	DINUBA	CA	93618	1631	54	06107	36.54780049	-119.3894155	Tulare County
106817	Fee-for-Service	1215220074	1215220074	1	1	AZADANI, PEYMAN N MD	1/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	145015	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
106837	Fee-for-Service	1609235324	1609235324	1	1	AUSTER-ROSEN, MEGAN S PHD	4/25/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
106855	Fee-for-Service	1164712576	1164712576	1	1	ATKINS, SCOTT A MD	6/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119076	30	Radiology	0	In state provider	None	39000 BOB HOPE DRIVE	RADIOLOGY DEPARTMENT	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
106883	Fee-for-Service	1932189032	1932189032	1	1	ANDRAS,NEMETH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8TH ANVEUE + C STREET	None	SALT LAKE CITY	UT	84143	0000	00	None	40.779063	-111.8805548	Salt Lake County
106899	Fee-for-Service	1619979028	1619979028	1	2	ANDERSON, ERIC MD	1/1/2024	207P00000X	NA	Other	026	PHYSICIANS	-	70	Clinic (mixed specialty)	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
106911	Fee-for-Service	1669614806	1669614806	1	1	ARAMBULO, JENNIFER G LCSW	5/11/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
106923	Fee-for-Service	1417443136	1417443136	1	1	ALEXANDRIAN, ARTIN NP	10/11/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1560 E CHEVY CHASE DR	SUITE 130	GLENDALE	CA	91206	4140	19	06037	34.15290734	-118.2302295	Los Angeles County
106983	Fee-for-Service	1003230038	1003230038	1	1	APLA HEALTH & WELLNESS	4/21/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	DAVID GEFFEN CENTER	611 S KINGSLEY DRIVE	SUITE 301	LOS ANGELES	CA	90005	2309	19	06037	34.06305793	-118.3028813	Los Angeles County
106989	Fee-for-Service	1033137633	1033137633	1	1	AHMED, KHAJA R MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	45423	45	Nephrology (Renal-Kidney)	0	In state provider	None	20911 EARL ST	STE 180	TORRANCE	CA	90503	4353	19	06037	33.840459	-118.3580985	Los Angeles County
106991	Fee-for-Service	1487657235	1487657235	1	1	ANTELOPE VALLEY HOME	10/8/1987	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE	44335 LOWTREE AVE	None	LANCASTER	CA	93534	9975	19	06037	34.68860876	-118.1540535	Los Angeles County
107012	Fee-for-Service	1437773850	1437773850	1	1	ANDRADA, JOSELITO S OT	8/3/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
107014	Fee-for-Service	1104592914	1104592914	1	1	ALOHA RESIDENTIAL CARE LLC	10/21/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	7476 BUNGALOW WAY	None	RANCHO CUCAMONGA	CA	91739	8868	36	06071	34.11763545	-117.5195011	San Bernardino County
107028	Fee-for-Service	1336881341	1336881341	1	1	AFZAAL IQBAL MD INC	4/21/2023	207LP2900X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1400 REYNOLDS AVENUE	SUITE 100	IRVINE	CA	92614	5562	30	06059	33.6957272	-117.8542013	Orange County
107059	Fee-for-Service	1558855403	1558855403	1	1	ARCURI, CHRISTINA N MD	10/8/2021	390200000X	NA	Other	026	PHYSICIANS	173740	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
107084	Fee-for-Service	1235575903	1235575903	1	1	ALEXANDER, BOBBY S MD	12/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136864	34	Urology and Urological Surgery	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
107091	Fee-for-Service	1013086768	1013086768	1	1	ANDREWS, SHIRLEY MD	1/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	69279	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
107122	Fee-for-Service	1487746855	1487746855	1	1	ALSHEIKH, HUDA Y MD	3/1/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	133872	40	Pediatrics	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
107127	Fee-for-Service	1982670139	1982670139	1	1	AMEEESH GARY K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5432 E SOUTHERN AVE	STE 101	MESA	AZ	85206	0000	00	None	33.394383	-111.7133415	Maricopa County
107134	Fee-for-Service	1144661653	1144661653	1	1	ALKHOURI, WADIE MD INC	11/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	51885	36	Psychiatry	0	In state provider	None	210 S GRAND AVE	STE 408	GLENDORA	CA	91741	4282	19	06037	34.133859	-117.872523	Los Angeles County
107197	Fee-for-Service	1205006954	1205006954	1	1	AZZAM, RAMZI I MD	11/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102375	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
107198	Fee-for-Service	1427684331	1427684331	1	1	ASPIRE LA HOME HEALTH CARE	10/29/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	500 N CENTRAL	SUITE 960	GLENDALE	CA	91203	3905	19	06037	34.15321627	-118.2578985	Los Angeles County
107202	Fee-for-Service	1497045017	1497045017	1	1	ANI, CHIZOBAM O MD	7/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126732	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
107209	Fee-for-Service	1063433449	1063433449	1	1	ABERNATHY, ROBERT A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	413 LILLY RD NE	None	OLYMPIA	WA	98506	5133	00	None	47.052801	-122.847462	Thurston County
107224	Fee-for-Service	1073798864	1073798864	1	1	ALLIED HOME HEALTH CORP	11/21/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	9602 LAS TUNAS DRIVE	SUITE 207	TEMPLE CITY	CA	91780	2157	19	06037	34.10664097	-118.0607679	Los Angeles County
107236	Fee-for-Service	1467563387	1467563387	1	1	AMI CARDIAC MONITORING INC	5/9/2010	193400000X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	2	Out of state provider	None	17810 MEETING HOUSE ROAD	SUITE 210	SANDY SPRINGS	MD	20860	1002	00	None	39.14896271	-77.02623363	Montgomery County
107238	Fee-for-Service	1932344058	1932344058	1	1	ALSAMMAN, HUSAM MD	7/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	54216	05	Anesthesiology	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
107242	Fee-for-Service	1679734735	1679734735	1	1	AERTS, ANN A R	9/19/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
107248	Fee-for-Service	1811086952	1811086952	1	1	ALPINER, DONALD M DO	12/31/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	4758	01	General Practice	0	In state provider	None	999 SAN BERNARDINO ROAD	None	UPLAND	CA	91786	0000	36	06071	34.1010559	-117.6369445	San Bernardino County
107258	Fee-for-Service	1871816207	1871816207	1	1	ABDOLMOHAMMADI, ALIREZA MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114907	78	Neoplastic Diseases/Oncology	0	In state provider	None	310 HARTNELL AVE	STE A	REDDING	CA	96002	1868	45	06089	40.56670901	-122.3688887	Shasta County
107271	Fee-for-Service	1972893782	1972893782	1	1	ASSISTED HOME CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	115 E MICHELTORENA ST	None	SANTA BARBARA	CA	93101	1905	42	06083	34.42766456	-119.7067497	Santa Barbara County
107274	Fee-for-Service	1205214939	1205214939	1	1	AUGUST, ALICIA R MD	2/17/2023	163WW0000X	NA	Other	026	PHYSICIANS	148897	None	None	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28200485	-118.4030797	Los Angeles County
107275	Fee-for-Service	1548693724	1548693724	1	1	ADELE WHITTED	10/25/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	565 ABBOTT RD	None	BUFFALO	NY	14220	2039	00	None	42.848208	-78.8129235	Erie County
107276	Fee-for-Service	1043522790	1043522790	1	1	AGGARWAL, RASHITA MD	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122607	41	Internal Medicine	0	In state provider	None	1000 GREENLY ROAD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
107278	Fee-for-Service	1033137633	1033137633	1	1	AHMED, KHAJA R MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	45423	41	Internal Medicine	0	In state provider	None	20911 EARL ST	STE 180	TORRANCE	CA	90503	4353	19	06037	33.840459	-118.3580985	Los Angeles County
107285	Fee-for-Service	1417565896	1417565896	1	1	ADVENTIST HEALTH PHYSICIANS	10/12/2020	207R00000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	20211 W VALLEY BLVD	None	TEHACHAPI	CA	93561	6748	15	06029	35.12450952	-118.489509	Kern County
107326	Fee-for-Service	1265627947	1265627947	1	1	AMAY, TERESITA M MD	6/23/2008	2084P0804X	NA	Psychiatry	026	PHYSICIANS	100976	26	Psychiatry (child)	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
107382	Fee-for-Service	1356530406	1356530406	1	1	ASGHAR, FAYAZ MD	2/22/1985	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	41499	41	Internal Medicine	0	In state provider	None	135 N JACKSON AVE	STE 203	SAN JOSE	CA	95116	1917	43	06085	37.36164758	-121.8466827	Santa Clara County
107395	Fee-for-Service	1366778227	1366778227	1	2	ANESTHESIA SERVICES OF SAN	12/27/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	JOAQUIN PC	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
107403	Fee-for-Service	1841443017	1841443017	1	1	ADVANCED SLEEP MEDICINE SRVS	7/3/2018	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	5301 OFFICE PARK DR	SUITE 215	BAKERSFIELD	CA	93309	0652	15	06029	35.3655365	-119.0624655	Kern County
107406	Fee-for-Service	1609027986	1609027986	1	1	AARUSH MANCHANDA, M.D.	7/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1303 N MAIN ST	None	CEDAR CITY	UT	84721	9746	00	None	37.699596	-113.0664465	Iron County
107416	Fee-for-Service	1649653700	1649653700	1	1	ASFAHAN, FADI MD	1/1/2022	207R00000X	NA	Other	026	PHYSICIANS	175521	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
107433	Fee-for-Service	1144433434	1144433434	1	1	ANTELOPE VALLEY SURGICAL	3/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	ASSOCIATES	1331 W AVENUE J	STE 203	LANCASTER	CA	93534	2954	19	06037	34.68946152	-118.155699	Los Angeles County
107445	Fee-for-Service	1225649353	1225649353	1	2	AARON J EPSTEIN MD INC	10/25/2022	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2625 WEST ALAMEDA AVE	SUITE 410	BURBANK	CA	91505	4818	19	06037	34.1577056	-118.329779	Los Angeles County
107486	Fee-for-Service	1205006954	1205006954	1	1	AZZAM, RAMZI I MD	11/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102375	30	Radiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
107521	Fee-for-Service	1689084006	1689084006	1	1	AFSHIN ZANDPOUR MD A PROFESS	10/25/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	IONAL MEDICAL CORPORAT	1001 N TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
107523	Fee-for-Service	1104436070	1104436070	1	1	ALDRICH, LAURIE M LMFT	10/13/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
107546	Fee-for-Service	1871816207	1871816207	1	1	ABDOLMOHAMMADI, ALIREZA MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114907	41	Internal Medicine	0	In state provider	None	310 HARTNELL AVE	STE A	REDDING	CA	96002	1868	45	06089	40.56670901	-122.3688887	Shasta County
107552	Fee-for-Service	1811604135	1811604135	1	1	ANDERSON TURNER NURSING INC.	4/23/2024	2084P0800X	NA	Psychiatry	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	222 OLIVE AVE	STE 5	REDLANDS	CA	92373	5268	36	06071	34.05492419	-117.1784739	San Bernardino County
107560	Fee-for-Service	1972893782	1972893782	1	1	ASSISTED HOME CARE INC	7/12/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	115 E MICHELTORENA ST	None	SANTA BARBARA	CA	93101	1905	42	06083	34.42766456	-119.7067497	Santa Barbara County
107601	Fee-for-Service	1558526251	1558526251	1	1	AMINOFF, ALEXANDRA R MD	12/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137102	83	Rheumatology	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
107615	Fee-for-Service	1760828958	1760828958	1	1	ALCALDE, VICTOR MD	3/5/2021	207P00000X	NA	Other	026	PHYSICIANS	170657	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
107652	Fee-for-Service	1568676229	1568676229	1	1	ALBINO,HIRRAM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1601 W ST MARYS RD	None	TUCSON	AZ	85745	0000	00	None	32.228199	-111.0000825	Pima County
107671	Fee-for-Service	1780794107	1780794107	1	1	ACKERMAN, JACK L DO	6/20/2000	208M00000X	NA	Other	026	PHYSICIANS	6210	41	Internal Medicine	0	In state provider	None	227 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36478223	-121.8497978	Santa Clara County
107673	Fee-for-Service	1366778227	1366778227	1	2	ANESTHESIA SERVICES OF SAN	12/27/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	JOAQUIN PC	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
107684	Fee-for-Service	1730510579	1730510579	1	1	ARAM, PEDRAM MD	4/14/2023	208800000X	NA	Other	026	PHYSICIANS	184433	None	None	0	In state provider	None	44151 15TH ST W	101	LANCASTER	CA	93534	4079	19	06037	34.68551775	-118.1568686	Los Angeles County
107689	Fee-for-Service	1295228799	1295228799	1	1	ADAMO, ALESSANDRA	1/30/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
107698	Fee-for-Service	1427148311	1427148311	1	1	ANN J MELVIN MD	12/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY NE	None	SEATTLE	WA	98105	3900	00	None	47.66165594	-122.2864502	King County
107699	Fee-for-Service	1467008805	1467008805	1	1	AINTABLIAN, NAIRY LCSW	6/23/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
107708	Fee-for-Service	1790910909	1790910909	1	1	AUSTIN, NAOLA S MD	8/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122845	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
107718	Fee-for-Service	1144433434	1144433434	1	1	ANTELOPE VALLEY SURGICAL	3/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	ASSOCIATES	1331 W AVENUE J	STE 203	LANCASTER	CA	93534	2954	19	06037	34.68946152	-118.155699	Los Angeles County
107733	Fee-for-Service	1285795526	1285795526	1	1	ARAMBULO, ERIC C MD	5/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54961	40	Pediatrics	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
107745	Fee-for-Service	1689983926	1689983926	1	1	ANAHEIM HILLS MEDICAL	10/8/2010	261Q00000X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	IMAGING LLC	781 S WEIR CANYON RD	STE 135	ANAHEIM	CA	92808	1965	30	06059	33.86181251	-117.7376332	Orange County
107788	Fee-for-Service	1427087287	1427087287	1	1	ALWAY, PHILIP P DPM	7/26/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1626 MYRTLE AVE	STE A	EUREKA	CA	95501	1457	12	06023	40.7946092	-124.1362277	Humboldt County
107813	Fee-for-Service	1790833747	1790833747	1	1	ASIMONT, DONNA J MD	7/4/1971	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	8971	05	Anesthesiology	0	In state provider	None	546 CASUDA CANYON DR	None	MONTEREY PARK	CA	91754	2102	19	06037	34.0554318	-118.1605692	Los Angeles County
107828	Fee-for-Service	1881665933	1881665933	1	1	ARGUELLO, JUAN C DO	12/18/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9233	26	Psychiatry (child)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
107835	Fee-for-Service	1811604135	1811604135	1	1	ANDERSON TURNER NURSING INC.	4/23/2024	2084P0800X	NA	Psychiatry	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	222 OLIVE AVE	STE 5	REDLANDS	CA	92373	5268	36	06071	34.05492419	-117.1784739	San Bernardino County
107857	Fee-for-Service	1982694022	1982694022	1	1	AMURAO, CLARITA G MD INC	4/26/1978	207L00000X	NA	Other	026	PHYSICIANS	30893	05	Anesthesiology	0	In state provider	None	11601 SANTA MONICA BLVD	None	LOS ANGELES	CA	90025	2907	19	06037	34.04458879	-118.4542015	Los Angeles County
107862	Fee-for-Service	1962930412	1962930412	1	1	AYNEHCHI, ANITA DO	6/8/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17406	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
107880	Fee-for-Service	1205840089	1205840089	1	1	ADDO, EMMANUEL J MD INC	5/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	83783	05	Anesthesiology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
107889	Fee-for-Service	1619210325	1619210325	1	1	ABE STORMS	8/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
107913	Fee-for-Service	1932138609	1932138609	1	1	ARRINGTON, AMANDA K MD	7/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116751	02	General Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
107921	Fee-for-Service	1265512347	1265512347	1	1	ANDERSON, CYNTHIA T MD	12/1/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	41728	05	Anesthesiology	0	In state provider	None	18552 MACARTHUR BLVD	STE 105	IRVINE	CA	92612	1240	30	06059	33.67814534	-117.8600359	Orange County
107925	Fee-for-Service	1942312848	1942312848	1	1	AFIFI, ALAA Y MD INC	11/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87135	02	General Surgery	0	In state provider	None	999 N TUSTIN AVE	STE 103	SANTA ANA	CA	92705	6504	30	06059	33.754167	-117.834191	Orange County
107949	Fee-for-Service	1295560050	1295560050	1	1	ABOAGYE, JESIKA NP	3/17/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
107955	Fee-for-Service	1265696660	1265696660	1	1	ALI, MARWAN MD	7/9/2018	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	125238	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
107963	Fee-for-Service	1841489440	1841489440	1	2	AZAD, JACK MD	5/14/2020	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	54433	None	None	0	In state provider	None	11507 OXNARD ST	# 3	NORTH HOLLYWOOD	CA	91606	4809	19	06037	34.17944448	-118.382598	Los Angeles County
107964	Fee-for-Service	1659352219	1659352219	1	1	ADAMS, DERRICK H DO	12/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	8900	07	Dermatology	0	In state provider	None	2450 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	5233	52	06103	40.14921426	-122.2216794	Tehama County
107968	Fee-for-Service	1841488665	1841488665	1	1	AIKINS-ADJAYE, ABA LCSW	10/23/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1200 DISCOVERY DR	None	BAKERSFIELD	CA	93309	7032	15	06029	35.36397746	-119.0589062	Kern County
107969	Fee-for-Service	1114016433	1114016433	1	1	ARTEAGA-HERNANDEZ, EDNA	5/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	63627	08	Family Practice	0	In state provider	None	851 W FOOTHILL BLVD	STE 101	RIALTO	CA	92376	4731	36	06071	34.10672307	-117.3864948	San Bernardino County
108011	Fee-for-Service	1992935563	1992935563	2	1	ALL SEASONS HEALTHCARE INC	5/10/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4201 LONG BEACH BLVD	SUITE 101	LONG BEACH	CA	90807	2010	19	06037	33.83493255	-118.1895197	Los Angeles County
108044	Fee-for-Service	1669890042	1669890042	1	1	APRIL N SMITH	7/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 POLE CREEK XING	None	SIDNEY	NE	69162	2901	00	None	41.135886	-102.95226	Cheyenne County
108142	Fee-for-Service	1285841916	1285841916	1	1	ARMSTRONG, LINDA K DO	11/4/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	17581	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
108201	Fee-for-Service	1932138609	1932138609	1	1	ARRINGTON, AMANDA K MD	7/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116751	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
108211	Fee-for-Service	1942312848	1942312848	1	1	AFIFI, ALAA Y MD INC	11/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87135	33	Thoracic Surgery	0	In state provider	None	999 N TUSTIN AVE	STE 103	SANTA ANA	CA	92705	6504	30	06059	33.754167	-117.834191	Orange County
108216	Fee-for-Service	1942592746	1942592746	1	1	ATOIAN, ANDRE G MD	8/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107342	05	Anesthesiology	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
108232	Fee-for-Service	1326487091	1326487091	1	1	ARAMESH, SHADI MD	10/5/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	140822	36	Psychiatry	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
108254	Fee-for-Service	1568889772	1568889772	1	1	ADLER, PAUL MD	10/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150148	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
108261	Fee-for-Service	1770070591	1770070591	1	1	AWAD, NADA MD	1/9/2020	390200000X	NA	Other	026	PHYSICIANS	164362	08	Family Practice	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
108288	Fee-for-Service	1699292045	1699292045	1	1	AN, TONYA W MD	4/28/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	153483	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
108293	Fee-for-Service	1609280478	1609280478	1	1	AHDOOT, ELI MD	10/3/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	14257	20	Orthopedic Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
108298	Fee-for-Service	1992935563	1992935563	2	1	ALL SEASONS HEALTHCARE INC	5/10/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4201 LONG BEACH BLVD	SUITE 101	LONG BEACH	CA	90807	2010	19	06037	33.83493255	-118.1895197	Los Angeles County
108300	Fee-for-Service	1356589790	1356589790	1	1	ARNO, MITCHELL G	12/13/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9280 W STOCKTON BLVD	SUITE 116	ELK GROVE	CA	95758	8073	34	06067	38.420235	-121.394961	Sacramento County
108318	Fee-for-Service	1760747398	1760747398	1	1	ADAM, NADIR E MD	7/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122234	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
108330	Fee-for-Service	1023341500	1023341500	1	1	ARMSTRONG, JULIE A PSYD	6/10/2022	103TF0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
108333	Fee-for-Service	1306004957	1306004957	1	1	APREVA CORPORATION	9/2/2009	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1565 HOTEL CIRCLE SOUTH	# 320	SAN DIEGO	CA	92108	3416	37	06073	32.75896354	-117.1774412	San Diego County
108339	Fee-for-Service	1134188097	1134188097	1	1	ASKREN, CARL C MD	6/21/2000	208200000X	NA	General Surgery	026	PHYSICIANS	60139	24	Plastic Surgery	0	In state provider	None	6153 N THESTA ST	None	FRESNO	CA	93710	5266	10	06019	36.82548093	-119.7831422	Fresno County
108361	Fee-for-Service	1952794455	1952794455	1	1	AZGHADI, SOHEILA MD	10/6/2022	261QX0203X	NA	Other	026	PHYSICIANS	157410	None	None	0	In state provider	None	575 LENNON LN	None	WALNUT CREEK	CA	94598	2443	07	06013	37.92946711	-122.0316061	Contra Costa County
108415	Fee-for-Service	1215007364	1215007364	1	1	ACOLOGY HOME HEALTHCARE	6/18/1996	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INC	1414 WILSHIRE BLVD	None	SANTA MONICA	CA	90403	5413	19	06037	34.02709264	-118.4884579	Los Angeles County
108419	Fee-for-Service	1609079490	1609079490	1	1	ABDEL-SAYED, SHELLEY F MD	12/8/2009	207L00000X	NA	Other	026	PHYSICIANS	94060	05	Anesthesiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
108456	Fee-for-Service	1598243230	1598243230	1	1	AAZAMI, SHEEBAH RCP	8/16/2018	2279G1100X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
108474	Fee-for-Service	1578572368	1578572368	1	1	AFRASIABI, KAMBIZ MD	9/12/2009	207RX0202X	NA	Oncology	026	PHYSICIANS	48498	66	Emergency Medicine (Urgent Care)	0	In state provider	CANCER TREATMENT MEDICAL	3010 W ORANGE AVE	SUITE 407	ANAHEIM	CA	92804	3173	30	06059	33.82472315	-117.994133	Orange County
108482	Fee-for-Service	1598977647	1598977647	1	1	ALEXANDER, JOHN M LCSW	11/3/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
108522	Fee-for-Service	1467500330	1467500330	1	1	AMAYA, CRISTINA Y MD	11/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72832	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
108527	Fee-for-Service	1255542601	1255542601	1	3	ALTAMED MEDICAL & DENTAL	11/21/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ESTRADA COURTS	1305 S CONCORD STREET	#18	LOS ANGELES	CA	90023	3503	19	06037	34.02072788	-118.2081793	Los Angeles County
108556	Fee-for-Service	1417023961	1417023961	1	1	ARACELY MUNGUIA	12/1/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2571 CALIFORNIA PARK DR	SUITE 210	CHICO	CA	95928	4042	04	06007	39.75131268	-121.7926291	Butte County
108590	Fee-for-Service	1073141206	1073141206	1	1	ANG, KATRINA B MD	10/3/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	189562	None	None	0	In state provider	None	2734 EL CAMINO REAL	None	SANTA CLARA	CA	95051	3007	43	06085	37.35228637	-121.9754073	Santa Clara County
108619	Fee-for-Service	1336175082	1336175082	1	1	ACKERMANN, RUTH A MD	10/1/2018	207L00000X	NA	Other	026	PHYSICIANS	46287	05	Anesthesiology	0	In state provider	None	4650 LINCOLN BLVD	None	MARINA DEL REY	CA	90292	6306	19	06037	33.98160766	-118.4400667	Los Angeles County
108621	Fee-for-Service	1306004957	1306004957	1	1	APREVA CORPORATION	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1565 HOTEL CIRCLE SOUTH	# 320	SAN DIEGO	CA	92108	3416	37	06073	32.75896354	-117.1774412	San Diego County
108659	Fee-for-Service	1194917252	1194917252	1	1	ABOULIAN, ARMEN MD	7/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97668	02	General Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	0000	19	06037	34.17030266	-118.5881699	Los Angeles County
108694	Fee-for-Service	1225436967	1225436967	1	1	ANTELOPE VALLEY SUPPORTIVE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE AND HOSPICE, INC	1505 W AVENUE J	SUITE 303	LANCASTER	CA	93534	2843	19	06037	34.68945168	-118.1571066	Los Angeles County
108695	Fee-for-Service	1992287767	1992287767	1	1	ALOHA NON EMERGENCY MEDICAL	3/5/2019	No Taxonomy Provided	Both NEMT & NMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TRANSPORT LLC	180 PROMENADE CIRCLE	STE 300	SACRAMENTO	CA	95834	2952	34	06067	38.636649	-121.49838	Sacramento County
108700	Fee-for-Service	1447711361	1447711361	1	1	ARJUNAN, VINODHINI MD	9/2/2022	208M00000X	NA	Other	026	PHYSICIANS	181221	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
108748	Fee-for-Service	1679062434	1679062434	1	2	ADDICTION RESEARCH AND TREAT	1/23/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	S ANGELES	11900 AVALON BLVD	200 AND 201	LOS ANGELES	CA	90061	2867	19	06037	33.92451047	-118.2652101	Los Angeles County
108759	Fee-for-Service	1356378087	1356378087	1	1	AKMAL, MOHAMMED MD	1/1/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	31697	41	Internal Medicine	0	In state provider	None	1720 ZONAL AVE	APT 280	LOS ANGELES	CA	90033	1045	19	06037	34.06127407	-118.2091699	Los Angeles County
108802	Fee-for-Service	1225264377	1225264377	1	1	ABARY, ALEXANDER V MD INC	12/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	33405	41	Internal Medicine	0	In state provider	None	3750 ATLANTIC AVE	None	LONG BEACH	CA	90807	3409	19	06037	33.825951	-118.185004	Los Angeles County
108817	Fee-for-Service	1255542601	1255542601	1	3	ALTAMED MEDICAL & DENTAL	11/21/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	ESTRADA COURTS	1305 S CONCORD STREET	#18	LOS ANGELES	CA	90023	3503	19	06037	34.02072788	-118.2081793	Los Angeles County
108841	Fee-for-Service	1851700223	1851700223	1	1	AMIN, ARPIT N MD	8/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149874	02	General Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
108876	Fee-for-Service	1528014172	1528014172	1	2	AGARWAL, CHANDRAHAS MD	2/1/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	43186	41	Internal Medicine	0	In state provider	None	8287 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10301177	-117.5641513	San Bernardino County
108913	Fee-for-Service	1245759513	1245759513	1	1	ASHTON, AMY L	10/26/2017	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1625 STOCKTON BLVD	STE 103	SACRAMENTO	CA	95816	7098	34	06067	38.56554	-121.4664615	Sacramento County
108923	Fee-for-Service	1588444871	1588444871	1	1	ANEM MEDICAL CORPORATION	12/20/2023	193400000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	11878 AVENUE OF INDUSTRY	None	SAN DIEGO	CA	92128	3423	37	06073	32.99058739	-117.0752486	San Diego County
108945	Fee-for-Service	1417991308	1417991308	1	1	ALI, KAREIM H MD	6/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85376	08	Family Practice	0	In state provider	None	1974 SANTA FE AVE	STE 101	LONG BEACH	CA	90810	4064	19	06037	33.793137	-118.2153705	Los Angeles County
108959	Fee-for-Service	1215048178	1215048178	1	1	ARCA, MELISSA Z MD	5/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78461	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
108962	Fee-for-Service	1578004990	1578004990	1	1	ANIREDDY, NIDHISHA MD	1/7/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	170399	None	None	0	In state provider	None	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
108965	Fee-for-Service	1720417272	1720417272	1	1	ADVENTIST HEALTH PHYSICIANS	2/22/2019	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	107 N HALL ST	STE B	VISALIA	CA	93291	5850	54	06107	36.330732	-119.308932	Tulare County
108981	Fee-for-Service	1225436967	1225436967	1	1	ANTELOPE VALLEY SUPPORTIVE	5/1/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE AND HOSPICE, INC	1505 W AVENUE J	SUITE 303	LANCASTER	CA	93534	2843	19	06037	34.68945168	-118.1571066	Los Angeles County
108988	Fee-for-Service	1518166677	1518166677	1	1	ARREOLA, KRISTIN N MD	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132090	68	Hematology	0	In state provider	None	TWO MEDICAL PLAZA	SUITE 200	ROSEVILLE	CA	95661	3042	31	06061	38.76507948	-121.2477476	Placer County
109008	Fee-for-Service	1578118295	1578118295	1	1	ADVENTIST HEALTH PHYSICIANS	10/29/2019	207RP1001X	NA	Pulmonology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1231 W VINE ST	19	LODI	CA	95240	5109	39	06077	38.1227934	-121.2876828	San Joaquin County
109019	Fee-for-Service	1871656603	1871656603	1	1	AINTABLIAN, AGOP MD INC	6/28/1980	207R00000X	NA	Other	026	PHYSICIANS	39300	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	416 E COLORADO ST	STE A	GLENDALE	CA	91205	5107	19	06037	34.14259896	-118.2505986	Los Angeles County
109029	Fee-for-Service	1659419828	1659419828	1	2	ADDICTION RESEARCH AND TREAT	12/14/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	539 NORTH VAN NESS AVE	None	FRESNO	CA	93728	3419	10	06019	36.751158	-119.7989285	Fresno County
109036	Fee-for-Service	1679062434	1679062434	1	2	ADDICTION RESEARCH AND TREAT	1/23/2022	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	S ANGELES	11900 AVALON BLVD	200 AND 201	LOS ANGELES	CA	90061	2867	19	06037	33.92451047	-118.2652101	Los Angeles County
109046	Fee-for-Service	1952752305	1952752305	1	1	ATIBALENTJA, DANIELLE MD	7/18/2024	207RX0202X	NA	Oncology	026	PHYSICIANS	162982	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
109049	Fee-for-Service	1083703979	1083703979	1	1	ASAP RX CORP	4/8/2005	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ASAP PHARMACY	1340 E WILSON AVE	None	GLENDALE	CA	91206	4632	19	06037	34.14802847	-118.2358035	Los Angeles County
109060	Fee-for-Service	1699169367	1699169367	1	1	ADVENTIST HEALTH PHYSICIANS	2/4/2020	261QM1300X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	475 N FORBES ST	None	LAKEPORT	CA	95453	4725	17	06033	39.04516616	-122.9161302	Lake County
109155	Fee-for-Service	1164530465	1164530465	1	1	ADVENTIST BOLINGBROOK	6/13/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL	500 REMINGTON BLVD	None	BOLINGBROOK	IL	60440	4906	00	None	41.68007936	-88.08309622	Will County
109162	Fee-for-Service	1528014172	1528014172	1	2	AGARWAL, CHANDRAHAS MD	2/1/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	43186	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8287 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10301177	-117.5641513	San Bernardino County
109164	Fee-for-Service	1982085973	1982085973	1	1	AKINJERO, AKINTUNDE M MD	8/26/2021	390200000X	NA	Other	026	PHYSICIANS	171700	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
109233	Fee-for-Service	1952559361	1952559361	1	1	ALYESHMERNI, AVIVA M MD	11/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	104771	40	Pediatrics	0	In state provider	None	27800 MEDICAL CENTER RD	SUITE 300	MISSION VIEJO	CA	92691	6409	30	06059	33.55952733	-117.6645199	Orange County
109237	Fee-for-Service	1417995291	1417995291	1	1	ANDERSON, WILLIAM D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	551 HILL COUNTRY DR	None	KERRVILLE	TX	78028	6085	00	None	30.04481871	-99.15170303	Kerr County
109275	Fee-for-Service	1518166677	1518166677	1	1	ARREOLA, KRISTIN N MD	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132090	78	Neoplastic Diseases/Oncology	0	In state provider	None	TWO MEDICAL PLAZA	SUITE 200	ROSEVILLE	CA	95661	3042	31	06061	38.76507948	-121.2477476	Placer County
109284	Fee-for-Service	1154805984	1154805984	2	1	ALFARO, ERICA LCSW	8/7/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12440 FIRESTONE BLVD	3001	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
109287	Fee-for-Service	1790044303	1790044303	1	2	AGNOLI, ALICIA MD	1/5/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	150159	-	NOT APPLICABLE	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
109293	Fee-for-Service	1871777698	1871777698	1	1	AJUMOBI, ADEWALE B MD	1/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	101199	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
109307	Fee-for-Service	1649952250	1649952250	1	1	ANG, AUDREY PT	9/8/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1020 TIERRA DEL REY	A1	CHULA VISTA	CA	91910	7886	37	06073	32.6377383	-117.0196092	San Diego County
109309	Fee-for-Service	1871656603	1871656603	1	1	AINTABLIAN, AGOP MD INC	6/28/1980	207R00000X	NA	Other	026	PHYSICIANS	39300	41	Internal Medicine	0	In state provider	None	416 E COLORADO ST	STE A	GLENDALE	CA	91205	5107	19	06037	34.14259896	-118.2505986	Los Angeles County
109328	Fee-for-Service	1639515638	1639515638	1	1	ANDINO-NIEVES, DAVID O MD	9/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126484	41	Internal Medicine	0	In state provider	None	125 SIR FRANCIS DRAKE	BLVD	KENTFIELD	CA	94904	1418	21	06041	37.94496361	-122.5189097	Marin County
109342	Fee-for-Service	1013902568	1013902568	2	1	ARULANANTHAM, INPAMANI S	4/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	22	Pathology (M.D. only)	0	In state provider	None	43830 10TH ST W	None	LANCASTER	CA	93534	4826	19	06037	34.67913961	-118.1478725	Los Angeles County
109343	Fee-for-Service	1174700710	1174700710	1	1	ALTAMED MEDICAL GROUP	4/28/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	ELA/WHITTIER	5427 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4101	19	06037	34.01966132	-118.1536008	Los Angeles County
109366	Fee-for-Service	1457327439	1457327439	1	1	ASTROFF, MATTHEW R MD	11/7/2018	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	46957	10	Gastroenterology (M.D. only)	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
109410	Fee-for-Service	1619111846	1619111846	1	1	ANGELO, JENNIFER L PT	1/2/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4605 BUENA VISTA RD	SUITE 690	BAKERSFIELD	CA	93311	8793	15	06029	35.31350802	-119.1281378	Kern County
109426	Fee-for-Service	1700878410	1700878410	1	1	ABDEEN, OMARAN A MD	1/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	55592	41	Internal Medicine	0	In state provider	None	11550 INDIAN HILLS RD	STE 371	MISSION HILLS	CA	91345	1252	19	06037	34.28024575	-118.4588775	Los Angeles County
109431	Fee-for-Service	1124205885	1124205885	1	1	ALBA, PATRICIA LCSW	11/20/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14500 ROSCOE BLVD STE 40	None	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
109443	Fee-for-Service	1164530465	1164530465	1	1	ADVENTIST BOLINGBROOK	6/13/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL	500 REMINGTON BLVD	None	BOLINGBROOK	IL	60440	4906	00	None	41.68007936	-88.08309622	Will County
109466	Fee-for-Service	1033120423	1033120423	1	1	ADVENTIST HEALTH SYSTEM	7/1/1998	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SUNBELT INC	11801 SOUTH FREEWAY	None	BURLESON	TX	76028	7021	00	None	32.586813	-97.316955	Tarrant County
109506	Fee-for-Service	1508936907	1508936907	1	1	AMIRKHAN, MOJGAN MD INC	2/9/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80416	08	Family Practice	0	In state provider	None	1100 N TUSTIN AVE	STE F	SANTA ANA	CA	92705	3509	30	06059	33.754707	-117.8342455	Orange County
109528	Fee-for-Service	1528116449	1528116449	1	1	ANDERSON, ANTHONY C MD	6/30/1986	207W00000X	NA	Ophthalmology	026	PHYSICIANS	41476	66	Emergency Medicine (Urgent Care)	0	In state provider	None	115 W E ST	None	TEHACHAPI	CA	93561	1607	15	06029	35.13009994	-118.4488237	Kern County
109543	Fee-for-Service	1801270699	1801270699	1	1	ALUKAL, JOSEPH MD	1/25/2022	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
109565	Fee-for-Service	1689011637	1689011637	1	1	ALTURA CENTERS FOR HEALTH	9/17/2013	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	3035 E BARDSLEY AVE	None	TULARE	CA	93274	6122	54	06107	36.19647282	-119.302504	Tulare County
109574	Fee-for-Service	1316427750	1316427750	1	1	AGUIRRE, FERNANDO LCSW	6/11/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
109595	Fee-for-Service	1306942909	1306942909	2	1	ALLEN, GWEN M MD	9/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	61790	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1141 W REDONDO BEACH BLV	SUITE 402	GARDENA	CA	90247	3582	19	06037	33.89247036	-118.2941482	Los Angeles County
109643	Fee-for-Service	1922451772	1922451772	1	1	ALMASIAN, SARA NP	11/14/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
109681	Fee-for-Service	1609074780	1609074780	1	1	AUGUSTO A MONTENEGRO	9/8/2012	164X00000X	NA	Other	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	150 S WOOD AVE	STE 215 BLDG-C	OAKDALE	CA	95361	3670	50	06099	37.76061567	-120.8596301	Stanislaus County
109689	Fee-for-Service	1578763652	1578763652	1	1	ARCEL, ELIZABETH R LMFT	9/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
109710	Fee-for-Service	1700878410	1700878410	1	1	ABDEEN, OMARAN A MD	1/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	55592	45	Nephrology (Renal-Kidney)	0	In state provider	None	11550 INDIAN HILLS RD	STE 371	MISSION HILLS	CA	91345	1252	19	06037	34.28024575	-118.4588775	Los Angeles County
109725	Fee-for-Service	1447024856	1447024856	1	1	ADVENTIST HEALTH PHYSICIANS	3/22/2024	207RG0100X	NA	Gastroenterology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	125 MALL DR	315	HANFORD	CA	93230	5794	16	06031	36.3246477	-119.6685218	Kings County
109730	Fee-for-Service	1649240276	1649240276	1	1	ASAAD JANDALI M.D	12/17/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	901 MACARTHUR BLVD	None	MUNSTER	IN	46321	2901	00	None	41.550678	-87.506217	Lake County
109755	Fee-for-Service	1033120423	1033120423	1	1	ADVENTIST HEALTH SYSTEM	1/11/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SUNBELT INC	11801 SOUTH FREEWAY	None	BURLESON	TX	76028	7021	00	None	32.586813	-97.316955	Tarrant County
109776	Fee-for-Service	1356116461	1356116461	1	1	AARON PETERSON OD OPTOMETRIC	5/3/2024	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2867 AGOURA RD	None	WESTLAKE VILLAGE	CA	91361	3218	56	06111	34.1501976	-118.8244431	Ventura County
109794	Fee-for-Service	1558421255	1558421255	1	1	AMBLER, CHRISTIAN C PHD	8/25/2017	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
109801	Fee-for-Service	1417118159	1417118159	1	1	ADELAJA, IBIRONKE V MD	6/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102787	89	Surgery-Traumatic	0	In state provider	None	2828 FRESNO ST	STE 203	FRESNO	CA	93721	1327	10	06019	36.7418099	-119.7838487	Fresno County
109804	Fee-for-Service	1437643004	1437643004	1	1	ALAMBYAN, VILAKSHAN MD	7/11/2022	207R00000X	NA	Other	026	PHYSICIANS	177584	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
109809	Fee-for-Service	1093761454	1093761454	1	1	ALLEMAN, DAVID G MD	8/1/1995	207L00000X	NA	Other	026	PHYSICIANS	79278	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
109831	Fee-for-Service	1689261562	1689261562	1	2	A TRANSPORTATION	3/24/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	574 S BARRANCA AVE	None	COVINA	CA	91723	2729	19	06037	34.0792301	-117.8812423	Los Angeles County
109852	Fee-for-Service	1487784617	1487784617	1	1	ARIETA, MARIA T PHD	6/7/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	SUITE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
109855	Fee-for-Service	1598799090	1598799090	2	1	ACTION ORTHOPEDIC COMPANY	10/2/2015	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	LLC	637 LUCAS AVE	STE 609	LOS ANGELES	CA	90017	1997	19	06037	34.05351827	-118.2646017	Los Angeles County
109856	Fee-for-Service	1689011637	1689011637	1	1	ALTURA CENTERS FOR HEALTH	2/21/2019	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	3035 E BARDSLEY AVE	None	TULARE	CA	93274	6122	54	06107	36.19647282	-119.302504	Tulare County
109891	Fee-for-Service	1689167991	1689167991	1	1	ALSON HOME HEALTH INC	1/14/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1412 W GLENOAKS BLVD	STE D	GLENDALE	CA	91201	1995	19	06037	34.16761168	-118.2850619	Los Angeles County
109892	Fee-for-Service	1356844120	1356844120	1	1	ALI, SANAH MD	10/22/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
109968	Fee-for-Service	1790167146	1790167146	1	1	ALTAVAS, NATHANIEL NP	9/13/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
109969	Fee-for-Service	1609074780	1609074780	1	1	AUGUSTO A MONTENEGRO	9/8/2012	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	150 S WOOD AVE	STE 215 BLDG-C	OAKDALE	CA	95361	3670	50	06099	37.76061567	-120.8596301	Stanislaus County
109971	Fee-for-Service	1730182619	1730182619	1	1	ACHEATEL, ROGER J MD	7/1/1985	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	45947	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	750 E GRAND AVE	None	ESCONDIDO	CA	92025	4460	37	06073	33.12531051	-117.0717604	San Diego County
109975	Fee-for-Service	1861423501	1861423501	1	1	ALVING, LOREN I MD	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	75668	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4785 N 1ST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
110008	Fee-for-Service	1619000775	1619000775	1	1	ANZA COMMUNITY MEDICAL	7/8/2008	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	56480 US HIGHWAY 371	None	ANZA	CA	92539	8826	33	06065	33.5551195	-116.6749785	Riverside County
110025	Fee-for-Service	1649612094	1649612094	1	1	ALGOS INC., A MEDICAL CORPOR	8/13/2021	103TB0200X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1127 WILSHIRE BLVD	SUITE 800	LOS ANGELES	CA	90017	3901	19	06037	34.05270508	-118.2641005	Los Angeles County
110063	Fee-for-Service	1609442565	1609442565	1	1	ANAND, SILPA MD	2/14/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
110070	Fee-for-Service	1750650982	1750650982	1	6	APEX RADIOLOGY MEDICAL GROUP	5/8/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
110142	Fee-for-Service	1689011637	1689011637	1	1	ALTURA CENTERS FOR HEALTH	9/17/2013	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3035 E BARDSLEY AVE	None	TULARE	CA	93274	6122	54	06107	36.19647282	-119.302504	Tulare County
110154	Fee-for-Service	1770514515	1770514515	1	1	ARAKELIAN, RONALD A MD	2/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	41222	41	Internal Medicine	0	In state provider	None	920 DELBON AVE	None	TURLOCK	CA	95382	2019	50	06099	37.51045858	-120.8376324	Stanislaus County
110158	Fee-for-Service	1275790677	1275790677	1	1	AZIZ, BASEM MD	10/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131081	25	Physical Medicine and Rehabilitation	0	In state provider	None	349 E BULLARD AVE	None	FRESNO	CA	93711	1609	10	06019	36.82285854	-119.7825885	Fresno County
110210	Fee-for-Service	1518400886	1518400886	1	1	AGORANYAN, RIMA	8/24/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	3274 E ACACIA AVE	None	FRESNO	CA	93726	0605	10	06019	36.80420376	-119.7682537	Fresno County
110222	Fee-for-Service	1144227372	1144227372	1	1	ABUNDIS, REBECCA DO	2/9/2018	207R00000X	NA	Other	026	PHYSICIANS	6394	None	None	0	In state provider	None	5 LOWER RAGSDALE DR	100	MONTEREY	CA	93940	5817	27	06053	36.57544273	-121.8164209	Monterey County
110248	Fee-for-Service	1841215290	1841215290	1	1	ALEXANDER, LANCELOT MD	2/8/2015	2084N0400X	NA	Neurology	026	PHYSICIANS	52251	13	Neurology (M.D. only)	0	In state provider	SUITE 111	16030 VENTURA BLVD	STE 100	ENCINO	CA	91436	2754	19	06037	34.15615339	-118.4824038	Los Angeles County
110256	Fee-for-Service	1740426485	1740426485	1	1	ARIZONA UROLOGY SPECIALISTS	11/30/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85038	9805	00	None	33.480864	-112.0795155	Maricopa County
110258	Fee-for-Service	1861423501	1861423501	1	1	ALVING, LOREN I MD	1/1/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	75668	13	Neurology (M.D. only)	0	In state provider	None	4785 N 1ST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
110262	Fee-for-Service	1194130849	1194130849	1	1	ANDERSON, RYAN J MD	8/25/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	140880	41	Internal Medicine	0	In state provider	None	411 30TH STREET	STE 314	OAKLAND	CA	94609	3312	01	06001	37.81903474	-122.2649444	Alameda County
110274	Fee-for-Service	1952487456	1952487456	1	1	ALBERTSON, PATTI MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	42002	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
110277	Fee-for-Service	1215096839	1215096839	1	1	ALANIS, JOE	5/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85793	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2623 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	19	06037	33.98921547	-118.2242565	Los Angeles County
110289	Fee-for-Service	1649612094	1649612094	1	1	ALGOS INC., A MEDICAL CORPOR	5/9/2018	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	1127 WILSHIRE BLVD	SUITE 800	LOS ANGELES	CA	90017	3901	19	06037	34.05270508	-118.2641005	Los Angeles County
110303	Fee-for-Service	1255788907	1255788907	1	1	ALAGAPPAN, MUTHURAMAN MD	7/29/2020	208M00000X	NA	Other	026	PHYSICIANS	169148	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
110358	Fee-for-Service	1003131590	1003131590	1	1	ANAND, SHEEBA MD	2/27/2024	208M00000X	NA	Other	026	PHYSICIANS	191462	None	None	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
110425	Fee-for-Service	1558671636	1558671636	1	1	AHMED, EDNAN MD INC	10/21/2010	207W00000X	NA	Ophthalmology	026	PHYSICIANS	107504	None	None	0	In state provider	None	225 E 2ND AVE	STE 350	ESCONDIDO	CA	92025	4245	37	06073	33.12175817	-117.0787555	San Diego County
110429	Fee-for-Service	1689011637	1689011637	1	1	ALTURA CENTERS FOR HEALTH	9/17/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3035 E BARDSLEY AVE	None	TULARE	CA	93274	6122	54	06107	36.19647282	-119.302504	Tulare County
110466	Fee-for-Service	1558830836	1558830836	1	1	AJ HOME HEALTH LLC	12/21/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3524 BREAKWATER AVE	STE C	HAYWARD	CA	94545	3622	01	06001	37.62892082	-122.1213168	Alameda County
110514	Fee-for-Service	1811087232	1811087232	1	1	ANTONIO, ANNA MARIE B NP	10/15/2007	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	678 2ND ST W	None	SONOMA	CA	95476	6901	49	06097	38.28914695	-122.4617525	Sonoma County
110531	Fee-for-Service	1134985807	1134985807	1	1	ALTUS SCHOOLS SAN DIEGO	7/1/2024	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	10170 HUENNEKENS ST	None	SAN DIEGO	CA	92121	2964	37	06073	32.90291536	-117.1839303	San Diego County
110546	Fee-for-Service	1356705941	1356705941	1	1	ARDENT HOME HEALTH	4/27/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	& PALIATIVE CARE	2040 N WINERY AVE	STE 101	FRESNO	CA	93703	4814	10	06019	36.76911951	-119.7317313	Fresno County
110548	Fee-for-Service	1376539296	1376539296	1	1	ARCHAMBEAU, PAUL MD	10/8/1997	207W00000X	NA	Ophthalmology	026	PHYSICIANS	5311	18	Ophthalmology	0	In state provider	None	380 TESCONI CT	None	SANTA ROSA	CA	95401	7117	49	06097	38.447631	-122.7345885	Sonoma County
110558	Fee-for-Service	1184079246	1184079246	1	1	ALI, NABEEL MD	11/5/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	3700 E SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.8601747	-118.148313	Los Angeles County
110577	Fee-for-Service	1649612094	1649612094	1	1	ALGOS INC., A MEDICAL CORPOR	5/14/2019	103TB0200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1127 WILSHIRE BLVD	SUITE 800	LOS ANGELES	CA	90017	3901	19	06037	34.05270508	-118.2641005	Los Angeles County
110586	Fee-for-Service	1467511170	1467511170	1	1	AMBASTHA, VINOD K MD	12/17/2007	207RP1001X	NA	Pulmonology	026	PHYSICIANS	48015	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
110589	Fee-for-Service	1366778227	1366778227	1	1	ANESTHESIA SERVICES OF SAN	4/30/2019	193400000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	JOAQUIN PC	500 WEST HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
110596	Fee-for-Service	1013156850	1013156850	1	3	AZARI, SORAYA MD	5/19/2021	207R00000X	NA	Other	086	MEDICAL DIRECTORS	106392	-	NOT APPLICABLE	0	In state provider	None	1001 POTRERO AVE	WARD 93, WARD 95 3RD FL	SAN FRANCISCO	CA	94110	3185	38	06075	37.75548534	-122.4065362	San Francisco County
110603	Fee-for-Service	1104970946	1104970946	1	1	ALMONTE, ANNA DO	2/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	9160	None	None	0	In state provider	None	3581 PALMER DR	STE 608	CAMERON PARK	CA	95682	8238	09	06017	38.66109103	-120.9649544	El Dorado County
110610	Fee-for-Service	1013920065	1013920065	1	1	AGUIRRE, NAN R PHD	8/27/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5855 E NAPLES PLAZA	STE 308	LONG BEACH	CA	90803	5060	19	06037	33.75591002	-118.119711	Los Angeles County
110650	Fee-for-Service	1518430347	1518430347	1	1	AMA ACUPUNCTURE INC	9/5/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	432 N MOUNT SHASTA BLVD	STE A	MOUNT SHASTA	CA	96067	2910	47	06093	41.3149558	-122.314574	Siskiyou County
110659	Fee-for-Service	1699200840	1699200840	1	1	ABDULLA, SARAH MD	6/4/2020	2086S0120X	NA	General Surgery	026	PHYSICIANS	158677	02	General Surgery	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
110667	Fee-for-Service	1588844245	1588844245	1	1	ALI, ZIAD A MD	9/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108972	41	Internal Medicine	0	In state provider	None	222 WEST 39TH AVENUE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
110677	Fee-for-Service	1720525769	1720525769	1	1	ANCHOR HEALTHCARE, LLC	3/29/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	280 ATLANTIC AVE	None	LONG BEACH	CA	90802	3213	19	06037	33.770331	-118.185011	Los Angeles County
110694	Fee-for-Service	1700016268	1700016268	1	1	A2Z MEDICAL SUPPLY	6/8/2010	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	A2Z MEDICAL SUPPLY	170 W. WILLOW STREET	None	POMONA	CA	91768	1828	19	06037	34.07911832	-117.7538131	Los Angeles County
110734	Fee-for-Service	1003454257	1003454257	1	3	ADVANCED HEALTH PREFERENCE G	2/19/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ROUP INC. A PROFESSIONAL	803 FIGUEROA ST	None	WILMINGTON	CA	90744	2300	19	06037	33.77932834	-118.2795853	Los Angeles County
110737	Fee-for-Service	1205167822	1205167822	1	1	ACOSTA-TECSON, TRINA C CNP	11/27/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	318 W EL NORTE PKWY	None	ESCONDIDO	CA	92026	1925	37	06073	33.14269478	-117.0953874	San Diego County
110741	Fee-for-Service	1972670701	1972670701	1	1	AUDUONG, KIM NP	10/18/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
110746	Fee-for-Service	1902243025	1902243025	1	1	ANAND, ROHIT MD	6/10/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	171186	None	None	0	In state provider	None	1100 TRANCAS ST	STE 350	NAPA	CA	94558	2959	28	06055	38.32316569	-122.2981938	Napa County
110763	Fee-for-Service	1235216409	1235216409	1	1	ASUNCION, DENEEN M LCSW	10/11/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
110782	Fee-for-Service	1629588512	1629588512	1	1	ABRAGAN, ROY PATRICK M NP	6/27/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
110860	Fee-for-Service	1437773504	1437773504	1	1	ARNA HOME HEALTH INC	9/26/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	539 N GLENOAKS BLVD	STE 203	BURBANK	CA	91502	3201	19	06037	34.18652984	-118.310858	Los Angeles County
110874	Fee-for-Service	1467511170	1467511170	1	1	AMBASTHA, VINOD K MD	12/17/2007	207RP1001X	NA	Pulmonology	026	PHYSICIANS	48015	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
110879	Fee-for-Service	1891115184	1891115184	1	1	AMICK, CRYSTAL A LMFT	1/9/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	15437 ANACAPA RD	26	VICTORVILLE	CA	92392	2458	36	06071	34.50557513	-117.3250277	San Bernardino County
110883	Fee-for-Service	1366778227	1366778227	1	1	ANESTHESIA SERVICES OF SAN	11/17/2009	193400000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	JOAQUIN PC	500 WEST HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
110901	Fee-for-Service	1821066333	1821066333	1	1	ALLWEIN, ALEX T MD	5/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146148	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
110930	Fee-for-Service	1578542569	1578542569	1	1	ABE, JOHN T MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	76041	41	Internal Medicine	0	In state provider	None	20911 EARL ST	STE 340	TORRANCE	CA	90503	4354	19	06037	33.840459	-118.3580985	Los Angeles County
110976	Fee-for-Service	1003129206	1003129206	1	1	ARCEWALLACH, NANCY E LCSW	12/16/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
110977	Fee-for-Service	1679791248	1679791248	1	2	ANSELMO GARCIA MD	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9212 N CENTRAL AVE	None	PHOENIX	AZ	85020	2416	00	None	33.570045	-112.0742055	Maricopa County
111001	Fee-for-Service	1609804921	1609804921	1	1	ANDERSEN, EDWARD P OD	8/1/1995	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 E GRANT AVE	None	WINTERS	CA	95694	1716	57	06113	38.52653937	-121.9667001	Yolo County
111024	Fee-for-Service	1871007534	1871007534	1	2	AEGIS TREATMENT CENTERS, LLC	6/2/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	109 MARGARET LANE	None	GRASS VALLEY	CA	95945	5211	29	06057	39.22903923	-121.0461317	Nevada County
111032	Fee-for-Service	1144308818	1144308818	1	1	ANDERSON, RANDAL W MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63025	07	Dermatology	0	In state provider	None	2024 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.60237854	-121.3921357	Sacramento County
111034	Fee-for-Service	1275857211	1275857211	1	1	ALLI, LATIFAT T MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125940	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
111052	Fee-for-Service	1598739161	1598739161	1	1	ALLEN, NATHAN H MD	1/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	37098	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2201 NORTHGATE BLVD	STE E	SACRAMENTO	CA	95833	2540	34	06067	38.607255	-121.4763165	Sacramento County
111109	Fee-for-Service	1013312594	1013312594	1	1	AROCHE, ANTULIO B JR DO APC	2/9/2015	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	13631	20	Orthopedic Surgery	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
111121	Fee-for-Service	1447421508	1447421508	1	1	AMINI, PARVIZ MD AMC	6/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	48740	41	Internal Medicine	0	In state provider	None	8435 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4625	19	06037	34.223724	-118.536109	Los Angeles County
111130	Fee-for-Service	1295831014	1295831014	1	1	ARAMANDLA, INDU L MD	6/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	105809	36	Psychiatry	0	In state provider	None	2060 FAIRMONT DR	None	SAN LEANDRO	CA	94578	1001	01	06001	37.71083326	-122.1208841	Alameda County
111140	Fee-for-Service	1780092262	1780092262	1	9	ASHER SHAHZAD MD PC	11/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
111142	Fee-for-Service	1619057783	1619057783	1	1	ALKIRRE, MICHAEL T MD	7/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	72787	05	Anesthesiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
111143	Fee-for-Service	1063467355	1063467355	1	1	ALAGAPPAN, RAVI MD	12/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	74076	30	Radiology	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4399	01	06001	37.76333626	-122.253868	Alameda County
111161	Fee-for-Service	1467511170	1467511170	1	1	AMBASTHA, VINOD K MD	12/17/2007	207RP1001X	NA	Pulmonology	026	PHYSICIANS	48015	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
111187	Fee-for-Service	1679555213	1679555213	1	1	APELLANES, ANTONIO E MD	10/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61655	40	Pediatrics	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95340	0000	24	06047	37.28825369	-120.4963159	Merced County
111197	Fee-for-Service	1205085800	1205085800	1	1	ARCE, TYRONE E MD	12/1/1996	207R00000X	NA	Other	026	PHYSICIANS	56377	01	General Practice	0	In state provider	None	2015 W 1ST ST	STE K	SANTA ANA	CA	92703	3516	30	06059	33.74538578	-117.8965217	Orange County
111217	Fee-for-Service	1033829478	1033829478	1	1	AGELESS HEALTH GROUP, A PROF	7/19/2024	363L00000X	NA	Nurse Practitioner	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	703 E E ST	None	ONTARIO	CA	91764	3820	36	06071	34.068429	-117.6411555	San Bernardino County
111218	Fee-for-Service	1578542569	1578542569	1	1	ABE, JOHN T MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	76041	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	20911 EARL ST	STE 340	TORRANCE	CA	90503	4354	19	06037	33.840459	-118.3580985	Los Angeles County
111225	Fee-for-Service	1851927883	1851927883	1	1	AGHILI, ROXANA DO	8/9/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	20404	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
111231	Fee-for-Service	1326561630	1326561630	1	1	ASHBY, DEJEUNEE C MD	6/10/2019	2080P0006X	NA	Psychiatry	026	PHYSICIANS	141365	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
111248	Fee-for-Service	1912252743	1912252743	1	1	ANARI, ALI MD	12/27/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	131998	40	Pediatrics	0	In state provider	None	107 N MACLAY AVE	None	SAN FERNANDO	CA	91340	2906	19	06037	34.28446581	-118.439746	Los Angeles County
111254	Fee-for-Service	1538134374	1538134374	1	1	AL-BACIL, AMR F MD	3/6/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	159482	01	General Practice	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
111285	Fee-for-Service	1699118992	1699118992	1	1	ALBAHRA, SAMER MD	6/17/2021	390200000X	NA	Other	026	PHYSICIANS	161115	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
111288	Fee-for-Service	1154521540	1154521540	1	1	ALI, SHAUKAT MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100025	41	Internal Medicine	0	In state provider	None	1180 E SHAW AVE	STE 101	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
111318	Fee-for-Service	1184809337	1184809337	1	1	AZZAWI, ZAHER MD	7/26/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48743	None	None	0	In state provider	None	10841 WHITE OAK AVENUE	SUITE 107	RANCHO CUCAMONGA	CA	91730	3811	36	06071	34.10467596	-117.5661881	San Bernardino County
111321	Fee-for-Service	1275857211	1275857211	1	1	ALLI, LATIFAT T MD	10/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125940	10	Gastroenterology (M.D. only)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
111387	Fee-for-Service	1346366572	1346366572	1	1	ALAMOS-DONNELLY,PATRICIA CNM	12/2/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	20940 BURBANK BLVD	None	WOODLAND HILLS	CA	91367	6601	19	06037	34.1719401	-118.5881418	Los Angeles County
111389	Fee-for-Service	1831214428	1831214428	1	1	ABBASI, AFSHAN R MD	5/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	79873	40	Pediatrics	0	In state provider	None	1124 W CARSON ST	None	TORRANCE	CA	90502	2006	19	06037	33.83154152	-118.2954105	Los Angeles County
111408	Fee-for-Service	1790384303	1790384303	1	2	ABROMS DOUGHERTY VISION ASC	4/19/2022	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	4472 BROAD ST	150	SAN LUIS OBISPO	CA	93401	7933	40	06079	35.24211197	-120.6389543	San Luis Obispo County
111414	Fee-for-Service	1861447302	1861447302	1	2	ANNUNZIATA, GARY M DO	12/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	6650	10	Gastroenterology (M.D. only)	0	In state provider	None	35900 BOB HOPE DR	275	RANCHO MIRAGE	CA	92270	1767	33	06065	33.790311	-116.405864	Riverside County
111418	Fee-for-Service	1992365431	1992365431	1	1	AFJEI, ANOUSHEH	12/13/2022	208M00000X	NA	Other	026	PHYSICIANS	181857	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
111419	Fee-for-Service	1891189551	1891189551	1	1	ARLETA FOOT CARE INC	3/21/2016	213EP1101X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	9068 WOODMAN AVENUE	None	ARLETA	CA	91331	6403	19	06037	34.23471053	-118.4399407	Los Angeles County
111423	Fee-for-Service	1790913259	1790913259	1	1	ALMONTE, LISA M LMFT	10/30/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
111428	Fee-for-Service	1780092262	1780092262	1	9	ASHER SHAHZAD MD PC	11/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	77	Infectious Disease	1	Border provider	None	3100 N TENAYA WAY	None	LAS VEGAS	NV	89128	0436	00	None	36.21499805	-115.2504953	Clark County
111439	Fee-for-Service	1598290793	1598290793	1	1	ABLE ORTHO CLINIC INC	5/25/2017	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	475 W STETSON AVENUE	SUITE C	HEMET	CA	92543	7070	33	06065	33.72936348	-116.9751825	Riverside County
111442	Fee-for-Service	1487987004	1487987004	1	1	AQUINO, YLISSA C LCSW	2/23/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
111445	Fee-for-Service	1902250574	1902250574	1	1	ABSELMISSEH, MARIAM M MD	2/20/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	157824	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
111453	Fee-for-Service	1285839704	1285839704	1	1	AURORA, RAJAT CNP	2/12/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1900 19TH AVE	None	SAN FRANCISCO	CA	94116	1250	38	06075	37.75211157	-122.4762664	San Francisco County
111463	Fee-for-Service	1528041704	1528041704	1	1	ALBERT, BRUCE M MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	40650	20	Orthopedic Surgery	0	In state provider	None	16300 SAND CANYON AVE	STE 901	IRVINE	CA	92618	3709	30	06059	33.66115075	-117.7742405	Orange County
111479	Fee-for-Service	1588123301	1588123301	1	1	ARICHAI, PIYAWAT MD	2/6/2023	390200000X	NA	Other	026	PHYSICIANS	176409	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
111490	Fee-for-Service	1528608064	1528608064	1	1	AHN, LISA H CCC-SLP	4/20/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
111494	Fee-for-Service	1366701385	1366701385	1	1	AU, JOSHUA MD	6/12/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	127683	04	Otology, Laryngology, Rhinology	0	In state provider	None	2400 BALFOUR DR	STE 300	BRENTWOOD	CA	94513	4950	07	06013	37.92519383	-121.734461	Contra Costa County
111506	Fee-for-Service	1790756617	1790756617	1	1	ARITA, ADAM A MD	7/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
111536	Fee-for-Service	1326470279	1326470279	1	1	ADVENTIST HEALTH PHYSICIANS	11/21/2014	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1142 ROSE AVENUE	STE C	SELMA	CA	93662	3251	10	06019	36.56886527	-119.5983853	Fresno County
111540	Fee-for-Service	1851772214	1851772214	1	1	AHMED, SALIM F MD	12/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149763	01	General Practice	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
111555	Fee-for-Service	1902034713	1902034713	1	1	ALHOSH, RABEA MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118525	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	None	34.09813032	-118.2901794	Los Angeles County
111560	Fee-for-Service	1326230228	1326230228	1	1	AFKHAMI, MICHELLE MD	2/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	105871	68	Hematology	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
111561	Fee-for-Service	1699789891	1699789891	1	1	ANDRUS, KIRK G MD	3/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	34543	08	Family Practice	0	In state provider	None	4135 MAIN ST	None	KELSEYVILLE	CA	95451	8941	17	06033	38.97752848	-122.8356478	Lake County
111585	Fee-for-Service	1023180874	1023180874	1	1	ABASCAL, LJUBA MD	1/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	74531	01	General Practice	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
111599	Fee-for-Service	1215385414	1215385414	1	1	ACCLAIM HOME HEALTH INC	3/30/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4020 W MAGNOLIA AVE	SUITE C	BURBANK	CA	91505	2828	19	06037	34.16656815	-118.3507978	Los Angeles County
111617	Fee-for-Service	1669529863	1669529863	1	1	ALTERNATE AVENUES	6/20/2003	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	WOMEN'S RESOURCE CENTER	17057 FOOTHILL BLVD	SUITE 204	FONTANA	CA	92335	3574	36	06071	34.10654917	-117.4330007	San Bernardino County
111642	Fee-for-Service	1336447572	1336447572	1	1	ARCHPRU, BRYAN T CRNA	12/6/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
111675	Fee-for-Service	1790139210	1790139210	1	1	ALVANDI, ALI M MD	11/4/2019	208M00000X	NA	Other	026	PHYSICIANS	153928	40	Pediatrics	0	In state provider	None	2825 CAPITOL AVE	None	SACRAMENTO	CA	95816	5615	34	06067	38.570805	-121.4696385	Sacramento County
111733	Fee-for-Service	1184070666	1184070666	1	1	AHMAD, MAZNA MD INC	6/30/2017	207R00000X	NA	Other	026	PHYSICIANS	116686	41	Internal Medicine	0	In state provider	None	11374 MOUNTAIN VIEW AVE	STE A	LOMA LINDA	CA	92354	3830	36	06071	34.0465275	-117.2436991	San Bernardino County
111757	Fee-for-Service	1306932025	1306932025	1	1	ANGLIN, DEIRDRE RUTH MD	1/31/1987	207P00000X	NA	Other	026	PHYSICIANS	41739	41	Internal Medicine	0	In state provider	None	1720 BROOKLYN AVE	None	LOS ANGELES	CA	90033	2462	19	06037	34.040502	-118.191954	Los Angeles County
111788	Fee-for-Service	1902453731	1902453731	1	2	ALTAMED HEALTH SERVICES	8/24/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2323 W OLYMPIC BLVD	STE 102	LOS ANGELES	CA	90006	2011	19	06037	34.05232398	-118.2825737	Los Angeles County
111791	Fee-for-Service	1891196986	1891196986	1	1	ALLRED, ALEXA LCSW	6/23/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
111802	Fee-for-Service	1093036543	1093036543	1	1	AZINGE, WELIM S MD	12/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126925	None	None	0	In state provider	None	207 W LEGION ROAD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
111850	Fee-for-Service	1326230228	1326230228	1	1	AFKHAMI, MICHELLE MD	2/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	105871	22	Pathology (M.D. only)	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
111853	Fee-for-Service	1699789891	1699789891	1	1	ANDRUS, KIRK G MD	3/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	34543	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4135 MAIN ST	None	KELSEYVILLE	CA	95451	8941	17	06033	38.97752848	-122.8356478	Lake County
111866	Fee-for-Service	1073907689	1073907689	1	1	ALL FOR HEALTH HEALTH FOR	7/10/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ALL INC	800 S CENTRAL AVE	SUITE 308	GLENDALE	CA	91204	4644	19	06037	34.13654729	-118.2578243	Los Angeles County
111888	Fee-for-Service	1821541475	1821541475	1	1	AVAKIAN, RITA MD	12/10/2018	207L00000X	NA	Other	026	PHYSICIANS	138830	05	Anesthesiology	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	4809	19	06037	34.158213	-118.328112	Los Angeles County
111890	Fee-for-Service	1457371635	1457371635	1	1	ALTERS, DENNIS B MD	11/8/2017	2084P0800X	NA	Psychiatry	026	PHYSICIANS	36206	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
111891	Fee-for-Service	1346219268	1346219268	1	1	ANTELOPE VALLEY FAMILY	3/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	43214	08	Family Practice	0	In state provider	HEALTH MEDICAL GRP INC	1672 W AVENUE J	STE 105	LANCASTER	CA	93534	2827	19	06037	34.68938947	-118.1609775	Los Angeles County
111895	Fee-for-Service	1538418884	1538418884	1	1	ABDUL-LATIF, MARIAM L MD	5/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122693	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
111908	Fee-for-Service	1356384325	1356384325	1	1	ALI, NAUROZ I MD	5/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1600 MEDICAL PARKWAY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
111948	Fee-for-Service	1558300681	1558300681	2	1	ALEX, WILLIAM R MD	9/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	86010	None	None	0	In state provider	None	4500 BROCKTON AVE	STE 316	RIVERSIDE	CA	92501	4135	33	06065	33.97785263	-117.3836152	Riverside County
111972	Fee-for-Service	1346793312	1346793312	1	1	ABDELSALAM, HAZEM MD	6/1/2022	207R00000X	NA	Other	026	PHYSICIANS	172630	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
112006	Fee-for-Service	1134508476	1134508476	2	1	AGUILAR-GODINEZ, ELIZABETH	2/11/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	S LMFT	1050 LAKES DR	STE 225	WEST COVINA	CA	91790	2910	19	06037	34.07127962	-117.9226429	Los Angeles County
112012	Fee-for-Service	1861888794	1861888794	1	1	ABIDALI, ALI DO	6/22/2023	204F00000X	NA	General Surgery	026	PHYSICIANS	20785	None	None	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
112021	Fee-for-Service	1326174632	1326174632	1	1	AGUSTIN, ARNOLD G	5/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
112036	Fee-for-Service	1083142376	1083142376	1	1	ADVANCED HEMATOLOGY ONCOLOGY	3/30/2018	261QM1300X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	MEDICAL GROUP INC	6221 WILSHIRE BLVD	STE 506	LOS ANGELES	CA	90048	5223	19	06037	34.06329534	-118.3640031	Los Angeles County
112060	Fee-for-Service	1477693885	1477693885	1	1	AUVIL, NANCY C LMFT	10/9/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
112068	Fee-for-Service	1790331460	1790331460	1	1	ACOSTA, CHELSEA	7/23/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1103 BUTTE HOUSE RD	SUITE E	YUBA CITY	CA	95991	3109	51	06101	39.14536728	-121.6306637	Sutter County
112076	Fee-for-Service	1902453731	1902453731	1	2	ALTAMED HEALTH SERVICES	8/24/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2323 W OLYMPIC BLVD	STE 102	LOS ANGELES	CA	90006	2011	19	06037	34.05232398	-118.2825737	Los Angeles County
112101	Fee-for-Service	1902224884	1902224884	1	1	ALCAM MEDICAL INC	11/16/2020	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1281 N GENE AUTRY TRL	SUITE K	PALM SPRINGS	CA	92262	5418	33	06065	33.83994851	-116.5063229	Riverside County
112122	Fee-for-Service	1629270608	1629270608	1	1	ADIE, MOHAMMAD A MD	12/8/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	91307	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
112123	Fee-for-Service	1326466145	1326466145	1	1	AGARWAL, PRIYANKA	4/29/2020	207RE0101X	NA	Endocrinology	026	PHYSICIANS	144072	67	Endocrinology	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
112127	Fee-for-Service	1306320049	1306320049	1	1	AA BROTHERS LLC	3/7/2025	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	2180 E WALNUT ST	UNIT B	PASADENA	CA	91107	3628	19	06037	34.14863065	-118.1051302	Los Angeles County
112151	Fee-for-Service	1568692580	1568692580	1	1	AHMADZIA, NAJLA MD	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114668	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
112154	Fee-for-Service	1073907689	1073907689	1	1	ALL FOR HEALTH HEALTH FOR	8/25/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	ALL INC	800 S CENTRAL AVE	SUITE 308	GLENDALE	CA	91204	4644	19	06037	34.13654729	-118.2578243	Los Angeles County
112155	Fee-for-Service	1164531992	1164531992	1	1	AGUIRRE,MELISSA A MD	2/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75810	40	Pediatrics	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
112166	Fee-for-Service	1801962345	1801962345	1	1	ADVANCED WOMENS HEALTH	11/20/2019	193400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CENTER A MEDICAL CORP	8501 BRIMHALL RD	BLDG 300	BAKERSFIELD	CA	93312	2254	15	06029	35.36876784	-119.0971029	Kern County
112187	Fee-for-Service	1366490773	1366490773	1	1	ANDERSON, JOHN R DO	12/4/2018	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	4226	30	Radiology	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
112210	Fee-for-Service	1215428461	1215428461	1	1	ALPHA OMEGA VENTANA HOSPICE	8/17/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	LLC	5575 RUFFIN RD	STE 250	SAN DIEGO	CA	92123	1387	37	06073	32.83605627	-117.1266464	San Diego County
112234	Fee-for-Service	1336305267	1336305267	1	1	ABC PEDIATRICS INC	8/21/2008	193400000X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	3663 W 6TH ST	STE 301	LOS ANGELES	CA	90020	3050	19	06037	34.06360557	-118.30199	Los Angeles County
112267	Fee-for-Service	1154410611	1154410611	1	1	ANDERSON, MARK E MD	12/4/2018	207T00000X	NA	General Surgery	026	PHYSICIANS	33410	14	Neurological Surgery	0	In state provider	None	16300 SAND CANYON AVE	1005	IRVINE	CA	92618	3710	30	06059	33.66115075	-117.7742405	Orange County
112283	Fee-for-Service	1104889229	1104889229	1	2	ALWAYS BETTER CARE HOME	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH PROVIDERS	3600 WILSHIRE BLVD	SUITE 1734	LOS ANGELES	CA	90010	2623	19	06037	34.0617065	-118.3036455	Los Angeles County
112301	Fee-for-Service	1619555497	1619555497	1	1	AIYUK, ANNE MARIE MD	7/8/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
112326	Fee-for-Service	1083142376	1083142376	1	1	ADVANCED HEMATOLOGY ONCOLOGY	3/30/2018	261QM1300X	NA	Other	026	PHYSICIANS	None	68	Hematology	0	In state provider	MEDICAL GROUP INC	6221 WILSHIRE BLVD	STE 506	LOS ANGELES	CA	90048	5223	19	06037	34.06329534	-118.3640031	Los Angeles County
112398	Fee-for-Service	1053484568	1053484568	1	1	ASSELIN, LYNNETTE M DO	7/1/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	6882	40	Pediatrics	0	In state provider	None	2067 W VISTA WAY	STE 100	VISTA	CA	92083	6032	37	06073	33.18505594	-117.285958	San Diego County
112409	Fee-for-Service	1295388387	1295388387	1	1	AERY, ANSHU MD	8/22/2022	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
112428	Fee-for-Service	1598722027	1598722027	1	2	AURORA SAN DIEGO, LLC	9/8/2000	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11820 AVE OF INDUSTRY	None	SAN DIEGO	CA	92128	3423	37	06073	32.9906029	-117.0761411	San Diego County
112441	Fee-for-Service	1073907689	1073907689	1	1	ALL FOR HEALTH HEALTH FOR	7/10/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	ALL INC	800 S CENTRAL AVE	SUITE 308	GLENDALE	CA	91204	4644	19	06037	34.13654729	-118.2578243	Los Angeles County
112453	Fee-for-Service	1801962345	1801962345	1	1	ADVANCED WOMENS HEALTH	11/20/2019	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CENTER A MEDICAL CORP	8501 BRIMHALL RD	BLDG 300	BAKERSFIELD	CA	93312	2254	15	06029	35.36876784	-119.0971029	Kern County
112468	Fee-for-Service	1558866376	1558866376	1	1	AKAGI, NAOMI E MD	7/29/2024	207ZP0105X	NA	Other	026	PHYSICIANS	166692	22	Pathology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
112472	Fee-for-Service	1780092262	1780092262	1	8	ASHER SHAHZAD MD PC	11/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	9300 W SUNSET ROAD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
112484	Fee-for-Service	1225054257	1225054257	1	1	ANTELOPE VLLY EMERGENCY	11/11/1994	193400000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	MEDICAL ASSOCIATES INC	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
112486	Fee-for-Service	1154842524	1154842524	1	1	ALTO PHARMACY, LLC	8/4/2021	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5916 BOWCROFT ST	None	LOS ANGELES	CA	90016	4302	19	06037	34.0192477	-118.3752722	Los Angeles County
112493	Fee-for-Service	1376508721	1376508721	1	1	ACHARYA, JANAK K MD	2/10/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88161	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1191 PHELPS AVE	None	COALINGA	CA	93210	9609	10	06019	36.15152163	-120.340676	Fresno County
112497	Fee-for-Service	1215428461	1215428461	1	1	ALPHA OMEGA VENTANA HOSPICE	8/17/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	LLC	5575 RUFFIN RD	STE 250	SAN DIEGO	CA	92123	1387	37	06073	32.83605627	-117.1266464	San Diego County
112506	Fee-for-Service	1770070807	1770070807	1	1	AN USA BEST RX	6/12/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	120 S HARBOR BLVD	UNIT B	SANTA ANA	CA	92704	1382	30	06059	33.744393	-117.9201975	Orange County
112528	Fee-for-Service	1659652915	1659652915	1	1	ABDOLLAHI MOFAKHAM, FATEMEH	11/23/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	162178	30	Radiology	0	In state provider	MD	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
112605	Fee-for-Service	1720189186	1720189186	1	1	ALAS POCASANGRE, JUAN A	8/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	56155	08	Family Practice	0	In state provider	MD	18335 VALLEY BLVD	None	LA PUENTE	CA	91744	5968	19	06037	34.00550085	-117.9026349	Los Angeles County
112611	Fee-for-Service	1083142376	1083142376	1	1	ADVANCED HEMATOLOGY ONCOLOGY	3/30/2018	261QM1300X	NA	Other	026	PHYSICIANS	None	78	Neoplastic Diseases/Oncology	0	In state provider	MEDICAL GROUP INC	6221 WILSHIRE BLVD	STE 506	LOS ANGELES	CA	90048	5223	19	06037	34.06329534	-118.3640031	Los Angeles County
112657	Fee-for-Service	1275633869	1275633869	1	1	ANANTHAKRISHNAN, SHUBHA MD	9/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	81348	45	Nephrology (Renal-Kidney)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
112664	Fee-for-Service	1982776837	1982776837	1	1	AMOS, ILANA S MD	11/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	74397	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
112666	Fee-for-Service	1841509320	1841509320	1	1	ASLAM, WAQAS MD	6/1/2020	207RC0200X	NA	Other	026	PHYSICIANS	126733	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LANE	SUITE 260	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
112708	Fee-for-Service	1023166931	1023166931	1	1	AFFLALO, SUZANNE E MD	8/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	49264	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
112724	Fee-for-Service	1770691511	1770691511	1	1	APRIA HEALTHCARE LLC	4/15/2004	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	APRIA HEALTHCARE INC	2530 JASON CT	None	OCEANSIDE	CA	92056	3592	37	06073	33.21572296	-117.2660601	San Diego County
112742	Fee-for-Service	1932214657	1932214657	1	7	AJAY G. MEKA M.D. INC.	7/11/2019	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	980 N D ST	None	SAN BERNARDINO	CA	92410	3520	36	06071	34.11722269	-117.2919263	San Bernardino County
112760	Fee-for-Service	1780092262	1780092262	1	8	ASHER SHAHZAD MD PC	11/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	77	Infectious Disease	1	Border provider	None	9300 W SUNSET ROAD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
112810	Fee-for-Service	1427352053	1427352053	1	1	ADVANCED SKIN INSTITUTE, INC	9/6/2023	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	3800 GEER RD	200	TURLOCK	CA	95382	1146	50	06099	37.52713247	-120.8488664	Stanislaus County
112811	Fee-for-Service	1609913409	1609913409	1	1	ANGEL VIEW CRIPPLED CHI	2/2/2007	311ZA0620X	NA	Other	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	13785 VIA REAL	None	DESERT HOT SPRING	CA	92240	5514	33	06065	33.94843334	-116.5122524	Riverside County
112812	Fee-for-Service	1770140378	1770140378	2	1	AMANDA WARE, LICENSED CLINIC	3/2/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	AL SOCIAL WORKER INC.	9333 FAIRWAY VIEW PL	SUITE 101	RANCHO CUCAMONGA	CA	91730	0963	36	06071	34.084008	-117.560054	San Bernardino County
112833	Fee-for-Service	1780092262	1780092262	1	3	ASHER SHAHZAD MD PC	11/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	77	Infectious Disease	1	Border provider	None	657 N TOWN CENTER DRIVE	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
112921	Fee-for-Service	1588752778	1588752778	1	1	AYELE, ETSEGENET T MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66741	41	Internal Medicine	0	In state provider	None	2777 PACIFIC AVE	STE E	LONG BEACH	CA	90806	2626	19	06037	33.80761478	-118.193744	Los Angeles County
112925	Fee-for-Service	1184067720	1184067720	1	1	AARONSON, ADAM LMFT	10/1/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	572 RIO LINDO AVE	STE 108	CHICO	CA	95926	1851	04	06007	39.75508407	-121.8487933	Butte County
112931	Fee-for-Service	1124264635	1124264635	1	2	AVICCENNA MEDICAL GROUP	3/27/2015	207RN0300X	NA	Nephrology	026	PHYSICIANS	100198	41	Internal Medicine	0	In state provider	None	9025 WILSHIRE BLVD	STE 210	BEVERLY HILLS	CA	90211	1831	19	06037	34.06708809	-118.3884174	Los Angeles County
112934	Fee-for-Service	1265454276	1265454276	1	1	ARNDT, TODD J. MD	12/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 STATE ST	None	MCCALL	ID	83638	3704	00	None	44.90904704	-116.1097318	Valley County
112944	Fee-for-Service	1275633869	1275633869	1	1	ANANTHAKRISHNAN, SHUBHA MD	9/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	81348	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
112961	Fee-for-Service	1992336044	1992336044	1	1	ANDERSON, DENNIS L LCSW	2/14/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
112971	Fee-for-Service	1285497446	1285497446	1	1	A2B MEDICAL	8/10/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	28999 OLD TOWN FRONT ST	STE. 203	TEMECULA	CA	92590	5805	33	06065	33.48395804	-117.1436329	Riverside County
112997	Fee-for-Service	1023166931	1023166931	1	1	AFFLALO, SUZANNE E MD	8/1/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	49264	90	Pathology-Forensic	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
113002	Fee-for-Service	1942836671	1942836671	1	1	AVALON HOSPICE CARE INC	1/28/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	20945 DEVONSHIRE ST	SUITE 101B	CHATSWORTH	CA	91211	2370	19	06037	34.25727552	-118.5901965	Los Angeles County
113009	Fee-for-Service	1447846373	1447846373	1	1	AKUA BEHAVIORAL HEALTH, INC.	2/17/2025	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	5355 E CARSON ST	None	LONG BEACH	CA	90808	1805	19	06037	33.83237947	-118.1274615	Los Angeles County
113025	Fee-for-Service	1760519011	1760519011	1	1	AUM PHYSICAL THERAPY & YOGA	12/20/2005	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	CENTER INC	1002 CALLOWAY DR	None	BAKERSFIELD	CA	93312	6337	15	06029	35.36711975	-119.1118605	Kern County
113027	Fee-for-Service	1932214657	1932214657	1	7	AJAY G. MEKA M.D. INC.	7/11/2019	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	980 N D ST	None	SAN BERNARDINO	CA	92410	3520	36	06071	34.11722269	-117.2919263	San Bernardino County
113029	Fee-for-Service	1558567446	1558567446	1	1	ALMANSOUR, MUMTAZ T MD	3/19/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	55926	08	Family Practice	0	In state provider	None	330 S MAGNOLIA AVE	101	EL CAJON	CA	92020	5290	37	06073	32.79218212	-116.9623617	San Diego County
113035	Fee-for-Service	1427390541	1427390541	2	1	ANGEL HOSPICE PROVIDERS INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2980 INLAND EMPIRE BLVD	SUITE 111	ONTARIO	CA	91764	7931	36	06071	34.069419	-117.5876055	San Bernardino County
113048	Fee-for-Service	1700219003	1700219003	1	1	ARON HULL	12/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5200 DTC PKWY	STE 400	GREENWOOD VLG	CO	80111	2719	00	None	39.621636	-104.8992545	Arapahoe County
113052	Fee-for-Service	1376824854	1376824854	1	1	AARON K TRAN MD INC	4/25/2019	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
113058	Fee-for-Service	1568673622	1568673622	1	1	AMARAL, CLARENCE L PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1201 S ORANGE AVE	None	EL CAJON	CA	92020	7521	37	06073	32.77914448	-116.9639444	San Diego County
113077	Fee-for-Service	1710008834	1710008834	1	1	AYSOLA, RAVIS S MD	5/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102842	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365	LOS ANGELES	CA	90024	7002	19	06037	34.06527974	-118.4462792	Los Angeles County
113087	Fee-for-Service	1700814373	1700814373	1	1	APPLIED MEDICAL	10/24/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	TECHNOLOGIES INC	11859 COMPTON AVE	None	LOS ANGELES	CA	90059	2958	19	06037	33.92489921	-118.2463202	Los Angeles County
113093	Fee-for-Service	1356970842	1356970842	1	1	ALSTON, ANJE'LE	9/17/2024	207R00000X	NA	Other	026	PHYSICIANS	22925	41	Internal Medicine	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
113094	Fee-for-Service	1114135142	1114135142	1	1	ANDREWS, KIERNAN M LMFT	5/8/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
113098	Fee-for-Service	1427352053	1427352053	1	1	ADVANCED SKIN INSTITUTE, INC	2/15/2023	207N00000X	NA	Dermatology	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	3800 GEER RD	200	TURLOCK	CA	95382	1146	50	06099	37.52713247	-120.8488664	Stanislaus County
113126	Fee-for-Service	1780092262	1780092262	1	3	ASHER SHAHZAD MD PC	11/15/2018	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	657 N TOWN CENTER DRIVE	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
113130	Fee-for-Service	1548503246	1548503246	1	1	AWADALLA, ANDREW C MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142079	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	18210 YORBA LINDA BLVD	STE 404	YORBA LINDA	CA	92886	4060	30	06059	33.8883981	-117.8154098	Orange County
113135	Fee-for-Service	1417442419	1417442419	1	1	ARMSTRONG, SIERRA C NP	7/2/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1090 3RD ST	None	SOUTH LAKE TAHOE	CA	96150	3462	09	06017	38.91492536	-119.9966528	El Dorado County
113139	Fee-for-Service	1295197259	1295197259	1	1	ALVAREZ, NATALIA V MD	4/1/2020	207P00000X	NA	Other	026	PHYSICIANS	161198	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 S GRANDE AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
113161	Fee-for-Service	1366512550	1366512550	1	1	AMERICAN HEALTH SERVICES LLC	11/6/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	717 LINCOLN BLVD.	None	VENICE	CA	90291	2845	19	06037	33.99949766	-118.464069	Los Angeles County
113186	Fee-for-Service	1023075579	1023075579	1	1	ARGUEDAS, CARLOS A MD	3/1/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	45750	41	Internal Medicine	0	In state provider	None	6226 E SPRING ST	STE 380	LONG BEACH	CA	90815	1444	19	06037	33.81040053	-118.1102715	Los Angeles County
113221	Fee-for-Service	1124264635	1124264635	1	2	AVICCENNA MEDICAL GROUP	3/27/2015	207RN0300X	NA	Nephrology	026	PHYSICIANS	100198	45	Nephrology (Renal-Kidney)	0	In state provider	None	9025 WILSHIRE BLVD	STE 210	BEVERLY HILLS	CA	90211	1831	19	06037	34.06708809	-118.3884174	Los Angeles County
113226	Fee-for-Service	1063736254	1063736254	1	1	AU, TINA T MD	4/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111781	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
113239	Fee-for-Service	1891960076	1891960076	2	2	ANDERSON, IVAN B MD	5/16/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	110448	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3288 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
113282	Fee-for-Service	1376654756	1376654756	1	3	ADOBE MEDICAL GROUP INC	11/2/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	26691 PLAZA DRIVE	SUITE 212	MISSION VIEJO	CA	92691	2788	30	06059	33.56533763	-117.6645538	Orange County
113293	Fee-for-Service	1942836671	1942836671	1	1	AVALON HOSPICE CARE INC	1/28/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	20945 DEVONSHIRE ST	SUITE 101B	CHATSWORTH	CA	91211	2370	19	06037	34.25727552	-118.5901965	Los Angeles County
113297	Fee-for-Service	1871170142	1871170142	1	1	ADDEPALLI, ARAVIND MD	7/30/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
113322	Fee-for-Service	1487053336	1487053336	1	1	AZAM, ARSALAN MD	12/3/2019	207P00000X	NA	Other	026	PHYSICIANS	161461	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
113324	Fee-for-Service	1427390541	1427390541	2	1	ANGEL HOSPICE PROVIDERS INC	5/14/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2980 INLAND EMPIRE BLVD	SUITE 111	ONTARIO	CA	91764	7931	36	06071	34.069419	-117.5876055	San Bernardino County
113343	Fee-for-Service	1144368093	1144368093	1	1	ANAHEIM UNION HIGH SD	1/3/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	501 N CRESCENT WAY	None	ANAHEIM	CA	92801	5401	30	06059	33.837174	-117.9473765	Orange County
113363	Fee-for-Service	1942957113	1942957113	1	1	AGULANNA, CHIKA NP	9/5/2022	163WP0809X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
113379	Fee-for-Service	1821302027	1821302027	1	1	ARROYO VISTA FAMILY HEALTH	6/5/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	4837 HUNTINGTON DRIVE N	None	LOS ANGELES	CA	90032	1981	19	06037	34.0860874	-118.1788432	Los Angeles County
113382	Fee-for-Service	1174899686	1174899686	1	1	ADVANCED INTERVENTIONAL PAIN	4/16/2012	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	CENTER LA	11645 WILSHIRE BLVD	STE 852	LOS ANGELES	CA	90025	6808	19	06037	34.05005135	-118.4602303	Los Angeles County
113387	Fee-for-Service	1679120836	1679120836	1	1	ANTHONY KELADA PSYCHIATRY IN	7/22/2021	2084P0800X	NA	Psychiatry	022	PHYSICIANS GROUP	-	None	None	0	In state provider	C	991 RESERVE DR	B	ROSEVILLE	CA	95678	1350	31	06061	38.766483	-121.271198	Placer County
113411	Fee-for-Service	1326350851	1326350851	1	1	AFZALI, PAYAM MD	6/30/2020	390200000X	NA	Other	026	PHYSICIANS	169011	47	Miscellaneous	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
113413	Fee-for-Service	1720516743	1720516743	1	1	ABRISHAMIAN, MATTHEW MD	6/22/2020	207P00000X	NA	Other	026	PHYSICIANS	164295	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
113418	Fee-for-Service	1053643536	1053643536	1	1	ALBINI, PAUL T MD	8/1/2018	208600000X	NA	General Surgery	026	PHYSICIANS	149166	02	General Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
113423	Fee-for-Service	1053733790	1053733790	1	1	ALVAREZ, SUSAN J MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119807	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
113434	Fee-for-Service	1790044303	1790044303	1	1	AGNOLI, ALICIA L MD	8/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150159	01	General Practice	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
113452	Fee-for-Service	1851882583	1851882583	1	1	AU-YEUNG, WINNIE W OD	7/28/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	375 LAGUNA HONDA BLVD	None	SAN FRANCISCO	CA	94116	1411	38	06075	37.74791027	-122.4587116	San Francisco County
113460	Fee-for-Service	1962577411	1962577411	1	1	ANN WELCH	12/16/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 BURDICK EXPY W	None	MINOT	ND	58701	4406	00	None	48.2325845	-101.2938165	Ward County
113468	Fee-for-Service	1447419957	1447419957	1	1	ANUNCIACION, DULCE S MD	8/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	104623	05	Anesthesiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
113470	Fee-for-Service	1982655304	1982655304	1	1	AHEARN, PATRICIA A MD	4/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	54979	41	Internal Medicine	0	In state provider	None	1040 ELM AVE	STE 204	LONG BEACH	CA	90813	3266	19	06037	33.779799	-118.1879535	Los Angeles County
113471	Fee-for-Service	1023565579	1023565579	1	2	AMERICAN ADDICTION INSTITUTE	7/22/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	OF MIND AND MEDICINE	1533 EAST 4TH STREET	None	SANTA ANA	CA	92701	5115	30	06059	33.74814149	-117.848421	Orange County
113504	Fee-for-Service	1710068366	1710068366	1	1	ASLAM, MOHAMMAD MD	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	33854	41	Internal Medicine	0	In state provider	None	395 TERRACINA BLVD	None	REDLANDS	CA	92373	4849	36	06071	34.036782	-117.2039042	San Bernardino County
113523	Fee-for-Service	1295791218	1295791218	1	1	AOUN, PATRICIA MD	12/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55610	22	Pathology (M.D. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
113524	Fee-for-Service	1891960076	1891960076	2	2	ANDERSON, IVAN B MD	5/16/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	110448	70	Clinic (mixed specialty)	0	In state provider	None	3288 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
113551	Fee-for-Service	1457334716	1457334716	1	1	ALCALAY, ALLISON D MD	6/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88679	41	Internal Medicine	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
113554	Fee-for-Service	1104227222	1104227222	1	1	ADVANCED HEALTH CARE	8/2/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PROVIDERS INC	17620 SHERMAN WAY	SUITE 215	VAN NUYS	CA	91406	3527	19	06037	34.20105176	-118.5171046	Los Angeles County
113572	Fee-for-Service	1922171420	1922171420	1	2	AMOS, RONALD D PHD	10/9/2020	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	74-710 HIGHWAY 111	STE 102	PALM DESERT	CA	92260	3820	33	06065	33.721101	-116.3648803	Riverside County
113576	Fee-for-Service	1225186133	1225186133	1	1	ADIGWE-MOZIA, MARTHA N NP	2/28/2019	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2547 W SHAW AVE	STE 117	FRESNO	CA	93711	3321	10	06019	36.80804173	-119.8385565	Fresno County
113596	Fee-for-Service	1023881166	1023881166	1	1	AHCS SPECIALTY CARE GARDEN G	12/13/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CY	1377 NORTH FAIR OAKS AVE	SUITE A	PASADENA	CA	91103	2101	19	06037	34.169598	-118.1507175	Los Angeles County
113609	Fee-for-Service	1487053336	1487053336	1	1	AZAM, ARSALAN MD	12/3/2019	207P00000X	NA	Other	026	PHYSICIANS	161461	70	Clinic (mixed specialty)	0	In state provider	None	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
113612	Fee-for-Service	1487051348	1487051348	1	1	AGAPE GROUP INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	255 E RINCON ST	SUITE 325	CORONA	CA	92879	1368	33	06065	33.88639376	-117.5620641	Riverside County
113617	Fee-for-Service	1720710023	1720710023	1	1	A CARING TOUCH BOARD AND	8/18/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	CARE III LLC	2110 OAK STREET	None	SANTA MONICA	CA	90405	5010	19	06037	34.01363458	-118.4626411	Los Angeles County
113630	Fee-for-Service	1144368093	1144368093	1	1	ANAHEIM UNION HIGH SD	7/1/1994	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	501 N CRESCENT WAY	None	ANAHEIM	CA	92801	5401	30	06059	33.837174	-117.9473765	Orange County
113651	Fee-for-Service	1568411015	1568411015	1	1	AFAQ AHMAD,MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	500 W BERKELEY ST	None	UNIONTOWN	PA	15401	5514	00	None	39.9022144	-79.73784796	Fayette County
113664	Fee-for-Service	1922425057	1922425057	1	1	AJURIA, MICHAEL J MD	4/24/2017	207R00000X	NA	Other	026	PHYSICIANS	144362	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
113667	Fee-for-Service	1821302027	1821302027	1	1	ARROYO VISTA FAMILY HEALTH	6/5/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	4837 HUNTINGTON DRIVE N	None	LOS ANGELES	CA	90032	1981	19	06037	34.0860874	-118.1788432	Los Angeles County
113683	Fee-for-Service	1538422183	1538422183	1	1	AMESUR, RAJIV P DO	12/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3001 ST ROSE PARKWAY	None	HENDERSON	NV	89052	3839	00	None	36.00555274	-115.1163108	Clark County
113689	Fee-for-Service	1972229136	1972229136	1	1	ALFARO, ANNETTE	6/27/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4211 B VALLEY VIEW AVE	None	NORCO	CA	92860	3502	33	06065	33.943446	-117.5498725	Riverside County
113697	Fee-for-Service	1447325048	1447325048	1	1	ASTWANI, MAHER MD	5/13/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	157513	13	Neurology (M.D. only)	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
113700	Fee-for-Service	1972226140	1972226140	1	1	ALMANZA, MICHELLE LCSW	2/6/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
113701	Fee-for-Service	1508472846	1508472846	1	1	ANDERSON, NICOLE NP	6/26/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
113703	Fee-for-Service	1467631887	1467631887	1	1	A-1 HOME HEALTH SERVICES INC	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1407 KUEHNER DR	None	SIMI VALLEY	CA	93063	4478	56	06111	34.265232	-118.6620425	Ventura County
113714	Fee-for-Service	1205203510	1205203510	1	2	ANAND, SUSHIL MD FAAP	8/14/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	1175 E ARROWY HWY	UNIT M	UPLAND	CA	91786	5525	36	06071	34.09981647	-117.636003	San Bernardino County
113757	Fee-for-Service	1942836424	1942836424	1	1	ALTAMED HEALTH SERVICES CORP	10/9/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	RISTOL	2720 SOUTH BRISTOL STREE	ROOM 100	SANTA ANA	CA	92704	6207	30	06059	33.710463	-117.8854565	Orange County
113761	Fee-for-Service	1821261371	1821261371	1	1	AVEDIAN, RAFFI S MD	10/21/2008	207XS0114X	NA	Orthopedic Surgery	026	PHYSICIANS	86813	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
113791	Fee-for-Service	1710068366	1710068366	1	1	ASLAM, MOHAMMAD MD	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	33854	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	395 TERRACINA BLVD	None	REDLANDS	CA	92373	4849	36	06071	34.036782	-117.2039042	San Bernardino County
113798	Fee-for-Service	1568191013	1568191013	1	1	AVERBUKH, DANIELLA B PT	12/7/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
113840	Fee-for-Service	1235447897	1235447897	1	1	ANDERSON, CYNTHIA E LMFT	5/24/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2130 MAIN STREET	SUITE 120	HUNTINGTON BEACH	CA	92648	2422	30	06059	33.680385	-117.9976275	Orange County
113884	Fee-for-Service	1609003086	1609003086	1	1	ADAM V. MEYER	2/13/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
113900	Fee-for-Service	1669614418	1669614418	1	1	AARON PETERSEN	8/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	714 W PINE ST	None	NEWPORT	WA	99156	9046	00	None	48.1820733	-117.0490023	Pend Oreille County
113901	Fee-for-Service	1487051348	1487051348	1	1	AGAPE GROUP INC	3/6/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	255 E RINCON ST	SUITE 325	CORONA	CA	92879	1368	33	06065	33.88639376	-117.5620641	Riverside County
113912	Fee-for-Service	1104849140	1104849140	1	1	AUSTIN, JEREMY R MD	12/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	74451	08	Family Practice	0	In state provider	None	1133 W SYCAMORE ST	None	WILLOWS	CA	95988	2601	11	06021	39.5205105	-122.2082775	Glenn County
113999	Fee-for-Service	1629074489	1629074489	1	1	ALLEN, ROBERT D	1/31/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	70950	08	Family Practice	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
114006	Fee-for-Service	1518038587	1518038587	1	1	ASHFORD, MARY H MD	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	64257	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
114030	Fee-for-Service	1689033748	1689033748	1	1	ACHO, CHRISTINE R DO	8/4/2021	207L00000X	NA	Other	026	PHYSICIANS	18886	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
114034	Fee-for-Service	1336196583	1336196583	1	1	ARAGONA, JODI L MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	60983	01	General Practice	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
114058	Fee-for-Service	1982686200	1982686200	1	1	ADIGOPULA, BINA MD	8/31/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45273	40	Pediatrics	0	In state provider	None	5360 JACKSON DR	STE 100	LA MESA	CA	91942	3012	37	06073	32.77680573	-117.0176327	San Diego County
114065	Fee-for-Service	1568635811	1568635811	1	2	A-1 HEALTHCARE MGMT, INC	6/4/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5011 ARGOSY AVE	SUITE 5	HUNTINGTON BEACH	CA	92649	1002	30	06059	33.74110809	-118.0409904	Orange County
114084	Fee-for-Service	1821593021	1821593021	1	1	ANUDOKEM, KELECHI B MD	6/12/2023	163WX0003X	NA	Other	026	PHYSICIANS	165868	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
114086	Fee-for-Service	1528089075	1528089075	1	1	APPLEGATE, RICHARD L MD	6/30/1985	207L00000X	NA	Other	026	PHYSICIANS	50516	None	None	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
114091	Fee-for-Service	1801182431	1801182431	1	1	ALY FATIMA ZAHRA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0002	00	None	32.240493	-110.9460825	Pima County
114121	Fee-for-Service	1003265745	1003265745	1	1	AHMAD, ROBINA MD	7/15/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	168887	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
114123	Fee-for-Service	1891450987	1891450987	1	1	ADVENTIST HEALTH PHYSICIANS	4/22/2022	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	900 THARP RD	None	YUBA CITY	CA	95993	9159	51	06101	39.138426	-121.6485595	Sutter County
114132	Fee-for-Service	1134734312	1134734312	1	1	ALIA CARE INC	10/13/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10545 BURBANK BLVD	STE 128	NORTH HOLLYWOOD	CA	91601	2249	19	06037	34.1721655	-118.3608315	Los Angeles County
114149	Fee-for-Service	1962515783	1962515783	1	1	ADVANCED TISSUE LLC	6/21/2013	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	7003 VALLEY RANCH DR	None	LITTLE ROCK	AR	72223	4696	00	None	34.812486	-92.4749595	Pulaski County
114159	Fee-for-Service	1053650341	1053650341	1	1	ARNOLD, JUSTIN D MD	7/8/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	176420	07	Dermatology	0	In state provider	None	4715 VALLEY EAST BLVD	STE. 3	ARCATA	CA	95521	3586	12	06023	40.90112023	-124.0814061	Humboldt County
114272	Fee-for-Service	1174552533	1174552533	1	1	ADLER, MARK J MD	9/30/1989	207RH0003X	NA	Oncology	026	PHYSICIANS	58922	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
114316	Fee-for-Service	1023121217	1023121217	1	1	AOUN, CHARBEL E MD	11/1/1996	207R00000X	NA	Other	026	PHYSICIANS	56181	41	Internal Medicine	0	In state provider	None	12401 HESPERIA RD	None	VICTORVILLE	CA	92395	7707	36	06071	34.4771995	-117.2911483	San Bernardino County
114324	Fee-for-Service	1336196583	1336196583	1	1	ARAGONA, JODI L MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	60983	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
114328	Fee-for-Service	1821146747	1821146747	1	1	ARELLANO, JOSEPH CRNA	10/12/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
114330	Fee-for-Service	1407808645	1407808645	1	1	AFFANY, ABDELMONIM MD	11/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56084	36	Psychiatry	0	In state provider	None	4785 N FIRST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
114332	Fee-for-Service	1609482397	1609482397	1	1	A BETTER LIFE TOGETHER, INC	3/21/2024	103TF0000X	NA	Mental Health Outpatient Services	048	COUNTY CLINICS NOT ASSOCIATED WITH HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	8825 AERO DR	215	SAN DIEGO	CA	92123	2200	37	06073	32.80967216	-117.1384291	San Diego County
114340	Fee-for-Service	1508670183	1508670183	1	1	ANGEL'S ON WING'S LLC	1/7/2025	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1440 WEST 92ND STREET	None	LOS ANGELES	CA	90047	3627	19	06037	33.95268913	-118.3017993	Los Angeles County
114346	Fee-for-Service	1346568029	1346568029	1	1	ALEXANDRA P LEADER	2/12/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
114349	Fee-for-Service	1437341492	1437341492	1	1	ALTER, CASSI CCC-SLP	7/13/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2836 W SUNSET BLVD	None	LOS ANGELES	CA	90026	9002	19	06037	34.08237374	-118.2726063	Los Angeles County
114357	Fee-for-Service	1124895958	1124895958	1	1	ADDISON SAMUELS, KEARIESHA N	6/24/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	NP	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
114373	Fee-for-Service	1609939818	1609939818	1	2	ADLER, KARL D MD	11/28/2016	2084P0800X	NA	Psychiatry	026	PHYSICIANS	66450	36	Psychiatry	0	In state provider	None	39001 SUNDALE DRIVE	None	FREMONT	CA	94538	2005	01	06001	37.5461169	-121.979068	Alameda County
114396	Fee-for-Service	1871709030	1871709030	1	1	APPLEBAUM, JAY MD INC	6/30/1990	207N00000X	NA	Dermatology	026	PHYSICIANS	54219	07	Dermatology	0	In state provider	None	1506 E CHAPMAN AVE	None	ORANGE	CA	92866	2231	30	06059	33.78778851	-117.837621	Orange County
114417	Fee-for-Service	1629128764	1629128764	1	1	ABDELNOUR, SHADI MD	9/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	67	Endocrinology	1	Border provider	None	3006 S MARYLAND-PKWY	SUITE 315	LAS VEGAS	NV	89109	6205	00	None	36.135288	-115.1368705	Clark County
114422	Fee-for-Service	1134734312	1134734312	1	1	ALIA CARE INC	10/13/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10545 BURBANK BLVD	STE 128	NORTH HOLLYWOOD	CA	91601	2249	19	06037	34.1721655	-118.3608315	Los Angeles County
114424	Fee-for-Service	1417070491	1417070491	1	1	AJIBOLA, AYODEJI J MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117267	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
114427	Fee-for-Service	1104982495	1104982495	2	3	AEGIS TREATMENT CENTERS, LLC	6/2/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1349 AND 1343 W. MAIN ST	A & B	MERCED	CA	95340	4438	24	06047	37.30624009	-120.4963217	Merced County
114452	Fee-for-Service	1366458317	1366458317	1	1	AU, LEE K W MD	12/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	88694	01	General Practice	0	In state provider	None	5320 CARRINGTON CIR	None	STOCKTON	CA	95210	3515	39	06077	38.00512188	-121.2937141	San Joaquin County
114485	Fee-for-Service	1124045018	1124045018	1	1	APPEAL, RONALD J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	101 W 8TH AVE	None	SPOKANE	WA	99204	2307	00	None	47.647989	-117.4112415	Spokane County
114513	Fee-for-Service	1174523096	1174523096	1	1	AMIRHAMZEH, MEHRDAD M R MD	6/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	86572	02	General Surgery	0	In state provider	None	1610 W YOSEMITE AVE	STE 3	MANTECA	CA	95337	5189	39	06077	37.79730746	-121.2429154	San Joaquin County
114516	Fee-for-Service	1639206733	1639206733	1	1	ABUSIEF, MARY E MD	10/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	100071	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
114534	Fee-for-Service	1861138273	1861138273	1	1	ALEPH LAB LLC	9/1/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	2637 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	07	06013	37.925712	-122.021856	Contra Costa County
114552	Fee-for-Service	1588956007	1588956007	1	1	ARCILA, SEBASTIAN B MD	10/24/2017	207RP1001X	NA	Pulmonology	026	PHYSICIANS	125823	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	27200 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.8955513	-117.189743	Riverside County
114565	Fee-for-Service	1699385468	1699385468	1	1	ALFRED LUI MD INC	10/9/2020	207ZP0102X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	GROUP	21250 HAWTHORNE BLVD	SUITE 800	TORRANCE	CA	90503	5513	19	06037	33.83566432	-118.3531683	Los Angeles County
114623	Fee-for-Service	1396079851	1396079851	1	1	ABRAMSON, MARIA L CCC-A	9/8/2019	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	28985 GOLDEN LANTERN	B105	LAGUNA NIGUEL	CA	92677	1567	30	06059	33.54224233	-117.6912078	Orange County
114653	Fee-for-Service	1144236845	1144236845	1	1	ANDERSON, TERESA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87131	2745	00	None	35.08771808	-106.6192188	Bernalillo County
114660	Fee-for-Service	1225287378	1225287378	1	1	AFSHAR, MASOUD MD	11/26/2008	207R00000X	NA	Other	026	PHYSICIANS	105324	None	None	0	In state provider	None	2205 ROSS AVENUE	STE. 101	EL CENTRO	CA	92243	3623	13	06025	32.78143643	-115.5804952	Imperial County
114715	Fee-for-Service	1104982495	1104982495	2	3	AEGIS TREATMENT CENTERS, LLC	6/2/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1349 AND 1343 W. MAIN ST	A & B	MERCED	CA	95340	4438	24	06047	37.30624009	-120.4963217	Merced County
114717	Fee-for-Service	1215964150	1215964150	1	1	AGARWAL, HARI MD	9/30/1983	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	46246	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5000 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
114752	Fee-for-Service	1033257175	1033257175	1	1	ANDERSON, KNUTE E PSYD	12/27/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
114754	Fee-for-Service	1972512176	1972512176	2	1	ADVANCED EYE ASSOCIATES, APC	1/1/2022	261QS0132X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	200 JOSE FIGUERES AVE	350	SAN JOSE	CA	95116	1594	43	06085	37.36122014	-121.8505998	Santa Clara County
114757	Fee-for-Service	1669091948	1669091948	1	1	ANKUS, EMILY J MD	8/17/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	184889	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
114778	Fee-for-Service	1578170122	1578170122	1	1	AMG HOME HEALTH, INC	2/1/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6911 TOPANGA CANYON BLVD	STE 202	CANOGA PARK	CA	91303	2369	19	06037	34.195887	-118.6059595	Los Angeles County
114793	Fee-for-Service	1922156900	1922156900	1	1	ARROYO, HECTOR MD	12/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74077	02	General Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
114796	Fee-for-Service	1639206733	1639206733	1	1	ABUSIEF, MARY E MD	10/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	100071	67	Endocrinology	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
114801	Fee-for-Service	1174523096	1174523096	1	1	AMIRHAMZEH, MEHRDAD M R MD	6/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	86572	33	Thoracic Surgery	0	In state provider	None	1610 W YOSEMITE AVE	STE 3	MANTECA	CA	95337	5189	39	06077	37.79730746	-121.2429154	San Joaquin County
114806	Fee-for-Service	1851394506	1851394506	1	1	ALBRIGHT, JANET L MD	1/5/2001	2086S0129X	NA	General Surgery	026	PHYSICIANS	-	33	Thoracic Surgery	1	Border provider	None	1500 E 2ND ST	STE 206	RENO	NV	89502	1198	00	None	39.52743427	-119.7932613	Washoe County
114826	Fee-for-Service	1194290411	1194290411	1	1	ASSINI-STRUCK, JOSEPHINE CN	5/14/2020	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	P	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
114844	Fee-for-Service	1700974987	1700974987	1	1	ALMAGUER, RICARDO R DO	9/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1600 MEDICAL PKWY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
114941	Fee-for-Service	1396811667	1396811667	1	1	ANGELISA M PALADIN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY NE	STE 100	SEATTLE	WA	98105	3954	00	None	47.66165594	-122.2864502	King County
114962	Fee-for-Service	1932315827	1932315827	1	1	ADHAMI, SHAWN A MD INC	3/14/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1000 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4639	19	06037	34.01070086	-118.1110129	Los Angeles County
114996	Fee-for-Service	1023398807	1023398807	1	1	AHS CLAREMORE REGIONAL	12/20/2015	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HOSPITAL LLC	1202 N MUSKOGEE PL	None	CLAREMORE	OK	74017	3058	00	None	36.322614	-95.60531299	Rogers County
115026	Fee-for-Service	1972056471	1972056471	1	1	ABDUL-ALI, RABIIA LMFT	10/19/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2020 29TH ST	205	SACRAMENTO	CA	95817	1119	34	06067	38.56185	-121.473279	Sacramento County
115041	Fee-for-Service	1285654939	1285654939	1	1	ARIYASU, REGINALD G MD	2/28/1993	207W00000X	NA	Ophthalmology	026	PHYSICIANS	64282	18	Ophthalmology	0	In state provider	None	1355 SAN PABLO ST	None	LOS ANGELES	CA	90033	1035	19	06037	34.06080447	-118.203734	Los Angeles County
115058	Fee-for-Service	1831141084	1831141084	1	1	ARTRIP, JOHN H MD	8/22/2019	208G00000X	NA	General Surgery	026	PHYSICIANS	160728	33	Thoracic Surgery	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
115061	Fee-for-Service	1801069729	1801069729	1	1	ADLER, FELIX MD	8/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87928	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2203	38	06075	37.76344756	-122.4581992	San Francisco County
115086	Fee-for-Service	1306801261	1306801261	1	1	AIRCARE MEDICAL SUPPLY	3/15/1996	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	6900 CANBY AVE	STE 105	RESEDA	CA	91335	8170	19	06037	34.19560922	-118.5350661	Los Angeles County
115093	Fee-for-Service	1609257831	1609257831	1	1	ALCASID, MATTHEW MD	10/28/2019	207R00000X	NA	Other	026	PHYSICIANS	149514	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
115097	Fee-for-Service	1851394506	1851394506	1	1	ALBRIGHT, JANET L MD	1/5/2001	2086S0129X	NA	General Surgery	026	PHYSICIANS	-	02	General Surgery	1	Border provider	None	1500 E 2ND ST	STE 206	RENO	NV	89502	1198	00	None	39.52743427	-119.7932613	Washoe County
115100	Fee-for-Service	1700191053	1700191053	1	1	AGBULOS, GERARD B MD	12/21/2018	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
115133	Fee-for-Service	1184605644	1184605644	1	1	AMIRI, AMIR A MD	4/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92743	02	General Surgery	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
115146	Fee-for-Service	1831357581	1831357581	1	1	AIDS HLTHCARE FOUNDATION	8/5/2008	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 30TH ST	STE 300	OAKLAND	CA	94609	3306	01	06001	37.81907725	-122.2648838	Alameda County
115162	Fee-for-Service	1639841109	1639841109	1	1	ARPD LLC	9/1/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2150 PYRAMID DR	None	EL SOBRANTE	CA	94803	3220	07	06013	37.96006975	-122.2991421	Contra Costa County
115170	Fee-for-Service	1699163741	1699163741	1	1	ALL SEASONS MEDICAL SUPPLY	3/22/2018	332B00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1220 E AVE S	SUITE B	PALMDALE	CA	93550	6196	19	06037	34.55797574	-118.1056225	Los Angeles County
115177	Fee-for-Service	1477610558	1477610558	1	2	ADVANCED EYE & LASER CENTER	11/9/2010	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	OF CALIFORNIA INC	10737 CAMINO RUIZ	SUITE 100	SAN DIEGO	CA	92126	2370	37	06073	32.91416051	-117.1437943	San Diego County
115229	Fee-for-Service	1659921054	1659921054	1	1	AMINI, NAZANIN	3/26/2021	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3392 MOTOR AVE	None	LOS ANGELES	CA	90034	3712	19	06037	34.02780514	-118.4095758	Los Angeles County
115249	Fee-for-Service	1932315827	1932315827	1	1	ADHAMI, SHAWN A MD INC	3/14/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1000 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4639	19	06037	34.01070086	-118.1110129	Los Angeles County
115276	Fee-for-Service	1801809751	1801809751	1	1	ADEYIGA, OLADUNNI B MD	8/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111580	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365 120 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
115338	Fee-for-Service	1174174114	1174174114	1	1	ACCENT HOME HEALTH INC	10/26/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	20944 SHERMAN WAY	STE 116	CANOGA PARK	CA	91303	3633	19	06037	34.20095151	-118.5900435	Los Angeles County
115366	Fee-for-Service	1023188786	1023188786	2	2	ALLSUPREME HOME CARE INC	12/18/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	13110 W WASHINGTON BLVD	None	CULVER CITY	CA	90066	5126	19	06037	33.99380654	-118.4410312	Los Angeles County
115373	Fee-for-Service	1073840948	1073840948	1	1	ARMENAKIS, ALEXIS D MD	1/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113096	36	Psychiatry	0	In state provider	None	2340 CLAY STREET	7TH FLOOR	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
115379	Fee-for-Service	1053483750	1053483750	1	1	ADAMS, KELLY L DO	4/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	5330 SOUTH HIGHWAY 95	None	FORT MOHAVE	AZ	89426	2545	00	None	35.002656	-114.595893	Mohave County
115398	Fee-for-Service	1003916636	1003916636	1	1	ASARO, LAURA L CNP	6/20/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
115404	Fee-for-Service	1598899437	1598899437	1	1	ANGLE,NATHAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL STREET	None	HONOLULU	HI	96813	0000	00	None	21.30800017	-157.8550765	Honolulu County
115433	Fee-for-Service	1891406039	1891406039	1	1	ALLISON, NGOZI MARY	5/25/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2621 WRENWOOD AVE	None	CLOVIS	CA	93611	8581	10	06019	36.81895933	-119.6627714	Fresno County
115443	Fee-for-Service	1558544064	1558544064	1	1	ALVILLAR, DANIEL LCSW	8/9/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1875 W REDONDO BEACH BLV	STE 303	GARDENA	CA	90247	3644	19	06037	33.8879044	-118.3111113	Los Angeles County
115452	Fee-for-Service	1114927241	1114927241	1	1	ACHANTA, KRANTHI K MD	8/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	69021	01	General Practice	0	In state provider	None	1860 MOWRY AVE	STE 400	FREMONT	CA	94538	1730	01	06001	37.55887933	-121.9797796	Alameda County
115457	Fee-for-Service	1528533940	1528533940	1	1	ANG, LANA P NP	5/17/2022	363LN0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
115471	Fee-for-Service	1093939399	1093939399	1	1	AHN, RANDALL PHD	10/31/2023	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10165 FOOTHILL BLVD	#3	RANCHO CUCAMONGA	CA	91730	0340	36	06071	34.10653497	-117.5834924	San Bernardino County
115482	Fee-for-Service	1093283905	1093283905	1	1	ALKHATIB, OUSAMA MD	5/6/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	170837	None	None	0	In state provider	None	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	19	06037	34.13101049	-118.151532	Los Angeles County
115540	Fee-for-Service	1932315827	1932315827	1	1	ADHAMI, SHAWN A MD INC	3/14/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1000 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4639	19	06037	34.01070086	-118.1110129	Los Angeles County
115541	Fee-for-Service	1689145807	1689145807	1	1	AYVAZYAN, SALINE CNP	6/30/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2626 COLORADO BLVD	None	LOS ANGELES	CA	90041	1070	19	06037	34.14236825	-118.2236654	Los Angeles County
115551	Fee-for-Service	1588203103	1588203103	1	1	ANAND, RACHNA CNP	6/18/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1707 EYE ST	100	BAKERSFIELD	CA	93301	5208	15	06029	35.37461686	-119.020062	Kern County
115565	Fee-for-Service	1801809751	1801809751	1	1	ADEYIGA, OLADUNNI B MD	8/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111580	77	Infectious Disease	0	In state provider	None	200 MEDICAL PLAZA	STE 365 120 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
115567	Fee-for-Service	1851095343	1851095343	1	1	ANGLIN, DESIANN PT	9/6/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
115611	Fee-for-Service	1265535777	1265535777	1	1	ALLISON, JAMES E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	18968	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
115630	Fee-for-Service	1912026097	1912026097	1	1	ADVANCED DERMATOLOGY & COSME	11/17/2023	174400000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	TICS LASER CARE A MEDI	28212 KELLY JOHNSON PKWY	SUITE 245	VALENCIA	CA	91355	5084	19	06037	34.44856821	-118.5794922	Los Angeles County
115681	Fee-for-Service	1629496740	1629496740	1	1	ADACHI, MARIE MD	5/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139611	38	Geriatrics	0	In state provider	None	200 UCLA MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.065126	-118.446237	Los Angeles County
115689	Fee-for-Service	1902363112	1902363112	1	1	ANTHONY, RONALD W NP	10/15/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
115705	Fee-for-Service	1730661083	1730661083	1	1	ACCESS PHYSICIAN INC.	10/11/2021	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IFORNIA	1517 KNICKERBOCKER	None	STOCKTON	CA	95210	3119	39	06077	38.02415455	-121.2934722	San Joaquin County
115720	Fee-for-Service	1891406039	1891406039	1	1	ALLISON, NGOZI MARY	5/25/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2621 WRENWOOD AVE	None	CLOVIS	CA	93611	8581	10	06019	36.81895933	-119.6627714	Fresno County
115733	Fee-for-Service	1255892063	1255892063	1	1	AZZAWI, SORAYA MD	9/8/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	189920	None	None	0	In state provider	None	514 N. PROSPECT AVE	None	REDONDO BEACH	CA	90277	3036	19	06037	33.85253987	-118.3796668	Los Angeles County
115734	Fee-for-Service	1265936728	1265936728	1	1	AGARWAL, GAURAV MD	11/30/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	100 PINE ST	STE 1250	SAN FRANCISCO	CA	94111	5235	38	06075	37.79237874	-122.3989278	San Francisco County
115749	Fee-for-Service	1134180219	1134180219	1	1	AHMED, SUMERA MD	11/24/2008	207R00000X	NA	Other	026	PHYSICIANS	95162	41	Internal Medicine	0	In state provider	None	5555 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	4000	01	06001	37.69212528	-121.8803442	Alameda County
115798	Fee-for-Service	1558627356	1558627356	1	1	AKERS, STEPHEN M MD FAAP	9/7/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	174171	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
115807	Fee-for-Service	1487017026	1487017026	1	1	ASFON SERVICES INC	2/1/2016	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	12377 LEWIS STREET	SUITE 205	GARDEN GROVE	CA	92840	4692	30	06059	33.78307129	-117.8990576	Orange County
115865	Fee-for-Service	1972865301	1972865301	1	1	ATMC LLC	7/1/2012	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	545 W BEVERLY PLACE	None	TRACY	CA	95376	3012	39	06077	37.74497853	-121.4341065	San Joaquin County
115872	Fee-for-Service	1740982081	1740982081	1	1	ALCANTAR, ARGELIA TOLABOR C	6/22/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
115882	Fee-for-Service	1871095562	1871095562	1	1	ARGHAVANI JACKSON, BAHAR LM	11/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
115900	Fee-for-Service	1265535777	1265535777	1	1	ALLISON, JAMES E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	18968	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
115917	Fee-for-Service	1912026097	1912026097	1	1	ADVANCED DERMATOLOGY & COSME	11/17/2023	174400000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	TICS LASER CARE A MEDI	28212 KELLY JOHNSON PKWY	SUITE 245	VALENCIA	CA	91355	5084	19	06037	34.44856821	-118.5794922	Los Angeles County
115933	Fee-for-Service	1649476037	1649476037	1	1	AMBROSE, CARLA B LCSW	12/11/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2829 WATT AVENUE	SUITE 150	SACRAMENTO	CA	95825	6237	34	06067	38.615247	-121.383558	Sacramento County
115945	Fee-for-Service	1285292102	1285292102	1	1	ASMS LLC	6/1/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1330 17TH ST	None	SANTA MONICA	CA	90404	1902	19	06037	34.02703133	-118.4837435	Los Angeles County
115973	Fee-for-Service	1629496740	1629496740	1	1	ADACHI, MARIE MD	5/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139611	41	Internal Medicine	0	In state provider	None	200 UCLA MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.065126	-118.446237	Los Angeles County
115974	Fee-for-Service	1962506998	1962506998	1	1	AUBLE, DANIEL W	10/3/2006	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	52 MISSION CIRCLE	STE 203	SANTA ROSA	CA	95409	5369	49	06097	38.457882	-122.674104	Sonoma County
115979	Fee-for-Service	1306378054	1306378054	1	1	AWWAD, ANDY B MD	8/17/2023	2085R0204X	NA	Other	026	PHYSICIANS	159700	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
116014	Fee-for-Service	1194487876	1194487876	1	1	AL-SOUQI, NOOR	9/22/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
116048	Fee-for-Service	1306897723	1306897723	1	1	ALLANKI, SAILAJA MD	11/22/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	138838	36	Psychiatry	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
116089	Fee-for-Service	1962937011	1962937011	1	1	AYOUB, DANNY W MD	11/19/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17441	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
116148	Fee-for-Service	1861871162	1861871162	1	1	ARMENTROUT, WILLIAM P LMFT	10/7/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
116179	Fee-for-Service	1447810940	1447810940	1	1	ATASUNTSEVA, ANAID PHD	2/22/2022	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
116229	Fee-for-Service	1144313768	1144313768	1	1	AHMADPOUR, HED MD FACC INC	5/24/2016	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	30282	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3650 E SOUTH STREET	SUITE 110B	LAKEWOOD	CA	90712	1502	19	06037	33.8601747	-118.1494013	Los Angeles County
116244	Fee-for-Service	1992403349	1992403349	1	1	ASHWANI KUMAR MD A PROFESSIO	3/16/2023	193400000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	NAL CORPORATION	2120 BENTON DR	None	REDDING	CA	96003	2151	45	06089	40.59845257	-122.3999855	Shasta County
116248	Fee-for-Service	1417446451	1417446451	1	1	ARONOWITZ, JULIE LCSW	7/10/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3150 18TH ST	SUITE 350	SAN FRANCISCO	CA	94110	2077	38	06075	37.76218347	-122.4141845	San Francisco County
116278	Fee-for-Service	1295208270	1295208270	1	1	AINABE, PEARL N NP	12/5/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
116279	Fee-for-Service	1134739949	1134739949	1	1	AVA VASCULAR CORP.	9/28/2022	2085R0204X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	25485 MEDICAL CENTER DRI	SUITE 106	MURRIETA	CA	92562	6927	33	06065	33.55785761	-117.1842222	Riverside County
116293	Fee-for-Service	1417629643	1417629643	1	1	ALONZO SANTILLAN, YOMIRA	3/17/2025	106S00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	8995 APOLLO WAY	None	DOWNEY	CA	90242	4031	19	06037	33.92305581	-118.128642	Los Angeles County
116304	Fee-for-Service	1891870986	1891870986	1	1	AURORA SURGERY CENTER, L.P.	11/2/2022	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	73950 ALESSANDRO DR	SUITE 1	PALM DESERT	CA	92260	3637	33	06065	33.72202876	-116.3745849	Riverside County
116308	Fee-for-Service	1255960050	1255960050	1	1	AMINPOUR, DANIEL MD	9/29/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181512	None	None	0	In state provider	None	345 N RIVERSIDE AVE	None	RIALTO	CA	92376	5925	36	06071	34.10524305	-117.3702612	San Bernardino County
116309	Fee-for-Service	1366209074	1366209074	1	1	ANDERSON, MACY J DOULA	3/21/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	12	06023	0	0	None
116323	Fee-for-Service	1861564601	1861564601	1	1	ANTONIOU, ANTONIS MD	4/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	41273	01	General Practice	0	In state provider	None	4785 N 1ST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
116330	Fee-for-Service	1699480913	1699480913	1	1	ALPHA CURE	10/31/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12003 S AVALON BLVD	103	LOS ANGELES	CA	90061	2859	19	06037	33.923223	-118.2652675	Los Angeles County
116336	Fee-for-Service	1982627675	1982627675	1	1	ABORDO, JOHN E DPM	12/14/2007	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
116342	Fee-for-Service	1144659491	1144659491	2	4	ALLERGY PARTNERS OF CALIFORN	4/24/2023	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	OUNTY	1140 W LA VETA AVE	SUITE 850	ORANGE	CA	92868	4218	30	06059	33.7802984	-117.8651669	Orange County
116345	Fee-for-Service	1467703561	1467703561	1	1	ALFORD, SUSAN N NP	8/7/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
116353	Fee-for-Service	1417030222	1417030222	1	1	ALVA, GUSTAVO MD	4/27/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	55247	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	3151 AIRWAY AVE	SUITE G1	COSTA MESA	CA	92626	4624	30	06059	33.67783408	-117.8720921	Orange County
116371	Fee-for-Service	1285792762	1285792762	1	1	AKIAN, ARET MD	1/2/2008	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	39280	01	General Practice	0	In state provider	None	1711 W TEMPLE ST	SUITE 5662	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
116377	Fee-for-Service	1790467231	1790467231	1	1	ARCADIAN RESIDENTIAL	12/6/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	COMMUNITY CORPORATION	24647 MOHR DRIVE	None	HAYWARD	CA	94545	2309	01	06001	37.64480874	-122.1138348	Alameda County
116469	Fee-for-Service	1548349038	1548349038	1	1	ALI, SYED S MD	12/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52372	08	Family Practice	0	In state provider	None	999 S FAIRMONT AVE	STE 130135	LODI	CA	95240	5100	39	06077	38.1206163	-121.2858323	San Joaquin County
116471	Fee-for-Service	1184625477	1184625477	2	1	ABM PHARMACY INC.	3/11/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1385 E. COLORADO ST.	None	GLENDALE	CA	91205	1462	19	06037	34.14276749	-118.2344085	Los Angeles County
116489	Fee-for-Service	1174528178	1174528178	1	1	AMBATI, NARAYANA S MD	1/1/1985	208800000X	NA	Other	026	PHYSICIANS	41681	34	Urology and Urological Surgery	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
116515	Fee-for-Service	1407242704	1407242704	1	1	ANDERSEN, CRYSSA B LMFT	12/15/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	102238	-	NOT APPLICABLE	0	In state provider	None	3714 S PARTON ST	None	SANTA ANA	CA	92707	4831	30	06059	33.698016	-117.874379	Orange County
116523	Fee-for-Service	1912493156	1912493156	1	1	ADEFUNMI, TORIS LMFT	8/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
116524	Fee-for-Service	1972744282	1972744282	1	1	AMCARE MEDICAL GROUP INC	11/10/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	92590	None	None	0	In state provider	None	27206 CALAROGA AVE	STE 205	HAYWARD	CA	94545	4300	01	06001	37.632357	-122.0868765	Alameda County
116563	Fee-for-Service	1073766424	1073766424	1	1	ACOSTA, ROSALBA M NP	2/9/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
116617	Fee-for-Service	1629359674	1629359674	1	1	AVALON HOME HEALTH INC	11/19/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2255 WATT AVE	SUITE 185	SACRAMENTO	CA	95825	0574	34	06067	38.604789	-121.38399	Sacramento County
116631	Fee-for-Service	1518945161	1518945161	2	1	APRIA HEALTHCARE LLC	8/28/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	691 N LAVERNE AVE	STE 102	FRESNO	CA	93727	6820	10	06019	36.74641224	-119.6750833	Fresno County
116633	Fee-for-Service	1528046315	1528046315	1	1	AMIR AUSEF	6/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7373 PERKINS RD	None	BATON ROUGE	LA	70808	4326	00	None	30.39804	-91.1122425	East Baton Rouge Parish
116641	Fee-for-Service	1093116329	1093116329	1	1	AKBERY, ZULAIKHA NP	3/9/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
116655	Fee-for-Service	1194881755	1194881755	2	2	AEGIS TREATMENT CENTERS, LLC	5/21/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	14238 & 14240 IMPERIAL H	None	LA MIRADA	CA	90638	1940	19	06037	33.9170457	-118.0281308	Los Angeles County
116680	Fee-for-Service	1316057755	1316057755	2	1	ABIAN-EAGER, AVISA MD	5/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	86850	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	SAN BERNARDINO	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino
116692	Fee-for-Service	1588371348	1588371348	1	1	ANDERSON, AMANDA OT	10/19/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
116707	Fee-for-Service	1659637452	1659637452	1	1	AL RABADI, LUAI S MD	6/17/2020	208M00000X	NA	Other	026	PHYSICIANS	133367	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
116717	Fee-for-Service	1902862089	1902862089	1	1	AHN, BETTY S MD	4/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77991	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
116729	Fee-for-Service	1114454386	1114454386	1	1	ASANUMA, JULIE M	8/16/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
116732	Fee-for-Service	1306920392	1306920392	1	1	ANDRIS, JOSEPH J DO	2/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	5625	05	Anesthesiology	0	In state provider	None	1300 KURT DR #102	None	ANGELS CAMP	CA	95222	0000	05	06009	38.07476917	-120.5364629	Calaveras County
116750	Fee-for-Service	1912085705	1912085705	1	1	ANDERSON, TERRY J MD	8/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	59480	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
116754	Fee-for-Service	1497927784	1497927784	1	1	ARAIN, SHEHLA MD	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	90632	90	Pathology-Forensic	0	In state provider	None	1211 W LA PALMA AVE	SUITE 306	ANAHEIM	CA	92801	2811	30	06059	33.84718298	-117.933758	Orange County
116759	Fee-for-Service	1386352789	1386352789	1	1	ADEDURO, MICHAEL NP	2/24/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	955 E THOMPSON BLVD	None	VENTURA	CA	93001	3008	56	06111	34.27831162	-119.286174	Ventura County
116763	Fee-for-Service	1215025333	1215025333	1	1	ALICE SEIDLER	5/17/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3424 KOSSUTH AVE	None	BRONX	NY	10467	2410	00	None	40.880385	-73.8815355	Bronx County
116764	Fee-for-Service	1992321509	1992321509	1	1	ADVENTIST HEALTH PHYSICIANS	9/22/2020	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	975 E MERRITT AVE	None	TULARE	CA	93274	2221	54	06107	36.22195053	-119.3332062	Tulare County
116765	Fee-for-Service	1629445168	1629445168	1	1	AMEZQUITA, MARIA A LCSW	5/21/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	82853	-	NOT APPLICABLE	0	In state provider	None	4211 S AVALON BLVD	None	LOS ANGELES	CA	90011	5622	19	06037	34.007238	-118.2653065	Los Angeles County
116771	Fee-for-Service	1578580544	1578580544	1	1	ANESTHESIOLOGY CONSULTANTS	1/15/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
116785	Fee-for-Service	1609074749	1609074749	1	1	AKHTAR SIM, NADIA LCSW	6/30/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18040 SHERMAN WAY	None	RESEDA	CA	91335	4631	19	06037	34.20103048	-118.526787	Los Angeles County
116788	Fee-for-Service	1083692594	1083692594	1	1	ADVENTIST HEALTH SYSTEM	5/9/2007	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SUNBELT INC	4200 SUN N' LAKE BLVD	None	SEBRING	FL	33872	1200	00	None	27.539226	-81.509634	Highlands County
116799	Fee-for-Service	1316937030	1316937030	1	1	AYUBI, AZRA S MD	7/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149534	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	500 DOYLE PARK DRIVE	STE 200	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
116847	Fee-for-Service	1780757609	1780757609	1	1	ALEXANDER, RICHARD L MD	9/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	53310	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1011 CASS ST	STE 105	MONTEREY	CA	93940	4531	27	06053	36.59201772	-121.8966282	Monterey County
116874	Fee-for-Service	1699090746	1699090746	1	1	ALLEN, JULIE L MD	4/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118179	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 230	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
116887	Fee-for-Service	1437135456	1437135456	1	1	AUNG, STANLEY M T MD	10/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148288	05	Anesthesiology	0	In state provider	None	975 S FAIRMONT AVE	None	LODI	CA	95240	5118	39	06077	38.12188356	-121.285872	San Joaquin County
116919	Fee-for-Service	1932264082	1932264082	1	1	ARVIN UNION SCHOOL DIST	7/27/1996	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	737 BEAR MOUNTAIN BLVD	None	ARVIN	CA	93203	1413	15	06029	35.2089935	-118.831995	Kern County
116923	Fee-for-Service	1669195053	1669195053	1	1	ARMS OUTSTRETCHED INC	7/18/2024	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	325 WEST REGENT STREET	None	INGLEWOOD	CA	90301	1105	19	06037	33.9643775	-118.3607459	Los Angeles County
116942	Fee-for-Service	1194881755	1194881755	2	2	AEGIS TREATMENT CENTERS, LLC	5/21/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	14238 & 14240 IMPERIAL H	None	LA MIRADA	CA	90638	1940	19	06037	33.9170457	-118.0281308	Los Angeles County
116986	Fee-for-Service	1245526169	1245526169	1	1	ANDRUSKA, ADAM M MD	6/18/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	135947	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
116987	Fee-for-Service	1346303336	1346303336	1	1	ARNDT, PRESTON W MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78299	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
117020	Fee-for-Service	1306920392	1306920392	1	1	ANDRIS, JOSEPH J DO	2/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	5625	41	Internal Medicine	0	In state provider	None	1300 KURT DR #102	None	ANGELS CAMP	CA	95222	0000	05	06009	38.07476917	-120.5364629	Calaveras County
117059	Fee-for-Service	1336894823	1336894823	1	1	ANAVIM, NICOLE LMFT	10/16/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
117066	Fee-for-Service	1346247392	1346247392	1	1	ADAMS, CAMERON R MD	3/13/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	82192	13	Neurology (M.D. only)	0	In state provider	None	7135 HOLLYWOOD BLVD	APT 1206	LOS ANGELES	CA	90046	3251	19	06037	34.10163552	-118.346499	Los Angeles County
117077	Fee-for-Service	1083692594	1083692594	1	1	ADVENTIST HEALTH SYSTEM	5/9/2007	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	SUNBELT INC	4200 SUN N' LAKE BLVD	None	SEBRING	FL	33872	1200	00	None	27.539226	-81.509634	Highlands County
117083	Fee-for-Service	1376981878	1376981878	1	1	AGARWAL, RASHI MD	11/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	127368	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
117086	Fee-for-Service	1275550980	1275550980	1	1	AIDS PROJECT LOS ANGELES	10/1/1989	251B00000X	NA	Other	073	AIDS WAIVER SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	611 S KINGSLEY DR	FL 4	LOS ANGELES	CA	90005	2319	19	06037	34.06305793	-118.3028813	Los Angeles County
117132	Fee-for-Service	1780757609	1780757609	1	1	ALEXANDER, RICHARD L MD	9/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	53310	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 CASS ST	STE 105	MONTEREY	CA	93940	4531	27	06053	36.59201772	-121.8966282	Monterey County
117159	Fee-for-Service	1114983848	1114983848	2	1	ALBRIGHT, EUGENE W JR MD	4/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	40864	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4000 14TH ST	STE 314	RIVERSIDE	CA	92501	4018	33	06065	33.97771007	-117.3818381	Riverside County
117161	Fee-for-Service	1699090746	1699090746	1	1	ALLEN, JULIE L MD	4/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118179	01	General Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 230	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
117174	Fee-for-Service	1649712530	1649712530	1	1	ANDERSSON, KARIN	11/21/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
117177	Fee-for-Service	1578841391	1578841391	1	1	AGRAWAL, SHUBHI MD	9/1/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	175472	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
117192	Fee-for-Service	1326222894	1326222894	1	1	ASAP PERSONAL CARE	12/31/2007	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	ASAP PERSONAL CARE AGENC	530 COMMERCE AVE	STE F	PALMDALE	CA	93551	4562	19	06037	34.58955354	-118.141074	Los Angeles County
117209	Fee-for-Service	1396108403	1396108403	1	2	AVOCADO MEDICAL CLINIC PROFE	9/12/2022	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SSIONAL CORP	10900 WARNER AVE	111	FOUNTAIN VALLEY	CA	92708	3846	30	06059	33.71628153	-117.9388215	Orange County
117221	Fee-for-Service	1053672048	1053672048	1	1	AFSARI, HAMID A DO	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13797	41	Internal Medicine	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3326	04	06007	39.74248474	-121.8493369	Butte County
117223	Fee-for-Service	1356385660	1356385660	1	1	AHMADY, ABDUL A MD	3/20/1989	207R00000X	NA	Other	026	PHYSICIANS	45871	41	Internal Medicine	0	In state provider	None	8100 SUNLAND BLVD	None	SUN VALLEY	CA	91352	3948	19	06037	34.21771742	-118.3701303	Los Angeles County
117225	Fee-for-Service	1316444276	1316444276	1	1	AL CHALABY, SHAHAD Y MD	8/30/2021	390200000X	NA	Other	026	PHYSICIANS	174300	None	None	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
117235	Fee-for-Service	1750840732	1750840732	1	1	ADAM, AHMAD S MD	5/17/2022	207R00000X	NA	Other	026	PHYSICIANS	176692	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
117267	Fee-for-Service	1235202722	1235202722	1	2	ANDERSON, KAREN E DPM	4/16/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5565 GROSSMONT CENTER DR	STE 152	LA MESA	CA	91942	3020	37	06073	32.77978322	-117.0094766	San Diego County
117272	Fee-for-Service	1245526169	1245526169	1	1	ANDRUSKA, ADAM M MD	6/18/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	135947	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
117281	Fee-for-Service	1346235793	1346235793	1	1	ANISMAN E DAVID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	26 SOUTH MAIN STREET	None	CENTERVILLE	UT	84014	1817	00	None	40.917096	-111.8789955	Davis County
117286	Fee-for-Service	1376182394	1376182394	1	1	AMARE VISTA HOSPICE	8/19/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3655 TORRANCE BLVD	SUITE 322	TORRANCE	CA	90503	4867	19	06037	33.83763146	-118.350612	Los Angeles County
117315	Fee-for-Service	1477126647	1477126647	1	1	ALVAREZ-GARCIA, GABRIEL CRN	3/24/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	A	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
117343	Fee-for-Service	1689736522	1689736522	1	1	AMSBERRY, JAMES K MD	4/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	72491	24	Plastic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
117358	Fee-for-Service	1659373850	1659373850	1	1	ALVAREZ-MOTT, STEVEN MD	2/14/1997	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	53551	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	315 E ALOSTA AVE	STE 201	GLENDORA	CA	91740	6257	19	06037	34.1288686	-117.8608708	Los Angeles County
117376	Fee-for-Service	1821191271	1821191271	1	1	ABILDGAARD, WILLIAM H MD	5/1/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	41370	07	Dermatology	0	In state provider	None	2780 ORO DAM BLVD	STE 1	OROVILLE	CA	95966	6115	04	06007	39.50929272	-121.5433589	Butte County
117412	Fee-for-Service	1528039500	1528039500	1	1	AGRAWAL, PRAMILA MD	11/15/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	42046	41	Internal Medicine	0	In state provider	None	1818 N ORANGE GROVE AVE	STE 101	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
117429	Fee-for-Service	1285652396	1285652396	1	1	AGCAOILI, CARMENCITA MD	9/30/1989	207RP1001X	NA	Pulmonology	026	PHYSICIANS	44473	41	Internal Medicine	0	In state provider	None	2557 MOWRY AVE	STE 12	FREMONT	CA	94538	1614	01	06001	37.55561575	-121.9826617	Alameda County
117446	Fee-for-Service	1609106715	1609106715	1	1	ALEXANDER, MOHINI MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110556	13	Neurology (M.D. only)	0	In state provider	None	608 E ORANGEBURG AVENUE	None	MODESTO	CA	95350	5513	50	06099	37.66359354	-120.985569	Stanislaus County
117448	Fee-for-Service	1720206378	1720206378	1	1	ALLEN, MATTHEW E	2/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	92825	2115	34	06067	38.602089	-121.3925895	Sacramento County
117450	Fee-for-Service	1699090746	1699090746	1	1	ALLEN, JULIE L MD	4/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118179	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1201 ALHAMBRA BLVD	STE 230	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
117482	Fee-for-Service	1932214657	1932214657	1	2	AJAY G. MEKA M.D. INC.	12/13/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	AMISTAD MEDICAL CLINIC	606 S EUCLID ST	None	ANAHEIM	CA	92802	1234	30	06059	33.824871	-117.9414415	Orange County
117494	Fee-for-Service	1396108403	1396108403	1	2	AVOCADO MEDICAL CLINIC PROFE	9/12/2022	261Q00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	SSIONAL CORP	10900 WARNER AVE	111	FOUNTAIN VALLEY	CA	92708	3846	30	06059	33.71628153	-117.9388215	Orange County
117528	Fee-for-Service	1629126669	1629126669	1	1	AHMAD, TAHA M MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73888	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
117573	Fee-for-Service	1376182394	1376182394	1	1	AMARE VISTA HOSPICE	8/19/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3655 TORRANCE BLVD	SUITE 322	TORRANCE	CA	90503	4867	19	06037	33.83763146	-118.350612	Los Angeles County
117611	Fee-for-Service	1922169838	1922169838	2	1	ALPHA RESPIRATORY SERVICES I	6/9/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	629 ENTLER AVE	SUITE 3 & 4	CHICO	CA	95928	7424	04	06007	39.70489127	-121.7909831	Butte County
117636	Fee-for-Service	1174648034	1174648034	1	1	AFSHIN, ESLAMI MD	12/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102804	02	General Surgery	0	In state provider	None	1641 CREEKSIDE DR	STE 102	FOLSOM	CA	95630	3831	34	06067	38.671488	-121.146426	Sacramento County
117637	Fee-for-Service	1245349349	1245349349	2	1	APRIA HEALTHCARE LLC	5/31/2018	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	490 GIANNI ST	None	SANTA CLARA	CA	95054	2413	43	06085	37.37861042	-121.9432718	Santa Clara County
117662	Fee-for-Service	1316972854	1316972854	1	1	APEXX PHYSICIANS MEDICAL	3/1/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CORPORATION	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
117664	Fee-for-Service	1649690686	1649690686	1	1	ABDUL-WAHAB, MUHAMMAD MD	8/28/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	188468	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
117694	Fee-for-Service	1427826387	1427826387	1	1	ABUSHI INVESTMENTS LLC	2/21/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3400 COTTAGE WAY	A1	SACRAMENTO	CA	95825	1474	34	06067	38.602854	-121.3836525	Sacramento County
117718	Fee-for-Service	1750952479	1750952479	1	1	ADHC OF MADERA	9/12/2024	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	629 E YOSEMITE AVE	None	MADERA	CA	93638	3335	20	06039	36.96593005	-120.0536199	Madera County
117726	Fee-for-Service	1861527095	1861527095	1	1	AMIEVA, MANUEL R MD	12/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	66183	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
117729	Fee-for-Service	1780603415	1780603415	1	1	ANGELIQUE L HOOD	6/13/1997	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	94	Licensed clinical social worker	0	In state provider	None	4781 EL CERRITO PL	None	SAN DIEGO	CA	92115	3747	37	06073	32.76316426	-117.0731394	San Diego County
117731	Fee-for-Service	1518267616	1518267616	1	1	ARSALA, WAIS N MD	3/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114365	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
117763	Fee-for-Service	1295166940	1295166940	1	1	ARAMAKI, ANDREW J	5/1/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
117764	Fee-for-Service	1467825331	1467825331	1	1	AGUDELO, STEPHANY LCSW	7/27/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
117766	Fee-for-Service	1932214657	1932214657	1	2	AJAY G. MEKA M.D. INC.	12/13/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	AMISTAD MEDICAL CLINIC	606 S EUCLID ST	None	ANAHEIM	CA	92802	1234	30	06059	33.824871	-117.9414415	Orange County
117785	Fee-for-Service	1285856401	1285856401	1	1	ADVANCED FOOT AND ANKLE INST	1/11/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	ITUTE, A PODIATRY CORPOR	10816 VALLEY BLVD	None	EL MONTE	CA	91731	2513	19	06037	34.07594083	-118.0378009	Los Angeles County
117786	Fee-for-Service	1750471322	1750471322	1	1	AL-TAKROURI, HATEM MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 MARSHALL STREET	SUITE 653	LITTLE ROCK	AR	72225	0000	00	None	34.74346583	-92.29154425	Pulaski County
117808	Fee-for-Service	1841285566	1841285566	1	1	ALLEN, SUSAN MD	4/29/1999	207L00000X	NA	Other	026	PHYSICIANS	81921	05	Anesthesiology	0	In state provider	None	2140 COTNER AVE	None	LOS ANGELES	CA	90025	5714	19	06037	34.03972174	-118.4396878	Los Angeles County
117817	Fee-for-Service	1376590604	1376590604	1	1	ARRUDA, JOHNNY MD FACS	8/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	69717	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
117845	Fee-for-Service	1912318528	1912318528	1	1	AKOPIAN, TALEEN	8/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	10 CONGRESS ST	STE 208	PASADENA	CA	91105	3027	19	06037	34.13396893	-118.1528162	Los Angeles County
117875	Fee-for-Service	1912024274	1912024274	1	1	ACOSTA, RIGOBERTO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 NE 139TH ST	None	VANCOUVER	WA	98686	2742	00	None	45.720117	-122.647986	Clark County
117886	Fee-for-Service	1760776728	1760776728	1	1	ABBOUD, JEAN PAUL MD	8/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	124825	24	Plastic Surgery	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
117903	Fee-for-Service	1235268285	1235268285	1	1	ANDERSON, STEFANIE E LMFT	8/9/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1432 TOMPKINS HILL RD	None	FORTUNA	CA	95540	9778	12	06023	40.62553836	-124.1807404	Humboldt County
117949	Fee-for-Service	1811918923	1811918923	1	1	ALLAN MORRISON MD &	1/28/2011	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	RITA KUMAR MD INC	4340 OVERLAND AVE	None	CULVER CITY	CA	90230	4117	19	06037	34.01096615	-118.3997058	Los Angeles County
117962	Fee-for-Service	1558660209	1558660209	1	1	AGAPECARE HOME HEALTH INC	3/23/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5701 LONETREE BLVD	SUITE 317	ROCKLIN	CA	95765	1200	31	06061	38.81255565	-121.2907365	Placer County
117997	Fee-for-Service	1518502079	1518502079	1	1	AGPAD, FREIDA A	11/19/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5051 N LAGUNA DR	None	SACRAMENTO	CA	95823	6811	34	06067	38.46159	-121.44249	Sacramento County
118003	Fee-for-Service	1861527095	1861527095	1	1	AMIEVA, MANUEL R MD	12/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	66183	77	Infectious Disease	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
118006	Fee-for-Service	1154372340	1154372340	1	1	ALBANY GENERAL HOSP	5/1/2000	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1046 6TH AVE SW	None	ALBANY	OR	97321	1999	00	None	44.63214872	-123.1157723	Linn County
118037	Fee-for-Service	1346872207	1346872207	1	1	ANAYA, KIMBERLY N LCSW	3/4/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	155 HOSPITALITY	245	SAN BERNARDINO	CA	92408	3305	36	06071	34.06580948	-117.2856915	San Bernardino County
118038	Fee-for-Service	1609858224	1609858224	1	1	ABEL, DAVID E MD	1/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	88702	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2210 E ILLINOIS	SUITE 301	FRESNO	CA	93701	2168	10	06019	36.74500687	-119.7846885	Fresno County
118073	Fee-for-Service	1821253584	1821253584	1	1	AGENDIA INC	12/15/2014	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	22 MORGAN	None	IRVINE	CA	92618	2022	30	06059	33.6500163	-117.7103011	Orange County
118079	Fee-for-Service	1538494794	1538494794	1	2	AZANZA, ROSANNA P LCSW	11/8/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
118089	Fee-for-Service	1639137425	1639137425	1	1	AYOUB, WILLIAM G DPM	1/1/1979	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1249 S DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	4122	19	06037	33.99928648	-117.8122643	Los Angeles County
118116	Fee-for-Service	1821030594	1821030594	1	1	ATLAS MEDICAL EQUIP, LLC	11/2/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ATLAS MEDICAL EQUIP, LLC	440 HINDRY AVE.	UNIT B	INGLEWOOD	CA	90301	2031	19	06037	33.957027	-118.3735605	Los Angeles County
118121	Fee-for-Service	1437297033	1437297033	1	1	A CHILD'S VIEW	12/31/1990	156FX1800X	NA	Other	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	15083 GOLDENWEST ST	None	HUNTINGTON BEACH	CA	92647	2710	30	06059	33.743403	-118.0089675	Orange County
118128	Fee-for-Service	1003855883	1003855883	1	1	AMBUSERVE INC	2/23/2002	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	MELISSA HARRIS	15105 S BROADWAY ST	None	GARDENA	CA	90248	1821	19	06037	33.89471584	-118.2787181	Los Angeles County
118135	Fee-for-Service	1134326895	1134326895	1	1	AMANN, CHRISTOPHER J MD	7/16/2020	207RC0200X	NA	Other	026	PHYSICIANS	132360	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
118149	Fee-for-Service	1760541536	1760541536	1	1	ARMBRUSTER, JULIA K PSYD	9/8/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3150 PIO PICO DR	STE 105	CARLSBAD	CA	92008	1951	37	06073	33.16162799	-117.3408476	San Diego County
118157	Fee-for-Service	1235443177	1235443177	1	1	ANG, OLIVER	3/19/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	568 N SUNRISE AVE	STE 250	ROSEVILLE	CA	95661	3035	31	06061	38.7576732	-121.2534645	Placer County
118174	Fee-for-Service	1760776728	1760776728	1	1	ABBOUD, JEAN PAUL MD	8/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	124825	18	Ophthalmology	0	In state provider	None	4077 5TH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
118210	Fee-for-Service	1073809919	1073809919	1	1	ALARS HOME HEALTH LLC	8/19/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4234 N FREEWAY BLVD	SUITE 200	SACRAMENTO	CA	95834	1237	34	06067	38.646495	-121.477518	Sacramento County
118227	Fee-for-Service	1952653404	1952653404	1	1	ALFONSO, ALVIN M CRNA	3/8/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
118233	Fee-for-Service	1396945127	1396945127	1	1	AUNG, LAI L MD	9/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98381	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
118248	Fee-for-Service	1750650982	1750650982	1	7	APEX RADIOLOGY MEDICAL GROUP	8/27/2019	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	820 E MOUNTAIN VIEW STRE	None	BARSTOW	CA	92311	3004	36	06071	34.89327944	-117.0174383	San Bernardino County
118254	Fee-for-Service	1407847718	1407847718	1	1	ALFARO, DENNIS MD	10/10/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67215	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1111 E STANLEY BLVD	None	LIVERMORE	CA	94550	4115	01	06001	37.67881307	-121.7823992	Alameda County
118283	Fee-for-Service	1518502079	1518502079	1	1	AGPAD, FREIDA A	10/28/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5051 N LAGUNA DR	None	SACRAMENTO	CA	95823	6811	34	06067	38.46159	-121.44249	Sacramento County
118292	Fee-for-Service	1154372340	1154372340	1	1	ALBANY GENERAL HOSP	5/1/2000	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1046 6TH AVE SW	None	ALBANY	OR	97321	1999	00	None	44.63214872	-123.1157723	Linn County
118303	Fee-for-Service	1235798125	1235798125	1	1	ARENAS, ARIANA G LCSW	12/2/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
118306	Fee-for-Service	1043296692	1043296692	1	1	ANDERSON, COREY H. MD	2/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4401 GARTH RD	None	BAYTOWN	TX	77521	2122	00	None	29.76910842	-94.97759843	Harris County
118325	Fee-for-Service	1144329848	1144329848	1	1	AMESUR, SANDEEP N MD	5/23/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	185980	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
118337	Fee-for-Service	1720016397	1720016397	1	1	ALLSWANG, BARRY S MD	7/20/1995	207R00000X	NA	Other	026	PHYSICIANS	34791	None	None	0	In state provider	None	1025 ATLANTIC AVE	None	LONG BEACH	CA	90813	3402	19	06037	33.779403	-118.1850775	Los Angeles County
118348	Fee-for-Service	1720381635	1720381635	1	1	ALPHA REHAB CENTER INC	3/19/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	505 S VIRGIL AVE	STE 203	LOS ANGELES	CA	90020	1453	19	06037	34.064883	-118.287086	Los Angeles County
118389	Fee-for-Service	1891865069	1891865069	1	1	AMERICAN HEALTH SERVICES LLC	11/6/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	6265 SEPULVEDA BLVD	STE 9	VAN NUYS	CA	91411	1126	19	06037	34.18438377	-118.4662174	Los Angeles County
118413	Fee-for-Service	1831144898	1831144898	1	1	AHLUWALIA, MALA MD	11/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84916	08	Family Practice	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
118426	Fee-for-Service	1265974992	1265974992	1	2	ARCIERO, TERESA LMFT	4/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27186 NEWPORT	D1	MENIFEE	CA	92584	7386	33	06065	33.68505447	-117.1854	Riverside County
118448	Fee-for-Service	1558098327	1558098327	1	1	AMAZING SUPPORT HM CARE LLC	3/21/2024	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	30 OAK CLIFF DR	None	POMONA	CA	91766	4857	19	06037	34.02808543	-117.7793708	Los Angeles County
118460	Fee-for-Service	1265974992	1265974992	1	1	ARCIERO, TERESA LMFT	11/22/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
118480	Fee-for-Service	1245737154	1245737154	1	1	ACCORTT, EYNAV E PHD	10/30/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
118510	Fee-for-Service	1154556306	1154556306	1	1	AKHAVANTAFTI, BASHIR MD	5/6/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	117619	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
118559	Fee-for-Service	1477610558	1477610558	1	1	ADVANCED EYE & LASER CENTER	11/9/2010	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	OF CALIFORNIA INC	4844 UNIVERSITY	SUITE A	SAN DIEGO	CA	92105	8021	37	06073	32.74956677	-117.0903274	San Diego County
118564	Fee-for-Service	1710243019	1710243019	1	1	ALEJO, ALEX G LMFT	12/8/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
118576	Fee-for-Service	1962732354	1962732354	1	1	ANDERSON, KRISTIN N MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117104	78	Neoplastic Diseases/Oncology	0	In state provider	None	1350 SOUTH ELISEO DR	SUITE 200	GREENBRAE	CA	94904	2018	21	06041	37.94490653	-122.537021	Marin County
118589	Fee-for-Service	1326566423	1326566423	1	1	AKESO HOME HEALTH CARE INC	12/15/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14621 TITUS ST	SUITE 127	VAN NUYS	CA	91402	1462	19	06037	34.21972652	-118.451799	Los Angeles County
118614	Fee-for-Service	1730765389	1730765389	1	1	ALBAYATI, OKSANA M DO	6/1/2024	207R00000X	NA	Other	026	PHYSICIANS	22701	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
118615	Fee-for-Service	1780171223	1780171223	1	1	ALAMOS CARE	11/1/2019	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2193 ALAMOS AVE	None	CLOVIS	CA	93611	4134	10	06019	36.80618077	-119.6730542	Fresno County
118627	Fee-for-Service	1366451908	1366451908	2	1	AL-AZAWI, HAIFA S MD	11/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	40702	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	16660 PARAMOUNT BLVD	STE 105	PARAMOUNT	CA	90723	5457	19	06037	33.882723	-118.1599535	Los Angeles County
118635	Fee-for-Service	1922722800	1922722800	1	1	ARNON DESAI MD INC	11/21/2022	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	9041 MAGNOLIA AVE	201	RIVERSIDE	CA	92503	3900	33	06065	33.92541585	-117.4378266	Riverside County
118640	Fee-for-Service	1639717218	1639717218	1	1	ANDERSON, SHAUNTE E NP	2/23/2022	207Q00000X	NA	Adult Primary Care	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16745 W BERNARDO DR	STE 240	SAN DIEGO	CA	92127	1907	37	06073	33.01539521	-117.0824934	San Diego County
118644	Fee-for-Service	1356357776	1356357776	1	1	ASENCIO, ADRIAN M OT	2/8/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
118659	Fee-for-Service	1215200381	1215200381	1	1	AIMIUWU, UYIOSA O MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125852	66	Emergency Medicine (Urgent Care)	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
118670	Fee-for-Service	1578774949	1578774949	1	1	ANSARI, HOSSEIN MD	6/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121526	13	Neurology (M.D. only)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
118672	Fee-for-Service	1144741323	1144741323	1	1	ARREOLA-REYES, ANA K LCSW	7/12/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
118680	Fee-for-Service	1720794936	1720794936	1	1	ALLEN, JAMETRA R BIRTH DOULA	2/9/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
118686	Fee-for-Service	1447795182	1447795182	1	1	ABRAHAM, ANN R NP	8/25/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95005144	-	NOT APPLICABLE	0	In state provider	None	5190 ATLANTIC AVE	None	LONG BEACH	CA	90805	6510	19	06037	33.850449	-118.1848215	Los Angeles County
118696	Fee-for-Service	1225126147	1225126147	1	1	ABEYTA, PAUL N MD	10/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81985	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
118704	Fee-for-Service	1417365008	1417365008	1	1	ALI, ANUM MD	8/12/2020	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	168502	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
118709	Fee-for-Service	1700902871	1700902871	1	1	ARMSTRONG, ELIZABETH LCSW	8/4/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4199 CAMPUS DR	SUITE 550, OFFICE 57	IRVINE	CA	92612	4684	30	06059	33.650775	-117.838296	Orange County
118712	Fee-for-Service	1750043055	1750043055	1	1	ASHLOCK, WHITNEY M LCSW	1/20/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	255 TERRACINA BLVD	SUITE 204	REDLANDS	CA	92373	4870	36	06071	34.03788441	-117.2055761	San Bernardino County
118726	Fee-for-Service	1215983218	1215983218	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	810 S STATE COLLEGE	None	ANAHEIM	CA	92806	4663	30	06059	33.83129548	-117.8891795	Orange County
118727	Fee-for-Service	1851850978	1851850978	1	1	AMADOR, ARTHUR KEVIN C MD	9/15/2022	207R00000X	NA	Other	026	PHYSICIANS	19752	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
118742	Fee-for-Service	1093930513	1093930513	2	1	ABOU JAOUDE, DORY R MD	5/20/2023	207R00000X	NA	Other	026	PHYSICIANS	166373	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
118748	Fee-for-Service	1578765830	1578765830	1	1	ALLOCCO, FRANCES T MD	2/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114036	02	General Surgery	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
118770	Fee-for-Service	1588775480	1588775480	1	1	AGUIRRE, BRAD DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2301 HONOLULU AVE	None	MONTROSE	CA	91020	1821	19	06037	34.20561197	-118.2283846	Los Angeles County
118804	Fee-for-Service	1346601663	1346601663	1	1	ANNAMRAJU, ELIZABETH C LMFT	7/26/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1317 W FOOTHILL BLVD	STE 140	UPLAND	CA	91786	3686	36	06071	34.10715453	-117.6734115	San Bernardino County
118813	Fee-for-Service	1104822808	1104822808	1	1	AGMG ENDOSCOPY CENTER A	9/15/2014	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	GENERAL PARTNERSHIP	1211 W LA PALMA AVE	STE 301	ANAHEIM	CA	92801	2811	30	06059	33.84718298	-117.933758	Orange County
118818	Fee-for-Service	1245269190	1245269190	1	1	ARTOUL, SAMIR G MD	5/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	51426	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
118832	Fee-for-Service	1740315043	1740315043	1	1	AKSHOOMOFF, NATACHA PHD	7/21/2017	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
118857	Fee-for-Service	1528602596	1528602596	1	1	AQUITANIA, RAFAELA C	11/20/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	831 E CHEVY CHASE DR	None	GLENDALE	CA	91205	4832	19	06037	34.13383739	-118.2440772	Los Angeles County
118863	Fee-for-Service	1962732354	1962732354	1	1	ANDERSON, KRISTIN N MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117104	68	Hematology	0	In state provider	None	1350 SOUTH ELISEO DR	SUITE 200	GREENBRAE	CA	94904	2018	21	06041	37.94490653	-122.537021	Marin County
118874	Fee-for-Service	1801159280	1801159280	1	1	ALVARADO, ELISA M LCSW	11/28/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CIRCLE	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
118911	Fee-for-Service	1891711065	1891711065	1	1	ALIMADADIAN, LINDA DO	5/30/2019	207R00000X	NA	Other	026	PHYSICIANS	7814	41	Internal Medicine	0	In state provider	None	15785 LAGUNA CANYON RD	STE 310	IRVINE	CA	92618	3178	30	06059	33.66542536	-117.7615537	Orange County
118959	Fee-for-Service	1831203231	1831203231	1	1	ARCH HEALTH PARTNERS	10/17/2011	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	15525 POMERADO RD	STE A1	POWAY	CA	92064	2425	37	06073	32.99479918	-117.0579468	San Diego County
118968	Fee-for-Service	1881140929	1881140929	1	1	ADVANCED MENTAL HEALTH CENTE	1/10/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	R, INC.	15315 MAGNOLIA BLVD	SUITE 400	SHERMAN OAKS	CA	91403	1175	19	06037	34.16488161	-118.4666419	Los Angeles County
119013	Fee-for-Service	1619174844	1619174844	1	1	ARTHUR, REBECCA A MD	10/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106203	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	999 S FAIRMONT AVE	STE 230	LODI	CA	95240	5142	39	06077	38.1206163	-121.2858323	San Joaquin County
119020	Fee-for-Service	1861834178	1861834178	1	1	AGUILERA, IVAN BRANDO DPM	7/7/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	4843 ARLINGTON AVE	None	RIVERSIDE	CA	92504	2760	33	06065	33.94622149	-117.408627	Riverside County
119034	Fee-for-Service	1740737402	1740737402	1	1	ACKER-NIELSEN, JULIA D H	11/2/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
119047	Fee-for-Service	1124576483	1124576483	1	1	ACHUFUSI, TAMARA	8/29/2016	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	6177 EAGLEMONT DR	None	FONTANA	CA	92336	5817	36	06071	34.14175679	-117.4517195	San Bernardino County
119093	Fee-for-Service	1740623289	1740623289	1	1	ARAC, AHMET MD	4/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138334	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	8346	19	06037	34.06473399	-118.445865	Los Angeles County
119095	Fee-for-Service	1245314210	1245314210	1	1	ARENT, GREGORY S MD	12/11/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	62131	41	Internal Medicine	0	In state provider	None	1540 5TH AVE	None	SAN RAFAEL	CA	94901	1807	21	06041	37.97487644	-122.5351838	Marin County
119097	Fee-for-Service	1295097897	1295097897	1	2	ARCH HEALTH PARTNERS	7/12/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	None	16918 DOVE CANYON RD	STE 102	SAN DIEGO	CA	92127	3455	37	06073	33.01707634	-117.1112373	San Diego County
119106	Fee-for-Service	1841672235	1841672235	1	1	AMANDA BLANCHARD	10/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	222 N 7TH ST	None	BISMARCK	ND	58501	4436	00	None	46.807308	-100.782459	Burleigh County
119143	Fee-for-Service	1528602596	1528602596	1	1	AQUITANIA, RAFAELA C	11/20/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	831 E CHEVY CHASE DR	None	GLENDALE	CA	91205	4832	19	06037	34.13383739	-118.2440772	Los Angeles County
119151	Fee-for-Service	1548321854	1548321854	1	1	ATKINS, CAROL J	2/8/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	25255 CABOT RD	STE 108	LAGUNA HILLS	CA	92653	5507	30	06059	33.59595988	-117.6763288	Orange County
119170	Fee-for-Service	1730685058	1730685058	1	1	AHMED, ZANE DO	8/31/2021	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
119196	Fee-for-Service	1093365116	1093365116	1	1	ALL FAMILY HOME HEALTH	8/7/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3721 W BURBANK BLVD	SUITE E	BURBANK	CA	91506	1417	19	06037	34.17444805	-118.3510762	Los Angeles County
119217	Fee-for-Service	1447813522	1447813522	1	1	AASAR, ABDUL MD	12/6/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1444 FLORIDA AVE	STE 101	MODESTO	CA	95350	4400	50	06099	37.66487562	-120.9961927	Stanislaus County
119219	Fee-for-Service	1821251133	1821251133	1	1	ARNOLD, THOMAS D MD	7/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96045	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
119226	Fee-for-Service	1083976294	1083976294	1	1	ADVENTIST HEALTH PHYSICIANS	11/8/2012	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1560 E CHEVY CHASE DR	SUITE 245	GLENDALE	CA	91206	4158	19	06037	34.15290734	-118.2302295	Los Angeles County
119235	Fee-for-Service	1598227183	1598227183	1	1	ARORA, NEDA MD	10/28/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19985	None	None	0	In state provider	None	501 J ST	None	SACRAMENTO	CA	95814	2325	34	06067	38.582118	-121.499325	Sacramento County
119245	Fee-for-Service	1740608942	1740608942	1	1	ANDRE, JOHN MD	7/21/2020	390200000X	NA	Other	026	PHYSICIANS	169149	02	General Surgery	0	In state provider	None	3301 C ST	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
119248	Fee-for-Service	1366671943	1366671943	1	1	AREKAPUDI, SUBRAMANYESWARA R	4/29/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	140899	68	Hematology	0	In state provider	None	7130 N MILLBROOK AVE	SUITE 100	FRESNO	CA	93720	3347	10	06019	36.83832032	-119.7632391	Fresno County
119263	Fee-for-Service	1144659491	1144659491	2	3	ALLERGY PARTNERS OF CALIFORN	1/12/2022	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	OUNTY	1440 N HARBOR BLVD	SUITE 708	FULLERTON	CA	92835	4120	30	06059	33.88513341	-117.926041	Orange County
119314	Fee-for-Service	1265883334	1265883334	1	1	ABU GOSH, MINA JAMALLEH MD	2/9/2024	207R00000X	NA	Other	026	PHYSICIANS	158477	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
119336	Fee-for-Service	1124576483	1124576483	1	1	ACHUFUSI, TAMARA	8/29/2016	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	6177 EAGLEMONT DR	None	FONTANA	CA	92336	5817	36	06071	34.14175679	-117.4517195	San Bernardino County
119345	Fee-for-Service	1295128825	1295128825	1	1	ARREOLA, HOLLY NP	5/30/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
119382	Fee-for-Service	1073769220	1073769220	1	1	ASKARI, REZA MD	11/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137328	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	621 BUTTE STREET	None	SAN PEDRO	CA	90732	3510	19	06037	33.73839738	-118.3065444	Los Angeles County
119395	Fee-for-Service	1629566740	1629566740	1	1	ANGEL CITY HOME HEALTH INC	3/29/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	511 E HARVARD ST	STE 5	GLENDALE	CA	91205	1184	19	06037	34.14449793	-118.2495946	Los Angeles County
119402	Fee-for-Service	1942709373	1942709373	1	1	ARVIZU, OMAR A PT	3/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1922 HACIENDA DR	None	VISTA	CA	92081	0000	37	06073	33.1855682	-117.2834788	San Diego County
119416	Fee-for-Service	1598878324	1598878324	1	3	ARONOW, DANIEL S MD	2/5/2018	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	63273	-	NOT APPLICABLE	0	In state provider	None	1002 PICO BLVD	None	SANTA MONICA	CA	90405	1416	19	06037	34.01333344	-118.4809119	Los Angeles County
119422	Fee-for-Service	1639212574	1639212574	1	1	AGCAOILI, JACQUELINE G MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	46231	41	Internal Medicine	0	In state provider	CORPORATION	4440 BROCKTON AVE	STE 320	RIVERSIDE	CA	92501	4026	33	06065	33.97764104	-117.3838896	Riverside County
119433	Fee-for-Service	1508944497	1508944497	1	1	ALTEBARMAKIAN, V K MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39935	34	Urology and Urological Surgery	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
119450	Fee-for-Service	1114997350	1114997350	1	1	ACHARYA, VICTORIA Z	6/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87846	None	None	0	In state provider	None	4650 W SUNSET BLVD	MS # 76	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
119481	Fee-for-Service	1053013748	1053013748	1	1	ABDELHAK, AHMED M MD	7/16/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
119483	Fee-for-Service	1912092792	1912092792	3	1	ADVENTIST HEALTH CLEARLAKE	4/1/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	5125 SKYWAY	None	PARADISE	CA	95969	5624	04	06007	39.74598961	-121.640736	Butte County
119503	Fee-for-Service	1558416537	1558416537	1	1	AHSAN, NUSRAT MD	8/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	91968	01	General Practice	0	In state provider	None	26732 CROWN VALLEY PKWY	STE 151	MISSION VIEJO	CA	92691	6337	30	06059	33.56347704	-117.66546	Orange County
119515	Fee-for-Service	1407056617	1407056617	1	1	AN, ESTHER S MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	102477	40	Pediatrics	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
119523	Fee-for-Service	1932214657	1932214657	1	16	AJAY G. MEKA M.D. INC.	6/28/2022	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1700 E CESAR CHAVEZ AVE	L200	LOS ANGELES	CA	90033	2424	19	06037	34.05101259	-118.217259	Los Angeles County
119525	Fee-for-Service	1588944490	1588944490	1	1	ASHER, XANTHE L LMFT	5/15/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
119529	Fee-for-Service	1770024903	1770024903	1	1	AZEEM, ARFAN MD	10/21/2019	390200000X	NA	Other	026	PHYSICIANS	163658	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
119553	Fee-for-Service	1366520108	1366520108	1	1	AHMAD, WASEEM MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	73846	45	Nephrology (Renal-Kidney)	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
119599	Fee-for-Service	1053984724	1053984724	1	1	AVERY CARE HOME HEALTH INC	9/1/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3380 FLAIR DR	STE 226	EL MONTE	CA	91731	2853	19	06037	34.06947952	-118.0717132	Los Angeles County
119637	Fee-for-Service	1235393232	1235393232	1	1	AVE, MARVIN RCP	2/12/2024	101Y00000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
119665	Fee-for-Service	1447337878	1447337878	1	1	AGUILAR, CHRISTINE M LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
119670	Fee-for-Service	1083047260	1083047260	1	1	ASHEH, ANGELO M DO	4/11/2022	207R00000X	NA	Other	026	PHYSICIANS	17366	None	None	0	In state provider	None	911 MORAGA RD STE 200	None	LAFAYETTE	CA	94549	4500	07	06013	37.88758326	-122.1181419	Contra Costa County
119675	Fee-for-Service	1457462459	1457462459	2	1	APRIA HEALTHCARE LLC	5/31/2018	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	16811 MILLIKAN AVE	None	IRVINE	CA	92606	5011	30	06059	33.69230848	-117.8325637	Orange County
119685	Fee-for-Service	1235579483	1235579483	1	1	ADAMS, TYSON R MD	5/8/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	13630	01	General Practice	0	In state provider	None	1650 RESPONSE BLVD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
119713	Fee-for-Service	1386093359	1386093359	1	1	ARCELAO, RICHARD A MD	9/11/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	160057	08	Family Practice	0	In state provider	None	565 N MOUNT VERNON AVE	None	SAN BERNARDINO	CA	92411	2661	36	06071	34.109406	-117.313813	San Bernardino County
119770	Fee-for-Service	1912092792	1912092792	3	1	ADVENTIST HEALTH CLEARLAKE	3/21/2023	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	5125 SKYWAY	None	PARADISE	CA	95969	5624	04	06007	39.74598961	-121.640736	Butte County
119778	Fee-for-Service	1093722431	1093722431	1	1	ADAMS, SARAH V LMFT	5/30/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	969 S VILLAGE OAKS DR	STE 201	COVINA	CA	91724	0606	19	06037	34.07200147	-117.8631788	Los Angeles County
119785	Fee-for-Service	1467153965	1467153965	1	1	ATLAS MEDICAL TRANSPORTATION	4/13/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	14726 RAMONA AVE	STE E8	CHINO	CA	91710	5730	36	06071	33.98583108	-117.7064762	San Bernardino County
119790	Fee-for-Service	1548465156	1548465156	1	1	AHLUWALIA, AJIT S MD	2/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55707	41	Internal Medicine	0	In state provider	None	26732 CROWN VALLEY PKWY	STE 151	MISSION VIEJO	CA	92691	6337	30	06059	33.56347704	-117.66546	Orange County
119811	Fee-for-Service	1932214657	1932214657	1	16	AJAY G. MEKA M.D. INC.	6/28/2022	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1700 E CESAR CHAVEZ AVE	L200	LOS ANGELES	CA	90033	2424	19	06037	34.05101259	-118.217259	Los Angeles County
119873	Fee-for-Service	1538782230	1538782230	1	1	ALTAMED HEALTH SERVICES CORP	7/8/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	TS	3945 WHITTIER BLVD	ROOM 100	LOS ANGELES	CA	90023	2440	19	06037	34.02394552	-118.187748	Los Angeles County
119890	Fee-for-Service	1245637560	1245637560	1	1	AFFILIATED PHYSICIAN	10/12/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PRACTICE INC	505 E ALMOND AVENUE	SUITE 109	MADERA	CA	93637	5745	20	06039	36.94551349	-120.0508739	Madera County
119926	Fee-for-Service	1669241113	1669241113	1	1	ALAMKHEL, FARIA LCSW	5/22/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
119927	Fee-for-Service	1932214657	1932214657	1	5	AJAY G. MEKA M.D. INC.	10/5/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	201 S. BROADWAY	None	SANTA ANA	CA	92701	5633	30	06059	33.744159	-117.8697125	Orange County
119942	Fee-for-Service	1295314441	1295314441	1	1	ARRIAGA, MOISES W MD	4/7/2025	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
119975	Fee-for-Service	1063942936	1063942936	1	1	ARSHAD, ALI MD	10/23/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169810	08	Family Practice	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
120038	Fee-for-Service	1902863418	1902863418	1	1	AURORA VISTA DEL MAR LLC	1/1/2002	283Q00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL	801 SENECA ST	None	VENTURA	CA	93001	1411	56	06111	34.30762576	-119.2837994	Ventura County
120051	Fee-for-Service	1063429991	1063429991	1	1	ARNOLD, DEBORAH MD	5/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4805 NE GLISAN ST	None	PORTLAND	OR	97213	2933	00	None	45.52655191	-122.6121355	Multnomah County
120058	Fee-for-Service	1912092792	1912092792	3	1	ADVENTIST HEALTH CLEARLAKE	4/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	5125 SKYWAY	None	PARADISE	CA	95969	5624	04	06007	39.74598961	-121.640736	Butte County
120108	Fee-for-Service	1508293788	1508293788	1	1	ADELSON, MIREILLE D CNM	1/17/2020	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
120148	Fee-for-Service	1255881546	1255881546	1	1	ACHAMALLAH, NATALIE H MD	11/3/2020	207R00000X	NA	Other	026	PHYSICIANS	158572	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
120158	Fee-for-Service	1013074632	1013074632	1	1	ADLER, KENT M MD	1/31/1990	207RX0202X	NA	Oncology	026	PHYSICIANS	60386	41	Internal Medicine	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
120196	Fee-for-Service	1144240904	1144240904	1	1	AYCC PHARMACY INC	11/1/2001	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1115 WHITLEY AVE	None	CORCORAN	CA	93212	2325	16	06031	36.0980173	-119.5617123	Kings County
120218	Fee-for-Service	1275652257	1275652257	1	1	ACOSTA, GABRIELA LMFT	8/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
120231	Fee-for-Service	1003946179	1003946179	1	1	AMIRHOUSHMAND, PARDIS PHD	4/16/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	317 W F ST	None	ONTARIO	CA	91762	3205	36	06071	34.06932	-117.6542865	San Bernardino County
120248	Fee-for-Service	1871850073	1871850073	1	1	ANGER, MATTHEW MD	9/12/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	154565	18	Ophthalmology	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
120258	Fee-for-Service	1053687152	1053687152	1	1	AJWANI, DIMPLE P DO	2/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12842	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
120281	Fee-for-Service	1790737617	1790737617	1	1	ATWAL, GURBIR S MD	2/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85463	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
120323	Fee-for-Service	1447069943	1447069943	1	1	AVILA, MONICA CNP	3/3/2025	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	888 S BREA CANYON RD	STE 330	DIAMOND BAR	CA	91789	3059	19	06037	34.00137763	-117.8453859	Los Angeles County
120327	Fee-for-Service	1902863418	1902863418	1	1	AURORA VISTA DEL MAR LLC	1/1/2002	283Q00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL	801 SENECA ST	None	VENTURA	CA	93001	1411	56	06111	34.30762576	-119.2837994	Ventura County
120333	Fee-for-Service	1417418377	1417418377	1	1	AU, ANDREW S DPM	6/10/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	6145 N THESTA ST	None	FRESNO	CA	93710	5266	10	06019	36.82545273	-119.7831405	Fresno County
120349	Fee-for-Service	1366838625	1366838625	1	1	AVEDSCHMIDT, PHILIP MD	12/8/2018	207P00000X	NA	Other	026	PHYSICIANS	153920	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
120383	Fee-for-Service	1700917515	1700917515	1	1	ANCHETA, BERNARDINO	9/1/2004	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	CONNIE'S ICF/DD-H	237 KENT PL	None	SAN RAMON	CA	94583	3728	07	06013	37.72776257	-121.9425243	Contra Costa County
120389	Fee-for-Service	1700029857	1700029857	1	1	ARORA, LOVKESH MD	10/25/2021	207LC0200X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	200 HAWKINS DRIVE	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
120433	Fee-for-Service	1104237148	1104237148	1	1	ARATOW-GALLARDO, NATALIE DO	4/13/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	14727	None	None	0	In state provider	None	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	44	06087	37.06232425	-122.0064552	Santa Cruz County
120448	Fee-for-Service	1013074632	1013074632	1	1	ADLER, KENT M MD	1/31/1990	207RX0202X	NA	Oncology	026	PHYSICIANS	60386	78	Neoplastic Diseases/Oncology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
120451	Fee-for-Service	1174722417	1174722417	1	1	ATASHROO, DIANA MD	1/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	160027	09	Gynecology (D.O. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
120513	Fee-for-Service	1841489440	1841489440	1	1	AZAD, JACK MD	9/25/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	54433	-	NOT APPLICABLE	0	In state provider	None	2080 CENTURY PARK E	STE 1210	CENTURY CITY	CA	90067	2001	19	06037	34.05887194	-118.4122914	Los Angeles County
120543	Fee-for-Service	1811032121	1811032121	1	1	AUTRY, PUSHPA LMFT	5/8/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
120578	Fee-for-Service	1851625990	1851625990	1	1	ADVANCED SURGICAL SOLUTIONS	10/20/2009	208600000X	NA	General Surgery	026	PHYSICIANS	87624	02	General Surgery	0	In state provider	AMC	6850 SEPULVEDA BLVD	STE 215	VAN NUYS	CA	91405	4450	19	06037	34.1955	-118.4661705	Los Angeles County
120580	Fee-for-Service	1053403105	1053403105	1	1	ANDERSON, BRADLEY W MD	1/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	127871	34	Urology and Urological Surgery	0	In state provider	None	2169 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7059	09	06017	38.91235146	-119.9974905	El Dorado County
120584	Fee-for-Service	1659908465	1659908465	1	1	AHMED, ZAINAB N MD	2/8/2024	207P00000X	NA	Other	026	PHYSICIANS	189102	None	None	0	In state provider	None	757 WESTWOOD PLAZA	STE 1517	LOS ANGELES	CA	90095	7402	19	06037	34.06633051	-118.4452686	Los Angeles County
120616	Fee-for-Service	1902863418	1902863418	1	1	AURORA VISTA DEL MAR LLC	1/1/2002	283Q00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL	801 SENECA ST	None	VENTURA	CA	93001	1411	56	06111	34.30762576	-119.2837994	Ventura County
120642	Fee-for-Service	1073956439	1073956439	1	1	AIVALIOTIS, VASILIKI MD	9/11/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	131899	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
120644	Fee-for-Service	1710075247	1710075247	1	1	ARYA, BRAMARA MD	12/1/1998	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	63135	40	Pediatrics	0	In state provider	None	1505 W 17TH ST	None	SAN BERNARDINO	CA	92411	1202	36	06071	34.13045153	-117.31869	San Bernardino County
120660	Fee-for-Service	1528196045	1528196045	1	1	AGRAWAL, VIBHA MD	3/28/2018	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	135409	25	Physical Medicine and Rehabilitation	0	In state provider	None	1017 S FAIR OAKS AVE	None	PASADENA	CA	91105	2621	19	06037	34.12830178	-118.1503497	Los Angeles County
120674	Fee-for-Service	1649232760	1649232760	1	1	ABRATOWSKI, EDWARD V MD	7/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91200	41	Internal Medicine	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
120713	Fee-for-Service	1558522466	1558522466	1	1	AZAD, GAGANDEEP K MD	12/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	117760	None	None	0	In state provider	None	460 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	51	06101	39.13140416	-121.6141951	Sutter County
120718	Fee-for-Service	1760553648	1760553648	1	1	ABDEL-SAYED, PETER S MD	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	67734	30	Radiology	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
120744	Fee-for-Service	1912114414	1912114414	1	1	ALAMEDA FAMILY SERVICES	2/10/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2325 CLEMENT AVENUE	SUITE A	ALAMEDA	CA	94501	7061	01	06001	37.77017367	-122.2389726	Alameda County
120805	Fee-for-Service	1891732921	1891732921	1	1	ADMIRAL HOME HEALTH INC	11/14/1995	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4010 WATSON PLAZA DR	STE 150	LAKEWOOD	CA	90712	4035	19	06037	33.83123565	-118.1550195	Los Angeles County
120806	Fee-for-Service	1962022707	1962022707	1	1	AISPURO, IVAN MD	8/2/2024	207P00000X	NA	Other	026	PHYSICIANS	186570	66	Emergency Medicine (Urgent Care)	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
120817	Fee-for-Service	1669569802	1669569802	1	1	ABUNDANT HOME CARE INC	4/26/2001	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	12545 KIRKHAM CT	None	POWAY	CA	92064	6815	37	06073	32.94365093	-117.0509291	San Diego County
120836	Fee-for-Service	1083757132	1083757132	1	1	AHDOOT, ROBEN D MD	5/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	62395	30	Radiology	0	In state provider	None	18546 ROSCOE BLVD	SUITE 120	NORTHRIDGE	CA	91324	5452	19	06037	34.22069869	-118.537684	Los Angeles County
120889	Fee-for-Service	1821253568	1821253568	1	1	ANGROOLA, AMARDEEP MD	3/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144332	08	Family Practice	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
120932	Fee-for-Service	1649421447	1649421447	1	1	ALMESTADY, RAJAA M MD	7/31/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	122529	None	None	0	In state provider	None	19111 TOWN CENTER DR	None	APPLE VALLEY	CA	92308	8989	36	06071	34.46573149	-117.2467156	San Bernardino County
120934	Fee-for-Service	1154409761	1154409761	1	1	ARNON, STEFAN D MD	1/27/2016	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	15154	30	Radiology	0	In state provider	UCD PROF SVC GRP	2533 MISSION STREET	None	SAN FRANCISCO	CA	94110	2511	38	06075	37.75647785	-122.4188315	San Francisco County
120954	Fee-for-Service	1396869715	1396869715	1	1	ATANASSOVA, NINA I LMFT	12/27/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	830 STEWART DRIVE	230	SUNNYVALE	CA	94085	4513	43	06085	37.38395509	-122.0096036	Santa Clara County
120979	Fee-for-Service	1740946722	1740946722	1	1	ALEXANDER, BREEANA OD	3/6/2025	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	670 SUTTON WY	None	GRASS VALLEY	CA	95945	5392	29	06057	39.23319097	-121.0359874	Nevada County
120987	Fee-for-Service	1104807684	1104807684	1	1	ASAD, NAVAID MD	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55215	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	65 NIELSON STREET	SUITE 102	WATSONVILLE	CA	95076	2468	44	06087	36.9282117	-121.7933197	Santa Cruz County
121043	Fee-for-Service	1982638227	1982638227	1	1	AMERICAN MEDICAL RESPONSE	2/1/1999	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	WEST	1870 HILLCREST RD	None	HOLLISTER	CA	95023	5204	35	06069	36.84664662	-121.3651488	San Benito County
121075	Fee-for-Service	1114394517	1114394517	1	1	ARGUELLES, ROBERT V PSYD	6/12/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1900 S MCDOWELL BLVD	12	PETALUMA	CA	94954	5473	49	06097	38.230006	-122.5958952	Sonoma County
121083	Fee-for-Service	1467505073	1467505073	1	1	ALFRED I DUPONT HOSPITAL	2/2/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 ROCKLAND RD	None	WILMINGTON	DE	19803	3607	00	None	39.779298	-75.555387	New Castle County
121086	Fee-for-Service	1952898744	1952898744	1	1	ARMANIOUS, NANCY S MD	11/5/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	175026	None	None	0	In state provider	None	26795 PORTOLA PARKWAY	None	FOOTHILL RANCH	CA	92610	1713	30	06059	33.67841042	-117.6624735	Orange County
121096	Fee-for-Service	1275510216	1275510216	1	1	AARESTAD, KAREN MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	68248	41	Internal Medicine	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
121097	Fee-for-Service	1295775625	1295775625	1	1	ALI, SYED I MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50860	05	Anesthesiology	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
121174	Fee-for-Service	1215961917	1215961917	1	1	ARJUMAND, ARSHIA MD	9/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56183	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
121185	Fee-for-Service	1558866863	1558866863	1	1	ANANTH, APOORVA A MD	12/16/2021	207R00000X	NA	Other	026	PHYSICIANS	166037	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
121194	Fee-for-Service	1851449847	1851449847	1	1	ALIMENTO, KENNETH U OD	5/9/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5620 MESMER AVE	None	CULVER CITY	CA	90230	6315	19	06037	33.98561217	-118.4005283	Los Angeles County
121244	Fee-for-Service	1538587712	1538587712	1	1	APPA, AYESHA A MD	10/19/2021	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	154797	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
121250	Fee-for-Service	1659463628	1659463628	1	1	ATKINSON, SEANN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	949 HARMON ST	None	STURGIS	SD	57785	2452	00	None	44.40196678	-103.5084023	Meade County
121287	Fee-for-Service	1578742896	1578742896	1	1	ABRAMED CORPORATION	11/5/2014	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	8134 FOOTHILL BLVD	None	SUNLAND	CA	91040	2941	19	06037	34.25963611	-118.3103495	Los Angeles County
121294	Fee-for-Service	1861262958	1861262958	1	1	ALBANO, MARC JOHN ANTHONY D	2/6/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	PT	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
121301	Fee-for-Service	1649209776	1649209776	1	1	APKER, KIMBERLY A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
121319	Fee-for-Service	1063529741	1063529741	1	1	AMBULANCE SERV. MANCHESTER	6/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	275 NEW STATE RD	None	MANCHESTER	CT	06042	1810	00	None	41.78722933	-72.55451455	Capitol Planning Region
121385	Fee-for-Service	1295775625	1295775625	1	1	ALI, SYED I MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50860	40	Pediatrics	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
121390	Fee-for-Service	1396931291	1396931291	1	1	AMYLON, MICHAEL D MD	1/1/1982	2080P0207X	NA	Hematology	026	PHYSICIANS	34542	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
121391	Fee-for-Service	1073907689	1073907689	1	2	ALL FOR HEALTH HEALTH FOR	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	141 SOUTH CEDAR STREET	None	GLENDALE	CA	91205	1207	19	06037	34.144785	-118.244358	Los Angeles County
121404	Fee-for-Service	1841220209	1841220209	1	1	ANDREW, J DAVID MD	1/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	29437	08	Family Practice	0	In state provider	None	599 SIR FRANCIS DRAKE BL	STE 208	GREENBRAE	CA	94904	1731	21	06041	37.95026531	-122.5332546	Marin County
121424	Fee-for-Service	1366419491	1366419491	1	1	ASSOCIATES IN WOMEN'S	8/30/2001	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	HEALTH CARE MEDICAL GRP	5 MEDICAL PLAZA DR	STE 250	ROSEVILLE	CA	95661	3044	31	06061	38.76604411	-121.2466761	Placer County
121446	Fee-for-Service	1083047294	1083047294	1	1	ABEDI, GOLNOUSH N LCSW	2/4/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
121461	Fee-for-Service	1962479337	1962479337	1	1	AROSEMENA, ERIC J MD	11/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	41664	08	Family Practice	0	In state provider	None	502 TORRANCE BLVD	None	REDONDO BEACH	CA	90277	3413	19	06037	33.83783749	-118.3832414	Los Angeles County
121462	Fee-for-Service	1386830602	1386830602	1	1	APPLETON, SARAH E LMFT	6/12/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	48208	-	NOT APPLICABLE	0	In state provider	None	1018 21ST STREET	None	BAKERSFIELD	CA	93301	4709	15	06029	35.37813217	-119.0132767	Kern County
121468	Fee-for-Service	1912949702	1912949702	3	1	ATG DESIGNING MOBILITY INC	12/26/2018	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	11075 KNOTT AVE	STE B & C	CYPRESS	CA	90630	5150	30	06059	33.80076198	-118.0111199	Orange County
121514	Fee-for-Service	1669464152	1669464152	1	1	ARNESTY, JANET E MD	7/1/1989	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63619	41	Internal Medicine	0	In state provider	None	1580 VALENCIA ST	None	SAN FRANCISCO	CA	94110	4423	38	06075	37.74746923	-122.4202583	San Francisco County
121525	Fee-for-Service	1699024331	1699024331	1	1	ARARAT HOSPICE CARE INC	3/16/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3535 SAN DIMAS ST	UNIT 12	BAKERSFIELD	CA	93301	1695	15	06029	35.39123916	-119.008246	Kern County
121534	Fee-for-Service	1508968603	1508968603	1	1	AMICO, MARK P	2/28/1989	207R00000X	NA	Other	026	PHYSICIANS	56952	08	Family Practice	0	In state provider	NORTHRIDGE FAM PRAC MED	18406 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.2206967	-118.5342638	Los Angeles County
121544	Fee-for-Service	1912066507	1912066507	1	1	ALFONSO, VICTORINO MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32667	36	Psychiatry	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
121545	Fee-for-Service	1134639859	1134639859	1	1	ASPIRE NEURO PSYCHOLOGICAL S	3/15/2018	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	ERVICES, INC.	2815 MITCHELL DR	STE 128	WALNUT CREEK	CA	94598	1622	07	06013	37.93129027	-122.0204585	Contra Costa County
121594	Fee-for-Service	1134644073	1134644073	1	1	ABL HEALTH CARE LLC	9/14/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6150 MISSION ST	103	DALY CITY	CA	94014	2063	41	06081	37.70686536	-122.4584578	San Mateo County
121618	Fee-for-Service	1972954410	1972954410	1	1	ACKER, LINDA M NP	8/25/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
121624	Fee-for-Service	1912302381	1912302381	1	1	A ONE HOSPICE INC	10/21/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5301 LAUREL CANYON BLVD	SUITE 223	VALLEY VILLAGE	CA	91607	2790	19	06037	34.166907	-118.396546	Los Angeles County
121643	Fee-for-Service	1538552534	1538552534	1	1	ALEGRE, RICHARD E DO	12/28/2019	207P00000X	NA	Other	026	PHYSICIANS	17431	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
121648	Fee-for-Service	1538471719	1538471719	1	1	ALJILANI, AMIR M MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	121455	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
121680	Fee-for-Service	1073907689	1073907689	1	2	ALL FOR HEALTH HEALTH FOR	10/22/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	141 SOUTH CEDAR STREET	None	GLENDALE	CA	91205	1207	19	06037	34.144785	-118.244358	Los Angeles County
121686	Fee-for-Service	1497489355	1497489355	1	1	A1RX,LLC	10/14/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8641 WILSHIRE BLVD	STE 120	BEVERLY HILLS	CA	90211	2919	19	06037	34.06614972	-118.3798912	Los Angeles County
121691	Fee-for-Service	1841220209	1841220209	1	1	ANDREW, J DAVID MD	1/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	29437	01	General Practice	0	In state provider	None	599 SIR FRANCIS DRAKE BL	STE 208	GREENBRAE	CA	94904	1731	21	06041	37.95026531	-122.5332546	Marin County
121746	Fee-for-Service	1619900750	1619900750	1	1	AGARWAL, CHANDRAHAS MD INC	8/31/1992	207UN0901X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8287 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10301177	-117.5641513	San Bernardino County
121756	Fee-for-Service	1245344514	1245344514	1	1	ARCE, JORGE MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35391	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	480 4TH AVE	STE 211	CHULA VISTA	CA	91910	4412	37	06073	32.63411298	-117.0816772	San Diego County
121782	Fee-for-Service	1447641816	1447641816	1	1	AJA, ANDREW P LCSW	11/14/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	118267	-	NOT APPLICABLE	0	In state provider	None	16314 CORNUTA AVE	16,18,22,22 1/2,22 7/8	BELLFLOWER	CA	90706	4814	19	06037	33.88571053	-118.1197984	Los Angeles County
121793	Fee-for-Service	1043309735	1043309735	1	2	ACCREDO HEALTH GROUP INC	12/19/2019	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	6272 LEE VISTA BLVD	SUITE 100	ORLANDO	FL	32822	5148	00	None	28.46595547	-81.29825205	Orange County
121802	Fee-for-Service	1447962485	1447962485	1	1	ANUGWOM, ONYINYECHI S NP	4/24/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
121815	Fee-for-Service	1699024331	1699024331	1	1	ARARAT HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3535 SAN DIMAS ST	UNIT 12	BAKERSFIELD	CA	93301	1695	15	06029	35.39123916	-119.008246	Kern County
121833	Fee-for-Service	1912066507	1912066507	1	1	ALFONSO, VICTORINO MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32667	25	Physical Medicine and Rehabilitation	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
121839	Fee-for-Service	1770143661	1770143661	1	1	AZMAT, SUMMER MD	8/14/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187376	None	None	0	In state provider	None	3100 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3866	31	06061	38.74399612	-121.2349547	Placer County
121864	Fee-for-Service	1952577504	1952577504	1	1	AMITA SINGH	8/27/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5841 S MARYLAND AVE	None	CHICAGO	IL	60637	1443	00	None	41.788431	-87.60489252	Cook County
121885	Fee-for-Service	1912478207	1912478207	1	1	ALVAREZ, ANGEL RCP	4/9/2019	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
121913	Fee-for-Service	1912302381	1912302381	1	1	A ONE HOSPICE INC	10/21/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5301 LAUREL CANYON BLVD	SUITE 223	VALLEY VILLAGE	CA	91607	2790	19	06037	34.166907	-118.396546	Los Angeles County
121916	Fee-for-Service	1144520651	1144520651	1	1	ACHARYA, SABEENA MD	9/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122957	None	None	0	In state provider	None	4785 N FIRST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
121920	Fee-for-Service	1174218259	1174218259	1	1	ADAMS, ALICE	6/14/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	43	06085	0	0	None
121938	Fee-for-Service	1124264635	1124264635	1	1	AVICCENNA MEDICAL GROUP	4/3/2009	207RN0300X	NA	Nephrology	026	PHYSICIANS	100198	45	Nephrology (Renal-Kidney)	0	In state provider	None	3392 MOTOR AVENUE	None	LOS ANGELES	CA	90034	3371	19	06037	34.02780514	-118.4095758	Los Angeles County
121939	Fee-for-Service	1467839936	1467839936	1	1	ANX HOSPICE CARE NURSING INC	9/26/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	455 HICKEY BLVD	SUITE 320	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
121953	Fee-for-Service	1154393809	1154393809	1	1	ANDERSON, CHRISTINA G MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	54860	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
121963	Fee-for-Service	1154363141	1154363141	2	1	ALEXSON, EDWARD R MD	10/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	27314	41	Internal Medicine	0	In state provider	None	1100 N TUSTIN AVE	STE A	SANTA ANA	CA	92705	3509	30	06059	33.754707	-117.8342455	Orange County
121979	Fee-for-Service	1174504674	1174504674	1	1	ALEXANDER, MICHAEL B MD	2/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	80472	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
121998	Fee-for-Service	1467594093	1467594093	1	1	ARREDONDO, ALEJANDRO OD	1/1/1999	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRIC CORP	2675 SATURN AVE	None	HUNTINGTON PARK	CA	90255	4142	19	06037	33.97693647	-118.2229245	Los Angeles County
122012	Fee-for-Service	1740222934	1740222934	1	2	AMERICAN INDIAN HEALTH	11/1/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	5412 CARPINTERIA AVE	None	CARPINTERIA	CA	93013	1423	42	06083	34.39520103	-119.5138394	Santa Barbara County
122026	Fee-for-Service	1740454735	1740454735	1	1	ANNIE SHU & MICHAEL CHU	4/6/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	632 W DUARTE RD	SUITE 170	ARCADIA	CA	91007	7610	19	06037	34.12635644	-118.0528457	Los Angeles County
122036	Fee-for-Service	1619900750	1619900750	1	1	AGARWAL, CHANDRAHAS MD INC	8/31/1992	207UN0901X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	8287 WHITE OAK AVE	None	RANCHO CUCAMONGA	CA	91730	7671	36	06071	34.10301177	-117.5641513	San Bernardino County
122045	Fee-for-Service	1245344514	1245344514	1	1	ARCE, JORGE MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35391	66	Emergency Medicine (Urgent Care)	0	In state provider	None	480 4TH AVE	STE 211	CHULA VISTA	CA	91910	4412	37	06073	32.63411298	-117.0816772	San Diego County
122050	Fee-for-Service	1417988445	1417988445	1	1	AJAELO, IKEM C MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	64079	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
122053	Fee-for-Service	1447391719	1447391719	1	5	ASIAN HEALTH SERVICES	7/1/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	900 FALLON ST	SC 410	OAKLAND	CA	94607	4808	01	06001	37.796058	-122.260959	Alameda County
122065	Fee-for-Service	1477682466	1477682466	1	1	ALHAMBRA HOSP MED CTR LP	7/2/1998	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	100 S RAYMOND AVE	None	ALHAMBRA	CA	91801	3199	19	06037	34.09027878	-118.1450083	Los Angeles County
122096	Fee-for-Service	1114022704	1114022704	2	1	ALMARAZ, GILBERT MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	66891	None	None	0	In state provider	None	14662 NEWPORT AVE	None	TUSTIN	CA	92780	6064	30	06059	33.73088521	-117.8293385	Orange County
122144	Fee-for-Service	1174743504	1174743504	1	1	ATONIAN, ANI A MD	12/17/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	93954	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
122153	Fee-for-Service	1538356670	1538356670	1	1	ATWOOD, SHARON L	6/21/2023	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
122177	Fee-for-Service	1366057465	1366057465	1	1	AFFECTIONATE HOSPICE CARE	8/4/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	11350 VENTURA BLVD	SUITE 202	STUDIO CITY	CA	91604	3140	19	06037	34.14014506	-118.3774984	Los Angeles County
122196	Fee-for-Service	1235365164	1235365164	1	1	ARAGON, DAVID C D JR LMFT	12/2/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	88865	-	NOT APPLICABLE	0	In state provider	None	801 70TH STREET	None	LOS ANGELES	CA	90044	5218	19	06037	33.97640749	-118.2874275	Los Angeles County
122217	Fee-for-Service	1184731283	1184731283	1	1	ABE, BENNETT K MD	8/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71688	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
122228	Fee-for-Service	1124264635	1124264635	1	1	AVICCENNA MEDICAL GROUP	4/3/2009	207RN0300X	NA	Nephrology	026	PHYSICIANS	100198	41	Internal Medicine	0	In state provider	None	3392 MOTOR AVENUE	None	LOS ANGELES	CA	90034	3371	19	06037	34.02780514	-118.4095758	Los Angeles County
122229	Fee-for-Service	1467839936	1467839936	1	1	ANX HOSPICE CARE NURSING INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	455 HICKEY BLVD	SUITE 320	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
122239	Fee-for-Service	1154393809	1154393809	1	1	ANDERSON, CHRISTINA G MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	54860	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
122252	Fee-for-Service	1952357964	1952357964	1	1	ACCENTCARE HOME HEALTH	5/9/2000	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA, INC	15455 SAN FERNANDO	SUITE C400	MISSION HILLS	CA	91345	1300	19	06037	34.27194157	-118.469079	Los Angeles County
122279	Fee-for-Service	1720169972	1720169972	1	1	ARTAL,ROY MD	8/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60669	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1245 WILSHIRE BLVD	STE 407	LOS ANGELES	CA	90017	4804	19	06037	34.05362775	-118.2661889	Los Angeles County
122284	Fee-for-Service	1073661047	1073661047	1	1	ATALLA, NABEEL S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32013	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
122291	Fee-for-Service	1134277056	1134277056	1	1	ARDARY, PHYLLIS G OD	1/27/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1511 W GARVEY AVE NORTH	None	WEST COVINA	CA	91790	2138	19	06037	34.07275848	-117.938241	Los Angeles County
122296	Fee-for-Service	1740222934	1740222934	1	2	AMERICAN INDIAN HEALTH	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	5412 CARPINTERIA AVE	None	CARPINTERIA	CA	93013	1423	42	06083	34.39520103	-119.5138394	Santa Barbara County
122305	Fee-for-Service	1174957153	1174957153	1	1	ALMEIDA, MURILO LMFT	3/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	349 E BULLARD AVE	STE 102	FRESNO	CA	93710	5298	10	06019	36.82285854	-119.7825885	Fresno County
122312	Fee-for-Service	1740454735	1740454735	1	1	ANNIE SHU & MICHAEL CHU	4/6/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	632 W DUARTE RD	SUITE 170	ARCADIA	CA	91007	7610	19	06037	34.12635644	-118.0528457	Los Angeles County
122321	Fee-for-Service	1912284647	1912284647	1	1	ALADE, ERICA LMFT	8/17/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
122336	Fee-for-Service	1255897237	1255897237	1	1	AVEEM INC	11/18/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2520 STANWELL DR	STE 100	CONCORD	CA	94520	4819	07	06013	37.98503234	-122.0481702	Contra Costa County
122341	Fee-for-Service	1447391719	1447391719	1	5	ASIAN HEALTH SERVICES	7/1/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	900 FALLON ST	SC 410	OAKLAND	CA	94607	4808	01	06001	37.796058	-122.260959	Alameda County
122342	Fee-for-Service	1356531297	1356531297	1	1	AWADA, ALI MD INC	12/8/2004	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	76844	40	Pediatrics	0	In state provider	None	12301 S HAWTHORNE BLVD	None	HAWTHORNE	CA	90250	2369	19	06037	33.92064813	-118.3528905	Los Angeles County
122345	Fee-for-Service	1265724215	1265724215	1	1	ALL TOWN TRANSPORT INC	11/1/2005	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	6727 ODESSA AVE	200	VAN NUYS	CA	91406	5747	19	06037	34.19266684	-118.4902671	Los Angeles County
122383	Fee-for-Service	1245775469	1245775469	1	1	APOLLO HOME HEALTHCARE LLC	11/20/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	533 PETERS AVE	100	PLEASANTON	CA	94566	6586	01	06001	37.661155	-121.8770424	Alameda County
122385	Fee-for-Service	1841449980	1841449980	1	1	AZZAM, OMAIMA Y MD	12/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105239	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
122407	Fee-for-Service	1578688370	1578688370	1	1	ALLEN, GARY LPCC	5/3/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11835 WEST OLYMPIC BLVD	SUITE 815E	LOS ANGELES	CA	90064	5056	19	06037	34.03273663	-118.4516927	Los Angeles County
122443	Fee-for-Service	1043361470	1043361470	1	1	AGAPIAN, JOHN V MD	9/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94833	02	General Surgery	0	In state provider	None	1510 S CENTRAL AVE	STE 200	GLENDALE	CA	91204	2588	19	06037	34.12709764	-118.2577911	Los Angeles County
122467	Fee-for-Service	1366057465	1366057465	1	1	AFFECTIONATE HOSPICE CARE	8/4/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	11350 VENTURA BLVD	SUITE 202	STUDIO CITY	CA	91604	3140	19	06037	34.14014506	-118.3774984	Los Angeles County
122473	Fee-for-Service	1184659161	1184659161	1	1	ALAMY, MOUSTAFA E MD	5/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	48912	10	Gastroenterology (M.D. only)	0	In state provider	None	6347 PACIFIC BLVD	None	HUNTINGTON PARK	CA	90255	4101	19	06037	33.9821769	-118.2252706	Los Angeles County
122502	Fee-for-Service	1073780714	1073780714	1	1	APFEL, BRIGITTE A MD	5/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101833	36	Psychiatry	0	In state provider	None	61 CAMINO ALTO	SUITE 100C	MILL VALLEY	CA	94941	2900	21	06041	37.89481706	-122.5301485	Marin County
122517	Fee-for-Service	1760630461	1760630461	1	1	AHMED, SABI MD	12/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105490	08	Family Practice	0	In state provider	None	500 WEST HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9989	39	06077	37.88652418	-121.2820956	San Joaquin County
122535	Fee-for-Service	1083849111	1083849111	1	1	AMBATI, MEGHA MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125755	41	Internal Medicine	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
122537	Fee-for-Service	1902277940	1902277940	1	1	AHMED, KELLY MD INC	2/19/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51407	None	None	0	In state provider	None	14285 AMARGOSA RD	None	VICTORVILLE	CA	92392	9707	36	06071	34.510329	-117.3301305	San Bernardino County
122538	Fee-for-Service	1497906374	1497906374	1	1	ALVARADO, ANTHONY S MD	6/6/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	146016	45	Nephrology (Renal-Kidney)	0	In state provider	None	1100 N PALM CANYON DR	STE 211	PALM SPRINGS	CA	92262	4426	33	06065	33.838182	-116.546744	Riverside County
122562	Fee-for-Service	1831384163	1831384163	1	2	AMBULATORY FOOT CARE	10/1/1995	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	PODIATRY CLINIC INC	2256 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1243	19	06037	34.03497597	-118.2171363	Los Angeles County
122569	Fee-for-Service	1720169972	1720169972	1	1	ARTAL,ROY MD	8/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60669	41	Internal Medicine	0	In state provider	None	1245 WILSHIRE BLVD	STE 407	LOS ANGELES	CA	90017	4804	19	06037	34.05362775	-118.2661889	Los Angeles County
122597	Fee-for-Service	1184794042	1184794042	1	1	ANGELES, GLORIA C CRNA	2/26/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2615 EYE ST	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
122600	Fee-for-Service	1790865871	1790865871	1	1	ANTONY, MAYA MERLIN T MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63922	38	Geriatrics	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
122604	Fee-for-Service	1861811291	1861811291	1	1	ABADIE, BRIANNA GINA M MD	3/6/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	139268	30	Radiology	0	In state provider	None	1516 COTNER AVE	None	LOS ANGELES	CA	90025	3303	19	06037	34.04905416	-118.4477438	Los Angeles County
122625	Fee-for-Service	1255897237	1255897237	1	1	AVEEM INC	11/18/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2520 STANWELL DR	STE 100	CONCORD	CA	94520	4819	07	06013	37.98503234	-122.0481702	Contra Costa County
122707	Fee-for-Service	1194012146	1194012146	1	1	ABDELMALEK, DIMYANA A MD	8/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150348	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
122731	Fee-for-Service	1649338005	1649338005	1	1	ALMERIA, JULIE A	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
122769	Fee-for-Service	1720439672	1720439672	1	1	ABORABEH, MAHMOUD MD	2/25/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	171284	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
122800	Fee-for-Service	1770697872	1770697872	1	1	ANDERSON, THOMAS G MD	11/1/1984	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
122814	Fee-for-Service	1174690002	1174690002	1	1	ASHWAL, SUSANNAH E MD	7/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79510	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
122816	Fee-for-Service	1295927887	1295927887	1	1	ANTELO, FERNANDO MD	9/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108309	None	None	0	In state provider	None	5125 MONTE VISTA STREET	None	LOS ANGELES	CA	90037	3931	19	06037	34.108303	-118.2015543	Los Angeles County
122817	Fee-for-Service	1861404832	1861404832	1	1	ACOSTA, OLGA MD	1/1/1998	207R00000X	NA	Other	026	PHYSICIANS	62193	40	Pediatrics	0	In state provider	None	2300 S FLOWER ST	STE 200	LOS ANGELES	CA	90007	2676	19	06037	34.0294397	-118.2734132	Los Angeles County
122821	Fee-for-Service	1811512866	1811512866	1	1	ANKLE & FOOT CARE CENTER INC	9/10/2020	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	15141 WHITTIER BLVD	SUITE 330	WHITTIER	CA	90603	2168	19	06037	33.94810044	-118.0039419	Los Angeles County
122850	Fee-for-Service	1891359212	1891359212	1	1	ANDERSON, CALEB K DO	8/1/2022	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	None	36.072729	-115.295094	Clark County
122862	Fee-for-Service	1417562208	1417562208	1	1	ACOSTA, JORDAN CCC-SLP	2/17/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	25102 JEFFERSON AVE	SUITE D	MURRIETA	CA	92562	1708	33	06065	33.55467403	-117.2033542	Riverside County
122866	Fee-for-Service	1033525456	1033525456	1	1	AL WAHSH, EZZADDIN MD	1/10/2025	207R00000X	NA	Other	026	PHYSICIANS	149189	41	Internal Medicine	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
122881	Fee-for-Service	1215118708	1215118708	1	1	ANTOSSYAN, LEVON MD INC	1/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53324	18	Ophthalmology	0	In state provider	None	1204 S CENTRAL	None	GLENDALE	CA	91204	2504	19	06037	34.132059	-118.257791	Los Angeles County
122884	Fee-for-Service	1790865871	1790865871	1	1	ANTONY, MAYA MERLIN T MD	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63922	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
122891	Fee-for-Service	1780761791	1780761791	1	1	ALTO, JOHN OD	11/26/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM DRIVE	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
122928	Fee-for-Service	1407097447	1407097447	1	1	AIZIN, VITALI MD INC	5/29/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	82761	41	Internal Medicine	0	In state provider	None	480 FOURTH AVE	STE 401	CHULA VISTA	CA	91910	4413	37	06073	32.63411298	-117.0816772	San Diego County
122945	Fee-for-Service	1013194497	1013194497	2	1	AMERICAN STAR HOME III	9/29/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	125 BROWNSTONE RD	None	OAKLEY	CA	94561	5900	07	06013	37.97128284	-121.6984266	Contra Costa County
122954	Fee-for-Service	1295754844	1295754844	1	1	ASPIRUS RIVERVIEW HOSPITAL &	10/14/2023	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	410 DEWEY ST	None	WISCONSIN RAPIDS	WI	54494	4715	00	None	44.38226896	-89.83029412	Wood County
122976	Fee-for-Service	1538123567	1538123567	1	1	ALLINA HEALTH SYSTEM DBA	5/26/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	303 CATLIN ST	None	BUFFALO	MN	55313	1947	00	None	45.19322147	-93.871017	Wright County
123004	Fee-for-Service	1295804250	1295804250	1	1	AHMAD, NASEER MD	10/4/2019	207RX0202X	NA	Oncology	026	PHYSICIANS	51228	41	Internal Medicine	0	In state provider	None	1135 S SUNSET BLVD	SUITE 301	WEST COVINA	CA	91790	3707	19	06037	34.06215064	-117.9453997	Los Angeles County
123023	Fee-for-Service	1851999122	1851999122	1	1	ALVARADO, BARBARA CNP	3/15/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
123049	Fee-for-Service	1598821803	1598821803	1	1	AHMED, BINA MD FACC	8/28/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	86965	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	221 W PUEBLO ST	None	SANTA BARBARA	CA	93105	6814	42	06083	34.431101	-119.7212764	Santa Barbara County
123131	Fee-for-Service	1871537902	1871537902	1	1	AUGER, WILLIAM R MD	8/31/1986	207R00000X	NA	Other	026	PHYSICIANS	58864	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	225 DICKINSON ST	# H201	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
123150	Fee-for-Service	1700850922	1700850922	1	1	ANDREW W MARCH, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1800 E VAN BUREN ST	None	PHOENIX	AZ	85006	3742	00	None	33.454944	-112.042467	Maricopa County
123155	Fee-for-Service	1154900983	1154900983	1	1	ALCON, SASHA MD	8/23/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
123158	Fee-for-Service	1740443845	1740443845	1	1	AMIN, ASHOKKUMAR I MD	4/17/2009	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	INC	1711 W ROMNEYA DRIVE	None	ANAHEIM	CA	92801	1804	30	06059	33.85069353	-117.9425745	Orange County
123162	Fee-for-Service	1881191153	1881191153	1	1	ADAMS, MATTHEW G MD	8/9/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	166808	None	None	0	In state provider	None	2829 WATT AVENUE	None	SACRAMENTO	CA	95821	6237	34	06067	38.615247	-121.383558	Sacramento County
123173	Fee-for-Service	1215118708	1215118708	1	1	ANTOSSYAN, LEVON MD INC	1/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53324	08	Family Practice	0	In state provider	None	1204 S CENTRAL	None	GLENDALE	CA	91204	2504	19	06037	34.132059	-118.257791	Los Angeles County
123214	Fee-for-Service	1407097447	1407097447	1	1	AIZIN, VITALI MD INC	5/29/2009	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	82761	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	480 FOURTH AVE	STE 401	CHULA VISTA	CA	91910	4413	37	06073	32.63411298	-117.0816772	San Diego County
123231	Fee-for-Service	1821220930	1821220930	1	1	ARHINFUL, ENOCH MD	9/1/2023	207R00000X	NA	Other	026	PHYSICIANS	188372	None	None	0	In state provider	None	1919 SANTA MONICA BLVD	STE 210	SANTA MONICA	CA	90604	1970	19	06037	34.0284492	-118.4803274	Los Angeles County
123243	Fee-for-Service	1295754844	1295754844	1	1	ASPIRUS RIVERVIEW HOSPITAL &	10/14/2023	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	410 DEWEY ST	None	WISCONSIN RAPIDS	WI	54494	4715	00	None	44.38226896	-89.83029412	Wood County
123248	Fee-for-Service	1336380088	1336380088	1	1	AFTAB, MUHAMMAD MD	10/28/2020	208G00000X	NA	General Surgery	026	PHYSICIANS	-	None	None	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
123258	Fee-for-Service	1205945003	1205945003	1	1	ANDERSON, LESLEY J MD	8/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	35519	20	Orthopedic Surgery	0	In state provider	None	2100 WEBSTER STREET	SUITE 309	SAN FRANCISCO	CA	94115	2376	38	06075	37.7904826	-122.4324477	San Francisco County
123298	Fee-for-Service	1255043303	1255043303	1	1	ANCHOR MEDICAL SUPPLY INC.	10/23/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	43391 BUSINESS PARK DR.	SUITE C7	TEMECULA	CA	92590	3694	33	06065	33.50124838	-117.1611816	Riverside County
123301	Fee-for-Service	1427437730	1427437730	1	1	AHMADI, TAMANA MD	8/3/2021	207RP1001X	NA	Pulmonology	026	PHYSICIANS	146937	None	None	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
123336	Fee-for-Service	1881695690	1881695690	1	1	ALMAGUER AUCHARD,	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75133	40	Pediatrics	0	In state provider	PATRICIA MD	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
123344	Fee-for-Service	1235233354	1235233354	1	1	AMERICAN PROFESSIONAL AM	8/31/2004	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	16945 SHERMAN WAY	None	VAN NUYS	CA	91406	3614	19	06037	34.20125238	-118.502504	Los Angeles County
123351	Fee-for-Service	1669420618	1669420618	1	1	ARAIN, MUSTAFA A MD	7/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136624	10	Gastroenterology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
123357	Fee-for-Service	1750775250	1750775250	1	1	ANDREATTA, AMBER DO	4/4/2019	207P00000X	NA	Other	026	PHYSICIANS	15382	66	Emergency Medicine (Urgent Care)	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
123362	Fee-for-Service	1881618197	1881618197	1	1	ALEJO, FLORANTE A MD INC	6/20/2005	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	37227	08	Family Practice	0	In state provider	None	282 E SEPULVEDA BLVD	None	CARSON	CA	90745	6323	19	06037	33.80798208	-118.2713843	Los Angeles County
123392	Fee-for-Service	1477192789	1477192789	1	1	ARFA, SHARON LMFT	12/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12087 LOPEZ CANYON RD	SUITE 128	SYLMAR	CA	91342	6063	19	06037	34.292754	-118.40463	Los Angeles County
123430	Fee-for-Service	1750378626	1750378626	1	1	AUERBACH, DAVID MD	7/28/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	180783	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
123446	Fee-for-Service	1740443845	1740443845	1	1	AMIN, ASHOKKUMAR I MD	4/17/2009	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC	1711 W ROMNEYA DRIVE	None	ANAHEIM	CA	92801	1804	30	06059	33.85069353	-117.9425745	Orange County
123459	Fee-for-Service	1427160902	1427160902	1	1	ARMSTRONG, DAVID G DPM	9/20/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
123499	Fee-for-Service	1003127903	1003127903	1	1	ANDREW R GOUGH	10/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2905 3RD AVE SE	None	ABERDEEN	SD	57401	5420	00	None	45.46217797	-98.44647558	Brown County
123533	Fee-for-Service	1336144484	1336144484	1	1	ASIAN AMERICAN HOME CARE	11/4/1996	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	1301 MARINA VILLAGE PKWY	SUITE 103	ALAMEDA	CA	94501	1058	01	06001	37.78649107	-122.2743425	Alameda County
123559	Fee-for-Service	1134697782	1134697782	1	1	ASHBY, CHRISTINA OT	11/12/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2492 NISSEN DRIVE	None	LIVERMORE	CA	94551	7704	01	06001	37.69957314	-121.8152197	Alameda County
123579	Fee-for-Service	1366747636	1366747636	1	1	ALBANO, NICOLE M MFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
123639	Fee-for-Service	1033384458	1033384458	1	1	AMBARDAR, SHEENIE MD	11/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105369	36	Psychiatry	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
123678	Fee-for-Service	1316279938	1316279938	1	1	ATIENZA, RONALD REA T CRNA	4/22/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
123748	Fee-for-Service	1376978791	1376978791	1	1	AGENJO HOHENGARTEN, ERIN D L	4/5/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CSW	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
123750	Fee-for-Service	1932214657	1932214657	1	15	AJAY G. MEKA M.D. INC.	3/10/2022	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	450 4TH AVE	301	CHULA VISTA	CA	91910	4429	37	06073	32.63513513	-117.0820663	San Diego County
123752	Fee-for-Service	1346599057	1346599057	1	1	AFFORDABLE HEALTHCARE INC	2/25/2013	193400000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1647 ANAHEIM STREET	None	HARBOR CITY	CA	90710	3213	19	06037	33.78621735	-118.3058946	Los Angeles County
123770	Fee-for-Service	1578198925	1578198925	1	1	ALPINE UNION ELEMENTARY	2/13/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	2001 TAVERN RD	None	ALPINE	CA	91901	3129	37	06073	32.82456979	-116.775382	San Diego County
123797	Fee-for-Service	1225328750	1225328750	1	1	AUGENSTEIN, JULIE A MD	1/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 E THOMAS ROAD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
123800	Fee-for-Service	1104688795	1104688795	1	1	APLA HEALTH & WELLNESS	4/16/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	7531 SANTA MONICA BLVD	SUITE 100	WEST HOLLYWOOD	CA	90046	6458	19	06037	34.09081315	-118.3541261	Los Angeles County
123824	Fee-for-Service	1750800132	1750800132	1	1	AGUILAR, JESSICA L	9/25/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
123826	Fee-for-Service	1982929881	1982929881	1	1	ASTENGO, STEVEN DO	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12746	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4001 J STREET	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
123834	Fee-for-Service	1013257567	1013257567	1	1	AFFILIATED PATHOLOGISTS OF	4/4/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	THE CENTRAL COAST	1100 LAS TABLAS	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
123854	Fee-for-Service	1497864441	1497864441	1	2	ALI, HARUN M LCSW	7/26/2016	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	250 DOS RIOS ST	STE A-1	SACRAMENTO	CA	95811	0442	34	06067	38.591757	-121.486113	Sacramento County
123856	Fee-for-Service	1881830883	1881830883	1	1	ANSARI, ERUM MD	6/3/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	102069	None	None	0	In state provider	None	1081 MARKET PL	#800	SAN RAMON	CA	94583	4750	07	06013	37.76342386	-121.9527794	Contra Costa County
123862	Fee-for-Service	1144389867	1144389867	1	1	ABELLON, LE MARIE T NP	12/2/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3851 SHAW RIDGE RD	None	SAN DIEGO	CA	92130	2807	37	06073	32.93516088	-117.2297377	San Diego County
123868	Fee-for-Service	1184102675	1184102675	1	1	AGUILUZ, ROBERTO A RCP	11/14/2018	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
123889	Fee-for-Service	1679546345	1679546345	1	1	ACIERNO, ANTHONY DC	2/8/2015	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1432 E 17TH ST	None	SANTA ANA	CA	92705	8501	30	06059	33.7598955	-117.8485065	Orange County
123903	Fee-for-Service	1821636804	1821636804	1	1	ALVAREZ, KAITLYN T PT	10/13/2020	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
123938	Fee-for-Service	1538658729	1538658729	1	1	ABDUR-RAHMAN, SYED MD	4/26/2022	207R00000X	NA	Other	026	PHYSICIANS	177230	None	None	0	In state provider	None	300 CANAL ST	None	KING CITY	CA	93930	3431	27	06053	36.20653258	-121.1319345	Monterey County
123954	Fee-for-Service	1013156850	1013156850	1	2	AZARI, SORAYA N MD	10/16/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	106392	-	NOT APPLICABLE	0	In state provider	None	1001 POTRERO AVE	WARD 93/95	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
124038	Fee-for-Service	1568484921	1568484921	1	1	AGUILAR, DAVID N MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	86882	05	Anesthesiology	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
124041	Fee-for-Service	1932214657	1932214657	1	15	AJAY G. MEKA M.D. INC.	3/10/2022	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	450 4TH AVE	301	CHULA VISTA	CA	91910	4429	37	06073	32.63513513	-117.0820663	San Diego County
124052	Fee-for-Service	1700388451	1700388451	1	1	AVRATIN, SARA T LMFT	4/19/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
124055	Fee-for-Service	1609214352	1609214352	1	1	AFFIRMATIVE HOME CARE INC	7/24/2013	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	BONNIE HARAGOS	518 S CITRUS AVE	None	ESCONDIDO	CA	92027	4202	37	06073	33.13420831	-117.0398115	San Diego County
124058	Fee-for-Service	1578198925	1578198925	1	1	ALPINE UNION ELEMENTARY	7/1/2021	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	2001 TAVERN RD	None	ALPINE	CA	91901	3129	37	06073	32.82456979	-116.775382	San Diego County
124061	Fee-for-Service	1124688189	1124688189	1	1	ADAMS, JOANN V OD	8/9/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7075 N SHARON AVE	None	FRESNO	CA	93720	3329	10	06019	36.83882737	-119.7590708	Fresno County
124065	Fee-for-Service	1427236629	1427236629	1	1	AL SOUQI, MOHAMMAD K MD	8/23/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112911	41	Internal Medicine	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
124087	Fee-for-Service	1104688795	1104688795	1	1	APLA HEALTH & WELLNESS	4/16/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	7531 SANTA MONICA BLVD	SUITE 100	WEST HOLLYWOOD	CA	90046	6458	19	06037	34.09081315	-118.3541261	Los Angeles County
124088	Fee-for-Service	1942763073	1942763073	1	1	ALANO, RYAN E MD	7/27/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	179822	None	None	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
124097	Fee-for-Service	1083077283	1083077283	1	1	AL-SALEH, YADANI MD	5/6/2020	207R00000X	NA	Other	026	PHYSICIANS	163379	41	Internal Medicine	0	In state provider	None	4300 ROSE DR	None	YORBA LINDA	CA	92886	2026	30	06059	33.89815111	-117.8419708	Orange County
124112	Fee-for-Service	1750492302	1750492302	1	1	ADEMOLA, FLORENCE B	9/18/2007	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	GLORIOUS MEDICAL SUPPLY	8731 S WESTERN AVE	None	LOS ANGELES	CA	90047	3327	19	06037	33.95844	-118.309039	Los Angeles County
124116	Fee-for-Service	1376864215	1376864215	1	1	ALCONCEL, KATHERINE N DO	12/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12724	41	Internal Medicine	0	In state provider	None	18300 HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
124173	Fee-for-Service	1114405974	1114405974	1	1	AHMED, SABAH MD	10/12/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173556	None	None	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
124185	Fee-for-Service	1356707772	1356707772	1	1	ACTIVE CARE CHIROPRACTIC, BE	7/19/2018	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	LLINGER/FOGG PROFESSIONA	1775 HARRISON AVE	None	EUREKA	CA	95501	1338	12	06023	40.79191911	-124.1395817	Humboldt County
124187	Fee-for-Service	1023145240	1023145240	1	1	A DIOP FAMILY CARE MED	3/10/2015	207QA0000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	GROUP INC	2710 W MANCHESTER BLVD	STE A	INGLEWOOD	CA	90305	2436	19	06037	33.9598587	-118.3237499	Los Angeles County
124190	Fee-for-Service	1134556418	1134556418	1	1	ARLT, REBEKAH A LCSW	11/29/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
124192	Fee-for-Service	1699031179	1699031179	1	1	ADEJUMO, OLUWAYEMISI L MD	7/31/2020	390200000X	NA	Other	026	PHYSICIANS	168063	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
124207	Fee-for-Service	1235480443	1235480443	1	1	AVANESSIAN, PATRICK MD	1/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127792	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
124279	Fee-for-Service	1992767933	1992767933	1	1	ANN ELIZABETH SPANGLER, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5801 FOREST PARK ROAD	None	DALLAS	TX	75235	6403	00	None	32.8204241	-96.84138994	Dallas County
124280	Fee-for-Service	1265810576	1265810576	1	2	ALGOS INC., A MEDICAL CORPOR	10/30/2024	103TB0200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	3231 WARING COURT	SUITE K	OCEANSIDE	CA	92056	4510	37	06073	33.18776771	-117.2893136	San Diego County
124282	Fee-for-Service	1174919039	1174919039	1	1	AZIZ, AMNA MD	3/6/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	170480	None	None	0	In state provider	None	2480 SONOMA STREET	None	REDDING	CA	96001	3027	45	06089	40.57326337	-122.403701	Shasta County
124284	Fee-for-Service	1285909051	1285909051	1	1	ABEDI, GAREN MD	7/20/2020	208800000X	NA	Other	026	PHYSICIANS	144906	34	Urology and Urological Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
124300	Fee-for-Service	1992771885	1992771885	1	1	ASINAS, REUEL S MD	11/30/1993	207L00000X	NA	Other	026	PHYSICIANS	50247	05	Anesthesiology	0	In state provider	None	23845 MCBEAN PKWY	None	VALENCIA	CA	91355	2001	19	06037	34.39696803	-118.5525278	Los Angeles County
124311	Fee-for-Service	1427675933	1427675933	1	1	ALTUS, BRYCE A AU	8/2/2022	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3003 LOMA VISTA	C	VENTURA	CA	93003	2935	56	06111	34.27572109	-119.255478	Ventura County
124337	Fee-for-Service	1902106503	1902106503	1	1	ANGELL, TREVOR E MD	7/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	113671	67	Endocrinology	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
124350	Fee-for-Service	1386937035	1386937035	1	1	AMANTE, HEATHER R NP	6/7/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2222 S MAIN ST	None	SANTA ANA	CA	92707	3220	30	06059	33.717168	-117.867929	Orange County
124375	Fee-for-Service	1992043301	1992043301	1	1	ALLEN-JONES, UMEKO S LMFT	11/28/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17326 EDWARD RD	None	CERRITOS	CA	90703	2444	19	06037	33.87401441	-118.0344613	Los Angeles County
124415	Fee-for-Service	1528139557	1528139557	1	1	ARIAS, MIGUEL A MD	4/30/1993	2084P0800X	NA	Psychiatry	026	PHYSICIANS	59122	26	Psychiatry (child)	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
124437	Fee-for-Service	1821451444	1821451444	1	1	ARAMIN, HERMINEH MD	7/29/2022	207ZP0105X	NA	Other	026	PHYSICIANS	158973	None	None	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
124473	Fee-for-Service	1356707772	1356707772	1	1	ACTIVE CARE CHIROPRACTIC, BE	6/11/2020	111N00000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	LLINGER/FOGG PROFESSIONA	1775 HARRISON AVE	None	EUREKA	CA	95501	1338	12	06023	40.79191911	-124.1395817	Humboldt County
124476	Fee-for-Service	1023145240	1023145240	1	1	A DIOP FAMILY CARE MED	3/10/2015	207QA0000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	GROUP INC	2710 W MANCHESTER BLVD	STE A	INGLEWOOD	CA	90305	2436	19	06037	33.9598587	-118.3237499	Los Angeles County
124480	Fee-for-Service	1699031179	1699031179	1	1	ADEJUMO, OLUWAYEMISI L MD	7/31/2020	390200000X	NA	Other	026	PHYSICIANS	168063	41	Internal Medicine	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
124484	Fee-for-Service	1336297233	1336297233	1	1	ALO, ROSSANNA V OD	3/28/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4650 PALM AVE	None	SAN DIEGO	CA	92154	8404	37	06073	32.5839467	-117.0337851	San Diego County
124523	Fee-for-Service	1194993568	1194993568	1	1	ANCHETA, CONCEPCION	1/15/2008	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ST DENIS HOME	2939 SAINT DENIS DR	None	SAN RAMON	CA	94583	2733	07	06013	37.74887822	-121.949056	Contra Costa County
124549	Fee-for-Service	1992782726	1992782726	1	1	ARYA, SHASHANK S MD	10/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80526	25	Physical Medicine and Rehabilitation	0	In state provider	None	538 MISSION ST	None	SOUTH PASADENA	CA	91030	3036	19	06037	34.11573349	-118.163565	Los Angeles County
124568	Fee-for-Service	1265810576	1265810576	1	2	ALGOS INC., A MEDICAL CORPOR	10/30/2024	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	3231 WARING COURT	SUITE K	OCEANSIDE	CA	92056	4510	37	06073	33.18776771	-117.2893136	San Diego County
124583	Fee-for-Service	1053758458	1053758458	1	1	AGRAWAL, PRIYA DO	10/21/2020	207L00000X	NA	Other	026	PHYSICIANS	15815	05	Anesthesiology	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
124584	Fee-for-Service	1891215620	1891215620	1	1	ASWANI, PATRICIA B DO	5/21/2021	207P00000X	NA	Other	026	PHYSICIANS	18463	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
124588	Fee-for-Service	1346877438	1346877438	1	1	AHMED, ANITHA F	7/28/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	187422	None	None	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
124592	Fee-for-Service	1649500141	1649500141	1	1	ARCH HEALTH PARTNERS	4/26/2021	207P00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
124622	Fee-for-Service	1902106503	1902106503	1	1	ANGELL, TREVOR E MD	7/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	113671	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
124646	Fee-for-Service	1073138608	1073138608	1	1	AMARI MEDICAL CORP	9/25/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	400 MINERAL KING	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
124674	Fee-for-Service	1548416720	1548416720	1	1	ALAHVERDIAN, RONE' LMFT	6/17/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
124675	Fee-for-Service	1467081711	1467081711	1	1	AVERY, GABRIELLE M MD	8/28/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
124710	Fee-for-Service	1730610551	1730610551	1	1	AMEEN, ZEENATH S MD	10/19/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	173595	None	None	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
124819	Fee-for-Service	1255539946	1255539946	1	1	ANITA D DAI, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9225 N 3RD STREET	STE 304	PHOENIX	AZ	85020	2466	00	None	33.57054	-112.0692465	Maricopa County
124849	Fee-for-Service	1154324507	1154324507	1	1	AVERA QUEEN OF PEACE HOS	6/12/2006	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	525 N FOSTER ST	None	MITCHELL	SD	57301	2999	00	None	43.714188	-98.00739947	Davison County
124881	Fee-for-Service	1649500141	1649500141	1	1	ARCH HEALTH PARTNERS	4/8/2011	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
124890	Fee-for-Service	1861821407	1861821407	1	1	ATASHROO, MEGAN E NP	8/9/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
124904	Fee-for-Service	1760479786	1760479786	2	1	AL-JASIM, MOHAMMED MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	82827	None	None	0	In state provider	None	1600 SOUTH IMPERIAL AVE	SUITE B	EL CENTRO	CA	92243	4242	13	06025	32.77882919	-115.5697116	Imperial County
124921	Fee-for-Service	1366196347	1366196347	1	1	AFFINITY HEALTHCARE SAN	8/15/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	DIEGO, INC	350 W 9TH AVE	STE 203	ESCONDIDO	CA	92025	5053	37	06073	33.11268613	-117.080005	San Diego County
124929	Fee-for-Service	1720674161	1720674161	1	1	AVA HOME HEALTH CARE INC	2/8/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	333 N SANTA ANITA AVE	STE 13A	ARCADIA	CA	91006	2863	19	06037	34.14447	-118.031608	Los Angeles County
124985	Fee-for-Service	1538109418	1538109418	1	1	AL-SAYYAD, MOHAMMAD F MD	4/1/2019	207P00000X	NA	Other	026	PHYSICIANS	43581	66	Emergency Medicine (Urgent Care)	0	In state provider	None	17772 BEACH BLVD	None	HUNTINGTON BEACH	CA	92647	6819	30	06059	33.703677	-117.9865035	Orange County
125002	Fee-for-Service	1518267814	1518267814	1	1	ALEXANDER, WILLIAM LMFT	6/15/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 BRADFORD	STE 270	REDWOOD CITY	CA	94063	1571	41	06081	37.48799425	-122.2320157	San Mateo County
125034	Fee-for-Service	1285794081	1285794081	1	1	ABJELINA MENTAL HEALTH INC	7/17/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	64789	36	Psychiatry	0	In state provider	None	23700 CAMINO DEL SOL	None	TORRANCE	CA	90505	5017	19	06037	33.8102385	-118.3441185	Los Angeles County
125038	Fee-for-Service	1447391719	1447391719	1	7	ASIAN HEALTH SERVICES	7/13/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	190 11TH STREET	None	OAKLAND	CA	94607	4841	01	06001	37.79986277	-122.2662421	Alameda County
125137	Fee-for-Service	1154324507	1154324507	1	1	AVERA QUEEN OF PEACE HOS	6/12/2006	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	525 N FOSTER ST	None	MITCHELL	SD	57301	2999	00	None	43.714188	-98.00739947	Davison County
125168	Fee-for-Service	1649500141	1649500141	1	1	ARCH HEALTH PARTNERS	12/28/2021	207P00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
125174	Fee-for-Service	1467485854	1467485854	1	1	AWAD, ABEER R MD	5/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	52776	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
125184	Fee-for-Service	1619474194	1619474194	1	1	ARASTU, DAANISH H MD	11/2/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	173579	None	None	0	In state provider	None	888 S HILL ROAD	None	VENTURA	CA	93003	8400	56	06111	34.26903979	-119.2062923	Ventura County
125189	Fee-for-Service	1114180643	1114180643	1	1	AYYAGARI, SRIKALA MD	10/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	118048	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
125218	Fee-for-Service	1265580252	1265580252	1	1	ALDER, ROBERTA A MD	8/31/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	24897	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
125279	Fee-for-Service	1609028703	1609028703	1	1	ALEX INC	8/8/2008	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1319 W BULLARD AVE	STE 6	FRESNO	CA	93711	2468	10	06019	36.82279535	-119.8156209	Fresno County
125326	Fee-for-Service	1447391719	1447391719	1	7	ASIAN HEALTH SERVICES	7/13/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	190 11TH STREET	None	OAKLAND	CA	94607	4841	01	06001	37.79986277	-122.2662421	Alameda County
125339	Fee-for-Service	1316964380	1316964380	1	1	AMINLARI, AMIR MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94415	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9300 CAMPUS POINT DR	None	LA JOLLA	CA	92307	1300	37	06073	32.877999	-117.225891	San Diego County
125363	Fee-for-Service	1396760120	1396760120	1	1	ASGARI, AZIZEH MD	2/9/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	48989	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
125410	Fee-for-Service	1508239930	1508239930	1	1	ACE AMBULETTE TRANSPORTATION	5/9/2016	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LLC	3294 CHERRY AVE	None	LONG BEACH	CA	90807	5214	19	06037	33.817068	-118.167611	Los Angeles County
125458	Fee-for-Service	1649500141	1649500141	1	1	ARCH HEALTH PARTNERS	4/8/2011	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
125461	Fee-for-Service	1962404723	1962404723	1	1	ALIABADI, DAVID G MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	69896	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
125480	Fee-for-Service	1811043839	1811043839	1	1	AMADOR, ERIC REY MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69277	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
125513	Fee-for-Service	1689846503	1689846503	1	1	AVA MEDICAL CORPORATION	4/8/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	80009	08	Family Practice	0	In state provider	None	1329 W WARNER AVE	None	SANTA ANA	CA	92704	5118	30	06059	33.7163182	-117.8857215	Orange County
125524	Fee-for-Service	1063930543	1063930543	1	1	ARTI C AMIN DPM INC	6/12/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1820 FULLERTON AVE.	SUITE 125	CORONA	CA	92881	7288	33	06065	33.858756	-117.5503465	Riverside County
125559	Fee-for-Service	1306284294	1306284294	1	1	ARORA, KERIN E MD	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137078	40	Pediatrics	0	In state provider	None	2734 EL CAMINO REAL	None	SANTA CLARA	CA	95051	3007	43	06085	37.35228637	-121.9754073	Santa Clara County
125583	Fee-for-Service	1962799189	1962799189	1	1	ABBAS, ZINA A MD	6/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145304	41	Internal Medicine	0	In state provider	None	435 H ST	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
125603	Fee-for-Service	1407021918	1407021918	1	1	ATTRI, NAVNEET MD	7/20/2009	207R00000X	NA	Other	026	PHYSICIANS	107672	41	Internal Medicine	0	In state provider	None	3883 AIRWAY DR	None	SANTA ROSA	CA	95403	1671	49	06097	38.483226	-122.739705	Sonoma County
125627	Fee-for-Service	1275505992	1275505992	1	1	ANTON, REIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
125628	Fee-for-Service	1770516882	1770516882	1	1	ANSELL, BENJAMIN J MD	5/31/1994	207R00000X	NA	Other	026	PHYSICIANS	77397	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0000	19	06037	34.06527974	-118.4462792	Los Angeles County
125641	Fee-for-Service	1972957678	1972957678	1	1	AU, CALVIN DO	6/11/2019	207P00000X	NA	Other	026	PHYSICIANS	16955	None	None	0	In state provider	None	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
125662	Fee-for-Service	1811367709	1811367709	1	1	APLA HEALTH & WELLNESS	12/12/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	1043 ELM AVENUE	STE 302	LONG BEACH	CA	90813	3295	19	06037	33.779655	-118.1880065	Los Angeles County
125683	Fee-for-Service	1245326040	1245326040	1	1	ANTHONY BOCK, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	15 HOSPITAL DR	None	YORK	ME	03909	1011	00	None	43.142589	-70.6516785	York County
125700	Fee-for-Service	1376883256	1376883256	1	1	AIDOO, GIFTY NP	11/29/2017	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3121 YOSEMITE BLVD.	SUITE D-2	MODESTO	CA	95354	4166	50	06099	37.63819029	-120.9367251	Stanislaus County
125715	Fee-for-Service	1114165057	1114165057	1	1	AMBALAL, ANEESH J MD	7/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111293	41	Internal Medicine	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
125741	Fee-for-Service	1235563677	1235563677	1	1	ALKAMALEE JABBAR, SAMEEHA F	8/12/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
125744	Fee-for-Service	1649500141	1649500141	1	1	ARCH HEALTH PARTNERS	12/28/2021	207P00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
125747	Fee-for-Service	1962404723	1962404723	1	1	ALIABADI, DAVID G MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	69896	01	General Practice	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
125764	Fee-for-Service	1740788744	1740788744	1	1	ADVENTIST HEALTH PHYSICIANS	9/18/2019	2086S0129X	NA	General Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	414 G	STE 112	MARYSVILLE	CA	95901	5663	58	06115	39.13913942	-121.5934649	Yuba County
125771	Fee-for-Service	1073786901	1073786901	1	1	ALL CARE HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	100 W BROADWAY	STE 810	GLENDALE	CA	91210	1227	19	06037	34.14643795	-118.2564824	Los Angeles County
125773	Fee-for-Service	1518388339	1518388339	1	1	ALVARADO-GARCIA, MARIA MD	4/26/2020	207R00000X	NA	Other	026	PHYSICIANS	155760	41	Internal Medicine	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
125797	Fee-for-Service	1174548622	1174548622	1	1	ALTMAN,RODNEY DOUGLAS MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	86323	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
125814	Fee-for-Service	1649855297	1649855297	1	1	AVY, LLC	4/29/2022	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1510 S CENTRAL AVE	SUITE 140	GLENDALE	CA	91204	3857	19	06037	34.12709764	-118.2577911	Los Angeles County
125839	Fee-for-Service	1659969574	1659969574	1	1	AGUILAR, ISAAC C PT	6/20/2022	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	403 W ADAMS BLVD	None	LOS ANGELES	CA	90007	2664	19	06037	34.02741539	-118.2743622	Los Angeles County
125850	Fee-for-Service	1063026508	1063026508	1	1	AMERICAN REGAL HOME CARE	5/26/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	18455 BURBANK BLVD	SUITE 314	TARZANA	CA	91356	6646	19	06037	34.17237215	-118.5354469	Los Angeles County
125879	Fee-for-Service	1457694796	1457694796	1	1	AVERY, JOHN A DO	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13586	41	Internal Medicine	0	In state provider	None	1023 NIPOMO ST	#110	SAN LUIS OBISPO	CA	93401	6155	40	06079	35.27897349	-120.6665371	San Luis Obispo County
125895	Fee-for-Service	1689738866	1689738866	1	1	AUSTIN, CHESTER J	6/1/2001	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	74402	08	Family Practice	0	In state provider	None	874 MAIN ST	None	FORTUNA	CA	95540	1926	12	06023	40.59801851	-124.158231	Humboldt County
125913	Fee-for-Service	1770310310	1770310310	1	1	ASHLEY PACULBA A MARRIAGE AN	9/18/2024	261QM0801X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NG SERVICES	35070 ORCHARD CREST CT	None	WINCHESTER	CA	92596	8418	33	06065	33.61517732	-117.096033	Riverside County
125928	Fee-for-Service	1992150098	1992150098	1	1	ASCIERTO, CRISTINA K LMFT	12/21/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	52863	-	NOT APPLICABLE	0	In state provider	None	103 SHORELINE PKWY	STE 201	SAN RAFAEL	CA	94901	5584	21	06041	37.9516451	-122.4933768	Marin County
125929	Fee-for-Service	1003109828	1003109828	1	1	ANACIUS, ELISABETH MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140385	01	General Practice	0	In state provider	None	333 MERCY AVENUE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
125950	Fee-for-Service	1811367709	1811367709	1	1	APLA HEALTH & WELLNESS	12/12/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	AFFILIATE	1043 ELM AVENUE	STE 302	LONG BEACH	CA	90813	3295	19	06037	33.779655	-118.1880065	Los Angeles County
125953	Fee-for-Service	1790193688	1790193688	1	1	ALY, DOAA G MD	6/9/2023	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	186329	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
125982	Fee-for-Service	1912499484	1912499484	1	1	ADVANCED SLEEP MEDICINE SERV	8/26/2019	261QS1200X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	ICES, INC.	730 N NORMA ST	STE C	RIDGECREST	CA	93555	3590	15	06029	35.634708	-117.6787245	Kern County
126034	Fee-for-Service	1649500141	1649500141	1	1	ARCH HEALTH PARTNERS	4/8/2011	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	37	06073	32.99706	-117.05544	San Diego County
126043	Fee-for-Service	1750594131	1750594131	1	1	AMMERMANN, MARIA THERESA NP	1/24/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	27201 TOURNEY RD	None	SANTA CLARITA	CA	91355	1854	19	06037	34.41741018	-118.5770409	Los Angeles County
126051	Fee-for-Service	1477968428	1477968428	2	1	ABDULLAH, MOHAMMAD A MD	2/10/2022	208M00000X	NA	Other	026	PHYSICIANS	171461	None	None	0	In state provider	None	820 E MOUNTAIN VIEW ST	None	BARSTOW	CA	92311	3004	36	06071	34.89327944	-117.0174383	San Bernardino County
126062	Fee-for-Service	1073786901	1073786901	1	1	ALL CARE HOSPICE	4/1/2008	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	100 W BROADWAY	STE 810	GLENDALE	CA	91210	1227	19	06037	34.14643795	-118.2564824	Los Angeles County
126147	Fee-for-Service	1063738110	1063738110	1	1	ACOSTA, DANIELLE NICOLE MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118573	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
126177	Fee-for-Service	1932214657	1932214657	1	8	AJAY G. MEKA M.D. INC.	9/11/2019	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	44	Public Health	0	In state provider	None	399 E HIGHLAND AVE	222	SAN BERNARDINO	CA	92404	3808	36	06071	34.1358627	-117.2757898	San Bernardino County
126221	Fee-for-Service	1659614303	1659614303	1	2	ARRIETA, IRIS R MD	8/27/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	12506	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1000 VALE TERRACE	None	VISTA	CA	92084	5218	37	06073	33.20904502	-117.2286439	San Diego County
126223	Fee-for-Service	1427392182	1427392182	1	1	ALLEE, BRANDI D MFT	12/3/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	87040	-	NOT APPLICABLE	0	In state provider	None	6244 EL CAJON BLVD	SUITE 15	SAN DIEGO	CA	92115	3918	37	06073	32.76342577	-117.0636924	San Diego County
126228	Fee-for-Service	1396892444	1396892444	1	1	ABEL TEWODROS M.D.	5/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13020 MERIDIAN AVE S	None	EVERETT	WA	98208	6468	00	None	47.8799292	-122.2332137	Snohomish County
126242	Fee-for-Service	1710408695	1710408695	1	2	ALTO PHARMACY LLC	3/27/2021	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	20 FAIRBANKS	STE 187	IRVINE	CA	92618	1673	30	06059	33.66099666	-117.7066132	Orange County
126249	Fee-for-Service	1497725261	1497725261	1	1	ALI, NESIB MD	9/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61789	08	Family Practice	0	In state provider	None	1700 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5115	36	06071	34.130214	-117.2788065	San Bernardino County
126273	Fee-for-Service	1598836520	1598836520	1	1	ABDOLLAHI, BEHNAM MD	2/8/2015	207ND0900X	NA	Dermatology	026	PHYSICIANS	67532	01	General Practice	0	In state provider	None	1400 W MCFADDEN AVE	None	SANTA ANA	CA	92704	3438	30	06059	33.73443251	-117.8870445	Orange County
126354	Fee-for-Service	1316554504	1316554504	1	1	ARONSEN COUNSELING SERVICES	3/17/2025	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	6717 MORRO ROAD	None	ATASCADERO	CA	93422	4429	40	06079	35.48268576	-120.6658099	San Luis Obispo County
126385	Fee-for-Service	1366544371	1366544371	1	1	AGUILAR, GABRIEL MD	4/1/1982	207W00000X	NA	Ophthalmology	026	PHYSICIANS	32877	18	Ophthalmology	0	In state provider	None	909 HYDE ST	STE 530	SAN FRANCISCO	CA	94109	4833	38	06075	37.78939387	-122.4170945	San Francisco County
126393	Fee-for-Service	1124524988	1124524988	1	1	AHMADIEH, NAZANIN MD	7/1/2024	390200000X	NA	Other	026	PHYSICIANS	22781	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
126397	Fee-for-Service	1023527975	1023527975	1	1	ALIAN, PHILIP D NP	1/30/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
126414	Fee-for-Service	1275979965	1275979965	1	1	ALLEN, JACQUELINE M MD	11/27/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144496	08	Family Practice	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
126428	Fee-for-Service	1487922712	1487922712	1	1	ANAND, SUMEET V DO	9/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11869	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
126455	Fee-for-Service	1255309696	1255309696	1	1	ADKINS, JEFFERY W MD	6/15/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75077	07	Dermatology	0	In state provider	None	5404 LAUREL HILLS DRIVE	None	SACRAMENTO	CA	95841	3106	34	06067	38.661669	-121.338675	Sacramento County
126464	Fee-for-Service	1932214657	1932214657	1	8	AJAY G. MEKA M.D. INC.	9/11/2019	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	399 E HIGHLAND AVE	222	SAN BERNARDINO	CA	92404	3808	36	06071	34.1358627	-117.2757898	San Bernardino County
126475	Fee-for-Service	1598905978	1598905978	1	1	ANANTH, LALITHA MD FACP INC	5/14/2009	193400000X	NA	Other	026	PHYSICIANS	40291	41	Internal Medicine	0	In state provider	None	11100 WARNER AVE	STE 304	FOUNTAIN VALLEY	CA	92708	7512	30	06059	33.716291	-117.9355051	Orange County
126534	Fee-for-Service	1164143020	1164143020	1	1	AMATA, LLC	9/25/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	222 W 6TH ST	None	CORONA	CA	92882	3301	33	06065	33.87558077	-117.5684235	Riverside County
126542	Fee-for-Service	1457912016	1457912016	1	1	AMBIKA-RAJENDRAN, MINU MD	1/25/2023	207R00000X	NA	Other	026	PHYSICIANS	181521	None	None	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
126560	Fee-for-Service	MSS00003F	None	1	1	ALTAMED HEALTH	7/1/1998	No Taxonomy Provided	NA	None	074	MULTIPURPOSE SENIOR SERVICES PROGRAM	-	-	NOT APPLICABLE	0	In state provider	SERV CORP	5425 POMONA BLVD	None	LOS ANGELES	CA	90022	1716	19	06037	34.03338446	-118.1488966	Los Angeles County
126635	Fee-for-Service	1336323971	1336323971	1	1	ADVANCED SURGICAL ASSOCIATES	8/17/2022	174400000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	3300 E SOUTH ST	#201	LONG BEACH	CA	90805	4588	19	06037	33.86018093	-118.1537163	Los Angeles County
126637	Fee-for-Service	1295269983	1295269983	1	1	ABBS, ELIZABETH S MD	1/3/2022	207R00000X	NA	Other	026	PHYSICIANS	159099	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
126652	Fee-for-Service	1518134923	1518134923	1	1	ASIMAKOPOULOS, FOTIOS MD	11/14/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	115772	68	Hematology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
126655	Fee-for-Service	1407898588	1407898588	1	1	ARTHUR M TAYLOR	3/1/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
126675	Fee-for-Service	1366880692	1366880692	1	1	ASTVATSATURYAN, KRISTINE MD	6/18/2019	207ZP0102X	NA	Other	026	PHYSICIANS	139202	22	Pathology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	ROOM 3719	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
126676	Fee-for-Service	1790116333	1790116333	1	1	AYE, THI THI MD	1/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129614	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
126680	Fee-for-Service	1043598378	1043598378	1	1	AZIM, SIDRA MD	9/24/2020	207RE0101X	NA	Endocrinology	026	PHYSICIANS	168957	67	Endocrinology	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
126687	Fee-for-Service	1568963288	1568963288	1	1	ACERO, VANESSA	7/15/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	893 PATRIOT DR	SUITE A	MOORPARK	CA	93021	3357	56	06111	34.27852938	-118.8627331	Ventura County
126699	Fee-for-Service	1922185248	1922185248	1	1	ALERT AMBULANCE SERVICE, INC	10/4/2015	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1290 WILSON RD	None	FALL RIVER	MA	02720	8604	00	None	41.737446	-71.1080235	Bristol County
126706	Fee-for-Service	1942529037	1942529037	1	1	ADVANCES IN MENTAL HEALTH& A	8/24/2024	103TB0200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	DDICTIONS TREATMENT, INC	18672 FLORIDA ST	#100	HUNTINGTON BEACH	CA	92648	1917	30	06059	33.691185	-117.9910425	Orange County
126717	Fee-for-Service	1487922712	1487922712	1	1	ANAND, SUMEET V DO	9/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	11869	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
126723	Fee-for-Service	1467644427	1467644427	1	1	ALCALA, HILDA J MD	1/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99618	05	Anesthesiology	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
126760	Fee-for-Service	1093963605	1093963605	1	1	ARYAFAR, HAMED MD	7/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99187	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
126766	Fee-for-Service	1235316936	1235316936	1	1	ANTHONY HUY TRAN	5/18/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	830 KEMPSVILLE RD	None	NORFOLK	VA	23502	3920	00	None	36.85158194	-76.19077823	Norfolk city
126789	Fee-for-Service	1639194095	1639194095	1	1	ARONSON, WILLIAM J MD	2/28/1992	208800000X	NA	Other	026	PHYSICIANS	64582	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
126860	Fee-for-Service	1952465791	1952465791	1	1	APPLEWOOD OPERATING COMPANY	1/3/2007	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	201 HARTNELL AVE	None	REDDING	CA	96002	1843	45	06089	40.56739956	-122.3690135	Shasta County
126874	Fee-for-Service	1619364908	1619364908	1	1	ABBOUD, STEVEN F MD	7/14/2021	207L00000X	NA	Other	026	PHYSICIANS	168206	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
126892	Fee-for-Service	1851680193	1851680193	1	1	ALIYEVA, CARMEN E	6/6/2011	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	500 OLD NEWPORT BLVD	STE 101	NEWPORT BEACH	CA	92663	4234	30	06059	33.62961361	-117.9255034	Orange County
126904	Fee-for-Service	1760463624	1760463624	1	1	AOKI, JEFFREY	9/1/1996	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	58464	08	Family Practice	0	In state provider	None	5727 N FRESNO ST	STE 101	FRESNO	CA	93710	6000	10	06019	36.821367	-119.7813455	Fresno County
126909	Fee-for-Service	1760418370	1760418370	1	1	ALERE HOME MONITORING, INC.	3/2/2015	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	6465 NATIONAL DRIVE	None	LIVERMORE	CA	94550	8808	01	06001	37.70074582	-121.7131241	Alameda County
126925	Fee-for-Service	1871543447	1871543447	1	1	AGNIESZKA J SILBERT, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	77 N AIRLITE ST	None	ELGIN	IL	60123	4912	00	None	42.03619743	-88.32792884	Kane County
126947	Fee-for-Service	1467023978	1467023978	1	1	ARAMS PHARMACY INC	5/3/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3716 SAN FERNANDO RD	None	GLENDALE	CA	91204	2919	19	06037	34.1246757	-118.2558008	Los Angeles County
126950	Fee-for-Service	1225395221	1225395221	1	1	AEBI, RACHEL L CO	5/9/2012	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	3520 E SHIELDS AVE	SUITE 102	FRESNO	CA	93726	6923	10	06019	36.77947947	-119.765781	Fresno County
126995	Fee-for-Service	1942529037	1942529037	1	1	ADVANCES IN MENTAL HEALTH& A	12/28/2018	103TB0200X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	DDICTIONS TREATMENT, INC	18672 FLORIDA ST	#100	HUNTINGTON BEACH	CA	92648	1917	30	06059	33.691185	-117.9910425	Orange County
127011	Fee-for-Service	1679014849	1679014849	1	1	ALY, SHERIF MD	10/1/2023	208600000X	NA	General Surgery	026	PHYSICIANS	189760	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
127032	Fee-for-Service	1932176146	1932176146	1	1	ADVENTIST HEALTH CALIF	8/27/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MEDICAL GRP INC	1530 RAILROAD AVE	None	ST HELENA	CA	94574	1106	28	06055	38.50733846	-122.4714652	Napa County
127068	Fee-for-Service	1568574994	1568574994	1	1	ALI, MIR M MD APC	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	36250	41	Internal Medicine	0	In state provider	None	3400 W BALL RD	STE 205	ANAHEIM	CA	92804	3737	30	06059	33.81724472	-118.0083216	Orange County
127077	Fee-for-Service	1306406277	1306406277	1	1	ALCOZIE, ABDUL KHALIQ MD	6/1/2024	207R00000X	NA	Other	026	PHYSICIANS	191705	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
127078	Fee-for-Service	1386352789	1386352789	1	2	ADEDURO, MICHAEL NP	10/2/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
127099	Fee-for-Service	1174066138	1174066138	1	1	ANDERSON, KATELYN E PHD	9/26/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
127102	Fee-for-Service	1043292584	1043292584	1	1	ADAMSON, ROBERT M MD	11/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	54880	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8008 FROST ST	STE 104	SAN DIEGO	CA	92123	4206	37	06073	32.80027859	-117.1524832	San Diego County
127127	Fee-for-Service	1093490021	1093490021	1	1	A TO Z PATIENT TRANSPORTATIO	8/14/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	N INC	9175 DATE ST	APT D	FONTANA	CA	92335	5657	36	06071	34.087203	-117.446594	San Bernardino County
127133	Fee-for-Service	1871112730	1871112730	1	1	ALKHUNAIZI, MANSOUR A MD	7/19/2024	207R00000X	NA	Other	026	PHYSICIANS	186086	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
127198	Fee-for-Service	1063875136	1063875136	1	1	ARBAR, MELISSA DO	9/15/2023	207L00000X	NA	Other	026	PHYSICIANS	15953	None	None	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
127226	Fee-for-Service	1902039902	1902039902	1	1	ABDERRAHMANE, SANAZ MD	9/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115623	77	Infectious Disease	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7098	34	06067	38.564991	-121.4696565	Sacramento County
127246	Fee-for-Service	1184827297	1184827297	1	1	AWADALLA, JOSEPH K MD	6/5/2023	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	47833	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
127270	Fee-for-Service	1134220403	1134220403	1	1	ARANT, REBECCA R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
127273	Fee-for-Service	1659860229	1659860229	1	1	ATALLAH, LIANA M MD	9/28/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	189919	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
127281	Fee-for-Service	1447444690	1447444690	1	1	ACLA DERMATOLOGY &	1/1/1979	193400000X	NA	Other	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	MEDICAL CLINIC	3701 STOCKER ST	STE 105	LOS ANGELES	CA	90008	5145	19	06037	34.00687315	-118.3375934	Los Angeles County
127282	Fee-for-Service	1942529037	1942529037	1	1	ADVANCES IN MENTAL HEALTH& A	12/28/2018	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	DDICTIONS TREATMENT, INC	18672 FLORIDA ST	#100	HUNTINGTON BEACH	CA	92648	1917	30	06059	33.691185	-117.9910425	Orange County
127289	Fee-for-Service	1376947648	1376947648	1	1	AMADEO, MICHAEL A NP	6/23/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
127308	Fee-for-Service	1942525423	1942525423	1	1	ALEXANDER, JESSE MD	6/18/2019	2085R0001X	NA	Other	026	PHYSICIANS	114416	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
127323	Fee-for-Service	1841502457	1841502457	1	1	ASHDJIAN, SHANT C MD	9/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119907	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
127334	Fee-for-Service	1821089830	1821089830	1	1	ALDEN HM HLTH CARE CORP	8/19/1997	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	ALDEN HOME HEALTH INC	1061 W AVENUE M14	STE A	PALMDALE	CA	93551	1430	19	06037	34.63305472	-118.1498743	Los Angeles County
127340	Fee-for-Service	1437538121	1437538121	1	1	ALDEA, INC	3/26/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1608 LAKE STREET	None	CALISTOGA	CA	94515	1359	28	06055	38.5840901	-122.5811973	Napa County
127354	Fee-for-Service	1568574994	1568574994	1	1	ALI, MIR M MD APC	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	36250	08	Family Practice	0	In state provider	None	3400 W BALL RD	STE 205	ANAHEIM	CA	92804	3737	30	06059	33.81724472	-118.0083216	Orange County
127374	Fee-for-Service	1124280391	1124280391	1	1	AGOSTINELLI, NICOLE R MD	7/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156148	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
127390	Fee-for-Service	1043292584	1043292584	1	1	ADAMSON, ROBERT M MD	11/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	54880	33	Thoracic Surgery	0	In state provider	None	8008 FROST ST	STE 104	SAN DIEGO	CA	92123	4206	37	06073	32.80027859	-117.1524832	San Diego County
127421	Fee-for-Service	1871112730	1871112730	1	1	ALKHUNAIZI, MANSOUR A MD	7/19/2024	207R00000X	NA	Other	026	PHYSICIANS	186086	70	Clinic (mixed specialty)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
127443	Fee-for-Service	1972773539	1972773539	1	2	ANWAR, ASMA MD	12/16/2020	207RH0003X	NA	Oncology	026	PHYSICIANS	113063	None	None	0	In state provider	None	540 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4230	42	06083	34.42739162	-119.7253175	Santa Barbara County
127463	Fee-for-Service	1043424880	1043424880	1	1	ALEXANDER, P ALICE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM STREET	SLOT 521	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
127481	Fee-for-Service	1487151973	1487151973	1	1	ARTIN, HEWA MD	6/8/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	163674	None	None	0	In state provider	None	300 UCLA MEDICAL PLAZA	3300	LOS ANGELES	CA	90095	8346	19	06037	34.06465655	-118.4461	Los Angeles County
127487	Fee-for-Service	1992244503	1992244503	1	1	ADVENTIST HEALTH PHYSICIANS	3/22/2018	261QU0200X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	301 SCIENCE DRIVE	STE 150	MOORPARK	CA	93021	2097	56	06111	34.27992368	-118.8694411	Ventura County
127503	Fee-for-Service	1457489502	1457489502	1	1	ALTA BATES SUMMIT MED CT	1/1/1995	283Q00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	ALTA BATES CAMPUS	1 COLBY PLAZA AT ASHBY	None	BERKELEY	CA	94705	0000	01	06001	37.856412	-122.2579485	Alameda County
127506	Fee-for-Service	1922171420	1922171420	1	1	AMOS, RONALD D PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1081 BORDEN RD	STE 101	ESCONDIDO	CA	92026	2162	37	06073	33.14681608	-117.1082977	San Diego County
127526	Fee-for-Service	1346531001	1346531001	1	1	AHMED, ABID H MD	1/29/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130555	41	Internal Medicine	0	In state provider	None	20 ALLEN STREET	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
127536	Fee-for-Service	1285678326	1285678326	1	1	ALLEN, EDWARD CHARLES MD	3/1/1984	174400000X	NA	Other	026	PHYSICIANS	39927	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3807 UNION AVE	None	BAKERSFIELD	CA	93305	2400	15	06029	35.394102	-119.0030165	Kern County
127571	Fee-for-Service	1942529037	1942529037	1	1	ADVANCES IN MENTAL HEALTH& A	12/28/2018	103TB0200X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	DDICTIONS TREATMENT, INC	18672 FLORIDA ST	#100	HUNTINGTON BEACH	CA	92648	1917	30	06059	33.691185	-117.9910425	Orange County
127574	Fee-for-Service	1184109605	1184109605	1	1	ALFONSO, JASMIN REHAM M	10/2/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
127577	Fee-for-Service	1407238835	1407238835	1	1	ANYAH, ANWULI DO	12/3/2020	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	18088	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
127583	Fee-for-Service	1487831145	1487831145	1	1	AGARWAL, NIKHIL MD	4/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	102503	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
127597	Fee-for-Service	1194020073	1194020073	1	2	ADVANCED HOME HEALTH	9/9/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	AND HOSPICE INC	855 HARTER PKWY	SUITE 380B	YUBA CITY	CA	95993	9452	51	06101	39.13848	-121.655494	Sutter County
127614	Fee-for-Service	1760670988	1760670988	1	1	AUEN, EDWARD L MD INC	12/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1401 SPANOS COURT	SUITE 122	MODESTO	CA	95355	2812	50	06099	37.66975543	-120.9724048	Stanislaus County
127617	Fee-for-Service	1336208255	1336208255	1	1	ASIAN PACIFIC HEALTH	1/1/2001	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CARE VENTURE, INC	1530 HILLHURST AVE	None	LOS ANGELES	CA	90027	5516	19	06037	34.098921	-118.287374	Los Angeles County
127635	Fee-for-Service	1083896013	1083896013	1	1	AYRES, JUSTIN B LMFT	1/7/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	461 W 6TH ST	STE 211	SAN PEDRO	CA	90731	2677	19	06037	33.73873948	-118.2868695	Los Angeles County
127643	Fee-for-Service	1780063487	1780063487	1	1	ALDEA, INC	3/26/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3000 NEWELL DRIVE	None	AMERICAN CANYON	CA	94503	1279	28	06055	38.16659006	-122.2404559	Napa County
127678	Fee-for-Service	1043292584	1043292584	1	1	ADAMSON, ROBERT M MD	11/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	54880	66	Emergency Medicine (Urgent Care)	0	In state provider	None	8008 FROST ST	STE 104	SAN DIEGO	CA	92123	4206	37	06073	32.80027859	-117.1524832	San Diego County
127745	Fee-for-Service	1518988377	1518988377	1	1	AKIN,MARIE-R0SE M MD	5/31/1987	207ZP0105X	NA	Other	026	PHYSICIANS	40441	22	Pathology (M.D. only)	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
127807	Fee-for-Service	1578837274	1578837274	1	1	ARMSTRONG-SUTTON, AVEN LUGH	9/12/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	125826	-	NOT APPLICABLE	0	In state provider	L MSW LCSW	8086 ORANGE AVE	None	FAIR OAKS	CA	95628	5941	34	06067	38.64735	-121.2650595	Sacramento County
127837	Fee-for-Service	1215053129	1215053129	1	1	AARONSON, DAVID S MD	7/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	95196	34	Urology and Urological Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
127857	Fee-for-Service	1942529037	1942529037	1	1	ADVANCES IN MENTAL HEALTH& A	12/28/2018	103TB0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	DDICTIONS TREATMENT, INC	18672 FLORIDA ST	#100	HUNTINGTON BEACH	CA	92648	1917	30	06059	33.691185	-117.9910425	Orange County
127888	Fee-for-Service	1194020073	1194020073	1	2	ADVANCED HOME HEALTH	9/9/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	AND HOSPICE INC	855 HARTER PKWY	SUITE 380B	YUBA CITY	CA	95993	9452	51	06101	39.13848	-121.655494	Sutter County
127894	Fee-for-Service	1558994665	1558994665	1	1	AMBIANCE TRANSPORTATION CO L	11/5/2020	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ION	6901 SAN FERNANDO RD	None	GLENDALE	CA	91201	1608	19	06037	34.17271104	-118.2976183	Los Angeles County
127900	Fee-for-Service	1730439035	1730439035	1	1	AMARILLAS, JASMIN LCSW	6/23/2020	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9000 MING AVE	STE L-1B	BAKERSFIELD	CA	93311	1318	15	06029	35.33989328	-119.1034715	Kern County
127903	Fee-for-Service	1336208255	1336208255	1	1	ASIAN PACIFIC HEALTH	1/1/2001	261QC1500X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CARE VENTURE, INC	1530 HILLHURST AVE	None	LOS ANGELES	CA	90027	5516	19	06037	34.098921	-118.287374	Los Angeles County
127917	Fee-for-Service	1891938122	1891938122	1	1	AHMC ANAHEIM REG MED CTR	7/1/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1111 W LA PALMA AVENUE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
127933	Fee-for-Service	1588693261	1588693261	1	1	AUNG, KAE T MD	12/8/2018	207R00000X	NA	Other	026	PHYSICIANS	73806	41	Internal Medicine	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
127975	Fee-for-Service	1710087655	1710087655	1	1	ARMENDARIZ, MARINA MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132715	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
128027	Fee-for-Service	1932214657	1932214657	1	6	AJAY G. MEKA M.D. INC.	7/19/2017	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3325 TYLER AVE	None	EL MONTE	CA	91731	3101	19	06037	34.069212	-118.0360275	Los Angeles County
128070	Fee-for-Service	1750355095	1750355095	1	1	AMEERALLY, EFFIDEEN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 W APACHE TRL	None	APACHE JCT	AZ	85220	3925	00	None	33.413931	-111.546837	Pinal County
128096	Fee-for-Service	1669765574	1669765574	1	1	ARMENION, REY LOUIE PT	6/25/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	13330 BLOOMFIELD AVE	STE 101	NORWALK	CA	90650	3259	19	06037	33.90988905	-118.0644875	Los Angeles County
128117	Fee-for-Service	1720257520	1720257520	1	1	AGRAWAL, REENA M MD	5/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	101328	25	Physical Medicine and Rehabilitation	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
128118	Fee-for-Service	1760544456	1760544456	1	2	AEGIS TREATMENT CENTERS, LLC	5/21/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	11041 E. VALLEY BOULEVAR	None	EL MONTE	CA	91731	2516	19	06037	34.07431877	-118.0338809	Los Angeles County
128125	Fee-for-Service	1790075026	1790075026	1	1	ALYONO, JENNIFER C MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123854	04	Otology, Laryngology, Rhinology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
128148	Fee-for-Service	1235589896	1235589896	1	1	ARNOLD, PETER PSYD	8/13/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5080 N FRUIT AVE	102	FRESNO	CA	93711	3062	10	06019	36.80974442	-119.8173823	Fresno County
128155	Fee-for-Service	1841721586	1841721586	1	1	ALLISON, ROBERT M MD	7/5/2023	207P00000X	NA	Other	026	PHYSICIANS	175468	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
128206	Fee-for-Service	1891938122	1891938122	1	1	AHMC ANAHEIM REG MED CTR	7/1/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	1111 W LA PALMA AVENUE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
128218	Fee-for-Service	1295110963	1295110963	1	1	ARASH A DINI MD MEDICAL CORP	1/29/2019	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	ORATION	4415 W PICO BLVD	None	LOS ANGELES	CA	90019	4242	19	06037	34.04825454	-118.3312406	Los Angeles County
128226	Fee-for-Service	1205078201	1205078201	1	1	ANTENUCCI, TODD J DO	12/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12310	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
128227	Fee-for-Service	1629021092	1629021092	1	1	AZINGE, ELIZABETH A MD	4/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85971	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
128239	Fee-for-Service	1699790139	1699790139	1	1	AHMAD, IRFAN MD	8/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51038	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
128244	Fee-for-Service	1649390949	1649390949	1	1	ADAMS, BONNIE	6/6/1988	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	9810 MARYKNOLL AVE	None	WHITTIER	CA	90605	2940	19	06037	33.94619182	-118.0408145	Los Angeles County
128248	Fee-for-Service	1376966648	1376966648	1	1	ALLEC, ROBIN L	11/2/2019	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	ER PRECIOUS PATHWAYS MID	18031 CA HWY 18	B	APPLE VALLEY	CA	92307	2152	36	06071	34.54008717	-117.2706344	San Bernardino County
128275	Fee-for-Service	1699741009	1699741009	1	1	ALEXANDRAKI, IRENE MD	7/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	85205	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
128308	Fee-for-Service	1457316374	1457316374	1	1	AKBARNIA, BEHROOZ A MD	3/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	39663	20	Orthopedic Surgery	0	In state provider	SAN DIEGO CNTR FOR SPINA	4130 LA JOLLA VILLAGE DR	STE 300	LA JOLLA	CA	92037	1481	37	06073	32.87194345	-117.2173414	San Diego County
128309	Fee-for-Service	1932826831	1932826831	1	1	A PLACE OF LOVE SENIOR	10/24/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	LIVING LLC	1360 N PALM AVE	None	HEMET	CA	92543	1896	33	06065	33.77043098	-116.9805251	Riverside County
128349	Fee-for-Service	1306290911	1306290911	1	1	AGUNBIADE, ABDULKAREEM MD	5/13/2020	207P00000X	NA	Other	026	PHYSICIANS	167710	66	Emergency Medicine (Urgent Care)	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
128356	Fee-for-Service	1992167886	1992167886	1	1	ALFARO QUEZADA, JOSE E MD	7/30/2021	208600000X	NA	General Surgery	026	PHYSICIANS	154966	None	None	0	In state provider	None	205 E RIVER PARK CIR	STE 460	FRESNO	CA	93720	1585	10	06019	36.85456375	-119.7863981	Fresno County
128386	Fee-for-Service	1689875478	1689875478	1	1	ALAMEDA COUNTY MED CTR	2/21/2001	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	NEWARK HEALTH CENTER	6066 CIVIC TERRACE AVE	None	NEWARK	CA	94560	3746	01	06001	37.53623835	-122.0285012	Alameda County
128401	Fee-for-Service	1760544456	1760544456	1	2	AEGIS TREATMENT CENTERS, LLC	5/21/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	11041 E. VALLEY BOULEVAR	None	EL MONTE	CA	91731	2516	19	06037	34.07431877	-118.0338809	Los Angeles County
128414	Fee-for-Service	1710115423	1710115423	1	1	ADAM BOSAK	4/7/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5750 W THUNDERBIRD RD	STE G780	GLENDALE	AZ	85306	4682	00	None	33.612507	-112.1822145	Maricopa County
128423	Fee-for-Service	1689832941	1689832941	1	1	ABRAMS, JOSEPH MD	8/24/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	178867	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
128427	Fee-for-Service	1265827505	1265827505	1	1	ALMLI, MARTA B MD	11/12/2019	207R00000X	NA	Other	026	PHYSICIANS	143696	41	Internal Medicine	0	In state provider	None	18460 ROSCOE BLVD	FL 3	NORTHRIDGE	CA	91325	4107	19	06037	34.22071454	-118.5357375	Los Angeles County
128431	Fee-for-Service	1619180569	1619180569	1	1	ALTHOEN, SINDA W MD	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88978	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	STE 700	ORANGE	CA	92868	4212	30	06059	33.78034779	-117.8655767	Orange County
128474	Fee-for-Service	1487838405	1487838405	1	1	ATKINS, GARY LCSW	5/11/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	75509	-	NOT APPLICABLE	0	In state provider	None	1260 E ARROW HIGHWAY	BLDGS B AND C	UPLAND	CA	91786	4982	36	06071	34.09953339	-117.6333297	San Bernardino County
128482	Fee-for-Service	1356117972	1356117972	1	1	APPLE URGENT CARE, INC.	3/4/2024	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	621 N STATE ST	A	SAN JACINTO	CA	92583	6567	33	06065	33.79501272	-116.9715035	Riverside County
128502	Fee-for-Service	1679580831	1679580831	1	1	ALDRETE, ANDRES M MD	10/1/2011	207P00000X	NA	Other	026	PHYSICIANS	78430	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 GRANT ROAD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
128524	Fee-for-Service	1699790139	1699790139	1	1	AHMAD, IRFAN MD	8/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51038	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
128535	Fee-for-Service	1811961204	1811961204	1	1	AFRASIABI, RAHMAT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	45530	41	Internal Medicine	0	In state provider	None	251 COHASSET RD	STE 310	CHICO	CA	95926	2239	04	06007	39.75090044	-121.8522609	Butte County
128545	Fee-for-Service	1053751875	1053751875	1	1	ALLEN, ASHLEY R MD	10/12/2024	207P00000X	NA	Other	026	PHYSICIANS	186620	70	Clinic (mixed specialty)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
128554	Fee-for-Service	1124111711	1124111711	1	1	AESTHETIC AND REFRACTIVE	8/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	71297	18	Ophthalmology	0	In state provider	SURGERY MEDICAL CENTER	455 O'CONNOR DR	STE 180	SAN JOSE	CA	95128	1632	43	06085	37.326654	-121.939897	Santa Clara County
128560	Fee-for-Service	1669764726	1669764726	1	1	AB SAFE HAVEN PALLIATIVE &	6/19/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE CARE INC	2855 TEMPLE AVENUE	SUITE B	SIGNAL HILL	CA	90755	2212	19	06037	33.809013	-118.1589655	Los Angeles County
128561	Fee-for-Service	1962996348	1962996348	1	1	ABDELATY, AMR H MD	1/20/2022	207R00000X	NA	Other	026	PHYSICIANS	174445	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
128581	Fee-for-Service	1275656662	1275656662	1	1	ABDELMALIK, ROBIN P MD	8/22/2008	207R00000X	NA	Other	026	PHYSICIANS	98113	41	Internal Medicine	0	In state provider	None	1310 W STEWART DRIVE	SUITE 410	ORANGE	CA	92868	3855	30	06059	33.78236048	-117.8664975	Orange County
128583	Fee-for-Service	1427349992	1427349992	1	1	ALLEN, CASSANDRA R LMFT	11/10/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14390 PARK AVE.	None	VICTORVILLE	CA	92392	2910	36	06071	34.512453	-117.324936	San Bernardino County
128586	Fee-for-Service	1063594372	1063594372	1	1	ANSARI, RASHAD A MD	7/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	52073	83	Rheumatology	0	In state provider	None	2023 W VISTA WAY	STE J	VISTA	CA	92083	6030	37	06073	33.18569169	-117.2846332	San Diego County
128597	Fee-for-Service	1457316374	1457316374	1	1	AKBARNIA, BEHROOZ A MD	3/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	39663	01	General Practice	0	In state provider	SAN DIEGO CNTR FOR SPINA	4130 LA JOLLA VILLAGE DR	STE 300	LA JOLLA	CA	92037	1481	37	06073	32.87194345	-117.2173414	San Diego County
128598	Fee-for-Service	1811160807	1811160807	1	1	AMERICAN WHEELCHAIR CENTER,	4/27/2012	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INC	605 SYCAMORE AVE	None	VISTA	CA	92043	7909	37	06073	33.16598794	-117.2153831	San Diego County
128620	Fee-for-Service	1518380203	1518380203	1	1	AYERZA, SONJA K LMFT	12/30/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST STREET	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
128630	Fee-for-Service	1851779425	1851779425	1	1	AHLERS, DANIEL M MD	8/13/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	149306	36	Psychiatry	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
128633	Fee-for-Service	1437517166	1437517166	1	1	ARISE CONGREGATE LIVING, INC	12/16/2019	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	12718 WEIDNER ST	None	PACOIMA	CA	91331	1137	19	06037	34.28215423	-118.410151	Los Angeles County
128636	Fee-for-Service	1750310967	1750310967	1	1	AU HARGRAVES, KATHERINE	11/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91202	66	Emergency Medicine (Urgent Care)	0	In state provider	T MD	14850 ROSCOE BLVD	None	PANORAMA CITY	CA	91402	4618	19	06037	34.22145548	-118.4566005	Los Angeles County
128637	Fee-for-Service	1295865426	1295865426	1	1	ANDREWS, HARRY B MD	8/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	31434	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
128650	Fee-for-Service	1295052249	1295052249	2	1	ARIANNA MEDICAL PHARMACY INC	10/21/2010	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3600 N VERDUGO RD	SUITE 103	GLENDALE	CA	91208	1243	19	06037	34.20395492	-118.2258507	Los Angeles County
128654	Fee-for-Service	1912572942	1912572942	1	1	AMERICAN RIVER INFUSION SERV	1/7/2022	3336H0001X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ICES	3855 N FREEWAY BLVD	STE. 110	SACRAMENTO	CA	95834	2934	34	06067	38.641014	-121.4861085	Sacramento County
128664	Fee-for-Service	1598268922	1598268922	1	1	ANM DIVERSIFIED INC	2/5/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5738 N LOLA AVE	None	FRESNO	CA	93722	2537	10	06019	36.8209475	-119.8913956	Fresno County
128669	Fee-for-Service	1871921692	1871921692	1	1	AFFINITY HOSPICE LLC	5/22/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5767 UPLANDER WAY	SUITE 208	CULVER CITY	CA	90230	6618	19	06037	33.98595974	-118.3849064	Los Angeles County
128670	Fee-for-Service	1649283557	1649283557	1	1	ALHAYYA, TAMEEM MD	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125541	41	Internal Medicine	0	In state provider	None	800 SOUTH MAIN STREET	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
128676	Fee-for-Service	1891808929	1891808929	1	1	ANTOS, MICHAEL D MD	7/31/1986	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	42909	40	Pediatrics	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
128681	Fee-for-Service	1336247592	1336247592	1	1	AGARWAL, SHWETA MD	1/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	98555	08	Family Practice	0	In state provider	None	2215 TRUXTUN AVENUE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
128701	Fee-for-Service	1255350351	1255350351	1	5	AMPLA HEALTH	1/23/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1231 PLUMAS ST	None	YUBA CITY	CA	95991	3410	51	06101	39.14838521	-121.617531	Sutter County
128706	Fee-for-Service	1427204023	1427204023	1	1	ABRAHAMSEN, AARON A MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107736	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6699	37	06073	32.61822301	-117.0234938	San Diego County
128709	Fee-for-Service	1396067500	1396067500	1	2	AAA COMPREHENSIVE HEALTHCARE	9/26/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	7451 N LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91605	2803	19	06037	34.20616081	-118.3878161	Los Angeles County
128743	Fee-for-Service	1730333014	1730333014	1	1	AGRAWAL, ASHISH T MD INC	12/29/2008	207RP1001X	NA	Pulmonology	026	PHYSICIANS	67061	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
128747	Fee-for-Service	1437885068	1437885068	1	1	ANA HOME HEALTH INC	11/19/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5315 LAUREL CANYON BLVD	STE 103	VALLEY VILLAGE	CA	91607	4914	19	06037	34.16713798	-118.3965446	Los Angeles County
128770	Fee-for-Service	1356117972	1356117972	1	1	APPLE URGENT CARE, INC.	3/4/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	621 N STATE ST	A	SAN JACINTO	CA	92583	6567	33	06065	33.79501272	-116.9715035	Riverside County
128800	Fee-for-Service	1952332025	1952332025	1	1	ALI, SYEDA M F MD MEDICAL	4/1/1999	261QM2500X	NA	Other	026	PHYSICIANS	64523	45	Nephrology (Renal-Kidney)	0	In state provider	CORPORATION	10 CONGRESS STREET	SUITE 507	PASADENA	CA	91105	3042	19	06037	34.13396893	-118.1528162	Los Angeles County
128806	Fee-for-Service	1053361501	1053361501	1	1	ABERLE, DENISE R MD	6/30/1992	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	49801	30	Radiology	0	In state provider	UCLA RADIOLOGY MED GRP	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
128829	Fee-for-Service	1154838118	1154838118	1	1	ALLEN, DANIELLE L	2/16/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
128832	Fee-for-Service	1053751875	1053751875	1	1	ALLEN, ASHLEY R MD	10/12/2024	207P00000X	NA	Other	026	PHYSICIANS	186620	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
128834	Fee-for-Service	1790823839	1790823839	1	1	ALMANZA, DIANE M OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 W LAMBERT RD	STE A	BREA	CA	92821	3936	30	06059	33.92474347	-117.901089	Orange County
128847	Fee-for-Service	1669764726	1669764726	1	1	AB SAFE HAVEN PALLIATIVE &	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE CARE INC	2855 TEMPLE AVENUE	SUITE B	SIGNAL HILL	CA	90755	2212	19	06037	33.809013	-118.1589655	Los Angeles County
128853	Fee-for-Service	1669680443	1669680443	1	1	AURORA MEDICAL CENTER OF	1/17/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SAN FERNANDO INC	405 N MACLAY AVE	STE 104	SAN FERNANDO	CA	91340	2455	19	06037	34.28673788	-118.4367207	Los Angeles County
128876	Fee-for-Service	1063594372	1063594372	1	1	ANSARI, RASHAD A MD	7/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	52073	22	Pathology (M.D. only)	0	In state provider	None	2023 W VISTA WAY	STE J	VISTA	CA	92083	6030	37	06073	33.18569169	-117.2846332	San Diego County
128911	Fee-for-Service	1497937460	1497937460	1	1	APARNATH, MALAYGIRI J MD	6/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105370	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
128914	Fee-for-Service	1467930149	1467930149	1	1	ARMSTRONG, THOMAS G LMSW	1/27/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
128926	Fee-for-Service	1730278656	1730278656	1	1	AM & BB IMAGING CENTER INC	6/1/2005	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	6010 HIDDEN VALLEY RD	SUITE 125	CARLSBAD	CA	92011	4213	37	06073	33.12288368	-117.3058276	San Diego County
128956	Fee-for-Service	1871921692	1871921692	1	1	AFFINITY HOSPICE LLC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5767 UPLANDER WAY	SUITE 208	CULVER CITY	CA	90230	6618	19	06037	33.98595974	-118.3849064	Los Angeles County
128990	Fee-for-Service	1255350351	1255350351	1	5	AMPLA HEALTH	1/23/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1231 PLUMAS ST	None	YUBA CITY	CA	95991	3410	51	06101	39.14838521	-121.617531	Sutter County
129003	Fee-for-Service	1336168707	1336168707	1	1	ADAJAR, ROMMEL U MD	11/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
129034	Fee-for-Service	1497783831	1497783831	1	1	AHN, SAM S MD	1/1/1982	2086S0129X	NA	General Surgery	026	PHYSICIANS	40241	01	General Practice	0	In state provider	None	2021 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2208	19	06037	34.02922048	-118.4793681	Los Angeles County
129055	Fee-for-Service	1356117972	1356117972	1	1	APPLE URGENT CARE, INC.	3/4/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	621 N STATE ST	A	SAN JACINTO	CA	92583	6567	33	06065	33.79501272	-116.9715035	Riverside County
129062	Fee-for-Service	1437227873	1437227873	1	1	ALAVYNEJAD, BABAK DPM	3/1/1996	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	INC	725 S ORANGE AVE	None	WEST COVINA	CA	91790	2614	19	06037	34.07079634	-117.9445034	Los Angeles County
129072	Fee-for-Service	1982010161	1982010161	1	1	ARKA LIMO LLC	3/25/2019	No Taxonomy Provided	NMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	13743 VICTORY BLVD	E	VAN NUYS	CA	91401	2316	19	06037	34.18669945	-118.432755	Los Angeles County
129080	Fee-for-Service	1154407856	1154407856	1	1	ADVANCED DERMATOLOGY	10/30/1986	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	07	Dermatology	0	In state provider	SURGICAL & MEDICAL GRP	3650 E SOUTH ST	STE 306	LAKEWOOD	CA	90712	1516	19	06037	33.8601747	-118.1494013	Los Angeles County
129089	Fee-for-Service	1952332025	1952332025	1	1	ALI, SYEDA M F MD MEDICAL	4/1/1999	261QM2500X	NA	Other	026	PHYSICIANS	64523	41	Internal Medicine	0	In state provider	CORPORATION	10 CONGRESS STREET	SUITE 507	PASADENA	CA	91105	3042	19	06037	34.13396893	-118.1528162	Los Angeles County
129100	Fee-for-Service	1477555472	1477555472	1	1	ARARAT HOME OF LA INC	12/6/1993	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	15099 MISSION HILLS RD	None	MISSION HILLS	CA	91345	1102	19	06037	34.28227018	-118.4628106	Los Angeles County
129172	Fee-for-Service	1457913402	1457913402	1	1	ASHOKKUMAR, SANDHYA MD	9/19/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
129191	Fee-for-Service	1932223781	1932223781	1	1	AIDS SERVICES FOUNDATION	4/8/2019	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	OF ORANGE CO	17982 SKY PARK CIR	STE J	IRVINE	CA	92614	6482	30	06059	33.68933118	-117.8596634	Orange County
129196	Fee-for-Service	1497937460	1497937460	1	1	APARNATH, MALAYGIRI J MD	6/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105370	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
129219	Fee-for-Service	1649698499	1649698499	1	1	AGAPOFF, JAMIE MD	4/4/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	152000	36	Psychiatry	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
129234	Fee-for-Service	1235337684	1235337684	1	1	AURAN, TIMOTHY L MD	7/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	88252	30	Radiology	0	In state provider	None	1310 LAS TABLAS	SUITE 103	TEMPLETON	CA	93465	9746	40	06079	35.55442349	-120.722643	San Luis Obispo County
129235	Fee-for-Service	1265661813	1265661813	1	1	AFZALI, EDRIS M MD	3/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124640	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13855 E 14TH ST	None	SAN LEANDRO	CA	94578	2611	01	06001	37.712385	-122.143428	Alameda County
129262	Fee-for-Service	1205033792	1205033792	1	1	ARIZPE-FERNANDEZ, MARISOL	9/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
129317	Fee-for-Service	1154422798	1154422798	1	1	ANASCO, MEGAN H OD	3/28/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
129323	Fee-for-Service	1013228113	1013228113	1	1	AARON L. HOLSINGER MD	10/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9850 ST LUKES DR	None	NAMPA	ID	83687	7912	00	None	43.618383	-116.5904145	Canyon County
129326	Fee-for-Service	1366921900	1366921900	2	1	ARNOLD, DUSTIN PSYD	6/19/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2651 E CHAPMAN AVE	STE 205	FULLERTON	CA	92831	3738	30	06059	33.87433553	-117.8829225	Orange County
129337	Fee-for-Service	1437213832	1437213832	1	1	ARTIST, KRISTINA M PHD	7/8/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY STREET	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
129345	Fee-for-Service	1356117972	1356117972	1	1	APPLE URGENT CARE, INC.	3/4/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	621 N STATE ST	A	SAN JACINTO	CA	92583	6567	33	06065	33.79501272	-116.9715035	Riverside County
129391	Fee-for-Service	1831146760	1831146760	1	1	ANDERSON, JILL E CRNA	12/19/2017	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
129439	Fee-for-Service	1811366644	1811366644	1	1	ALEXANDER, BRENTON S MD	8/5/2019	207L00000X	NA	Other	026	PHYSICIANS	145937	05	Anesthesiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
129451	Fee-for-Service	1043422694	1043422694	1	1	AMERICAN TRADE MARK CORP	3/5/2001	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	AMONG FRIENDS ADHC	851 S A ST	None	OXNARD	CA	93030	7139	56	06111	34.192629	-119.1786695	Ventura County
129463	Fee-for-Service	1376654756	1376654756	1	1	ADOBE MEDICAL GROUP INC	4/28/1998	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	31921 CAMINO CAPISTRANO	STE 19	SAN JUAN CAPO	CA	92675	3219	30	06059	33.498864	-117.662539	Orange County
129478	Fee-for-Service	1932223781	1932223781	1	1	AIDS SERVICES FOUNDATION	8/15/1989	251E00000X	NA	Other	073	AIDS WAIVER SERVICES	-	-	NOT APPLICABLE	0	In state provider	OF ORANGE CO	17982 SKY PARK CIR	STE J	IRVINE	CA	92614	6482	30	06059	33.68933118	-117.8596634	Orange County
129526	Fee-for-Service	1467403147	1467403147	1	1	ADEYANJU, JOHNSON O MD	10/31/1990	207R00000X	NA	Other	026	PHYSICIANS	49920	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
129527	Fee-for-Service	1770780447	1770780447	1	1	ANCHETA, WON-KAY L	6/22/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3900 E PACIFIC COAST HWY	None	LONG BEACH	CA	90804	2013	19	06037	33.78982251	-118.1462265	Los Angeles County
129537	Fee-for-Service	1679791248	1679791248	1	1	ANSELMO GARCIA MD	6/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9310 N CENTRAL AVE	STE 1	PHOENIX	AZ	85020	2418	00	None	33.570612	-112.0742325	Maricopa County
129604	Fee-for-Service	1578716098	1578716098	1	1	AU, ALVIN Y MD	4/30/1988	193400000X	NA	Other	026	PHYSICIANS	45911	10	Gastroenterology (M.D. only)	0	In state provider	None	1360 BAILEY DRIVE	None	HANFORD	CA	93230	5921	16	06031	36.32737465	-119.6660765	Kings County
129606	Fee-for-Service	1518978287	1518978287	1	1	AIJIAN, PETER C	2/28/1987	207P00000X	NA	Other	026	PHYSICIANS	39896	66	Emergency Medicine (Urgent Care)	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
129630	Fee-for-Service	1386890556	1386890556	1	1	ALBERT AMINI M.D.	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5240 E KNIGHT DR	STE 116	TUCSON	AZ	85712	2122	00	None	32.24889	-110.880729	Pima County
129642	Fee-for-Service	1487163309	1487163309	1	1	ALEXIS ALEXANDRIDIS MD INC	3/1/2018	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	246 PERKINS ST	None	SONOMA	CA	95476	6954	49	06097	38.2891423	-122.4629004	Sonoma County
129679	Fee-for-Service	1811120371	1811120371	1	1	ALEXANDER, SINDU MD	1/16/2018	2085N0904X	NA	Other	026	PHYSICIANS	113889	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
129686	Fee-for-Service	1346568052	1346568052	1	1	ALLEYNE, TRICIA S MD	2/4/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
129693	Fee-for-Service	1881640407	1881640407	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	450 E CYPRESS AVE	None	REDLANDS	CA	92373	6115	36	06071	34.04965529	-117.1723119	San Bernardino County
129764	Fee-for-Service	1477542678	1477542678	1	1	AHN, ESTHER L OD	5/25/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11900 SOUTH STREET	STE 121	CERRITOS	CA	90703	6800	19	06037	33.85844949	-118.079559	Los Angeles County
129768	Fee-for-Service	1891180972	1891180972	1	1	AMIN, MAYANK H DO	6/13/2020	207R00000X	NA	Other	026	PHYSICIANS	16378	41	Internal Medicine	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
129770	Fee-for-Service	1477061745	1477061745	1	1	ACTIVE CARE PHARMACY INC	4/23/2018	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17050 BUSHARD ST	STE 300	FOUNTAIN VALLEY	CA	92708	2832	30	06059	33.71510531	-117.9630777	Orange County
129811	Fee-for-Service	1467403147	1467403147	1	1	ADEYANJU, JOHNSON O MD	10/31/1990	207R00000X	NA	Other	026	PHYSICIANS	49920	41	Internal Medicine	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
129884	Fee-for-Service	1730152711	1730152711	1	1	AZARI, KODI K MD	10/9/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83352	20	Orthopedic Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
129898	Fee-for-Service	1043356850	1043356850	1	1	AHMAD, BUSHRA F MD	12/3/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	73057	-	NOT APPLICABLE	0	In state provider	None	1295 W STATE ST	SUITES 101-106	EL CENTRO	CA	92243	2881	13	06025	32.79169087	-115.5674379	Imperial County
129904	Fee-for-Service	1427011212	1427011212	1	1	APPLESTEIN, JEFFREY M MD	12/1/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	34043	41	Internal Medicine	0	In state provider	None	9844 GENESEE AVE	STE 400	LA JOLLA	CA	92037	1209	37	06073	32.883714	-117.2266425	San Diego County
129925	Fee-for-Service	1477636405	1477636405	1	1	ALTHOUSE, RAPH G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	21601 76TH AVE W	None	EDMONDS	WA	98026	7507	00	None	47.803239	-122.335652	Snohomish County
129946	Fee-for-Service	1811184237	1811184237	1	1	AMOOIE, ADRIAN A MD	4/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101428	41	Internal Medicine	0	In state provider	None	1025 W OLYMPIC BLVD	None	LOS ANGELES	CA	90015	1319	19	06037	34.04624254	-118.267606	Los Angeles County
129954	Fee-for-Service	1073873220	1073873220	1	1	AHMED, AMEERA J MD	9/9/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	141720	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
129988	Fee-for-Service	1912592346	1912592346	1	1	ANDRADE, PERLA E LPCC	1/28/2025	No Taxonomy Provided	NA	None	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SERVICES	12936 OSBORNE ST	None	PACOIMA	CA	91331	3337	19	06037	34.25015343	-118.4149757	Los Angeles County
130027	Fee-for-Service	1497176309	1497176309	1	1	AMERICAN HOSPICE AND HOME	4/29/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTH CARE SERVICES INC	6850 REGIONAL STREET	SUITE 100B	DUBLIN	CA	94568	2939	01	06001	37.70205259	-121.933262	Alameda County
130034	Fee-for-Service	1487953865	1487953865	1	1	ALEXANDER, KEVIN M MD	5/22/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	154090	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
130089	Fee-for-Service	1255463725	1255463725	1	1	ARRON, SARAH T MD	4/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88721	07	Dermatology	0	In state provider	None	1701 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3011	38	06075	37.78553106	-122.4399475	San Francisco County
130117	Fee-for-Service	1730798836	1730798836	1	1	ALL LIVES MATTER HOSPICE	2/25/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1254 S WATERMAN AVE	STE 45	SAN BERNARDINO	CA	92408	2858	36	06071	34.07886	-117.278817	San Bernardino County
130127	Fee-for-Service	1053303933	1053303933	1	1	AN, CHARLENE H MD	10/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148153	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
130151	Fee-for-Service	1295835916	1295835916	1	1	ARMON, CARMEL MD	1/3/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	49306	None	None	0	In state provider	None	11370 ANDERSON ST	STE B100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
130191	Fee-for-Service	1427011212	1427011212	1	1	APPLESTEIN, JEFFREY M MD	12/1/1977	No Taxonomy Provided	NA	None	026	PHYSICIANS	34043	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	9844 GENESEE AVE	STE 400	LA JOLLA	CA	92037	1209	37	06073	32.883714	-117.2266425	San Diego County
130253	Fee-for-Service	1831508381	1831508381	1	1	ALONSO, CARINA A	8/3/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
130264	Fee-for-Service	1104188697	1104188697	1	1	ARTHUR, NICOLE D MD	10/28/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	178811	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
130267	Fee-for-Service	1841242351	1841242351	1	1	ALLEN, CHRISTINA R MD	7/24/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79907	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
130302	Fee-for-Service	1568509321	1568509321	1	1	ANGEL VIEW INC	9/25/1997	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	66897 CAHUILLA AVE	None	DESERT HOT SPRING	CA	92240	4055	33	06065	33.9586456	-116.493934	Riverside County
130322	Fee-for-Service	1487953865	1487953865	1	1	ALEXANDER, KEVIN M MD	5/22/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	154090	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
130335	Fee-for-Service	1780628875	1780628875	1	1	ARAB, MEHDI K MD	8/9/2005	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	42130	None	None	0	In state provider	None	6555 COYLE AVE	STE 200	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
130347	Fee-for-Service	1528146180	1528146180	1	1	AHN, JAMES MD	6/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	62745	01	General Practice	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
130354	Fee-for-Service	1053906347	1053906347	1	1	ANNON, JEFFREY J LMFT	4/7/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
130375	Fee-for-Service	1881776060	1881776060	1	1	ANAND, AARTHI MD	5/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	95944	01	General Practice	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CRUZ	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
130404	Fee-for-Service	1730798836	1730798836	1	1	ALL LIVES MATTER HOSPICE	2/25/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1254 S WATERMAN AVE	STE 45	SAN BERNARDINO	CA	92408	2858	36	06071	34.07886	-117.278817	San Bernardino County
130415	Fee-for-Service	1568991073	1568991073	1	1	ALBRIGHT, JOSEPH P DPM	7/30/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	47 PENNY LN STE 1	None	WATSONVILLE	CA	95076	6055	44	06087	36.92995246	-121.778301	Santa Cruz County
130427	Fee-for-Service	1669911574	1669911574	1	1	AHMED, SAIF	10/31/2023	208600000X	NA	General Surgery	026	PHYSICIANS	19439	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
130443	Fee-for-Service	1477548709	1477548709	1	1	AZCARRAGA, ROBERTO MD	7/31/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	72793	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1234 EMPIRE ST	None	FAIRFIELD	CA	94533	5711	48	06095	38.25037548	-122.049045	Solano County
130446	Fee-for-Service	1558910299	1558910299	1	1	AGUIRRE, DESTINY LMFT	11/8/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
130485	Fee-for-Service	1679060495	1679060495	1	1	ASAMOAH, JULINE ADELLE A MD	7/28/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	180553	None	None	0	In state provider	None	514 N. PROSPECT AVE	None	REDONDO BEACH	CA	90277	3036	19	06037	33.85253987	-118.3796668	Los Angeles County
130495	Fee-for-Service	1538217310	1538217310	1	1	AHMED, SYED A MD	3/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93321	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
130506	Fee-for-Service	1225404528	1225404528	1	1	ARIF, SALMAN MD	8/12/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
130508	Fee-for-Service	1548790926	1548790926	1	1	ANDAYA, MICHAEL MD	8/17/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	158628	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
130510	Fee-for-Service	1447391719	1447391719	1	1	ASIAN HEALTH SERVICES	1/2/1992	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	818 WEBSTER ST	None	OAKLAND	CA	94607	4220	01	06001	37.79946052	-122.2711864	Alameda County
130520	Fee-for-Service	1538574660	1538574660	1	2	AMAR SIDDIQUE MD INC	7/3/2021	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	726 N MEDICAL CENTER DR	STE 205	CLOVIS	CA	93611	6886	10	06019	36.84186593	-119.6624867	Fresno County
130660	Fee-for-Service	1457599185	1457599185	1	1	AL-NAHHAL, RAMY I MD	6/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109554	41	Internal Medicine	0	In state provider	None	1230 JEFFERSON ST	None	DELANO	CA	93215	2204	15	06029	35.77274103	-119.2450573	Kern County
130667	Fee-for-Service	1992403349	1992403349	1	2	ASHWANI KUMAR MD A PROFESSIO	3/16/2023	193400000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	NAL CORPORATION	3550 CHURN CREEK RD	None	REDDING	CA	96002	2718	45	06089	40.55569803	-122.3530101	Shasta County
130724	Fee-for-Service	1124254933	1124254933	1	1	ABRAHAM, RONNIE M MD	2/21/2020	207ZP0102X	NA	Other	026	PHYSICIANS	159083	22	Pathology (M.D. only)	0	In state provider	None	3440 EMPRESA DR	SUITE B	SAN LUIS OBISPO	CA	93401	7345	40	06079	35.253333	-120.667047	San Luis Obispo County
130742	Fee-for-Service	1134878432	1134878432	1	1	ALN HOLDINGS INC	5/2/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11755 VICTORY BLVD	STE 102	NORTH HOLLYWOOD	CA	91606	3448	19	06037	34.18670448	-118.389699	Los Angeles County
130747	Fee-for-Service	1255350351	1255350351	1	2	AMPLA HEALTH	5/8/2024	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	355 SAMUEL DR	None	YUBA CITY	CA	95991	6324	51	06101	39.12322541	-121.6100736	Sutter County
130793	Fee-for-Service	1225404528	1225404528	1	1	ARIF, SALMAN MD	8/12/2024	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	-	77	Infectious Disease	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
130798	Fee-for-Service	1447391719	1447391719	1	1	ASIAN HEALTH SERVICES	1/2/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	818 WEBSTER ST	None	OAKLAND	CA	94607	4220	01	06001	37.79946052	-122.2711864	Alameda County
130814	Fee-for-Service	1538574660	1538574660	1	2	AMAR SIDDIQUE MD INC	7/3/2021	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	726 N MEDICAL CENTER DR	STE 205	CLOVIS	CA	93611	6886	10	06019	36.84186593	-119.6624867	Fresno County
130913	Fee-for-Service	1497073993	1497073993	1	1	AKMAN, MITCHELL S MD INC	8/4/2010	207RE0101X	NA	Endocrinology	026	PHYSICIANS	54308	None	None	0	In state provider	None	1555 EAST ST	STE 300	REDDING	CA	96001	1153	45	06089	40.58440354	-122.3880021	Shasta County
130931	Fee-for-Service	1437196094	1437196094	1	1	AUERHAN,LEE ANN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4231 W 16TH AVE	None	DENVER	CO	80204	1335	00	None	39.74280302	-105.0412741	City and County of Denver
130945	Fee-for-Service	1811410244	1811410244	1	1	ABDIRAHMAN, HAMDI H MD	12/18/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169817	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
130946	Fee-for-Service	1326235458	1326235458	1	1	ALGAZE YOJAY, CLAUDIA MD	5/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	107822	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
130968	Fee-for-Service	1104129485	1104129485	1	1	ARELLANO, JACQUELINE LAC	2/25/2021	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
130980	Fee-for-Service	1548208812	1548208812	1	1	ASUDANI, DEEPAK G MD	12/1/2008	207R00000X	NA	Other	026	PHYSICIANS	100515	41	Internal Medicine	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
130994	Fee-for-Service	1992773311	1992773311	1	1	ALFREY, EDWARD J MD	12/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	72742	None	None	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
131024	Fee-for-Service	1255350351	1255350351	1	1	AMPLA HEALTH	7/1/1994	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	355 SAMUEL DR	None	YUBA CITY	CA	95991	6324	51	06101	39.12322541	-121.6100736	Sutter County
131064	Fee-for-Service	1518544733	1518544733	1	1	AKBARSHAHI, NATALY K MD	9/3/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	19	06037	34.06704253	-118.3835029	Los Angeles County
131071	Fee-for-Service	1932577434	1932577434	1	1	ARROLIGA, MATEO S CRNA	2/26/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
131087	Fee-for-Service	1447391719	1447391719	1	1	ASIAN HEALTH SERVICES	2/14/2019	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	818 WEBSTER ST	None	OAKLAND	CA	94607	4220	01	06001	37.79946052	-122.2711864	Alameda County
131090	Fee-for-Service	1578806089	1578806089	1	1	ALEXANIAN, DAVID	2/18/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	135986	10	Gastroenterology (M.D. only)	0	In state provider	None	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	19	06037	34.13101049	-118.151532	Los Angeles County
131092	Fee-for-Service	1124528104	1124528104	1	1	AJIFU - TULLY, SARA A LCSW	2/7/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
131093	Fee-for-Service	1255934493	1255934493	1	1	AMIN, VANISHA PT	1/10/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7525 METROPOLITAN DR	STE 306	SAN DIEGO	CA	92108	4404	37	06073	32.77677653	-117.1592911	San Diego County
131096	Fee-for-Service	1538574660	1538574660	1	2	AMAR SIDDIQUE MD INC	9/21/2021	2080N0001X	NA	Pediatric Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	726 N MEDICAL CENTER DR	STE 205	CLOVIS	CA	93611	6886	10	06019	36.84186593	-119.6624867	Fresno County
131142	Fee-for-Service	1780118554	1780118554	1	1	ADASTRA HEALTH CARE INC	9/14/2018	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	20453 ELKWOOD ST	None	WINNETKA	CA	91306	2233	19	06037	34.21239151	-118.57905	Los Angeles County
131232	Fee-for-Service	1861633851	1861633851	1	1	AGARWAL, ASHOK K MD INC	5/10/2017	174400000X	NA	Other	026	PHYSICIANS	42204	01	General Practice	0	In state provider	None	136 S SAN JACINTO ST	None	HEMET	CA	92543	4503	33	06065	33.72936811	-116.9586194	Riverside County
131233	Fee-for-Service	1326235458	1326235458	1	1	ALGAZE YOJAY, CLAUDIA MD	5/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	107822	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
131241	Fee-for-Service	1194354399	1194354399	1	1	ABRAHAM, TINU MD	1/16/2024	207R00000X	NA	Other	026	PHYSICIANS	187252	None	None	0	In state provider	None	6001 NORRIS CANYON RD	None	SAN RAMON	CA	94583	5400	07	06013	37.7755858	-121.958923	Contra Costa County
131245	Fee-for-Service	1205394756	1205394756	1	1	ARMITAGE, ANGEL D	8/9/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	280 SHASTA AVENUE	None	MORRO BAY	CA	93442	2734	40	06079	35.35760482	-120.8463981	San Luis Obispo County
131274	Fee-for-Service	1982086278	1982086278	1	1	AVALOS, JOSE A NP	9/18/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
131294	Fee-for-Service	1104182468	1104182468	1	1	ATLURI, RAO L MD INC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	29778	41	Internal Medicine	0	In state provider	None	14051 E RAMONA PKWY	None	BALDWIN PARK	CA	91706	4114	19	06037	34.08521541	-117.9674931	Los Angeles County
131310	Fee-for-Service	1881605640	1881605640	1	1	ANTONY, JOSEPH G MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	79048	05	Anesthesiology	0	In state provider	None	1801 HANOVER DR	STE F	DAVIS	CA	95616	1067	57	06113	38.55895232	-121.7567316	Yolo County
131312	Fee-for-Service	1255350351	1255350351	1	1	AMPLA HEALTH	9/1/1992	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	355 SAMUEL DR	None	YUBA CITY	CA	95991	6324	51	06101	39.12322541	-121.6100736	Sutter County
131332	Fee-for-Service	1528332889	1528332889	1	1	ADVANCED SLEEP MEDICINE SRVS	7/3/2018	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	104 E OLIVE AVE	SUITE 104	REDLANDS	CA	92373	5255	36	06071	34.0540723	-117.1800104	San Bernardino County
131336	Fee-for-Service	1811990708	1811990708	1	1	ALI, MOSHIN MD	9/17/2009	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	36319	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5451 LA PALMA AVE	STE 16	LA PALMA	CA	90623	1729	30	06059	33.84643146	-118.038843	Orange County
131434	Fee-for-Service	1457855975	1457855975	1	1	ATTAIE, SHEILA M DO	11/1/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17715	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
131441	Fee-for-Service	1285811992	1285811992	1	1	ALVARADO EMERGENCY MEDICAL	3/1/2008	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	ASSOCIATES INC	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
131457	Fee-for-Service	1720494578	1720494578	1	1	A GRACEFUL WAY LLC	7/14/2014	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	6307 5TH AVENUE	None	LOS ANGELES	CA	90043	4257	19	06037	33.98274816	-118.322613	Los Angeles County
131490	Fee-for-Service	1477021244	1477021244	1	1	AMERICAN COMPASSIONATE	7/29/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE CARE INC	5531 BUSINESS PARK SOUTH	202A	BAKERSFIELD	CA	93309	1667	15	06029	35.35738668	-119.0601246	Kern County
131523	Fee-for-Service	1053306795	1053306795	1	1	ASHCROFT, ANDREW B MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	96865	08	Family Practice	0	In state provider	None	1301 SOUTHPOINT BLVD	STE A	PETALUMA	CA	94954	6858	49	06097	38.26109022	-122.6476782	Sonoma County
131532	Fee-for-Service	1205394756	1205394756	1	1	ARMITAGE, ANGEL D	8/9/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	280 SHASTA AVENUE	None	MORRO BAY	CA	93442	2734	40	06079	35.35760482	-120.8463981	San Luis Obispo County
131533	Fee-for-Service	1841203163	1841203163	1	1	AZIMI, SOHEIL MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	64730	None	None	0	In state provider	None	11303 W WASHINGTON BLVD	STE 100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
131534	Fee-for-Service	1760021026	1760021026	1	1	ALVAREZ, AMANDA K CNP	2/25/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3327 ROSECRANS ST	None	SAN DIEGO	CA	92110	4223	37	06073	32.74779742	-117.2076448	San Diego County
131539	Fee-for-Service	1720067333	1720067333	1	1	ABEDI, PARASTOU MD	6/8/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79258	18	Ophthalmology	0	In state provider	None	15 MAREBLU	STE 260	ALISO VIEJO	CA	92656	3056	30	06059	33.5729913	-117.703431	Orange County
131599	Fee-for-Service	1255350351	1255350351	1	1	AMPLA HEALTH	9/1/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	355 SAMUEL DR	None	YUBA CITY	CA	95991	6324	51	06101	39.12322541	-121.6100736	Sutter County
131606	Fee-for-Service	1497743702	1497743702	1	1	ABROMS, ADAM D MD	10/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	73707	18	Ophthalmology	0	In state provider	None	628 CALIFORNIA BLVD	STE C	SAN LUIS OBISPO	CA	93401	2547	40	06079	35.28917428	-120.6578269	San Luis Obispo County
131621	Fee-for-Service	1861662124	1861662124	1	1	AGUILERA, ERIKA LPCC	12/12/2022	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
131622	Fee-for-Service	1811082852	1811082852	1	1	ANDERSON, CHERYL D LMFT	12/12/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1675 PERMANENTE WY	None	NAPA	CA	94558	3338	28	06055	38.32058088	-122.3044116	Napa County
131624	Fee-for-Service	1760133292	1760133292	1	1	ABOFF, ALYSSA H CRNA	7/26/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
131677	Fee-for-Service	1205876760	1205876760	1	1	ADAMS-BERRY, KATHY L MD	3/13/2016	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	82301	None	None	0	In state provider	None	6444 COYLE AVE	STE 3	CARMICHAEL	CA	95608	6337	34	06067	38.667807	-121.3129395	Sacramento County
131708	Fee-for-Service	1760409049	1760409049	1	1	AJAYI, OLAKUNLE O MD	3/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	81125	02	General Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
131748	Fee-for-Service	1932527116	1932527116	1	1	ANDLER, CAROLINE F MD	6/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142393	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
131777	Fee-for-Service	1477021244	1477021244	1	1	AMERICAN COMPASSIONATE	7/29/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE CARE INC	5531 BUSINESS PARK SOUTH	202A	BAKERSFIELD	CA	93309	1667	15	06029	35.35738668	-119.0601246	Kern County
131785	Fee-for-Service	1740640051	1740640051	1	1	AACHI, VENKAT RAGHAV MD	10/26/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	155273	None	None	0	In state provider	None	2190 LYNN RD	SUITE 380	THOUSAND OAKS	CA	91360	1856	56	06111	34.20728091	-118.8855456	Ventura County
131813	Fee-for-Service	1376621011	1376621011	1	1	ABERRA, OLANA MD	8/5/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85296	01	General Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
131829	Fee-for-Service	1245697713	1245697713	1	1	AUGUSTINE, STEVEN B CNP	9/19/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
131830	Fee-for-Service	1487609939	1487609939	1	2	ALTERMAN, RUSSELL S DO	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	6838	None	None	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
131831	Fee-for-Service	1023222171	1023222171	1	1	ALPHA RESPIRATORY INC	10/23/2007	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	LINCARE	843 PARALLEL ROAD	None	LAKEPORT	CA	95453	5707	17	06033	39.03804825	-122.9285143	Lake County
131858	Fee-for-Service	1790039733	1790039733	1	1	ABDELAZIZ, AHMED A MD	10/17/2016	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	142800	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1418 E MAIN ST	SUITE 210	SANTA MARIA	CA	93454	4836	42	06083	34.95286855	-120.4137315	Santa Barbara County
131931	Fee-for-Service	1467790774	1467790774	1	1	ADVENTIST HEALTH PHYSICIANS	4/9/2013	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	115 HOSPITAL DR	None	UKIAH	CA	95482	4591	23	06045	39.15095011	-123.2032368	Mendocino County
131951	Fee-for-Service	1306360987	1306360987	1	1	ASJK, LLC	9/1/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2043 19TH AVE	None	SAN FRANCISCO	CA	94116	1253	38	06075	37.74965673	-122.4761431	San Francisco County
131956	Fee-for-Service	1457847873	1457847873	1	1	ARRIAGA, IVAN PT	9/5/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
131998	Fee-for-Service	1437412905	1437412905	1	1	ADVENTIST HEALTH PHYSICIANS	11/8/2012	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	801 S CHEVY CHASE DR	SUITE 102	GLENDALE	CA	91205	4437	19	06037	34.136757	-118.2396195	Los Angeles County
132004	Fee-for-Service	1669631529	1669631529	1	1	ANG, RODERICK T MD	11/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106878	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
132019	Fee-for-Service	1134350572	1134350572	1	2	ANG, AIMEE S MD	11/19/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	129729	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
132081	Fee-for-Service	1851533905	1851533905	1	1	AN, JASON MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113121	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4199	33	06065	33.9760587	-117.3800672	Riverside County
132082	Fee-for-Service	1245444983	1245444983	1	1	ATLURI, DILEEP K MD	9/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	148765	10	Gastroenterology (M.D. only)	0	In state provider	None	6555 COYLE AVE	STE 330	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
132094	Fee-for-Service	1184375859	1184375859	1	1	AZONWU, CHARLENE N NP	2/22/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
132111	Fee-for-Service	1710483060	1710483060	1	1	ASADI, AMRAN K MD	4/23/2024	207L00000X	NA	Other	026	PHYSICIANS	163542	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
132142	Fee-for-Service	1376736397	1376736397	1	1	AIKEN, ALLISON M MD	4/12/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	136557	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
132197	Fee-for-Service	1568586774	1568586774	1	1	ANDERSON, MEGAN L MD	9/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112093	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
132243	Fee-for-Service	1730137043	1730137043	1	1	AMMIRATI, MARIO MD	9/27/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	46168	14	Neurological Surgery	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
132249	Fee-for-Service	1134477599	1134477599	1	1	ALI, MAHBOOB MD	1/13/2022	207R00000X	NA	Other	026	PHYSICIANS	147096	None	None	0	In state provider	None	1801 E MARCH LN	A-170	STOCKTON	CA	95210	6629	39	06077	38.00315652	-121.2868715	San Joaquin County
132272	Fee-for-Service	1811006489	1811006489	2	1	APRIA HEALTHCARE LLC	7/11/2019	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	815 MARLBOROUGH AVE	SUITE 200	RIVERSIDE	CA	92507	2187	33	06065	33.99750012	-117.3283585	Riverside County
132294	Fee-for-Service	1013466093	1013466093	1	1	ARROWHEAD EYE ASSOCIATES INC	8/21/2020	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	10837 LAUREL ST	SUITE 103	RANCHO CUCAMONGA	CA	91730	7643	36	06071	34.10480629	-117.5685104	San Bernardino County
132305	Fee-for-Service	1083660088	1083660088	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	38727 TIERRA SUBIDA AVE	None	PALMDALE	CA	93551	4248	19	06037	34.586091	-118.147518	Los Angeles County
132317	Fee-for-Service	1598770380	1598770380	1	1	ADVANCED SURGICAL INSTITUTE	6/7/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	14418 W MEEKER BLVD	STE 202	SUN CITY WEST	AZ	85375	5291	00	None	33.65982	-112.3699545	Maricopa County
132345	Fee-for-Service	1891848982	1891848982	1	1	ACACIO, MARTHA B LMFT	7/17/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1475 HUNTINGTON AVE	#218	SAN FRANCISCO	CA	94080	5599	41	06081	37.64239261	-122.4202978	San Mateo County
132423	Fee-for-Service	1649439043	1649439043	1	1	ALEXANDER, JOHNNY O MD	6/22/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	158332	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
132463	Fee-for-Service	1023145463	1023145463	1	1	AARONSON, JASON MD	5/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	55538	30	Radiology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
132503	Fee-for-Service	1609019918	1609019918	1	1	ACEBEDO, ERICHGLENN C MD	7/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
132523	Fee-for-Service	1851954523	1851954523	1	1	AKKARI, IBRAHIM DPM	8/5/2022	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5220 CLARK AVE	SUITE 125	LAKEWOOD	CA	90712	2623	19	06037	33.8527092	-118.1337623	Los Angeles County
132537	Fee-for-Service	1962554188	1962554188	1	1	AQUA, MFON S MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	64656	41	Internal Medicine	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
132610	Fee-for-Service	1770110314	1770110314	1	1	APOLIS, LIANA MD	11/30/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	181689	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
132660	Fee-for-Service	1932416781	1932416781	1	1	AHN, DANIEL DO	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12253	18	Ophthalmology	0	In state provider	None	181 ANDRIEUX STREET	SUITE 100	SONOMA	CA	95476	6920	49	06097	38.28809911	-122.4613026	Sonoma County
132692	Fee-for-Service	1316050578	1316050578	1	1	ALDAVE, ANTHONY J	4/1/2000	207W00000X	NA	Ophthalmology	026	PHYSICIANS	71201	18	Ophthalmology	0	In state provider	None	1001 POTRERO AVE	# 4M	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
132702	Fee-for-Service	1932761053	1932761053	1	1	ARMSTRONG, ALEXA L DO	11/6/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	21296	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
132721	Fee-for-Service	1811582075	1811582075	1	1	ANGEL HOME HEALTH LLC	11/10/2023	251E00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	3498 CLAYTON RD	STE. 101	CONCORD	CA	94519	2447	07	06013	37.97084354	-122.0125928	Contra Costa County
132722	Fee-for-Service	1811358823	1811358823	1	1	AMBERKARE HOME HEALTH INC	10/15/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2751 E CHAPMAN AVE	SUITE 104	FULLERTON	CA	92831	3706	30	06059	33.8743446	-117.8815517	Orange County
132752	Fee-for-Service	1285709188	1285709188	1	1	ABRAMSON, MARC F MD	2/8/2015	2084P0800X	NA	Psychiatry	026	PHYSICIANS	9251	36	Psychiatry	0	In state provider	None	825 OAK GROVE AVE	None	MENLO PARK	CA	94025	4434	41	06081	37.45154377	-122.1866179	San Mateo County
132777	Fee-for-Service	1902334451	1902334451	1	1	AKHTER ALAM, FAHMIDA MD	12/18/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166499	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
132792	Fee-for-Service	1255657649	1255657649	1	1	ABDELGADIR ADAM, MOHAMED O M	10/16/2020	208600000X	NA	General Surgery	026	PHYSICIANS	170392	02	General Surgery	0	In state provider	D	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
132815	Fee-for-Service	1023562378	1023562378	1	1	ARCHWOOD HOUSE CLHF, INC	11/27/2019	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	14011 ARCHWOOD ST	None	VALLEY GLEN	CA	91405	4822	19	06037	34.19303311	-118.4382154	Los Angeles County
132829	Fee-for-Service	1619178597	1619178597	1	1	AELONY, YOSSEF MD	1/1/1982	207RP1001X	NA	Pulmonology	026	PHYSICIANS	12380	41	Internal Medicine	0	In state provider	None	1100 PACIFIC COAST HWY	None	HARBOR CITY	CA	90710	3511	19	06037	33.7899001	-118.2974971	Los Angeles County
132831	Fee-for-Service	1619083961	1619083961	1	1	ALAGIRI, MADHU MD	6/5/1996	208800000X	NA	Other	026	PHYSICIANS	83089	34	Urology and Urological Surgery	0	In state provider	None	7930 FROST ST	STE 407	SAN DIEGO	CA	92123	4286	37	06073	32.80027001	-117.1532893	San Diego County
132862	Fee-for-Service	1275778243	1275778243	1	1	AGHAMIR, SHAHAB MD	3/25/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104886	41	Internal Medicine	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
132870	Fee-for-Service	1992887814	1992887814	1	1	ASHLEY CLIN DIAG LAB	7/19/1989	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	5542 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4120	19	06037	34.10855455	-118.1948437	Los Angeles County
132880	Fee-for-Service	1770984098	1770984098	1	1	ABRAHAM, NICHOLAS M MD	5/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	132194	66	Emergency Medicine (Urgent Care)	0	In state provider	None	925 CORPORATE CENTER PK	SUITE A	SANTA ROSA	CA	95407	5453	49	06097	38.425383	-122.7536235	Sonoma County
132891	Fee-for-Service	1659700755	1659700755	1	1	AREIZA KING, VANESSA LMFT	9/25/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	163 SECOND ST	None	WOODLAND	CA	95695	3316	57	06113	38.68060768	-121.7718082	Yolo County
132894	Fee-for-Service	1356651681	1356651681	1	1	ATHOS BROWN, ELAINE A MD	6/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135432	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
132899	Fee-for-Service	1790732931	1790732931	1	1	ANNE MARIE HACKMAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	901 7TH AVE	STE 310	FORTH WORTH	TX	76104	2724	00	None	32.73508113	-97.34196577	Tarrant County
133005	Fee-for-Service	1467835991	1467835991	1	1	AN, STEPHEN DPM	6/13/2023	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	400 CARLTON AVE	SUITE 200	LOS GATOS	CA	95032	2629	43	06085	37.24728836	-121.9514527	Santa Clara County
133043	Fee-for-Service	1295082436	1295082436	1	1	ACCUVISION OPTOMETRY INC	10/1/2013	152WC0802X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	236 S CITRUS ST	None	WEST COVINA	CA	91791	2144	19	06037	34.06897239	-117.8900623	Los Angeles County
133100	Fee-for-Service	1326238569	1326238569	1	1	AGURS, LATANYA MD	12/10/2019	2084N0402X	NA	Neurology	026	PHYSICIANS	102112	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
133106	Fee-for-Service	1023000569	1023000569	1	1	AHMC WHITTIER HOSPITAL LP	11/1/2004	282N00000X	NA	Hospitals	065	PEDIATRIC SUBACUTE CARE/LTC	-	-	NOT APPLICABLE	0	In state provider	None	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
133115	Fee-for-Service	1760698740	1760698740	1	1	ALL FAMILY NEIGHBORHOOD	6/26/2007	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	MED CLINIC & WELLNESS	874 W MARTIN LUTHER KING	None	LOS ANGELES	CA	90037	1205	19	06037	34.01092167	-118.2898462	Los Angeles County
133118	Fee-for-Service	1093794604	1093794604	1	1	ABEDI, ESRAFIL A MD	1/1/1997	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	30818	20	Orthopedic Surgery	0	In state provider	None	23961 CALLE DE MAGDALENA	STE 430	LAGUNA HILLS	CA	92653	0000	30	06059	33.60918911	-117.7104355	Orange County
133186	Fee-for-Service	1912386558	1912386558	1	1	ALDEA INC	3/26/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2475 JEFFERSON STREET	None	NAPA	CA	94558	4931	28	06055	38.310948	-122.299074	Napa County
133215	Fee-for-Service	1700184991	1700184991	1	1	ALOE HOLDINGS LLC	6/7/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3400 BELL ROAD	None	AUBURN	CA	95603	9241	31	06061	38.94188162	-121.1099369	Placer County
133217	Fee-for-Service	1679515688	1679515688	1	1	ALLEN, MICHELLE MD	12/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95163	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
133234	Fee-for-Service	1407877335	1407877335	1	1	ALLEN ORTHOPEDIC LABS, INC.	6/2/2021	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	711 D ST	SUITE 108	SAN RAFAEL	CA	94901	3707	21	06041	37.97088061	-122.5324469	Marin County
133249	Fee-for-Service	1598063034	1598063034	1	1	ABONGWA, NGEGHA MD	1/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121352	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
133254	Fee-for-Service	1750655668	1750655668	1	1	AYALA, JOANNA MD	9/23/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	120236	08	Family Practice	0	In state provider	None	29995 TECHNOLOGY	202	MURRIETA	CA	92563	2632	33	06065	33.56041691	-117.1370428	Riverside County
133272	Fee-for-Service	1669567509	1669567509	1	1	AUSTIN, PAUL F MD	2/1/2022	2088P0231X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
133283	Fee-for-Service	1982947198	1982947198	1	1	ALBERS, MARK MD	11/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134567	01	General Practice	0	In state provider	None	1150 VETERANS BOULEVARD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
133338	Fee-for-Service	1366449837	1366449837	1	1	ANOINA, DOROTHY MD	9/19/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	176949	None	None	0	In state provider	None	9920 TALBERT	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.7016655	-117.955521	Orange County
133348	Fee-for-Service	1174574222	1174574222	1	1	AKBAR, SYED MD	10/22/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	169815	None	None	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
133372	Fee-for-Service	1659797322	1659797322	1	1	AYSON, JOSEPHINE	7/1/2014	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	711 CLYDE AVENUE	None	SANTA CLARA	CA	95054	1902	43	06085	37.39228685	-121.9468902	Santa Clara County
133375	Fee-for-Service	1689605578	1689605578	1	1	AASHA PEDIATRICS, INC	7/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	68350	40	Pediatrics	0	In state provider	None	1569 LEXANN AVENUE	SUITE 230	SAN JOSE	CA	95121	1795	43	06085	37.30790568	-121.8141983	Santa Clara County
133390	Fee-for-Service	1326110941	1326110941	1	1	ALEXANDER, STEVEN M MD	11/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	85400	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	# 5008	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
133393	Fee-for-Service	1063631281	1063631281	1	1	ADZOTOR, KWASI E MD	11/10/2008	207R00000X	NA	Other	026	PHYSICIANS	102066	41	Internal Medicine	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
133395	Fee-for-Service	1023000569	1023000569	1	1	AHMC WHITTIER HOSPITAL LP	11/1/2004	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
133417	Fee-for-Service	1306811906	1306811906	1	1	AGUINALDO, TYLER F MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73599	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
133433	Fee-for-Service	1912060740	1912060740	1	1	AMERICAS BEST CARE PLUS INC	3/26/2018	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	1825 EVERETT DRIVE W	None	FORT PAYNE	AL	35968	3356	00	None	34.46455205	-85.72843342	DeKalb County
133456	Fee-for-Service	1487880506	1487880506	1	1	ASIRYAN, VARDUI MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128242	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3975 JACKSON STREET	SUITE 110	RIVERSIDE	CA	92503	3946	33	06065	33.92729721	-117.4413503	Riverside County
133480	Fee-for-Service	1992283675	1992283675	1	1	ACCUMEN TMS CENTER	3/13/2019	106H00000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	7840 IMPERIAL HWY	B	DOWNEY	CA	90242	3457	19	06037	33.92542657	-118.1549366	Los Angeles County
133494	Fee-for-Service	1972517019	1972517019	1	1	ARCHER, THOMAS L MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	31946	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
133495	Fee-for-Service	1902162456	1902162456	1	1	AMES, DANIEL MD	4/6/2022	208M00000X	NA	Other	026	PHYSICIANS	130606	None	None	0	In state provider	None	1101 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	9411	38	06075	37.78610439	-122.421569	San Francisco County
133559	Fee-for-Service	1982721320	1982721320	1	1	ARAGON, STEVEN L MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	59121	22	Pathology (M.D. only)	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
133600	Fee-for-Service	1225488612	1225488612	1	1	ALVA, BRIAN M OD	7/16/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	555 N 13TH AVE	None	UPLAND	CA	91786	4904	36	06071	34.10042233	-117.6335451	San Bernardino County
133627	Fee-for-Service	1992788384	1992788384	2	1	ASPEN SURGERY VENTURE LLC	3/2/2009	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2750 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1502	56	06111	34.28529962	-118.7437672	Ventura County
133635	Fee-for-Service	1154375335	1154375335	1	1	ARISTA MEDICAL CENTER	12/13/2016	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1775 W LINCOLN AVE	None	ANAHEIM	CA	92801	6715	30	06059	33.83260148	-117.945333	Orange County
133655	Fee-for-Service	1093211096	1093211096	1	1	AL-LOZI, AMAL M MD	9/23/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	179541	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
133674	Fee-for-Service	1659797322	1659797322	1	1	AYSON, JOSEPHINE	7/1/2014	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	711 CLYDE AVENUE	None	SANTA CLARA	CA	95054	1902	43	06085	37.39228685	-121.9468902	Santa Clara County
133677	Fee-for-Service	1326110941	1326110941	1	1	ALEXANDER, STEVEN M MD	11/1/1999	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	85400	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3020 CHILDRENS WAY	# 5008	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
133680	Fee-for-Service	1063631281	1063631281	1	1	ADZOTOR, KWASI E MD	11/10/2008	207R00000X	NA	Other	026	PHYSICIANS	102066	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
133682	Fee-for-Service	1023000569	1023000569	1	1	AHMC WHITTIER HOSPITAL LP	11/1/2004	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
133722	Fee-for-Service	1093843005	1093843005	1	1	ARROWHEAD PEDIATRICS	6/2/2006	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	MEDICAL GROUP INC	400 N PEPPER AVE	FL 6	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
133723	Fee-for-Service	1700273422	1700273422	1	1	ALI, NOOR B MD	12/19/2018	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	156082	10	Gastroenterology (M.D. only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
133729	Fee-for-Service	1154919306	1154919306	1	1	ABAD, ALVIN JOSEPH U NP	7/19/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
133740	Fee-for-Service	1790988772	1790988772	1	1	ANCHALA, ANUPAMA R MD	7/4/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	167958	18	Ophthalmology	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
133757	Fee-for-Service	1174141188	1174141188	1	1	AGING ASSISTANT LLC	10/11/2023	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	9578 2ND AVE	None	ELK GROVE	CA	95624	1954	34	06067	38.409948	-121.3673265	Sacramento County
133766	Fee-for-Service	1992283675	1992283675	1	1	ACCUMEN TMS CENTER	3/13/2019	106H00000X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	7840 IMPERIAL HWY	B	DOWNEY	CA	90242	3457	19	06037	33.92542657	-118.1549366	Los Angeles County
133854	Fee-for-Service	1902644842	1902644842	1	1	ALTAMED HEALTH SERVICES CORP	1/2/2025	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9056 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2038	19	06037	33.90283704	-118.1405511	Los Angeles County
133868	Fee-for-Service	1588171730	1588171730	1	2	ALICIA MITTLEMAN LICENSED CL	4/15/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	INICAL SOCIAL WORKER C	2945 RAMCO ST	110	WEST SACRAMENTO	CA	95691	5992	57	06113	38.55460926	-121.562961	Yolo County
133960	Fee-for-Service	1417053257	1417053257	1	1	ALBURY, DENISE A MD	5/19/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	74533	66	Emergency Medicine (Urgent Care)	0	In state provider	None	133 N PRAIRIE AVE	STE B	INGLEWOOD	CA	90301	4879	19	06037	33.963957	-118.3439985	Los Angeles County
133966	Fee-for-Service	1487897047	1487897047	1	1	ADVENTIST HLTH CLEARLAKE	10/29/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	ST HELENA HOSPITAL	15630 18TH AVE	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
133993	Fee-for-Service	1194022012	1194022012	1	1	ANARDE, BROOKE M LCSW	3/7/2019	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
134020	Fee-for-Service	1316218456	1316218456	1	1	AMDE, DANIEL MD	9/13/2013	207R00000X	NA	Other	026	PHYSICIANS	121962	41	Internal Medicine	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
134048	Fee-for-Service	1619923083	1619923083	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	19307 SATICOY ST	None	RESEDA	CA	91335	2330	19	06037	34.20838149	-118.5542325	Los Angeles County
134050	Fee-for-Service	1093843005	1093843005	1	1	ARROWHEAD PEDIATRICS	6/2/2006	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	43	Pediatric Allergy	0	In state provider	MEDICAL GROUP INC	400 N PEPPER AVE	FL 6	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
134055	Fee-for-Service	1992283675	1992283675	1	1	ACCUMEN TMS CENTER	3/13/2019	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	7840 IMPERIAL HWY	B	DOWNEY	CA	90242	3457	19	06037	33.92542657	-118.1549366	Los Angeles County
134069	Fee-for-Service	1326164633	1326164633	1	1	AMIN, SAMEER T MD	6/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	108307	41	Internal Medicine	0	In state provider	None	2699 ATLANTIC AVE	None	LONG BEACH	CA	90806	2710	19	06037	33.805971	-118.1850555	Los Angeles County
134093	Fee-for-Service	1558558023	1558558023	1	1	ABUDAYEH, NABIL K MD	11/14/2016	193200000X	NA	Other	026	PHYSICIANS	59072	None	None	0	In state provider	PROFESSIONAL CORPORATION	20700 LAKE CHABOT RD	STE 107	CASTRO VALLEY	CA	94546	5402	01	06001	37.69510954	-122.0868383	Alameda County
134094	Fee-for-Service	1225307457	1225307457	1	1	AHRENS, JILLIAN A MD	11/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125753	41	Internal Medicine	0	In state provider	None	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	34	06067	38.570553	-121.481325	Sacramento County
134139	Fee-for-Service	1427004928	1427004928	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1235 S DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	4121	19	06037	33.99993979	-117.811849	Los Angeles County
134147	Fee-for-Service	1366451692	1366451692	1	1	ANGEL, SARAH K PT	4/7/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1535 RIVER PARK DR	STE 1000	SACRAMENTO	CA	95815	4601	34	06067	38.600334	-121.4361675	Sacramento County
134223	Fee-for-Service	1316970452	1316970452	1	1	ARBOLEDA, ANTONIO MD INC	9/1/2002	174400000X	NA	Other	026	PHYSICIANS	46476	40	Pediatrics	0	In state provider	None	2211 W MAGNOLIA BLVD	STE 280	BURBANK	CA	91506	1761	19	06037	34.1728873	-118.3320905	Los Angeles County
134239	Fee-for-Service	1164972345	1164972345	1	1	AMITY MEDICAL GROUP, INC.	8/12/2019	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	9808 VENICE BLVD	100	CULVER CITY	CA	90232	2732	19	06037	34.0236396	-118.3980847	Los Angeles County
134244	Fee-for-Service	1285772004	1285772004	1	1	AGUIRRE, THOMAS V MD	7/11/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67925	10	Gastroenterology (M.D. only)	0	In state provider	None	2403 CASTILLO ST	STE 201	SANTA BARBARA	CA	93105	5316	42	06083	34.43053648	-119.7243139	Santa Barbara County
134248	Fee-for-Service	1417053257	1417053257	1	1	ALBURY, DENISE A MD	5/19/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	74533	40	Pediatrics	0	In state provider	None	133 N PRAIRIE AVE	STE B	INGLEWOOD	CA	90301	4879	19	06037	33.963957	-118.3439985	Los Angeles County
134255	Fee-for-Service	1013245216	1013245216	1	1	ADIGUE, KAREN JOY T PT	7/4/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
134293	Fee-for-Service	1467024331	1467024331	1	1	ALERTIVE HEALTHCARE MEDICAL	7/1/2023	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	GROUP APC	4500 BROCKTON AVE.	SUITE 305	RIVERSIDE	CA	92501	4027	33	06065	33.97785263	-117.3836152	Riverside County
134298	Fee-for-Service	1093843005	1093843005	1	1	ARROWHEAD PEDIATRICS	6/2/2006	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	35	Pediatric Cardiology (M.D. only)	0	In state provider	MEDICAL GROUP INC	400 N PEPPER AVE	FL 6	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
134310	Fee-for-Service	1114337151	1114337151	1	1	ANAYA, NANCY MD	5/10/2017	390200000X	NA	Other	026	PHYSICIANS	147853	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 POTRERO AVE	RM1E21	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
134313	Fee-for-Service	1447308374	1447308374	1	1	ASHE, MELANIE G MD	6/1/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	64077	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
134314	Fee-for-Service	1275111031	1275111031	1	1	AVENIDO, MARIA LOUISE MD	10/1/2024	390200000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
134339	Fee-for-Service	1457196164	1457196164	1	1	ADORACION REYES MD A PROFESS	10/4/2024	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	11618 SOUTH ST	STE 214	ARTESIA	CA	90701	6618	19	06037	33.85835151	-118.0856835	Los Angeles County
134385	Fee-for-Service	1225307457	1225307457	1	1	AHRENS, JILLIAN A MD	11/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125753	77	Infectious Disease	0	In state provider	None	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	34	06067	38.570553	-121.481325	Sacramento County
134404	Fee-for-Service	1306194832	1306194832	1	1	AYALA-ENCALADA, JOSELYN J	6/19/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	13200 CROSSROADS PKWY	STE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
134453	Fee-for-Service	1912519836	1912519836	1	1	ADVENTIST HEALTH PHYSICIANS	1/11/2021	207V00000X	NA	Obstetrics & Gynecology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	6283 CLARK RD	STE 5	PARADISE	CA	95969	4100	04	06007	39.7674117	-121.6005321	Butte County
134459	Fee-for-Service	1023894086	1023894086	1	1	ATRIUM TRANSPORT	5/9/2024	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2261 SAINT GEORGE LN	STE, F	CHICO	CA	95926	1372	04	06007	39.75587696	-121.8463385	Butte County
134466	Fee-for-Service	1932264082	1932264082	1	3	ARVIN UNION SCHOOL DIST	10/17/2011	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	911 EL CAMINO REAL	None	ARVIN	CA	93203	9451	15	06029	35.18715734	-118.8340372	Kern County
134488	Fee-for-Service	1669138947	1669138947	1	1	ADVENTIST HEALTH PHYSICIANS	10/10/2024	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	2950 SYCAMORE DR	300	SIMI VALLEY	CA	93065	1210	56	06111	34.28932056	-118.7438673	Ventura County
134518	Fee-for-Service	1164824785	1164824785	1	1	AMARO CHAVEZ, ADILENE LMFT	2/24/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3160 TELEGRAPH ROAD	STE 200	VENTURA	CA	93003	3250	56	06111	34.27228149	-119.2529119	Ventura County
134533	Fee-for-Service	1164144374	1164144374	1	1	ABRAHAMYAN, TIGRAN NP	4/10/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1100 E BROADWAY UNIT 300	None	GLENDALE	CA	91205	4653	19	06037	34.14622171	-118.2415193	Los Angeles County
134537	Fee-for-Service	1871527689	1871527689	1	1	ALLEN,MARSHALL D CRNA	4/12/2005	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
134558	Fee-for-Service	1720268998	1720268998	1	1	AMERICAN FAMILY MEDICAL	10/7/2010	174400000X	NA	Other	026	PHYSICIANS	85470	41	Internal Medicine	0	In state provider	PROVIDERS INC	10 CONGRESS ST	SUITE 506	PASADENA	CA	91105	3023	19	06037	34.13396893	-118.1528162	Los Angeles County
134579	Fee-for-Service	1053322826	1053322826	1	1	APRIA HEALTHCARE LLC	4/8/2003	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	12981 LOMA RICA DR	None	GRASS VALLEY	CA	95945	9061	29	06057	39.22153198	-121.0029499	Nevada County
134580	Fee-for-Service	1083101125	1083101125	1	1	ACKLIN, RIHANA LCSW	11/6/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
134581	Fee-for-Service	1467024331	1467024331	1	1	ALERTIVE HEALTHCARE MEDICAL	7/1/2023	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP APC	4500 BROCKTON AVE.	SUITE 305	RIVERSIDE	CA	92501	4027	33	06065	33.97785263	-117.3836152	Riverside County
134626	Fee-for-Service	1457196164	1457196164	1	1	ADORACION REYES MD A PROFESS	10/4/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	11618 SOUTH ST	STE 214	ARTESIA	CA	90701	6618	19	06037	33.85835151	-118.0856835	Los Angeles County
134674	Fee-for-Service	1972700458	1972700458	2	1	AARABI, SHAHRAM MD	4/25/2019	208600000X	NA	General Surgery	026	PHYSICIANS	159097	02	General Surgery	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
134686	Fee-for-Service	1891413795	1891413795	1	1	AGENTS OF HEALING HOMECARE	6/27/2023	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	LLC	277 BLOOMINGTON AVE	219	RIALTO	CA	92376	6494	36	06071	34.0893964	-117.3736746	San Bernardino County
134715	Fee-for-Service	1780786772	1780786772	1	1	ARONSON, LOUISE MD	8/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	78498	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
134748	Fee-for-Service	1811391303	1811391303	1	1	AMADOR CALAVERAS COUNSELING	6/23/2015	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	SERVICES	32 MAIN STREET	None	SUTTER CREEK	CA	95685	4231	03	06005	38.39271966	-120.8028632	Amador County
134752	Fee-for-Service	1467567511	1467567511	1	1	ANDERSON, PERRY SHARZER	10/1/1994	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MDS MEDICAL GROUP	3033 W ORANGE AVE	None	ANAHEIM	CA	92804	3156	30	06059	33.82476552	-117.994914	Orange County
134755	Fee-for-Service	1457353690	1457353690	1	1	ABDULLAH, SHEIKH A MD	12/29/2021	208200000X	NA	General Surgery	026	PHYSICIANS	130233	None	None	0	In state provider	None	1541 FLORIDA AVE	STE 101	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
134790	Fee-for-Service	1932214657	1932214657	1	11	AJAY G. MEKA M.D. INC.	9/28/2020	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1042 E CHAPMAN	None	ORANGE	CA	92866	2111	30	06059	33.78782652	-117.84249	Orange County
134795	Fee-for-Service	1689846081	1689846081	1	1	ALSPACH, AMY E MD	9/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	22	Pathology (M.D. only)	1	Border provider	None	77 PRINGLE	None	RENO	NV	89502	1959	00	None	39.52484706	-119.7951825	Washoe County
134835	Fee-for-Service	1194458489	1194458489	1	1	ALBANEZ, KATHIA G OD	8/22/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
134851	Fee-for-Service	1407813116	1407813116	1	1	AMIN, MANISH N DO	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7612	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3001 SILLECT AVE	None	BAKERSFIELD	CA	93308	6337	15	06029	35.38601911	-119.0400416	Kern County
134875	Fee-for-Service	1598233629	1598233629	1	1	ASIDO, JEROMY C NP	4/18/2019	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	415 W ROUTE 66	SUITE 202	GLENDORA	CA	91740	4335	19	06037	34.12883848	-117.869958	Los Angeles County
134919	Fee-for-Service	1215131404	1215131404	1	1	AYMOND,STEPHANIE C MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
134927	Fee-for-Service	1326662727	1326662727	1	1	AGESON, MIRANDA LCSW	9/11/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	140 COMMONWEALTH AVE	SUITE 208	FULLERTON	CA	92832	1905	30	06059	33.87034048	-117.922437	Orange County
134943	Fee-for-Service	1134311236	1134311236	1	1	ASHOK, ASHWIN P REDDY MD	8/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	97611	10	Gastroenterology (M.D. only)	0	In state provider	None	15725 E WHITTIER BLVD	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
134963	Fee-for-Service	1205123239	1205123239	1	1	ACE ANESTHESIA GROUP INC	9/1/2011	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	911 SUNSET DRIVE	None	HOLLISTER	CA	95023	5695	35	06069	36.83504962	-121.3858245	San Benito County
134966	Fee-for-Service	1740869676	1740869676	1	1	ALAGHA, TARIK A MD	10/28/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
134990	Fee-for-Service	1740442532	1740442532	1	1	ANIL POTHARAJU, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2800 E AJO WAY	None	TUCSON	AZ	85713	6204	00	None	32.175801	-110.9306925	Pima County
135001	Fee-for-Service	1780786772	1780786772	1	1	ARONSON, LOUISE MD	8/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	78498	38	Geriatrics	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
135002	Fee-for-Service	1538379706	1538379706	1	1	AMNEUS, MALAIKA W	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	91471	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
135009	Fee-for-Service	1699739219	1699739219	1	1	AGUIRRE, RICARDO E MD	7/17/2020	208G00000X	NA	General Surgery	026	PHYSICIANS	29923	70	Clinic (mixed specialty)	0	In state provider	None	5401 NORRIS CANYON RD	STE 202	SAN RAMON	CA	94583	5406	07	06013	37.77752374	-121.9579277	Contra Costa County
135022	Fee-for-Service	1336754472	1336754472	1	2	ANKUR GUPTA MEDICAL CORPORAT	3/23/2021	193400000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	ION	820 S AKERS ST	130	VISALIA	CA	93277	8346	54	06107	36.323757	-119.3491755	Tulare County
135023	Fee-for-Service	1619580826	1619580826	1	1	ALPHACARE HEALTH PROVIDERS I	10/19/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC.	12440 FIRESTONE BLVD	STE 1024	NORWALK	CA	90560	4366	19	06037	33.90523023	-118.0681168	Los Angeles County
135047	Fee-for-Service	1457950768	1457950768	1	1	AMHH HOSPICE INC	3/2/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14542 VENTURA BLVD	STE 206	SHERMAN OAKS	CA	91403	5512	19	06037	34.15111125	-118.4500521	Los Angeles County
135062	Fee-for-Service	1497726038	1497726038	1	1	ALPINE HOME MEDICAL INC	6/8/2012	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	13908 SEAL BEACH BLVD	None	SEAL BEACH	CA	90740	5301	30	06059	33.76164842	-118.0777907	Orange County
135069	Fee-for-Service	1598782336	1598782336	1	1	ADI, SALEH MD	12/1/2000	2080P0205X	NA	Endocrinology	026	PHYSICIANS	52361	40	Pediatrics	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
135112	Fee-for-Service	1497054639	1497054639	1	1	ALBON, JENNIFER R MD	10/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149072	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
135135	Fee-for-Service	1548459449	1548459449	1	1	ABDU, AREBU T MD	8/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107594	40	Pediatrics	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
135139	Fee-for-Service	1598386062	1598386062	1	1	AFRAZ, SADAF DO	12/16/2024	207R00000X	NA	Other	026	PHYSICIANS	23389	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
135147	Fee-for-Service	1063443877	1063443877	1	1	AARON BARKSDALE MD	5/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MEDICAL	None	OMAHA	NE	68198	7400	00	None	0	0	None
135148	Fee-for-Service	1972997021	1972997021	1	1	ARKIN, NICOLE E MD	5/15/2019	207L00000X	NA	Other	026	PHYSICIANS	144719	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
135194	Fee-for-Service	1639132731	1639132731	1	1	ALEMAN, MICHAEL A MD	8/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55356	34	Urology and Urological Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
135210	Fee-for-Service	1497790349	1497790349	1	2	AMG, A PROFESSIONAL MEDICAL	3/29/2023	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CORPORATION	193 E ORANGE GROVE BLVD	None	PASADENA	CA	91103	3487	19	06037	34.15787172	-118.1462979	Los Angeles County
135223	Fee-for-Service	1548345069	1548345069	1	1	ALPINE ALLERGY AND	5/19/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	ASTHMA ASSOCIATES, INC	300 SIERRA COLLEGE DR	STE 235	GRASS VALLEY	CA	95945	5084	29	06057	39.23625806	-121.054471	Nevada County
135240	Fee-for-Service	1477610558	1477610558	1	4	ADVANCED EYE & LASER CENTER	3/27/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	OF CALIFORNIA INC	6882 LINDA VISTA RD	None	SAN DIEGO	CA	92111	7050	37	06073	32.78282226	-117.1720993	San Diego County
135262	Fee-for-Service	1942693049	1942693049	1	1	AGAPE ASSISTED LIVING INC	2/28/2016	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1841 ANDREA LN	None	CONCORD	CA	94519	1830	07	06013	37.98037151	-122.0077209	Contra Costa County
135267	Fee-for-Service	1487721387	1487721387	1	1	ALSHAK, NAJEEB MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	47953	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
135273	Fee-for-Service	1871963512	1871963512	1	1	ARISTIGI, JANNET LCSW	5/4/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
135287	Fee-for-Service	1336695675	1336695675	1	1	ALGOS INC., A MEDICAL CORPOR	8/2/2018	103TB0200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	69780 STELLAR DR	SUITE A	RANCHO MIRAGE	CA	92270	2954	33	06065	33.76299197	-116.444597	Riverside County
135294	Fee-for-Service	1376547612	1376547612	1	1	ANSEL, DAVID A MD	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137323	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
135334	Fee-for-Service	1457950768	1457950768	1	1	AMHH HOSPICE INC	3/2/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14542 VENTURA BLVD	STE 206	SHERMAN OAKS	CA	91403	5512	19	06037	34.15111125	-118.4500521	Los Angeles County
135356	Fee-for-Service	1598782336	1598782336	1	1	ADI, SALEH MD	12/1/2000	2080P0205X	NA	Endocrinology	026	PHYSICIANS	52361	67	Endocrinology	0	In state provider	None	3700 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
135381	Fee-for-Service	1205299815	1205299815	1	1	AUNG, THU THU MD	11/3/2023	207RR0500X	NA	Other	026	PHYSICIANS	186852	None	None	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
135401	Fee-for-Service	1194348656	1194348656	1	1	ABD ELMASEH, SHENODA Y MD	11/10/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181983	None	None	0	In state provider	None	26800 CROWN VALLEY PKWY	STE 150	MISSION VIEJO	CA	92691	8018	30	06059	33.56286021	-117.6673449	Orange County
135411	Fee-for-Service	1013363845	1013363845	1	1	ALLIANCE HOME HEALTH &	7/14/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE, LLC	6717 MISSION ST	SUITE D-1	DALY CITY	CA	94014	2070	41	06081	37.701208	-122.4633528	San Mateo County
135412	Fee-for-Service	1487650230	1487650230	1	1	AYAD, ONSY S MD	5/10/2017	2080P0203X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	700 CHILDRENS DRIVE	None	COLUMBUS	OH	43205	2664	00	None	39.95288635	-82.98152375	Franklin County
135433	Fee-for-Service	1861550865	1861550865	1	1	ALLEN, TAMMY M MD	12/19/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	170329	None	None	0	In state provider	None	1000 TRANCAS ST	SUITE 1	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
135466	Fee-for-Service	1275638413	1275638413	1	1	ALLIANCE SURGERY CENTER INC	5/10/2024	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	295 IMPERIAL HWY	SUITE 200B	FULLERTON	CA	92835	1020	30	06059	33.91748047	-117.9291825	Orange County
135471	Fee-for-Service	1063744688	1063744688	1	1	ACES HOME HEALTHCARE	7/16/2011	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	4959 PALO VERDE ST	SUITE 102B	MONTCLAIR	CA	91763	2323	36	06071	34.08129954	-117.6966135	San Bernardino County
135486	Fee-for-Service	1598743833	1598743833	1	1	ASIS,MARTIN JOSE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 THOMPSON ST	None	ST PAUL	MN	55102	2370	00	None	44.94428014	-93.10733608	Ramsey County
135490	Fee-for-Service	1922588169	1922588169	1	1	AHMU, MICHAEL D RCP	9/24/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
135498	Fee-for-Service	1497790349	1497790349	1	2	AMG, A PROFESSIONAL MEDICAL	3/29/2023	193400000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	CORPORATION	193 E ORANGE GROVE BLVD	None	PASADENA	CA	91103	3487	19	06037	34.15787172	-118.1462979	Los Angeles County
135507	Fee-for-Service	1942536495	1942536495	1	1	ANMANGANDLA, DILIP MD	8/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119597	41	Internal Medicine	0	In state provider	None	11165 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1113	19	06037	34.2738618	-118.4678337	Los Angeles County
135520	Fee-for-Service	1881950632	1881950632	1	1	ASHER, AVA I MD	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127049	01	General Practice	0	In state provider	None	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	34	06067	38.570553	-121.481325	Sacramento County
135531	Fee-for-Service	1568809226	1568809226	1	1	AHN, RICHARD S MD	9/1/2019	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	162729	20	Orthopedic Surgery	0	In state provider	None	5750 DOWNEY AVE	STE 308	LAKEWOOD	CA	90712	1482	19	06037	33.859611	-118.1511435	Los Angeles County
135547	Fee-for-Service	1487074449	1487074449	1	1	ALCOHOLISM CENTER FOR WOMEN,	1/25/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INC.	1135 S ALVARADO ST	None	LOS ANGELES	CA	90006	4100	19	06037	34.04932111	-118.2814182	Los Angeles County
135551	Fee-for-Service	1710199674	1710199674	2	1	ANTELOPE VALLEY COMM CLINIC	4/28/1997	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1122 W AVENUE L12	STE 103	LANCASTER	CA	93534	7051	19	06037	34.64937595	-118.1509885	Los Angeles County
135562	Fee-for-Service	1811329899	1811329899	1	1	AMPLA HEALTH	4/17/2025	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	7981 HIGHWAY 99 E	None	LOS MOLINOS	CA	96055	9782	52	06103	40.02757963	-122.0999188	Tehama County
135573	Fee-for-Service	1285832717	1285832717	1	1	AMIR, ASAD MD	8/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121673	36	Psychiatry	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
135575	Fee-for-Service	1336695675	1336695675	1	1	ALGOS INC., A MEDICAL CORPOR	8/2/2018	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	69780 STELLAR DR	SUITE A	RANCHO MIRAGE	CA	92270	2954	33	06065	33.76299197	-116.444597	Riverside County
135583	Fee-for-Service	1639308984	1639308984	1	1	ALYESH, MICHAEL I MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119500	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
135597	Fee-for-Service	1447364526	1447364526	1	1	AHMAD, NASIR J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	296 W SPRING ST	None	SOUTH ELGIN	IL	60177	1534	00	None	41.99502151	-88.2984735	Kane County
135619	Fee-for-Service	1346486511	1346486511	1	1	ALTURA CENTERS FOR HEALTH	6/6/2008	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	737 W BARDSLEY AVE	None	TULARE	CA	93274	5005	54	06107	36.1963947	-119.357535	Tulare County
135649	Fee-for-Service	1114382058	1114382058	1	1	AL-HELO, FADY T F	4/12/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	400 N MOUNTAIN AVE	SUITE 310	UPLAND	CA	91786	5182	36	06071	34.098489	-117.670074	San Bernardino County
135655	Fee-for-Service	1770677957	1770677957	1	1	ALBEG, JONATHAN C MD	1/1/1998	207R00000X	NA	Other	026	PHYSICIANS	64791	41	Internal Medicine	0	In state provider	None	370 DISTEL CIR	None	LOS ALTOS	CA	94022	1404	43	06085	37.39572142	-122.1051204	Santa Clara County
135679	Fee-for-Service	1144613241	1144613241	1	1	ASSURED HOME HEALTH CARE,	4/1/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	230 N MARYLAND AVE	STE 302	GLENDALE	CA	91206	4281	19	06037	34.149357	-118.2537315	Los Angeles County
135698	Fee-for-Service	1013363845	1013363845	1	1	ALLIANCE HOME HEALTH &	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE, LLC	6717 MISSION ST	SUITE D-1	DALY CITY	CA	94014	2070	41	06081	37.701208	-122.4633528	San Mateo County
135700	Fee-for-Service	1104385319	1104385319	1	1	ALDEA, DANIEL A MD	7/28/2022	208M00000X	NA	Other	026	PHYSICIANS	179544	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
135787	Fee-for-Service	1497790349	1497790349	1	2	AMG, A PROFESSIONAL MEDICAL	3/29/2023	193400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	CORPORATION	193 E ORANGE GROVE BLVD	None	PASADENA	CA	91103	3487	19	06037	34.15787172	-118.1462979	Los Angeles County
135788	Fee-for-Service	1083792741	1083792741	1	1	ASTORINO, RICHARD N MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39556	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
135833	Fee-for-Service	1295831139	1295831139	1	1	ANAHEIM HEALTHCARE CTR	6/18/1996	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	501 S BEACH BLVD	None	ANAHEIM	CA	92804	1810	30	06059	33.82618908	-117.9934893	Orange County
135834	Fee-for-Service	1457309742	1457309742	1	1	ARNOUX BLANCHARD, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 S ANDREWS AVE	None	FT LAUDERDALE	FL	33316	2510	00	None	26.102142	-80.1408645	Broward County
135838	Fee-for-Service	1710199674	1710199674	2	1	ANTELOPE VALLEY COMM CLINIC	4/28/1997	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1122 W AVENUE L12	STE 103	LANCASTER	CA	93534	7051	19	06037	34.64937595	-118.1509885	Los Angeles County
135845	Fee-for-Service	1699398016	1699398016	1	1	ANG, JOSHUA DO	4/10/2025	207KA0200X	NA	Other	026	PHYSICIANS	23828	03	Allergy	0	In state provider	None	94 N MADISON AVE	None	PASADENA	CA	91101	1740	19	06037	34.14768278	-118.1383874	Los Angeles County
135850	Fee-for-Service	1811329899	1811329899	1	1	AMPLA HEALTH	7/25/2015	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	7981 HIGHWAY 99 E	None	LOS MOLINOS	CA	96055	9782	52	06103	40.02757963	-122.0999188	Tehama County
135876	Fee-for-Service	1639644735	1639644735	1	1	ALLEN, DAVID P CRNA	4/26/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
135898	Fee-for-Service	1649427642	1649427642	1	1	ASHER, ARASH MD	11/13/2008	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	91475	25	Physical Medicine and Rehabilitation	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
135902	Fee-for-Service	1952328866	1952328866	1	1	ADONIS ZUNIGA GOLDWATER MD	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2412 JACAMAN RD	STE 103	LAREDO	TX	78041	2700	00	None	27.56186813	-99.45067411	Webb County
135908	Fee-for-Service	1346486511	1346486511	1	1	ALTURA CENTERS FOR HEALTH	6/6/2008	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	737 W BARDSLEY AVE	None	TULARE	CA	93274	5005	54	06107	36.1963947	-119.357535	Tulare County
135925	Fee-for-Service	1427310648	1427310648	1	1	ADVENTIST HEALTH PHYSICIANS	11/8/2012	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	801 S CHEVY CHASE DR	SUITE 200	GLENDALE	CA	91205	4435	19	06037	34.136757	-118.2396195	Los Angeles County
135965	Fee-for-Service	1275627671	1275627671	2	1	ASHAPURIMAA INC	9/29/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	SIERRA SAN ANTONIO PHARM	16465 SIERRA LAKES PKWY	STE 110	FONTANA	CA	92336	1242	36	06071	34.13805177	-117.4457839	San Bernardino County
135970	Fee-for-Service	1043228224	1043228224	1	1	AGATEP, ELMO M MD	10/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	85575	01	General Practice	0	In state provider	None	1198 PACIFIC COAST HWY	STE I	SEAL BEACH	CA	90740	6278	30	06059	33.74325823	-118.1004531	Orange County
135989	Fee-for-Service	1932182318	1932182318	1	1	AHMAD, SHIRIN M MD	3/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89557	08	Family Practice	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
136001	Fee-for-Service	1366737942	1366737942	1	1	ANSARI, DOMINIC O MD	10/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144489	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
136041	Fee-for-Service	1972534147	1972534147	1	2	AW PATHOLOGY MEDICAL	11/16/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP, INC	400 OLD RIVER RD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
136075	Fee-for-Service	1295104313	1295104313	1	1	AVICENNA MEDICAL CLINIC	8/1/2016	193200000X	NA	Other	026	PHYSICIANS	122436	01	General Practice	0	In state provider	None	18445 VANOWEN ST	STE A	RESEDA	CA	91335	5324	19	06037	34.19387449	-118.5351975	Los Angeles County
136093	Fee-for-Service	1982267340	1982267340	1	1	ADAMIAN, ALEX MD	2/27/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177080	None	None	0	In state provider	None	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	19	06037	34.13998921	-118.7070142	Los Angeles County
136103	Fee-for-Service	1225490451	1225490451	1	1	ASHER, EMILY M MD	5/4/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	169714	None	None	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
136138	Fee-for-Service	1811329899	1811329899	1	1	AMPLA HEALTH	4/14/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	7981 HIGHWAY 99 E	None	LOS MOLINOS	CA	96055	9782	52	06103	40.02757963	-122.0999188	Tehama County
136147	Fee-for-Service	1366520942	1366520942	1	1	ACHALU, RADHA MD	10/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90528	08	Family Practice	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
136150	Fee-for-Service	1669608790	1669608790	1	1	AWADALLA, FARAH C MD	10/1/2018	207ND0101X	NA	Dermatology	026	PHYSICIANS	125067	None	None	0	In state provider	None	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	15	06029	35.356203	-119.0612695	Kern County
136152	Fee-for-Service	1043338296	1043338296	1	1	AHN, JANE C MD	9/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	94872	05	Anesthesiology	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
136167	Fee-for-Service	1811992209	1811992209	1	1	ADKINS, MICHAEL A MD	12/10/2019	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
136193	Fee-for-Service	1346486511	1346486511	1	1	ALTURA CENTERS FOR HEALTH	6/6/2008	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	737 W BARDSLEY AVE	None	TULARE	CA	93274	5005	54	06107	36.1963947	-119.357535	Tulare County
136199	Fee-for-Service	1902915028	1902915028	1	1	AHN, JAMES MD	2/28/1986	207W00000X	NA	Ophthalmology	026	PHYSICIANS	52250	18	Ophthalmology	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
136219	Fee-for-Service	1992884639	1992884639	1	1	AYAD, MAGED MD	9/28/2004	193400000X	NA	Other	026	PHYSICIANS	56313	41	Internal Medicine	0	In state provider	A MEDICAL CORP	2031 W ALAMEDA AVE	STE 340	BURBANK	CA	91506	2960	19	06037	34.15972797	-118.3237055	Los Angeles County
136246	Fee-for-Service	1932214657	1932214657	1	10	AJAY G. MEKA M.D. INC.	11/18/2019	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	502 EUCLID AVE	STE 304	NATIONAL CITY	CA	91950	2931	37	06073	32.68505421	-117.0832793	San Diego County
136265	Fee-for-Service	1073868527	1073868527	1	1	AVENAL COMMUNITY HEALTH	8/14/2012	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	140 C STREET	None	LEMOORE	CA	93245	2929	16	06031	36.30111141	-119.7823533	Kings County
136292	Fee-for-Service	1740693506	1740693506	1	1	AMTHUL, FAHZIA MD	3/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130200	40	Pediatrics	0	In state provider	None	3700 CALIFORNIA STREET	None	SAN FRANCISCO	CA	94118	1618	38	06075	37.78614008	-122.4556866	San Francisco County
136315	Fee-for-Service	1497976831	1497976831	1	1	AMIRAHMADI, MODJTABA MD	10/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105874	18	Ophthalmology	0	In state provider	None	1360 E HERNDON AVENUE	SUITE 301	FRESNO	CA	93720	3326	10	06019	36.83744648	-119.7646425	Fresno County
136342	Fee-for-Service	1295209047	1295209047	1	1	AJIBOYE, ABIBAT B NP	5/7/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
136348	Fee-for-Service	1053463851	1053463851	1	1	ACHANTA, JAYAPRADA MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72123	05	Anesthesiology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
136384	Fee-for-Service	1740377795	1740377795	1	1	ANNE MARIA KENNEDY,MD	10/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	50 N MEDICAL DR	None	SALT LAKE CITY	UT	84132	0100	00	None	40.77197161	-111.8352608	Salt Lake County
136414	Fee-for-Service	1639239247	1639239247	1	1	ADVENT MEDICAL EQUIP &	9/15/2004	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ADVENT MED EQUIP & SUPLY	5806 MONTEREY RD	None	LOS ANGELES	CA	90042	4926	19	06037	34.10413646	-118.185119	Los Angeles County
136426	Fee-for-Service	1811329899	1811329899	1	1	AMPLA HEALTH	4/14/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	7981 HIGHWAY 99 E	None	LOS MOLINOS	CA	96055	9782	52	06103	40.02757963	-122.0999188	Tehama County
136430	Fee-for-Service	1326064700	1326064700	1	1	AMERICARE RESP SVC INC	9/21/2004	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	30 CORPORATE PARK	309	IRVINE	CA	92606	5117	30	06059	33.68877068	-117.8283449	Orange County
136460	Fee-for-Service	1740427657	1740427657	1	14	ALTAMED HEALTH SERVICES CORP	4/18/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	243 SOUTH BUSH STREET	None	ORANGE	CA	92868	3802	30	06059	33.78530356	-117.8661524	Orange County
136464	Fee-for-Service	1306877121	1306877121	1	1	AXIS COMMUNITY HEALTH	9/1/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3311 PACIFIC AVE	None	LIVERMORE	CA	94550	7007	01	06001	37.67610149	-121.755159	Alameda County
136477	Fee-for-Service	1972913788	1972913788	1	1	ADAMS, NAHERA MD	10/1/2018	207R00000X	NA	Other	026	PHYSICIANS	146308	41	Internal Medicine	0	In state provider	None	3100 W CHRISTOFFERSEN PK	None	TURLOCK	CA	95382	9547	50	06099	37.52910755	-120.8840959	Stanislaus County
136483	Fee-for-Service	1346486511	1346486511	1	1	ALTURA CENTERS FOR HEALTH	2/21/2019	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	737 W BARDSLEY AVE	None	TULARE	CA	93274	5005	54	06107	36.1963947	-119.357535	Tulare County
136509	Fee-for-Service	1669518361	1669518361	1	1	ALP UMAR M.D.	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9212 N CENTRAL AVE	None	PHOENIX	AZ	85020	2416	00	None	33.570045	-112.0742055	Maricopa County
136524	Fee-for-Service	1265967376	1265967376	1	1	ARAFA, IMAN M MD	9/23/2020	208M00000X	NA	Other	026	PHYSICIANS	164189	41	Internal Medicine	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
136525	Fee-for-Service	1558962803	1558962803	1	1	ALOZIE, UCHECHUKWU A LCSW	1/19/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	22365 BARTON RD	STE 302	GRAND TERRACE	CA	92313	5078	36	06071	34.03387854	-117.316818	San Bernardino County
136544	Fee-for-Service	1174543474	1174543474	1	1	ATKIN, DAVE M MD	10/16/2008	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	65707	01	General Practice	0	In state provider	None	1580 VALENCIA ST	STE 703	SAN FRANCISCO	CA	94110	4415	38	06075	37.74746923	-122.4202583	San Francisco County
136554	Fee-for-Service	1073868527	1073868527	1	1	AVENAL COMMUNITY HEALTH	10/15/2015	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	140 C STREET	None	LEMOORE	CA	93245	2929	16	06031	36.30111141	-119.7823533	Kings County
136558	Fee-for-Service	1174744577	1174744577	1	1	AYE, LYDIA L DO	9/18/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12843	41	Internal Medicine	0	In state provider	None	11370 ANDERSON	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
136597	Fee-for-Service	1689735201	1689735201	1	1	ADHIKESAVAN, LEENA G MD	11/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89928	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
136617	Fee-for-Service	1336162759	1336162759	1	1	ABDISHOO, SERGE MD	8/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85433	36	Psychiatry	0	In state provider	None	1430 E CHAPMAN AVE	None	ORANGE	CA	92866	2229	30	06059	33.7877945	-117.83817	Orange County
136631	Fee-for-Service	1932181724	1932181724	1	1	ARENDS, GARY L DO	4/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8430	08	Family Practice	0	In state provider	None	1505 WILSON TER	STE 200	GLENDALE	CA	91206	4073	19	06037	34.14960934	-118.2313491	Los Angeles County
136667	Fee-for-Service	1265643142	1265643142	1	1	AKUAMOAH, EMMANUEL LCSW	12/5/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
136689	Fee-for-Service	1235329012	1235329012	1	1	ANKENY, HEATHER PHD	1/31/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
136727	Fee-for-Service	1376842880	1376842880	1	1	ALMEIDA-HUNT, OLIVIA C MD	6/10/2022	207L00000X	NA	Other	026	PHYSICIANS	122696	None	None	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
136732	Fee-for-Service	1396488433	1396488433	1	1	ABERNATHY-CORNELIUS, JORDAN	8/13/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
136738	Fee-for-Service	1437385069	1437385069	1	1	AJT DIABETIC INCORPORATED	10/28/2015	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	8500 ALMEDA GENOA ROAD	STE 112A	HOUSTON	TX	77075	2224	00	None	29.62636146	-95.26584247	Harris County
136750	Fee-for-Service	1740427657	1740427657	1	18	ALTAMED HEALTH SERVICES CORP	5/13/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	910 WEST ANAHURST PLACE	None	SANTA ANA	CA	92707	2501	30	06059	33.71791022	-117.8755362	Orange County
136752	Fee-for-Service	1306877121	1306877121	1	1	AXIS COMMUNITY HEALTH	9/1/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	3311 PACIFIC AVE	None	LIVERMORE	CA	94550	7007	01	06001	37.67610149	-121.755159	Alameda County
136765	Fee-for-Service	1164860110	1164860110	1	1	ALWAN, DAREEN MD	5/1/2018	208M00000X	NA	Other	026	PHYSICIANS	146125	41	Internal Medicine	0	In state provider	None	800 SOUTH MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
136811	Fee-for-Service	1528275864	1528275864	1	1	AVILA, TIFFANY P MD	3/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138522	78	Neoplastic Diseases/Oncology	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
136829	Fee-for-Service	1619388808	1619388808	1	1	ATTAIN HEALTH HOME HEALTH	11/2/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	1513 AVIATION BLVD	None	REDONDO BEACH	CA	90278	2805	19	06037	33.86840689	-118.3828963	Los Angeles County
136831	Fee-for-Service	1295232338	1295232338	1	1	AKARAKIAN, ROY R MD	6/15/2022	207PE0004X	NA	Other	026	PHYSICIANS	176672	None	None	0	In state provider	None	13010 HESPERIA RD	600	VICTORVILLE	CA	92395	8321	36	06071	34.48843676	-117.2909745	San Bernardino County
136834	Fee-for-Service	1205493665	1205493665	1	1	ALARCON, JEMMA MD	6/30/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181631	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
136839	Fee-for-Service	1760470736	1760470736	2	1	ALEXANDRIA CARE CENTER LLC	8/5/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1515 N ALEXANDRIA AVE	None	LOS ANGELES	CA	90027	5203	19	06037	34.098885	-118.2983775	Los Angeles County
136842	Fee-for-Service	1073868527	1073868527	1	1	AVENAL COMMUNITY HEALTH	8/14/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	140 C STREET	None	LEMOORE	CA	93245	2929	16	06031	36.30111141	-119.7823533	Kings County
136860	Fee-for-Service	1093826539	1093826539	1	1	AMIRI, MARIAM S DPM	3/24/2005	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	18225 OUTER HWY 18	None	SAN BERNARDINO	CA	92307	1319	36	06071	34.54037022	-117.2667488	San Bernardino
136915	Fee-for-Service	1194807297	1194807297	2	1	AIDS FOR DAILY LIVING INC	9/3/2009	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1140 SUNSET BLVD	SUITE 140	ROCKLIN	CA	95765	3770	31	06061	38.81264423	-121.2849748	Placer County
136922	Fee-for-Service	1225561673	1225561673	1	1	ASEF, MARK MD	1/9/2020	390200000X	NA	Other	026	PHYSICIANS	165100	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
136929	Fee-for-Service	1205378981	1205378981	1	1	ALMOND ROAD SENIOR ESTATES	4/16/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	17635 ALMOND ROAD	None	CASTRO VALLEY	CA	94546	1205	01	06001	37.71787261	-122.0857304	Alameda County
136931	Fee-for-Service	1891922324	1891922324	1	1	ALEXANDER, JESSIE L MD	3/16/2023	2080P0207X	NA	Hematology	026	PHYSICIANS	113429	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
136941	Fee-for-Service	1750481750	1750481750	1	1	ANDREWS, LANING N MD	12/1/1999	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	235 W 6TH ST	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
136981	Fee-for-Service	1114379039	1114379039	1	1	AMIR, MARYAM MD	7/30/2021	207R00000X	NA	Other	026	PHYSICIANS	172753	None	None	0	In state provider	None	1020 29TH ST	STE 580	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
136993	Fee-for-Service	1518398031	1518398031	1	1	ALL FOR HEALTH HEALTH FOR	7/10/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ALL INC	1030 SOUTH GLENDALE AVE	SUITE 307	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
137033	Fee-for-Service	1942338090	1942338090	1	1	ALCOTT CENTER FOR MENTAL	4/14/2016	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	HEALTH SERVICES	1433 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	3414	19	06037	34.05373818	-118.3839685	Los Angeles County
137035	Fee-for-Service	1740427657	1740427657	1	18	ALTAMED HEALTH SERVICES CORP	5/13/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	910 WEST ANAHURST PLACE	None	SANTA ANA	CA	92707	2501	30	06059	33.71791022	-117.8755362	Orange County
137036	Fee-for-Service	1588706584	1588706584	1	1	ALEGARBES, PINKY M MD	8/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	88583	41	Internal Medicine	0	In state provider	None	3567 W MT WHITNEY AVE	None	RIVERDALE	CA	93656	0543	10	06019	36.43078218	-119.8620732	Fresno County
137039	Fee-for-Service	1306877121	1306877121	1	1	AXIS COMMUNITY HEALTH	9/1/1992	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3311 PACIFIC AVE	None	LIVERMORE	CA	94550	7007	01	06001	37.67610149	-121.755159	Alameda County
137092	Fee-for-Service	1831117456	1831117456	1	1	ACTION PHYSICAL THERAPY PART	6/15/2023	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	680 E ROMIE LN	A	SALINAS	CA	93901	4206	27	06053	36.65922321	-121.6430933	Monterey County
137099	Fee-for-Service	1528275864	1528275864	1	1	AVILA, TIFFANY P MD	3/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138522	14	Neurological Surgery	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
137118	Fee-for-Service	1902585110	1902585110	1	1	AURA COUNSELING INC.	2/24/2025	101Y00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	522 BROADWAY ST	STE. D	KING CITY	CA	93930	3243	27	06053	36.21109736	-121.1298997	Monterey County
137122	Fee-for-Service	1104386432	1104386432	1	1	AKLADEOS, NERMEEN A MD	9/11/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	177859	None	None	0	In state provider	None	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	33	06065	33.49890392	-117.1612965	Riverside County
137130	Fee-for-Service	1073868527	1073868527	1	1	AVENAL COMMUNITY HEALTH	1/2/2013	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	140 C STREET	None	LEMOORE	CA	93245	2929	16	06031	36.30111141	-119.7823533	Kings County
137156	Fee-for-Service	1306456082	1306456082	1	1	A PLUS PRIME CARE HOSPICE	12/11/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	4625 1ST ST	STE 230	PLEASANTON	CA	94566	7169	01	06001	37.65822479	-121.8753726	Alameda County
137169	Fee-for-Service	1548447675	1548447675	1	1	AYE, YIN Y MD	11/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109952	41	Internal Medicine	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
137238	Fee-for-Service	1447645338	1447645338	1	1	AIR EVAC EMS, INC.	10/31/2022	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	1401 DIGGS RD	STE A	PARIS	TN	38242	7538	00	None	36.33516442	-88.38067469	Henry County
137271	Fee-for-Service	1790946895	1790946895	1	1	ABOU ABBASS, AHMAD MD	8/22/2018	208600000X	NA	General Surgery	026	PHYSICIANS	152200	02	General Surgery	0	In state provider	None	24411 HEALTH CENTER DR	SUITE 350	LAGUNA HILLS	CA	92653	3687	30	06059	33.6087201	-117.7076948	Orange County
137276	Fee-for-Service	1043492143	1043492143	1	1	AREVALO, LIEZLE M CRNA	10/26/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
137279	Fee-for-Service	1518398031	1518398031	1	1	ALL FOR HEALTH HEALTH FOR	7/10/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	ALL INC	1030 SOUTH GLENDALE AVE	SUITE 307	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
137284	Fee-for-Service	1992722995	1992722995	1	1	AWADA, ALI MD INC	5/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	76844	40	Pediatrics	0	In state provider	None	11633 HAWTHORNE BLVD	STE 100	HAWTHORNE	CA	90250	2324	19	06037	33.928488	-118.3527475	Los Angeles County
137297	Fee-for-Service	1285793745	1285793745	1	1	ALAHAKOON, OSHANA MD	4/15/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
137325	Fee-for-Service	1740427657	1740427657	1	14	ALTAMED HEALTH SERVICES CORP	4/18/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	243 SOUTH BUSH STREET	None	ORANGE	CA	92868	3802	30	06059	33.78530356	-117.8661524	Orange County
137420	Fee-for-Service	1073868527	1073868527	1	1	AVENAL COMMUNITY HEALTH	8/14/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	140 C STREET	None	LEMOORE	CA	93245	2929	16	06031	36.30111141	-119.7823533	Kings County
137449	Fee-for-Service	1306456082	1306456082	1	1	A PLUS PRIME CARE HOSPICE	12/11/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	4625 1ST ST	STE 230	PLEASANTON	CA	94566	7169	01	06001	37.65822479	-121.8753726	Alameda County
137489	Fee-for-Service	1124229000	1124229000	1	1	ANDIC, CLARISSA MD	4/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82084	36	Psychiatry	0	In state provider	None	25825 VERMONT AVENUE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
137495	Fee-for-Service	1295988970	1295988970	1	1	ABELLAR, ROSANNA G MD	10/29/2018	207ZP0102X	NA	Other	026	PHYSICIANS	156446	22	Pathology (M.D. only)	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
137512	Fee-for-Service	1396935896	1396935896	1	1	AURORA FAMILY COUNSELING CEN	11/30/2018	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	TER, INC.	24977 WASHINGTON AVENUE	SUITES K & L	MURRIETA	CA	92562	6149	33	06065	33.55150034	-117.2118708	Riverside County
137519	Fee-for-Service	1619061736	1619061736	2	1	ALTRIKI, MOHAMAD MD	5/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	82828	41	Internal Medicine	0	In state provider	None	768 MOUNTAIN RANCH RD	None	SAN ANDREAS	CA	95249	9707	05	06009	38.19058212	-120.6709481	Calaveras County
137540	Fee-for-Service	1578090999	1578090999	1	1	AHN, TERESA L CCC-SLP	11/9/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1857 KNOLL DR	None	VENTURA	CA	93003	7321	56	06111	34.2558809	-119.2202677	Ventura County
137541	Fee-for-Service	1346335072	1346335072	1	1	AULAKH, RITIKA K DO	3/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9593	08	Family Practice	0	In state provider	None	2778 JUNIPERO SERRA BLVD	None	DALY CITY	CA	94015	1634	41	06081	37.69053604	-122.4710671	San Mateo County
137552	Fee-for-Service	1770685901	1770685901	1	1	ALESSI, ROBERT F MD	8/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	89408	36	Psychiatry	0	In state provider	None	1335 N DUTTON AVE	None	SANTA ROSA	CA	95401	4609	49	06097	38.449431	-122.734035	Sonoma County
137562	Fee-for-Service	1467688036	1467688036	1	1	ALEXANDER, JOHN A DO	5/12/2020	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	35	Pediatric Cardiology (M.D. only)	1	Border provider	None	3006 S MARYLAND PKWY	STE 690	LAS VEGAS	NV	89109	2297	00	None	36.135288	-115.1368705	Clark County
137583	Fee-for-Service	1639343759	1639343759	1	1	AMY TRAHAN MD	2/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W THOMAS RD	None	PHOENIX	AZ	85013	3742	00	None	33.480864	-112.0795155	Maricopa County
137586	Fee-for-Service	1700448768	1700448768	1	1	ALOBBA, ALVIN KEANE P CNP	12/4/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8850 VALLEY VIEW ST	None	BUENA PARK	CA	90620	3562	30	06059	33.833988	-118.0282915	Orange County
137599	Fee-for-Service	1548654908	1548654908	1	1	AYCINENA, ALICIA MD	10/18/2020	207SG0201X	NA	Other	026	PHYSICIANS	154760	None	None	0	In state provider	None	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
137628	Fee-for-Service	1932286549	1932286549	1	1	ANDERSON, DANIEL S MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35665	01	General Practice	0	In state provider	None	225 DICKINSON ST	# H207	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
137647	Fee-for-Service	1063839439	1063839439	1	1	ADILI, ABULAITA MD	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150147	41	Internal Medicine	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
137648	Fee-for-Service	1790953560	1790953560	1	1	AROUS, LENA R MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124309	41	Internal Medicine	0	In state provider	None	43839 N 15TH STREET WEST	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
137678	Fee-for-Service	1023298676	1023298676	2	1	ASR HEALTH INC.	7/18/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18522 US HIGHWAY 18	103	APPLE VALLEY	CA	92307	2321	36	06071	34.53944358	-117.2599885	San Bernardino County
137689	Fee-for-Service	1588891022	1588891022	1	1	ALLEM, KAVITTA B MD	12/20/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125319	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
137735	Fee-for-Service	1073570743	1073570743	1	1	ANDERSON JOSEPH C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	987400 NEBRASKA MED CTR	None	OMAHA	NE	68198	0001	00	None	0	0	None
137800	Fee-for-Service	1396935896	1396935896	1	1	AURORA FAMILY COUNSELING CEN	7/11/2019	101YM0800X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	TER, INC.	24977 WASHINGTON AVENUE	SUITES K & L	MURRIETA	CA	92562	6149	33	06065	33.55150034	-117.2118708	Riverside County
137860	Fee-for-Service	1225318041	1225318041	1	1	ALONZO, SHIRIN MD	1/25/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	119906	40	Pediatrics	0	In state provider	None	7910 FROST ST	STE 350	SAN DIEGO	CA	92123	2753	37	06073	32.80027449	-117.153846	San Diego County
137897	Fee-for-Service	1851497465	1851497465	1	1	ALAMAR, ALI MD	2/1/2000	174400000X	NA	Other	026	PHYSICIANS	69613	41	Internal Medicine	0	In state provider	A PROFESSIONAL CORP	5565 GROSSMONT CENTER DR	BLDG 1, STE 210	LA MESA	CA	91942	3020	37	06073	32.77978322	-117.0094766	San Diego County
137911	Fee-for-Service	1134167828	1134167828	1	1	ACCESS DOCTOR CARE MEDICAL	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	32893	08	Family Practice	0	In state provider	CLINIC INC	215 N STATE COLLEGE BLVD	STE A	ANAHEIM	CA	92806	2938	30	06059	33.84270255	-117.8893257	Orange County
137914	Fee-for-Service	1225509896	1225509896	1	1	AGAPE SENIOR HOMES LLC	11/11/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	11442 NEWPORT AVE	None	SANTA ANA	CA	92705	2219	30	06059	33.76714688	-117.7948615	Orange County
137921	Fee-for-Service	1134279532	1134279532	1	1	ALEXANDER, LANCELOT O M D	4/22/2011	2084N0400X	NA	Neurology	026	PHYSICIANS	52251	13	Neurology (M.D. only)	0	In state provider	A MEDICAL CORPORATION	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65911769	-121.6448024	Monterey County
137924	Fee-for-Service	1336498757	1336498757	1	1	ALLSBROOK, HEATHER J LMFT	5/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
137964	Fee-for-Service	1396165890	1396165890	1	1	ALVAREZ, LIA F MD	8/1/2018	207L00000X	NA	Other	026	PHYSICIANS	154244	05	Anesthesiology	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
137965	Fee-for-Service	1508073925	1508073925	1	1	AXBERG, AMY	11/8/2024	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	33423 N 32ND AVE	None	PHOENIX	AZ	85085	8874	00	None	33.786909	-112.129047	Maricopa County
137973	Fee-for-Service	1609876929	1609876929	1	1	AMERICAN LEGION AMBULANC	8/16/1993	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	12134 AIRPORT RD	None	SUTTER CREEK	CA	95685	0000	03	06005	38.37883847	-120.8005991	Amador County
138020	Fee-for-Service	1083635528	1083635528	1	1	ANDERSON, DONALD MD	1/1/1982	207L00000X	NA	Other	026	PHYSICIANS	28968	05	Anesthesiology	0	In state provider	None	11226 CAMPUS ST	None	LOMA LINDA	CA	92354	3204	36	06071	34.0497213	-117.2657177	San Bernardino County
138036	Fee-for-Service	1881690949	1881690949	1	1	ADVANCED AMBULATORY SURGERY	9/19/2018	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER LP	1901 W LUGONIA AVE	STE 100	REDLANDS	CA	92374	9704	36	06071	34.07027851	-117.218421	San Bernardino County
138047	Fee-for-Service	1801950225	1801950225	1	1	ALLEN, MISTY MD.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	708 W FOREST AVE	None	JACKSON	TN	38301	3901	00	None	35.63557288	-88.83180943	Madison County
138072	Fee-for-Service	1093852899	1093852899	1	1	ANGEL VIEW INC	8/14/1998	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	66811 4TH ST	None	DESERT HOT SPRING	CA	92240	3266	33	06065	33.96541181	-116.4954673	Riverside County
138074	Fee-for-Service	1619112059	1619112059	1	1	ATKINSONALLAH, ASEYE LCSW	3/5/2019	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
138103	Fee-for-Service	1710416136	1710416136	1	1	ACCENTCARE UCLA HEALTH, LLC	5/31/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	9221 CORBIN AVE	SUITE 160	NORTHRIDGE	CA	91324	1659	19	06037	34.23776171	-118.5623227	Los Angeles County
138115	Fee-for-Service	1073991360	1073991360	1	1	AGELY, ALI MD	6/29/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	167964	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
138117	Fee-for-Service	1265590863	1265590863	1	1	AZIZ, KUSAI S MD	7/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97987	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 E NOBLE AVE	None	VISALIA	CA	93277	2717	54	06107	36.326115	-119.29203	Tulare County
138130	Fee-for-Service	1881331775	1881331775	1	1	ACUNA, MARCELA NP	12/18/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
138186	Fee-for-Service	1851497465	1851497465	1	1	ALAMAR, ALI MD	2/1/2000	174400000X	NA	Other	026	PHYSICIANS	69613	66	Emergency Medicine (Urgent Care)	0	In state provider	A PROFESSIONAL CORP	5565 GROSSMONT CENTER DR	BLDG 1, STE 210	LA MESA	CA	91942	3020	37	06073	32.77978322	-117.0094766	San Diego County
138199	Fee-for-Service	1134167828	1134167828	1	1	ACCESS DOCTOR CARE MEDICAL	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	32893	01	General Practice	0	In state provider	CLINIC INC	215 N STATE COLLEGE BLVD	STE A	ANAHEIM	CA	92806	2938	30	06059	33.84270255	-117.8893257	Orange County
138209	Fee-for-Service	1134279532	1134279532	1	1	ALEXANDER, LANCELOT O M D	4/22/2011	2084N0400X	NA	Neurology	026	PHYSICIANS	52251	41	Internal Medicine	0	In state provider	A MEDICAL CORPORATION	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65911769	-121.6448024	Monterey County
138221	Fee-for-Service	1700653508	1700653508	1	1	ALPHA OMEGA PHARMACY INC	5/30/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10500 MAGNOLIA AVE	UNIT D	ANAHEIM	CA	92804	5817	30	06059	33.809724	-117.9743355	Orange County
138240	Fee-for-Service	1124260385	1124260385	1	1	AHMAD ALHAMMOUN	3/26/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1960 W FRYE RD	STE 5	CHANDLER	AZ	85224	6238	00	None	33.299361	-111.875625	Maricopa County
138252	Fee-for-Service	1831765551	1831765551	1	1	AEGIS TREATMENT CENTERS, LLC	5/26/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	6001 TRUXTUN AVE	100 & 110	BAKERSFIELD	CA	93309	0679	15	06029	35.36252236	-119.072932	Kern County
138273	Fee-for-Service	1326316233	1326316233	1	1	AVAKIAN, SARO MD A MEDICAL	3/19/2012	193400000X	NA	Other	026	PHYSICIANS	95713	08	Family Practice	0	In state provider	CORPORATION	1030 S GLENDALE AVE	SUITE 403	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
138278	Fee-for-Service	1497287791	1497287791	1	1	ALHOURANI, AHMAD MD	5/22/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
138329	Fee-for-Service	1902428162	1902428162	1	1	APOLLO HOME HEALTH CARE INC	8/15/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11755 VICTORY BLVD	STE 160	NORTH HOLLYWOOD	CA	91606	3463	19	06037	34.18670448	-118.389699	Los Angeles County
138330	Fee-for-Service	1164503330	1164503330	1	1	AHAMED, FARAH K DO	3/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10100	41	Internal Medicine	0	In state provider	None	2382 CRENSHAW BLVD	STE 5	TORRANCE	CA	90501	3333	19	06037	33.82267285	-118.3284556	Los Angeles County
138358	Fee-for-Service	1760553689	1760553689	1	1	ABARCA, ADAN MD	9/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61262	08	Family Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
138383	Fee-for-Service	1003836990	1003836990	1	1	ARAKAKI, ROGER Y MD	8/24/2004	207L00000X	NA	Other	026	PHYSICIANS	48419	05	Anesthesiology	0	In state provider	None	12373 LEWIS ST	STE 102	GARDEN GROVE	CA	92840	4676	30	06059	33.78307435	-117.8981519	Orange County
138411	Fee-for-Service	1811243603	1811243603	1	1	ABELL, NICOLE L DO	9/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14594	None	None	0	In state provider	None	1700 N ROSE AVE	STE 210	OXNARD	CA	93030	7639	56	06111	34.21746	-119.155545	Ventura County
138428	Fee-for-Service	1790076941	1790076941	1	1	AZOUR, LEA MD	1/23/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	146680	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
138439	Fee-for-Service	1174940787	1174940787	1	1	ANGELS HAND HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2501 W BURBANK BLVD	SUITE 310	BURBANK	CA	91505	2347	19	06037	34.17861961	-118.3385265	Los Angeles County
138445	Fee-for-Service	1992239677	1992239677	1	1	ARUNKUMAR, AMIT MD	8/11/2023	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	187380	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
138449	Fee-for-Service	1134175136	1134175136	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13045 ROSEDALE HWY	None	BAKERSFIELD	CA	93314	9496	15	06029	35.38346424	-119.1464256	Kern County
138519	Fee-for-Service	1245375500	1245375500	1	1	ADAMS, SARAH E LCSW	10/20/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	301 N R ST	None	LOMPOC	CA	93436	5226	42	06083	34.6423983	-120.4705911	Santa Barbara County
138536	Fee-for-Service	1316240666	1316240666	1	1	AWOH, MAH NP	7/9/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
138539	Fee-for-Service	1831765551	1831765551	1	1	AEGIS TREATMENT CENTERS, LLC	5/26/2022	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	6001 TRUXTUN AVE	100 & 110	BAKERSFIELD	CA	93309	0679	15	06029	35.36252236	-119.072932	Kern County
138546	Fee-for-Service	1891226965	1891226965	1	1	AZIZ, SANDRA MD	4/5/2024	2081H0002X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	169565	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
138554	Fee-for-Service	1932856879	1932856879	1	1	ALNOOR ADULT CARE INC	4/10/2024	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	905 W MAIN ST	None	EL CAJON	CA	92020	3163	37	06073	32.79494154	-116.9734635	San Diego County
138563	Fee-for-Service	1992771307	1992771307	1	1	ADODRA, SNEHAL MD	7/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70121	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
138593	Fee-for-Service	1295819068	1295819068	1	1	APPLE VALLEY UNIFIED SD	9/30/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	12555 NAVAJO RD	None	APPLE VALLEY	CA	92308	7256	36	06071	34.47985497	-117.1901358	San Bernardino County
138606	Fee-for-Service	1114035128	1114035128	1	1	ALBERTSON, MICHAEL J MD	1/30/1978	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	22904	10	Gastroenterology (M.D. only)	0	In state provider	None	2625 W ALAMEDA AVE	None	BURBANK	CA	91505	4806	19	06037	34.1577056	-118.329779	Los Angeles County
138614	Fee-for-Service	1578577011	1578577011	1	1	AMONIC, ROBERT S MD	11/27/1985	2086S0122X	NA	General Surgery	026	PHYSICIANS	21380	24	Plastic Surgery	0	In state provider	None	2001 SN MONICA BLVD 790	None	SANTA MONICA	CA	90404	0000	19	06037	34.02890179	-118.479761	Los Angeles County
138619	Fee-for-Service	1255086369	1255086369	1	1	ANI HARUTYUNYAN LICENSED CLI	3/2/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NICAL SOCIAL WORKER APC	16530 VENTURA BLVD	400	ENCINO	CA	91436	4551	19	06037	34.15766626	-118.4934057	Los Angeles County
138634	Fee-for-Service	1265506893	1265506893	1	1	ACCETTA, AUGUST D MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	61628	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8501 BRIMHALL RD	BLDG 300	BAKERSFIELD	CA	93312	2254	15	06029	35.36876784	-119.0971029	Kern County
138638	Fee-for-Service	1285257493	1285257493	1	1	ASTRID PALLIATIVE CARE INC	3/11/2021	207QH0002X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2501 W BURBANK BLVD	200	BURBANK	CA	91505	2347	19	06037	34.17861961	-118.3385265	Los Angeles County
138664	Fee-for-Service	1548228844	1548228844	1	1	AUSTIN J. GRAHAM, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	824 S DIAMOND ST	None	NAMPA	ID	83686	5960	00	None	43.560486	-116.5583115	Canyon County
138711	Fee-for-Service	1255713780	1255713780	1	1	ALFSON, DANIEL B MD	11/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137167	02	General Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
138712	Fee-for-Service	1780927368	1780927368	1	1	ASHOUR, SYLVIA MD INC	12/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	97354	05	Anesthesiology	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
138729	Fee-for-Service	1174940787	1174940787	1	1	ANGELS HAND HOSPICE CARE INC	12/22/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2501 W BURBANK BLVD	SUITE 310	BURBANK	CA	91505	2347	19	06037	34.17861961	-118.3385265	Los Angeles County
138743	Fee-for-Service	1366947772	1366947772	1	1	ATLURI, MOKSHASREE DO	10/4/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	20128	None	None	0	In state provider	None	5821 JAMESON CT	None	CARMICHAEL	CA	95608	0820	34	06067	38.651409	-121.3290945	Sacramento County
138746	Fee-for-Service	1740427657	1740427657	1	5	ALTAMED HEALTH SERVICES CORP	5/10/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1415 FAIRHAVEN AVENUE	None	SANTA ANA	CA	92705	6822	30	06059	33.7733235	-117.8501535	Orange County
138767	Fee-for-Service	1124186614	1124186614	1	1	AGUILAR, DENISE NP	11/10/2008	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	30 RIVER PARK PL W	STE 260	FRESNO	CA	93720	1547	10	06019	36.85863998	-119.7892053	Fresno County
138788	Fee-for-Service	1164599924	1164599924	1	1	ALONZO, ROGELIO E NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9449 IMPERIAL HWY	STE ABCD	DOWNEY	CA	90242	2814	19	06037	33.91714048	-118.1262915	Los Angeles County
138790	Fee-for-Service	1235335316	1235335316	1	1	ABEDI, GELAREH MD	8/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122910	18	Ophthalmology	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
138819	Fee-for-Service	1447572508	1447572508	1	1	ACEVEDO, ANITA	5/1/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
138838	Fee-for-Service	1720681349	1720681349	1	1	A AND S HOSPICE PALLIATIVE	6/21/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	1425 W BURBANK BLVD	STE J	BURBANK	CA	91506	1307	19	06037	34.18217865	-118.3279216	Los Angeles County
138844	Fee-for-Service	1629544531	1629544531	1	1	ANISHBAN, JESSICA S LMFT	11/22/2019	103TC2200X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ENTER	22935 VENTURA	212	WOODLAND HILLS	CA	91364	1217	19	06037	34.16510774	-118.6263139	Los Angeles County
138845	Fee-for-Service	1902970502	1902970502	1	1	AGADI, SMITHA G MD	3/8/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95661	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
138849	Fee-for-Service	1255384343	1255384343	1	1	ALTON, WILLIAM J MD	9/19/2014	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	36721	41	Internal Medicine	0	In state provider	None	2040 VIBORG ROAD	SUITE 110	SOLVANG	CA	93463	2273	42	06083	34.6024706	-120.1275138	Santa Barbara County
138887	Fee-for-Service	1962633065	1962633065	1	1	ALLEN, CHERYL D LCSW	8/13/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5443 WILLIAM S HART RD	None	PIONEERTOWN	CA	92268	0000	36	06071	34.15452915	-116.4949594	San Bernardino County
138902	Fee-for-Service	1871685008	1871685008	2	1	ANDERSEN, MICHAEL	9/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	83821	None	None	0	In state provider	None	25405 HANCOCK AVENUE	#203	MURRIETA	CA	92562	5978	33	06065	33.5580833	-117.1850127	Riverside County
138917	Fee-for-Service	1508519836	1508519836	1	1	ARTS HOME HEALTH CARE INC	11/14/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6900 CANBY AVE	STE 111	RESEDA	CA	91335	4312	19	06037	34.19560922	-118.5350661	Los Angeles County
138923	Fee-for-Service	1407414485	1407414485	1	1	ARIBINDI, SWETHA MD	6/10/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
138987	Fee-for-Service	1821185133	1821185133	1	1	ABBAH, EFFIEM J MD	3/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89092	25	Physical Medicine and Rehabilitation	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
138991	Fee-for-Service	1609506914	1609506914	1	1	ARIA HOME HEALTH SERVICES IN	8/27/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	12235 BEACH BLVD	STE 205C	STANTON	CA	90680	3962	30	06059	33.784425	-117.9930265	Orange County
139034	Fee-for-Service	1740427657	1740427657	1	5	ALTAMED HEALTH SERVICES CORP	5/10/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1415 FAIRHAVEN AVENUE	None	SANTA ANA	CA	92705	6822	30	06059	33.7733235	-117.8501535	Orange County
139043	Fee-for-Service	1629103569	1629103569	2	1	AZALEA HEALTHCARE INC	7/18/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1 E VALLEY BLVD	None	ALHAMBRA	CA	91801	5115	19	06037	34.07868077	-118.1224983	Los Angeles County
139049	Fee-for-Service	1396822250	1396822250	1	1	ALBIN, CATHERINE L MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	49510	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
139071	Fee-for-Service	1033266879	1033266879	1	1	ALPERIN, MARIANN MD	11/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102879	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
139092	Fee-for-Service	1932599982	1932599982	1	1	ARGO HOSPICE, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10523 BURBANK BLVD	SUITE 115	NORTH HOLLYWOOD	CA	91601	2233	19	06037	34.17216449	-118.36017	Los Angeles County
139098	Fee-for-Service	1518393768	1518393768	1	1	ALVIN, MATTHEW D MD	8/11/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	169273	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
139103	Fee-for-Service	1578146312	1578146312	1	1	ARGO HOME HEALTH INC	11/13/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12501 CHANDLER BLVD	STE 200	VALLEY VILLAGE	CA	91607	1966	19	06037	34.16870346	-118.4056065	Los Angeles County
139104	Fee-for-Service	1952562290	1952562290	1	1	ALLEN, CHARMAYNE A PHD	12/4/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
139117	Fee-for-Service	1477690238	1477690238	2	1	ANGEL VIEW INC	12/28/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	FOUNDATION INC	66863 FLORA AVE	None	DESERT HOT SPRING	CA	92240	4618	33	06065	33.95592158	-116.49523	Riverside County
139127	Fee-for-Service	1720681349	1720681349	1	1	A AND S HOSPICE PALLIATIVE	6/21/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	1425 W BURBANK BLVD	STE J	BURBANK	CA	91506	1307	19	06037	34.18217865	-118.3279216	Los Angeles County
139140	Fee-for-Service	1275191744	1275191744	1	1	ANDERSON, CAITLYN O DO	10/7/2022	207P00000X	NA	Other	026	PHYSICIANS	19842	None	None	0	In state provider	None	27300 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.89552551	-117.186021	Riverside County
139157	Fee-for-Service	1467832311	1467832311	1	1	AWAN, FATIMA MD	12/9/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	172268	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
139159	Fee-for-Service	1487617072	1487617072	1	1	AMIRKIAI, MEHRYAR DPM	11/25/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	500 E REMINGTON DR	STE 12	SUNNYVALE	CA	94087	2611	43	06085	37.35898474	-122.0281716	Santa Clara County
139185	Fee-for-Service	1730661620	1730661620	1	1	ABDELMALAK PODIATRY CORP	4/5/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	ARE	3503 LEXINGTON AVE	None	EL MONTE	CA	91731	2607	19	06037	34.072227	-118.039478	Los Angeles County
139216	Fee-for-Service	1679590566	1679590566	1	1	AL-JAZAYRLY, GHASSAN MD	11/17/2010	207RH0003X	NA	Oncology	026	PHYSICIANS	52470	78	Neoplastic Diseases/Oncology	0	In state provider	None	1300 N VERMONT AVE	# 606	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
139224	Fee-for-Service	1013335124	1013335124	1	1	ADAMSON, GREGORY T MD	7/13/2021	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	140732	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
139242	Fee-for-Service	1689783284	1689783284	1	2	APRIA HEALTHCARE LLC	4/8/2003	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1450 EXPO PKWY	None	SACRAMENTO	CA	95815	4230	34	06067	38.597139	-121.4558685	Sacramento County
139260	Fee-for-Service	1316151756	1316151756	1	1	ALVARADO MED GRP INC	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	6386 ALVARADO COURT	STE 310	SAN DIEGO	CA	92120	4908	37	06073	32.77666838	-117.0614255	San Diego County
139279	Fee-for-Service	1447391719	1447391719	1	6	ASIAN HEALTH SERVICES	7/7/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE UNIT 1	2000 DOOLITTLE DRIVE	None	SAN LEANDRO	CA	94577	3237	01	06001	37.70601654	-122.1809505	Alameda County
139287	Fee-for-Service	1699457879	1699457879	1	1	ACE ROADSIDE ASSISTANCE INC	8/18/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	9100 AUTUMN SUNSET DR	None	BAKERSFIELD	CA	93311	3630	15	06029	35.30794876	-119.1033666	Kern County
139293	Fee-for-Service	1740368968	1740368968	1	1	ABDOO, DAVID C DPM	1/1/2001	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	SALINAS VLLY FT & ANKLE	110 HARDEN PKWY	STE 101	SALINAS	CA	93906	5257	27	06053	36.7136486	-121.6508436	Monterey County
139300	Fee-for-Service	1891542098	1891542098	1	1	APEX MEDICAL CLINICS PC	5/10/2024	207QB0002X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	2120 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3703	15	06029	35.3734495	-119.026503	Kern County
139318	Fee-for-Service	1215182910	1215182910	1	1	ANNAMALAI, ALAGAPPAN MD	9/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111518	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
139338	Fee-for-Service	1396822250	1396822250	1	1	ALBIN, CATHERINE L MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	49510	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
139350	Fee-for-Service	1215188032	1215188032	1	1	AM MEDICAL DISTRIBUTORS	5/8/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	10418 S PRAIRIE AVE	#A	INGLEWOOD	CA	90303	1832	19	06037	33.941241	-118.3439145	Los Angeles County
139380	Fee-for-Service	1932599982	1932599982	1	1	ARGO HOSPICE, INC	2/9/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10523 BURBANK BLVD	SUITE 115	NORTH HOLLYWOOD	CA	91601	2233	19	06037	34.17216449	-118.36017	Los Angeles County
139396	Fee-for-Service	1144075938	1144075938	1	1	ADVENTIST HEALTH PHYSICIANS	7/9/2024	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	2755 ALAMO ST # 201	None	SIMI VALLEY	CA	93065	1311	56	06111	34.28643348	-118.742904	Ventura County
139410	Fee-for-Service	1053974931	1053974931	1	1	AKSU, ZEHRA CCC-SLP	9/9/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
139458	Fee-for-Service	1588735096	1588735096	1	1	ARMOSILLA, FRANCISCO A	11/4/2008	173000000X	NA	Other	026	PHYSICIANS	50568	40	Pediatrics	0	In state provider	MD	1045 ATLANTIC AVENUE	SUITE 818	LONG BEACH	CA	90813	3410	19	06037	33.780267	-118.1850795	Los Angeles County
139463	Fee-for-Service	1114215944	1114215944	1	1	ALOIS ZAUNER, M.D. INC.	10/17/2011	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2403 CASTILLO ST	STE 203	SANTA BARBARA	CA	93105	5316	42	06083	34.43053648	-119.7243139	Santa Barbara County
139482	Fee-for-Service	1114215944	1114215944	1	3	ALOIS ZAUNER, M.D. INC.	4/16/2020	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1700 NORTH ROSE AVENUE	SUITE 360	OXNARD	CA	93030	3790	56	06111	34.21746	-119.155545	Ventura County
139502	Fee-for-Service	1679590566	1679590566	1	1	AL-JAZAYRLY, GHASSAN MD	11/17/2010	207RH0003X	NA	Oncology	026	PHYSICIANS	52470	41	Internal Medicine	0	In state provider	None	1300 N VERMONT AVE	# 606	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
139536	Fee-for-Service	1275864910	1275864910	1	1	ABC CHILDRENS CLINIC INC	1/13/2014	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	96525	None	None	0	In state provider	None	26730 TOWNE CENTRE DRIVE	204	FOOTHILL RANCH	CA	92610	2842	30	06059	33.67419218	-117.6628315	Orange County
139555	Fee-for-Service	1841539921	1841539921	1	1	AMERICAN INDIAN CHANGING	6/13/2016	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	SPIRITS	2120 W WILLIAMS STREET	BLDG 1, 2 AND 3	LONG BEACH	CA	90810	3636	19	06037	33.7929977	-118.2210007	Los Angeles County
139567	Fee-for-Service	1447391719	1447391719	1	6	ASIAN HEALTH SERVICES	7/7/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MOBILE UNIT 1	2000 DOOLITTLE DRIVE	None	SAN LEANDRO	CA	94577	3237	01	06001	37.70601654	-122.1809505	Alameda County
139568	Fee-for-Service	1396114666	1396114666	1	1	AMERICAN HEALTHCARE	6/28/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL GROUP	11700 DUBLIN BLVD	STE 130	DUBLIN	CA	94568	2822	01	06001	37.70067515	-121.9404942	Alameda County
139588	Fee-for-Service	1447463658	1447463658	1	2	AUSTIN, MATTHEW J MD	4/17/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	92849	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
139606	Fee-for-Service	1215182910	1215182910	1	1	ANNAMALAI, ALAGAPPAN MD	9/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111518	01	General Practice	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
139626	Fee-for-Service	1518288125	1518288125	1	1	AMIN, NIVEK M MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128463	05	Anesthesiology	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
139628	Fee-for-Service	1427243104	1427243104	1	1	ARCE, FELIPE J MD	1/5/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	80151	None	None	0	In state provider	None	200 N LA CUMBRE RD	M	SANTA BARBARA	CA	93110	1577	42	06083	34.44255908	-119.7510269	Santa Barbara County
139687	Fee-for-Service	1841785284	1841785284	1	1	ACKER, CHELSEA K PSYD	5/22/2023	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
139711	Fee-for-Service	1316297294	1316297294	1	1	ANZ CLINICS INC	8/26/2013	207R00000X	NA	Other	026	PHYSICIANS	10575	41	Internal Medicine	0	In state provider	None	1503 N IMPERIAL AVE	STE 204	EL CENTRO	CA	92243	6302	13	06025	32.806881	-115.5697535	Imperial County
139748	Fee-for-Service	1609409077	1609409077	1	1	ALTAMED HEALTH SERVICES CORP	4/24/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	MACY WESTLAKE	2100 W 3RD ST.	SUITE 190	LOS ANGELES	CA	90057	1999	19	06037	34.06308947	-118.2733326	Los Angeles County
139759	Fee-for-Service	1376907535	1376907535	1	1	ADVANCED CENTER FOR SPORTS &	5/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	13043	None	None	0	In state provider	MUSCULOSKELETAL MEDICINE	41990 COOK ST	STE 1006F	PALM DESERT	CA	92211	6105	33	06065	33.748371	-116.356173	Riverside County
139763	Fee-for-Service	1629498779	1629498779	1	1	AMERINASAB, REZA MD	4/19/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	191770	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
139774	Fee-for-Service	1184844581	1184844581	1	1	ABBO, MICHELLE M MD	12/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94227	41	Internal Medicine	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
139775	Fee-for-Service	1932828589	1932828589	1	1	ALWAHAB MD INC	12/30/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	250 E CHASE AVE	STE 110	EL CAJON	CA	92020	6305	37	06073	32.78042748	-116.9591715	San Diego County
139787	Fee-for-Service	1013002435	1013002435	1	1	ANDERSON, ALBERT R III MD	12/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	56013	01	General Practice	0	In state provider	None	81767 DR CARREON BLVD	STE 102	INDIO	CA	92201	5598	33	06065	33.70738112	-116.237755	Riverside County
139806	Fee-for-Service	1982147609	1982147609	1	1	AHN, TONY J	5/31/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
139845	Fee-for-Service	1356763742	1356763742	1	1	ACHILLES PROSTHETICS AND	7/14/2017	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ORTHOTICS INC	234 HEATHER CT	SUITE 101	TEMLETON	CA	93465	8765	40	06079	35.55398686	-120.7176543	San Luis Obispo County
139864	Fee-for-Service	1174937221	1174937221	1	1	AGOSTINELLI, JENNIFER J LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2001 JUNIPERO SERRA BLVD	STE 650	DALY CITY	CA	94014	3891	41	06081	37.70124814	-122.4706974	San Mateo County
139870	Fee-for-Service	1598711319	1598711319	1	1	ANGELOW, ANGEL G MD	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	49125	08	Family Practice	0	In state provider	None	605 W 6TH ST	None	SAN PEDRO	CA	90731	2523	19	06037	33.73875028	-118.2904334	Los Angeles County
139887	Fee-for-Service	1699092353	1699092353	1	1	AMANDA FINNEY DO	9/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	346 GRAND AVE	None	JOHNSON CITY	NY	13790	2580	00	None	42.109812	-75.9635235	Broome County
139916	Fee-for-Service	1770514945	1770514945	1	1	ALAN E. GORENBERG MD, INC.	3/24/2022	207KA0200X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	8506 E CHAPMAN AVE	None	ORANGE	CA	92869	2461	30	06059	33.79257086	-117.7626894	Orange County
139934	Fee-for-Service	1700065901	1700065901	1	1	ALONSO, LAZARO V MD AMC	11/1/1996	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	ALONSO MEDICAL GROUP	15216 VANOWEN ST	None	VAN NUYS	CA	91405	3601	19	06037	34.19389833	-118.4642439	Los Angeles County
139961	Fee-for-Service	1770712689	1770712689	1	1	ABBASSI, SHERVIN LMFT	4/20/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17111 BEACH BLVD	STE 205	HUNTINGTON BEACH	CA	92647	5947	30	06059	33.713937	-117.9892085	Orange County
140044	Fee-for-Service	1669562237	1669562237	1	1	APUYA, JESUS MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	800 MARSHALL STREET	SLOT 653	LITTLE ROCK	AR	72202	3510	00	None	34.74346583	-92.29154425	Pulaski County
140079	Fee-for-Service	1831676055	1831676055	1	1	ASANAD, KIAN MD	7/5/2024	208800000X	NA	Other	026	PHYSICIANS	166865	34	Urology and Urological Surgery	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
140107	Fee-for-Service	1881039873	1881039873	1	1	ARORA-THISSEN, SABRINA DO	8/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	13844	01	General Practice	0	In state provider	None	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	1384	07	06013	37.9991883	-122.2867117	Contra Costa County
140108	Fee-for-Service	1700960788	1700960788	1	1	AKHTAR, SHAFQAT M MD	5/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	45081	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
140110	Fee-for-Service	1194834192	1194834192	1	1	ACE ORTHOPEDICS INC	6/8/2004	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	7860 IMPERIAL HWY	#E	DOWNEY	CA	90242	3464	19	06037	33.92529838	-118.1547578	Los Angeles County
140139	Fee-for-Service	1679892004	1679892004	1	1	ADHIKARI, PRABHAT MD	7/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119498	41	Internal Medicine	0	In state provider	None	1180 E SHAW	#101	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
140181	Fee-for-Service	1417453945	1417453945	1	1	ADHIKARI, SHANTA NP	9/29/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
140201	Fee-for-Service	1679178933	1679178933	1	1	AAA ROYAL SENIOR LIVING INC	1/14/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6214 BECKFORD AVE	None	TARZANA	CA	91335	6634	19	06037	34.18311357	-118.5513886	Los Angeles County
140224	Fee-for-Service	1700065901	1700065901	1	1	ALONSO, LAZARO V MD AMC	11/1/1996	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	11	Aviation (M.D. only)	0	In state provider	ALONSO MEDICAL GROUP	15216 VANOWEN ST	None	VAN NUYS	CA	91405	3601	19	06037	34.19389833	-118.4642439	Los Angeles County
140226	Fee-for-Service	1508251653	1508251653	1	1	AUNG, THET T MD	1/27/2020	390200000X	NA	Other	026	PHYSICIANS	153094	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
140235	Fee-for-Service	1053602128	1053602128	1	1	AGNETTA, VLATKA MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122120	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92411	1217	36	06071	34.131303	-117.3225325	San Bernardino County
140272	Fee-for-Service	1013116821	1013116821	1	1	ALBRECHT, ANNE F LAC	1/9/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
140281	Fee-for-Service	1184776262	1184776262	1	1	ACEVEDO, SYLVIA R	5/16/2006	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1700 ALAMEDA ST	None	POMONA	CA	91768	1727	19	06037	34.07825822	-117.7555489	Los Angeles County
140290	Fee-for-Service	1649779844	1649779844	1	1	ARMENTA, MONICA LMFT	1/12/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	HERAPY	605 S F STREET	None	IMPERIAL	CA	92251	1838	13	06025	32.841999	-115.573648	Imperial County
140322	Fee-for-Service	1497164016	1497164016	1	1	ABUERSHAID, HANA N MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136257	41	Internal Medicine	0	In state provider	None	THREE MEDICAL PLAZA	SUITE 120	ROSEVILLE	CA	95661	3088	31	06061	38.76566391	-121.2457432	Placer County
140328	Fee-for-Service	1013370410	1013370410	1	1	ABRAAMYAN, TORGOM MD	8/23/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	171399	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
140332	Fee-for-Service	1669562237	1669562237	1	1	APUYA, JESUS MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	800 MARSHALL STREET	SLOT 653	LITTLE ROCK	AR	72202	3510	00	None	34.74346583	-92.29154425	Pulaski County
140353	Fee-for-Service	1871671768	1871671768	1	1	ALVAREZ, ADOLFO MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	54950	02	General Surgery	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
140398	Fee-for-Service	1275160400	1275160400	1	1	ASTOR, OLIVIA MD	7/1/2023	390200000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
140421	Fee-for-Service	1710933635	1710933635	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13270 NEWPORT AVE	None	TUSTIN	CA	92780	3410	30	06059	33.74605628	-117.8139923	Orange County
140422	Fee-for-Service	1235913351	1235913351	1	1	ARYA MEDICAL GROUP CORP	12/27/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	121 BELMONT AVENUE	SUITE 100	MENDOTA	CA	93640	8231	10	06019	36.74934166	-120.3867513	Fresno County
140432	Fee-for-Service	1043578222	1043578222	1	1	APPLERIDGE ASSISTED LIVING	7/13/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	3950 ANNADALE LANE	None	SACRAMENTO	CA	95821	0000	34	06067	38.638323	-121.3774785	Sacramento County
140440	Fee-for-Service	1750359071	1750359071	1	1	ALI, MOHSEN I MD	1/9/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	33406	13	Neurology (M.D. only)	0	In state provider	None	1330 W COVINA BLVD	STE 103	SAN DIMAS	CA	91773	3200	19	06037	34.09894509	-117.8340464	Los Angeles County
140448	Fee-for-Service	1821477522	1821477522	1	1	ALDEA INC	3/26/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1401 GRAYSON AVENUE	ROOM 103	ST HELENA	CA	94574	2128	28	06055	38.49751104	-122.462889	Napa County
140449	Fee-for-Service	1780719799	1780719799	1	1	ABENOJAR, JIMMARK V MD	7/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97351	36	Psychiatry	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
140458	Fee-for-Service	1710139704	1710139704	1	1	ADVANCED SLEEP MEDICINE SRVS	7/3/2018	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	17835 VENTURA BLVD	SUITE 300	ENCINO	CA	91316	3677	19	06037	34.1633551	-118.5215171	Los Angeles County
140490	Fee-for-Service	1114990785	1114990785	1	1	ALEJO, WILFREDO Y MD	2/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52629	None	None	0	In state provider	None	420 W ROWLAND ST	None	COVINA	CA	91723	2943	19	06037	34.078949	-117.8963031	Los Angeles County
140504	Fee-for-Service	1912093436	1912093436	1	1	AHMADPOUR, HEDAYATOLAH	11/28/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	30282	06	Cardiovascular Disease (M.D. only)	0	In state provider	MD	1505 WILSON TER	STE 150	GLENDALE	CA	91206	4076	19	06037	34.14960934	-118.2313491	Los Angeles County
140528	Fee-for-Service	1205286713	1205286713	1	1	ADVANCED SLEEP MEDICINE SRVS	7/3/2018	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	4281 KATELLA AVE	SUITE 110	LOS ALAMITOS	CA	90720	3500	30	06059	33.80315853	-118.058328	Orange County
140578	Fee-for-Service	1124054424	1124054424	1	1	ANWAR, FAISAL MD	3/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110681	41	Internal Medicine	0	In state provider	None	555 S SEVENTH AVE	None	BARSTOW	CA	92311	3043	36	06071	34.894062	-117.0196215	San Bernardino County
140581	Fee-for-Service	1194800094	1194800094	1	1	AHMADI, SHEILA H MD	10/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51700	67	Endocrinology	0	In state provider	None	200 MED PLAZA	STE 530	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
140585	Fee-for-Service	1578701934	1578701934	1	1	ARNOLD, MONIKA T LCSW	1/3/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	71530	-	NOT APPLICABLE	0	In state provider	None	86 SOUTH 14TH STREET	None	SAN JOSE	CA	95112	2015	43	06085	37.34109735	-121.8760463	Santa Clara County
140613	Fee-for-Service	1881770386	1881770386	1	1	ALLOGGIAMENTO, THOMAS MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	56180	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
140642	Fee-for-Service	1033294780	1033294780	1	1	ANTONIA CHIESA MD	11/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	None	39.742164	-104.8350375	Adams County
140652	Fee-for-Service	1811978364	1811978364	1	1	AMANI-YAZDI, RAMBOD	6/30/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	70521	None	None	0	In state provider	None	1234 FOOTHILL BLVD	STE 2	LA VERNE	CA	91750	3329	19	06037	34.11800774	-117.7794559	Los Angeles County
140653	Fee-for-Service	1568721918	1568721918	1	1	ANTELOPE HOSPICE CORPORATION	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1061 W AVENUE M14	SUITE D	PALMDALE	CA	93551	1440	19	06037	34.63305472	-118.1498743	Los Angeles County
140704	Fee-for-Service	1760624092	1760624092	1	1	ARCADIA GARDENS DIALYSIS LLC	9/29/2010	261QE0700X	NA	Other	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	3722 E COLORADO BLVD	None	PASADENA	CA	91107	3872	19	06037	34.14619947	-118.0725435	Los Angeles County
140711	Fee-for-Service	1235913351	1235913351	1	1	ARYA MEDICAL GROUP CORP	3/25/2025	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	121 BELMONT AVENUE	SUITE 100	MENDOTA	CA	93640	8231	10	06019	36.74934166	-120.3867513	Fresno County
140715	Fee-for-Service	1407239718	1407239718	1	1	ABU KAR, ABDULLAH MD	9/23/2022	208M00000X	NA	Other	026	PHYSICIANS	181829	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
140720	Fee-for-Service	1306365416	1306365416	1	1	ALMOND, AMANDA M NP	12/12/2018	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3130 DEL MONTE BLVD	None	MARINA	CA	93933	3047	27	06053	36.68590557	-121.8010492	Monterey County
140753	Fee-for-Service	1245301969	1245301969	1	1	ARMAS, MATTHEW W	6/1/2000	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	6592 N FIRST ST	None	FRESNO	CA	93710	3931	10	06019	36.833571	-119.7719445	Fresno County
140792	Fee-for-Service	1700270477	1700270477	2	1	APPLE RX PHARMACY INC	12/11/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3625 MARTIN LUTHER KING	STE 1B	LYNWOOD	CA	90262	9070	19	06037	33.93044131	-118.2021564	Los Angeles County
140797	Fee-for-Service	1013449297	1013449297	1	1	ACE EYECARE INC	10/30/2017	193200000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1721 WESTWIND DR	STE B	BAKERSFIELD	CA	93301	3026	15	06029	35.37519935	-119.0425415	Kern County
140850	Fee-for-Service	1033351739	1033351739	1	1	ADAMS, NATHAN J CRNA	3/4/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
140857	Fee-for-Service	1992986947	1992986947	1	1	ANAKWENZE, VICKI M MD	8/29/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61291	01	General Practice	0	In state provider	None	11149 CRENSHAW BLVD	None	INGLEWOOD	CA	90303	2338	19	06037	33.933465	-118.3265975	Los Angeles County
140873	Fee-for-Service	1194800094	1194800094	1	1	AHMADI, SHEILA H MD	10/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	51700	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	STE 530	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
140893	Fee-for-Service	1326022708	1326022708	1	1	AMINPOUR, SHERVIN MD PC	1/13/2021	174400000X	NA	Other	026	PHYSICIANS	99486	None	None	0	In state provider	None	7345 MEDICAL CENTER DR	540	WEST HILLS	CA	91307	1910	19	06037	34.20369349	-118.629837	Los Angeles County
140894	Fee-for-Service	1720414196	1720414196	1	1	ATIENZA, SHARON NP	8/4/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
140899	Fee-for-Service	1770260317	1770260317	1	1	ARINGO, CYNTHIA INDOMBO	8/9/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2452 DONATELLO STREET	None	MANTECA	CA	95337	8403	39	06077	37.78158218	-121.2598781	San Joaquin County
140912	Fee-for-Service	1730226465	1730226465	2	1	ADDICTION RESEARCH AND TREAT	11/11/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3707 SUNSET LANE AND 371	A & B	ANTIOCH	CA	94509	6101	07	06013	37.98459755	-121.8042179	Contra Costa County
140943	Fee-for-Service	1568721918	1568721918	1	1	ANTELOPE HOSPICE CORPORATION	9/17/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1061 W AVENUE M14	SUITE D	PALMDALE	CA	93551	1440	19	06037	34.63305472	-118.1498743	Los Angeles County
140970	Fee-for-Service	1851737340	1851737340	1	1	ABRAMS, ERIC R MD	6/22/2018	207P00000X	NA	Other	026	PHYSICIANS	152593	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
140975	Fee-for-Service	1164659959	1164659959	1	1	ALTMAN, NICHOLAS D MD	3/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134165	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
140984	Fee-for-Service	1528098498	1528098498	1	1	ALAN GRILLO	6/1/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	715 DELMORE DR	None	ROSEAU	MN	56751	1534	00	None	48.83948581	-95.7599527	Roseau County
140988	Fee-for-Service	1225176068	1225176068	1	1	AGUIRRE, OLIVIA L LMFT	2/13/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
140998	Fee-for-Service	1518276880	1518276880	1	1	ABDUL RAHMAN, DIANA M MD	4/1/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	139768	13	Neurology (M.D. only)	0	In state provider	None	2895 N TOWNE AVE	None	POMONA	CA	91767	2009	19	06037	34.098525	-117.7368955	Los Angeles County
141001	Fee-for-Service	1235913351	1235913351	1	1	ARYA MEDICAL GROUP CORP	12/27/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	121 BELMONT AVENUE	SUITE 100	MENDOTA	CA	93640	8231	10	06019	36.74934166	-120.3867513	Fresno County
141010	Fee-for-Service	1003407388	1003407388	1	1	ADOM TELEPSYCHIATRY AND MENT	9/20/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	AL HEALTH SERVICES, A PR	4199 FLAT ROCK DR	STE 148	RIVERSIDE	CA	92505	7115	33	06065	33.90364208	-117.4931242	Riverside County
141057	Fee-for-Service	1639174816	1639174816	2	1	ANTEBI, ALON DO	10/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	42135 10TH STREET WEST	STE 101	LANCASTER	CA	93534	7099	19	06037	34.648533	-118.1477975	Los Angeles County
141064	Fee-for-Service	1598239881	1598239881	1	1	ABRAMSON, SHELBY NP	10/8/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	769 MEDICAL CENTER COURT	STE 300	CHULA VISTA	CA	91911	6602	37	06073	32.619186	-117.0200925	San Diego County
141067	Fee-for-Service	1790203388	1790203388	1	1	ALTMAN, JESSICA PT	12/14/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
141068	Fee-for-Service	1265775035	1265775035	1	1	AGCAOILI, ANDREA L DO	11/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14672	01	General Practice	0	In state provider	None	1450 TREAT BLVD	STE 120A	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
141085	Fee-for-Service	1013449297	1013449297	1	1	ACE EYECARE INC	10/30/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1721 WESTWIND DR	STE B	BAKERSFIELD	CA	93301	3026	15	06029	35.37519935	-119.0425415	Kern County
141087	Fee-for-Service	1295441533	1295441533	1	1	ACE 4Q INC	9/3/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	941 S EUCLID ST	None	ANAHEIM	CA	92802	1583	30	06059	33.81918207	-117.9415353	Orange County
141098	Fee-for-Service	1710638440	1710638440	1	1	ALL CITY MEDICAL TRANSPORTAT	2/11/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ION, INC.	524 S VERDUGO DR	UNIT B	BURBANK	CA	91502	2344	19	06037	34.16978109	-118.3120139	Los Angeles County
141113	Fee-for-Service	1568963528	1568963528	1	1	ARDON, VIVIAN C LMFT	6/13/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
141114	Fee-for-Service	1528420734	1528420734	1	1	ANG, MICHELLE A	8/9/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
141115	Fee-for-Service	1801636899	1801636899	1	1	ALEX HASHEMI M.D., INC	11/1/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1771 ROMNEYA DR	STE A	ANAHEIM	CA	92801	1817	30	06059	33.85067649	-117.9445635	Orange County
141165	Fee-for-Service	1245759372	1245759372	1	1	ALLARANDA GANAPATHY, VARUN U	9/24/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	706 N DIAMOND BAR BLVD	STE B	DIAMOND BAR	CA	91765	1059	19	06037	34.03167081	-117.8089198	Los Angeles County
141169	Fee-for-Service	1659530327	1659530327	1	2	A & P HOME HEALTH, INC.	6/13/2019	251E00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	212 N GLENDALE AVE	104	GLENDALE	CA	91206	4734	19	06037	34.14873322	-118.2461855	Los Angeles County
141170	Fee-for-Service	1902079452	1902079452	1	7	ABLE PHYSICAL THERAPY CORP	9/3/2019	225X00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9470 FIRESTONE BLVD	None	DOWNEY	CA	90241	5504	19	06037	33.93069029	-118.1144429	Los Angeles County
141179	Fee-for-Service	1427433762	1427433762	1	1	ALMAGUEL, FRANKIS MD	5/21/2020	174400000X	NA	Other	026	PHYSICIANS	123708	30	Radiology	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
141186	Fee-for-Service	1770260317	1770260317	1	1	ARINGO, CYNTHIA INDOMBO	8/9/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	2452 DONATELLO STREET	None	MANTECA	CA	95337	8403	39	06077	37.78158218	-121.2598781	San Joaquin County
141236	Fee-for-Service	1053715011	1053715011	1	1	ALLSTATE CARE HOSPICE INC	4/12/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8285 W SUNSET BLVD	SUITE 4	WEST HOLLYWOOD	CA	90046	2420	19	06037	34.0966221	-118.3701746	Los Angeles County
141239	Fee-for-Service	1912141664	1912141664	1	1	AMIN, SHALIN J MD	4/1/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104574	30	Radiology	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
141248	Fee-for-Service	1780613380	1780613380	1	1	ANDERSON, DAVID J MD	1/1/1982	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	41509	01	General Practice	0	In state provider	None	505 PARNASSUS AVE	# 997M	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
141271	Fee-for-Service	1205975208	1205975208	1	1	ALLEN, CARLETON A MD	2/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	1	Border provider	None	2020 PALOMINO LANE	SUITE 100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
141283	Fee-for-Service	1316235427	1316235427	1	1	ALWAYS BEST CASE MANAGEMENT	9/12/2011	No Taxonomy Provided	NA	None	093	CARE COORDINATOR AGENCIES (CCA)	-	-	NOT APPLICABLE	0	In state provider	MICHAEL NEWMAN	1406 BLUE OAKS BLVD	None	ROSEVILLE	CA	95747	5199	31	06061	38.79553247	-121.3153743	Placer County
141292	Fee-for-Service	1891215026	1891215026	1	1	ALFI, MINA E MD	11/15/2022	207L00000X	NA	Other	026	PHYSICIANS	177819	None	None	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
141300	Fee-for-Service	1003407388	1003407388	1	1	ADOM TELEPSYCHIATRY AND MENT	3/22/2024	2084P0800X	NA	Psychiatry	022	PHYSICIANS GROUP	-	None	None	0	In state provider	AL HEALTH SERVICES, A PR	4199 FLAT ROCK DR	STE 148	RIVERSIDE	CA	92505	7115	33	06065	33.90364208	-117.4931242	Riverside County
141310	Fee-for-Service	1538111547	1538111547	1	1	ARUN, PARVATANENI MD	9/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30167	41	Internal Medicine	0	In state provider	None	2777 PACIFIC AVE	STE K	LONG BEACH	CA	90806	2627	19	06037	33.80761478	-118.193744	Los Angeles County
141335	Fee-for-Service	1487609939	1487609939	1	1	ALTERMAN, RUSSELL S DO	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	6838	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
141338	Fee-for-Service	1891847950	1891847950	2	1	AUDREY REID AND ASSOCIATES,	9/26/2019	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	ROUP	800 FAIRMOUNT AVE	110	PASADENA	CA	91105	3151	19	06037	34.13193177	-118.1517805	Los Angeles County
141347	Fee-for-Service	1770807646	1770807646	1	1	ALVAREZ, GRISELDA MD	7/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110447	67	Endocrinology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
141360	Fee-for-Service	1609295468	1609295468	1	1	AHMED, SARA MD	8/17/2023	207RE0101X	NA	Endocrinology	026	PHYSICIANS	147669	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
141419	Fee-for-Service	1245859883	1245859883	1	1	ALONZO-FRISZ, CONNIE M LMFT	8/17/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 BRADFORD	STE 270	REDWOOD CITY	CA	94063	1571	41	06081	37.48799425	-122.2320157	San Mateo County
141448	Fee-for-Service	1598374555	1598374555	1	1	AMICA HOSPICE CARE, INC	1/19/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	SUITE 305	ENCINO	CA	91436	2988	19	06037	34.15524484	-118.4756687	Los Angeles County
141468	Fee-for-Service	1427433762	1427433762	1	1	ALMAGUEL, FRANKIS MD	5/21/2020	174400000X	NA	Other	026	PHYSICIANS	123708	42	Nuclear Medicine	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
141492	Fee-for-Service	1225156763	1225156763	1	1	AMIN,AZIZ	6/14/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1901 1ST AVENUE	None	NEW YORK	NY	10029	7404	00	None	40.784778	-73.9439055	New York County
141506	Fee-for-Service	1508856881	1508856881	1	1	ARNST, DENNIS J PHD	1/1/1999	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1066 N CHERRY ST	None	TULARE	CA	93274	2251	54	06107	36.22347717	-119.3374086	Tulare County
141523	Fee-for-Service	1053715011	1053715011	1	1	ALLSTATE CARE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8285 W SUNSET BLVD	SUITE 4	WEST HOLLYWOOD	CA	90046	2420	19	06037	34.0966221	-118.3701746	Los Angeles County
141536	Fee-for-Service	1710166095	1710166095	1	1	AFGHANI, ELHAM MD	6/2/2010	207R00000X	NA	Other	026	PHYSICIANS	107262	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92863	4091	30	06059	33.78674051	-117.8888713	Orange County
141557	Fee-for-Service	1952313140	1952313140	1	1	ACACIO, BRIAN D MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80390	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2750 E WASHINGTON BLVD	STE 230	PASADENA	CA	91107	1449	19	06037	34.1680038	-118.0943955	Los Angeles County
141587	Fee-for-Service	1003407388	1003407388	1	1	ADOM TELEPSYCHIATRY AND MENT	3/22/2024	2084P0800X	NA	Psychiatry	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	AL HEALTH SERVICES, A PR	4199 FLAT ROCK DR	STE 148	RIVERSIDE	CA	92505	7115	33	06065	33.90364208	-117.4931242	Riverside County
141598	Fee-for-Service	1538111547	1538111547	1	1	ARUN, PARVATANENI MD	9/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30167	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2777 PACIFIC AVE	STE K	LONG BEACH	CA	90806	2627	19	06037	33.80761478	-118.193744	Los Angeles County
141614	Fee-for-Service	1629495742	1629495742	1	1	ACACIA HOME HEALTH AND	4/12/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE INC	11770 WARNER AVE	SUITE 101	FOUNTAIN VALLEY	CA	92708	2659	30	06059	33.71573417	-117.9239528	Orange County
141623	Fee-for-Service	1487609939	1487609939	1	1	ALTERMAN, RUSSELL S DO	8/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	6838	01	General Practice	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
141629	Fee-for-Service	1164690988	1164690988	1	1	ANDRAS, LINDSAY M MD	8/1/2012	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	19420 W SIERRA ESTS DR	None	SANTA CLARITA	CA	91321	2128	19	06037	34.39782763	-118.4752058	Los Angeles County
141637	Fee-for-Service	1407926074	1407926074	1	1	ARCANGELI, CARLOS G MD	10/29/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	84527	34	Urology and Urological Surgery	0	In state provider	None	1595 SOQUEL DR	STE 100	SANTA CRUZ	CA	95065	1720	44	06087	36.98879599	-121.9826354	Santa Cruz County
141735	Fee-for-Service	1598374555	1598374555	1	1	AMICA HOSPICE CARE, INC	1/19/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	15720 VENTURA BLVD	SUITE 305	ENCINO	CA	91436	2988	19	06037	34.15524484	-118.4756687	Los Angeles County
141753	Fee-for-Service	1538763800	1538763800	1	2	AURORA SPRING HOSPICE CARE,	8/7/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	435 ORANGE SHOW LANE	STE 205	SAN BERNARDINO	CA	92408	2017	36	06071	34.08100788	-117.2922379	San Bernardino County
141767	Fee-for-Service	1538768361	1538768361	1	1	ALLEGIANCE HOSPICE INC	9/15/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	13609 VICTORY BLVD	STE 247-A	VAN NUYS	CA	91401	1736	19	06037	34.18671049	-118.429353	Los Angeles County
141788	Fee-for-Service	1255542601	1255542601	1	6	ALTAMED MEDICAL & DENTAL	4/9/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	4360 DOZIER STREET	None	LOS ANGELES	CA	90022	1404	19	06037	34.04145855	-118.171764	Los Angeles County
141794	Fee-for-Service	1447328117	1447328117	1	1	ANDERSON, PAYNESHA M MD	7/19/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125482	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2545 W HAMMER LANE	None	STOCKTON	CA	95209	2839	39	06077	38.0214303	-121.3461515	San Joaquin County
141816	Fee-for-Service	1033314075	1033314075	1	1	ARNOLD, RYAN C MD	4/2/2020	207P00000X	NA	Other	026	PHYSICIANS	162827	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2050 VIBORG RD	None	SOLVANG	CA	93463	2220	42	06083	34.60246267	-120.1261332	Santa Barbara County
141824	Fee-for-Service	1669053245	1669053245	1	1	AHMAD, MUHMOD MD	12/2/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
141844	Fee-for-Service	1285922922	1285922922	1	1	ARIAZAND, VISHTASB MD	10/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135889	None	None	0	In state provider	None	25455 MEDICAL CENTER DR	STE 100	MURRIETA	CA	92562	5963	33	06065	33.55689911	-117.1863428	Riverside County
141863	Fee-for-Service	1649951641	1649951641	1	1	AMARE VILLA CORP	8/22/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2042 KALLIOPE AVE	None	LANCASTER	CA	93536	4625	19	06037	34.6628731	-118.1670992	Los Angeles County
141881	Fee-for-Service	1336111269	1336111269	1	1	ADLER, DANIEL C MD	3/31/1994	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	64280	30	Radiology	0	In state provider	None	10666 N TORREY PINES RD	# MS317	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
141899	Fee-for-Service	1629495742	1629495742	1	1	ACACIA HOME HEALTH AND	4/12/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE INC	11770 WARNER AVE	SUITE 101	FOUNTAIN VALLEY	CA	92708	2659	30	06059	33.71573417	-117.9239528	Orange County
141908	Fee-for-Service	1225280373	1225280373	1	1	ALEXANDER, ALEX S LMFT	6/12/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1902 ORANGE TREE LN	SUITE 200	REDLANDS	CA	92374	2888	36	06071	34.06785293	-117.2179967	San Bernardino County
141915	Fee-for-Service	1164690988	1164690988	1	1	ANDRAS, LINDSAY M MD	7/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115457	89	Surgery-Traumatic	0	In state provider	None	19420 W SIERRA ESTS DR	None	SANTA CLARITA	CA	91321	2128	19	06037	34.39782763	-118.4752058	Los Angeles County
141925	Fee-for-Service	1093712143	1093712143	1	1	ASHER, REGAN K MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33055	30	Radiology	0	In state provider	None	6600 MADISON AVE	STE 11	CARMICHAEL	CA	95608	0645	34	06067	38.663028	-121.310271	Sacramento County
141991	Fee-for-Service	1013646272	1013646272	1	1	ASSURITY HOME HEALTH	11/12/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14640 VICTORY BLVD	STE 212	VAN NUYS	CA	91411	1623	19	06037	34.18663255	-118.452402	Los Angeles County
141993	Fee-for-Service	1174151021	1174151021	1	1	ARASTOO, SARA MD	8/22/2024	207L00000X	NA	Other	026	PHYSICIANS	190748	05	Anesthesiology	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
142012	Fee-for-Service	1518456441	1518456441	1	1	ADRAN, DANIEL MD	4/14/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	184982	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
142021	Fee-for-Service	1336767169	1336767169	1	1	ARAGON & HERNANDEZ SOCIAL SE	9/26/2024	106H00000X	NA	Mental Health Outpatient Services	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	RVICES INC	12440 FIRESTONE BLVD	3001	NORWALK	CA	90650	4328	19	06037	33.90523023	-118.0681168	Los Angeles County
142028	Fee-for-Service	1144661000	1144661000	1	1	AUJLA, HARLEEN K MD	8/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140702	41	Internal Medicine	0	In state provider	None	3351 M STREET	SUITE 125	MERCED	CA	95348	2731	24	06047	37.32477488	-120.4783805	Merced County
142030	Fee-for-Service	1265900062	1265900062	1	1	ATHOME HOSPICE CARE LLC	11/16/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	100 TOWER RD	STE 15 BLDG B	AMERICAN CANYON	CA	94503	9650	28	06055	38.21150599	-122.2572239	Napa County
142040	Fee-for-Service	1003311051	1003311051	1	1	ARNOLD, DAVID MD	10/1/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	19246	07	Dermatology	0	In state provider	None	360 SAN MIGUEL DR	STE 309	NEWPORT BEACH	CA	92660	7836	30	06059	33.61321911	-117.8722084	Orange County
142041	Fee-for-Service	1538763800	1538763800	1	2	AURORA SPRING HOSPICE CARE,	8/7/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	435 ORANGE SHOW LANE	STE 205	SAN BERNARDINO	CA	92408	2017	36	06071	34.08100788	-117.2922379	San Bernardino County
142057	Fee-for-Service	1538768361	1538768361	1	1	ALLEGIANCE HOSPICE INC	9/15/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	13609 VICTORY BLVD	STE 247-A	VAN NUYS	CA	91401	1736	19	06037	34.18671049	-118.429353	Los Angeles County
142063	Fee-for-Service	1750953014	1750953014	1	1	AKANNO, IJEOMA	4/7/2023	163WP0809X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
142077	Fee-for-Service	1255542601	1255542601	1	6	ALTAMED MEDICAL & DENTAL	4/9/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	4360 DOZIER STREET	None	LOS ANGELES	CA	90022	1404	19	06037	34.04145855	-118.171764	Los Angeles County
142080	Fee-for-Service	1861579039	1861579039	1	1	ARTANDI, MAJA K MD	3/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84033	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
142136	Fee-for-Service	1639234354	1639234354	1	1	ALLERGY MEDICAL CLINIC	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	None	11620 WILSHIRE BLVD	STE 200	LOS ANGELES	CA	90025	1767	19	06037	34.05024415	-118.4598908	Los Angeles County
142148	Fee-for-Service	1124158027	1124158027	1	1	ANDRADE, GENEVIEVE M PSY	5/14/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA ST	STE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
142153	Fee-for-Service	1295266260	1295266260	1	1	ACEVEDO, JOSEPH R MD	9/6/2022	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	162581	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
142160	Fee-for-Service	1629014576	1629014576	1	1	ABIHANNA, ADEL B MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69395	10	Gastroenterology (M.D. only)	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
142171	Fee-for-Service	1336111269	1336111269	1	1	ADLER, DANIEL C MD	3/31/1994	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	64280	70	Clinic (mixed specialty)	0	In state provider	None	10666 N TORREY PINES RD	# MS317	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
142189	Fee-for-Service	1629495742	1629495742	1	1	ACACIA HOME HEALTH AND	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE INC	11770 WARNER AVE	SUITE 101	FOUNTAIN VALLEY	CA	92708	2659	30	06059	33.71573417	-117.9239528	Orange County
142204	Fee-for-Service	1770742264	1770742264	1	1	AL-NOURI, OMAR DO	1/30/2019	2086S0129X	NA	General Surgery	026	PHYSICIANS	16931	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
142211	Fee-for-Service	1114636578	1114636578	1	1	ALERACARE MEDICAL GROUP OF C	11/7/2023	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ALIFORNIA, A MEDICAL C	435 ARDEN AVE	460	GLENDALE	CA	91203	1130	19	06037	34.15848148	-118.2628845	Los Angeles County
142221	Fee-for-Service	1801879291	1801879291	2	1	ASR HEALTH INC.	7/18/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	12677 HESPERIA RD	180	VICTORVILLE	CA	92395	7735	36	06071	34.48148078	-117.2906175	San Bernardino County
142249	Fee-for-Service	1740756196	1740756196	1	1	ABANOBI, ALI L CRNA	3/22/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
142254	Fee-for-Service	1316972854	1316972854	1	2	APEXX PHYSICIANS MEDICAL	10/15/2009	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
142279	Fee-for-Service	1225011620	1225011620	1	1	ARASE, RANDAL P MD INC	2/28/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	25418	02	General Surgery	0	In state provider	None	201 S ALVARADO ST	STE 716	LOS ANGELES	CA	90057	2390	19	06037	34.06417777	-118.2719543	Los Angeles County
142289	Fee-for-Service	1548202245	1548202245	1	1	ABRAMS, REID MD	7/31/1992	207XS0106X	NA	Orthopedic Surgery	026	PHYSICIANS	59829	20	Orthopedic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
142316	Fee-for-Service	1144661000	1144661000	1	1	AUJLA, HARLEEN K MD	8/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	140702	45	Nephrology (Renal-Kidney)	0	In state provider	None	3351 M STREET	SUITE 125	MERCED	CA	95348	2731	24	06047	37.32477488	-120.4783805	Merced County
142317	Fee-for-Service	1265900062	1265900062	1	1	ATHOME HOSPICE CARE LLC	11/16/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	100 TOWER RD	STE 15 BLDG B	AMERICAN CANYON	CA	94503	9650	28	06055	38.21150599	-122.2572239	Napa County
142326	Fee-for-Service	1396067500	1396067500	1	1	AAA COMPREHENSIVE HEALTHCARE	8/26/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	7451 N LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91605	2803	19	06037	34.20616081	-118.3878161	Los Angeles County
142334	Fee-for-Service	1942349998	1942349998	1	1	ANIL G INDULKAR PHARMACI	11/28/2006	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	AVALON PHARMACY	58471 29 PALMS HWY	STE 301	YUCCA VALLEY	CA	92284	5818	36	06071	34.13270029	-116.3881647	San Bernardino County
142350	Fee-for-Service	1679697593	1679697593	1	1	AHMADPOUR, OLIVER A MD	1/22/2019	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	92269	-	NOT APPLICABLE	0	In state provider	None	8616 LA TIJERA BLVD	STE 404	LOS ANGELES	CA	90045	3950	19	06037	33.95943215	-118.3918599	Los Angeles County
142355	Fee-for-Service	1376072652	1376072652	1	1	AMBURSD MEDICAL TRANSPORTATI	6/16/2020	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ON INC.	11012 VENTURA BLVD	H	STUDIO CITY	CA	91604	3546	19	06037	34.14056822	-118.3705788	Los Angeles County
142359	Fee-for-Service	1669465878	1669465878	1	1	ARNOLD, TAMMIE K DO	9/12/2014	207R00000X	NA	Other	026	PHYSICIANS	10023	41	Internal Medicine	0	In state provider	None	1212 FARROLL AVE	None	ARROYO GRANDE	CA	93420	3718	40	06079	35.11072649	-120.6020655	San Luis Obispo County
142365	Fee-for-Service	1407360894	1407360894	1	1	ALLSUP, BRITTANY Y CNP	10/1/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9888 GENESEE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
142373	Fee-for-Service	1942547047	1942547047	1	1	ADAMS, JENNIFER M LCSW	12/5/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
142401	Fee-for-Service	1801280102	1801280102	1	1	ANTONETTO, THOMAS V LMFT	10/17/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	123 E 9TH ST	100C	UPLAND	CA	91786	6023	36	06071	34.0961745	-117.6493095	San Bernardino County
142419	Fee-for-Service	1639200264	1639200264	1	1	ANDERSON, CHRISTOPHER R LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
142445	Fee-for-Service	1629014576	1629014576	1	1	ABIHANNA, ADEL B MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	69395	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
142471	Fee-for-Service	1568547206	1568547206	2	1	ABBEY, SHAWNA H MD	1/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
142481	Fee-for-Service	1922522507	1922522507	1	1	ASFP, LLC	9/1/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2707 PINE STREET	None	SAN FRANCISCO	CA	94115	2522	38	06075	37.78704929	-122.4405555	San Francisco County
142498	Fee-for-Service	1114636578	1114636578	1	1	ALERACARE MEDICAL GROUP OF C	8/14/2024	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ALIFORNIA, A MEDICAL C	435 ARDEN AVE	460	GLENDALE	CA	91203	1130	19	06037	34.15848148	-118.2628845	Los Angeles County
142526	Fee-for-Service	1659394195	1659394195	1	1	AMARAL, LINDA N A LMFT	8/9/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16935 W BERNARDO DR	STE 110	SAN DIEGO	CA	92127	1635	37	06073	33.02335619	-117.0804364	San Diego County
142557	Fee-for-Service	1457498503	1457498503	1	1	ALCALA, DIANE LMFT	4/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
142580	Fee-for-Service	1164555710	1164555710	1	1	AVINA, ANGELICA	11/17/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	49	06097	0	0	None
142599	Fee-for-Service	1386830305	1386830305	1	1	ASHRAFZADEH, NINA LMFT	3/4/2024	103T00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	302 W 5TH ST STE 308	None	SAN PEDRO	CA	90731	2750	19	06037	33.73971572	-118.284045	Los Angeles County
142605	Fee-for-Service	1336247055	1336247055	1	1	ANDERSON, CLARKE P MD	6/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	73677	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
142612	Fee-for-Service	1396067500	1396067500	1	1	AAA COMPREHENSIVE HEALTHCARE	8/26/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	7451 N LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91605	2803	19	06037	34.20616081	-118.3878161	Los Angeles County
142636	Fee-for-Service	1053688234	1053688234	1	1	ABDELKARIM, RIAD Z MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	55755	41	Internal Medicine	0	In state provider	None	1801 W ROMNEYA DR	STE 305	ANAHEIM	CA	92801	1825	30	06059	33.8506615	-117.946413	Orange County
142647	Fee-for-Service	1669465878	1669465878	1	1	ARNOLD, TAMMIE K DO	9/12/2014	207R00000X	NA	Other	026	PHYSICIANS	10023	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1212 FARROLL AVE	None	ARROYO GRANDE	CA	93420	3718	40	06079	35.11072649	-120.6020655	San Luis Obispo County
142691	Fee-for-Service	1265511307	1265511307	1	1	ABRAMSON, OREN N MD	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69345	40	Pediatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
142698	Fee-for-Service	1336567338	1336567338	1	1	AHMED, NAUSHAD S DO	8/20/2019	207L00000X	NA	Other	026	PHYSICIANS	16489	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
142721	Fee-for-Service	1366415440	1366415440	1	1	ALLEN, CALLIOPE E MD	1/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	68234	18	Ophthalmology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
142749	Fee-for-Service	1629187539	1629187539	1	1	ALLISON, STEPHANI R MD	10/22/2018	207L00000X	NA	Other	026	PHYSICIANS	86339	None	None	0	In state provider	None	2131 W 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
142776	Fee-for-Service	1144468786	1144468786	1	1	ATOMIC SHRINK PSYCHOLOGY, IN	11/4/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	C.	100 N BRAND BLVD	STE 316 AND 317	GLENDALE	CA	91203	2614	19	06037	34.14652066	-118.2549229	Los Angeles County
142848	Fee-for-Service	1609414689	1609414689	1	1	AGUILAR, SCARLETT LMFT	3/7/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
142869	Fee-for-Service	1851746945	1851746945	1	1	ANC CORPORATION	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7484 UNIVERSITY AVE	SUITE 250	LA MESA	CA	91942	6030	37	06073	32.75856212	-117.0361153	San Diego County
142893	Fee-for-Service	1336247055	1336247055	1	1	ANDERSON, CLARKE P MD	6/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	73677	68	Hematology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
142960	Fee-for-Service	1023215357	1023215357	1	1	ALLEN, JONATHAN L MD	7/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
142980	Fee-for-Service	1447391719	1447391719	1	4	ASIAN HEALTH SERVICES	7/1/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	817 HARRISON ST	None	OAKLAND	CA	94607	4422	01	06001	37.79921451	-122.2699864	Alameda County
143034	Fee-for-Service	1841329661	1841329661	1	1	AHMAD, MUEED MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	99939	84	Surgery-Head and Neck	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
143057	Fee-for-Service	1841731072	1841731072	1	1	ASIRIFI, KOFI M MD	12/28/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164009	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
143100	Fee-for-Service	1154611796	1154611796	1	1	ATCHA, MUNEERA MD	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	133648	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
143137	Fee-for-Service	1407081524	1407081524	1	1	A. CLARK GUNNERSON	3/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1380 E MEDICAL CENTER DR	None	ST GEORGE	UT	84790	2123	00	None	37.097622	-113.553828	Washington County
143144	Fee-for-Service	1235246695	1235246695	1	1	ANDERSON, JOHN P MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	25583	30	Radiology	0	In state provider	None	3033 W ORANGE AVE	None	ANAHEIM	CA	92804	3156	30	06059	33.82476552	-117.994914	Orange County
143156	Fee-for-Service	1740843499	1740843499	1	1	ALBINO, NICHOLAS K MD	10/25/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	179851	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
143158	Fee-for-Service	1851746945	1851746945	1	1	ANC CORPORATION	8/2/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7484 UNIVERSITY AVE	SUITE 250	LA MESA	CA	91942	6030	37	06073	32.75856212	-117.0361153	San Diego County
143181	Fee-for-Service	1336247055	1336247055	1	1	ANDERSON, CLARKE P MD	6/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	73677	78	Neoplastic Diseases/Oncology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
143196	Fee-for-Service	1235353137	1235353137	1	1	ADVANCED INSTRUMENTS INC.	9/9/2015	193400000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1534 TENNESSEE ST	None	VALLEJO	CA	94590	4627	48	06095	38.1098075	-122.2396425	Solano County
143214	Fee-for-Service	1740213990	1740213990	1	1	A-RAHIM, YOUSIF I MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	STRAUB CLINIC & HOSPITAL	888 SOUTH KING STREET	None	HONOLULU	HI	96813	0000	00	None	21.30218603	-157.8505732	Honolulu County
143226	Fee-for-Service	1750723342	1750723342	1	1	AARON HANSEN	7/25/2013	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	15 S ESTADOS STREET	None	MOUNTAIN HOUSE	CA	95391	2093	39	06077	37.77781133	-121.5560595	San Joaquin County
143251	Fee-for-Service	1386008027	1386008027	1	1	AMERICA WEST MEDICAL TRANSPO	8/29/2019	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	RTATION INC	9090 UNION PARK WAY	117	ELK GROVE	CA	95624	2786	34	06067	38.386053	-121.3623765	Sacramento County
143269	Fee-for-Service	1447391719	1447391719	1	4	ASIAN HEALTH SERVICES	7/1/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	817 HARRISON ST	None	OAKLAND	CA	94607	4422	01	06001	37.79921451	-122.2699864	Alameda County
143273	Fee-for-Service	1902338585	1902338585	1	1	ANDERSON, SCOTT MD	8/14/2023	207RC0200X	NA	Other	026	PHYSICIANS	164327	None	None	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
143305	Fee-for-Service	1174167936	1174167936	1	1	ARDENT HOSPICE SERVICES INC	11/7/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	24301 SOUTHLAND DRIVE	SUITE B10	HAYWARD	CA	94545	1548	01	06001	37.65344508	-122.1045736	Alameda County
143308	Fee-for-Service	1780064055	1780064055	1	1	ARROYO, JEFFREY MD	6/11/2018	390200000X	NA	Other	026	PHYSICIANS	145274	08	Family Practice	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3298	30	06059	33.78674051	-117.8888713	Orange County
143346	Fee-for-Service	1871906396	1871906396	1	1	ASHOURI, SAMMY M MD	7/1/2019	2085R0001X	NA	Other	026	PHYSICIANS	160913	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
143356	Fee-for-Service	1962588178	1962588178	1	1	ASKARIYEH-YAZDY, H MD	3/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	25165	33	Thoracic Surgery	0	In state provider	None	25 N 14TH ST	STE 670	SAN JOSE	CA	95112	6214	43	06085	37.34293357	-121.8775187	Santa Clara County
143363	Fee-for-Service	1013379551	1013379551	1	1	AGARWAL, NEHA MD	4/19/2019	207R00000X	NA	Other	026	PHYSICIANS	150711	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
143369	Fee-for-Service	1538711197	1538711197	1	1	APOLLO HOSPICE CARE INC	6/24/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	150 E OLIVE AVE	SUITE 214	BURBANK	CA	91502	1850	19	06037	34.18064474	-118.3089507	Los Angeles County
143375	Fee-for-Service	1972920916	1972920916	1	1	AZIZI, MAYSAM MD	12/8/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146765	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
143378	Fee-for-Service	1912096454	1912096454	2	1	AUSTERLITZ, MICHAEL A MD	2/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	25290	45	Nephrology (Renal-Kidney)	0	In state provider	None	4588 WHITTIER BLVD	None	LOS ANGELES	CA	90022	2430	19	06037	34.02268096	-118.1682101	Los Angeles County
143436	Fee-for-Service	1871865287	1871865287	1	1	ABDELMELEK, SAM W MD INC	7/1/2012	193200000X	NA	Other	026	PHYSICIANS	106876	41	Internal Medicine	0	In state provider	None	5750 DOWNEY AVE	STE #201	LAKEWOOD	CA	90712	1468	19	06037	33.859611	-118.1511435	Los Angeles County
143442	Fee-for-Service	1104913946	1104913946	1	1	ANEGAWA, LINDA J MD	8/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	72637	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
143451	Fee-for-Service	1609496231	1609496231	1	1	ARIF, MUHAMMAD Z MD	10/18/2024	390200000X	NA	Other	026	PHYSICIANS	190534	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
143514	Fee-for-Service	1750723342	1750723342	1	1	AARON HANSEN	7/25/2013	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	15 S ESTADOS STREET	None	MOUNTAIN HOUSE	CA	95391	2093	39	06077	37.77781133	-121.5560595	San Joaquin County
143538	Fee-for-Service	1699856864	1699856864	1	1	ANDRONESCU, LUMINITA	8/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84609	None	None	0	In state provider	None	355 E 21ST ST	STE C	SAN BERNARDINO	CA	92404	4851	36	06071	34.13404548	-117.2779515	San Bernardino County
143542	Fee-for-Service	1649550872	1649550872	1	1	AU, VIVIEN W DO	2/22/2018	207W00000X	NA	Ophthalmology	026	PHYSICIANS	14980	18	Ophthalmology	0	In state provider	None	1085 W EL CAMINO REAL	None	SUNNYVALE	CA	94087	1030	43	06085	37.37270741	-122.0517412	Santa Clara County
143591	Fee-for-Service	1174167936	1174167936	1	1	ARDENT HOSPICE SERVICES INC	11/7/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	24301 SOUTHLAND DRIVE	SUITE B10	HAYWARD	CA	94545	1548	01	06001	37.65344508	-122.1045736	Alameda County
143606	Fee-for-Service	1518990639	1518990639	1	1	ARAUJO, JESUS A MD	2/25/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	65234	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA #365	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
143629	Fee-for-Service	1932257847	1932257847	1	1	ACHILLY, PATRICIA L CNM	1/13/2014	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	6860 AVENIDA ENCINAS	None	CARLSBAD	CA	92009	3201	37	06073	33.10754269	-117.3146974	San Diego County
143633	Fee-for-Service	1699036855	1699036855	1	1	ALI, HIBA MD	2/17/2020	207R00000X	NA	Other	026	PHYSICIANS	162033	41	Internal Medicine	0	In state provider	None	15031 RINALDI STREET	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
143638	Fee-for-Service	1497702542	1497702542	1	1	ABDALLA, ADEL MD	10/12/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	96246	None	None	0	In state provider	None	495 BIRCH ST	B	CALEXICO	CA	92231	2374	13	06025	32.6794317	-115.4928454	Imperial County
143639	Fee-for-Service	1326516014	1326516014	1	1	AMERICAN MANAGEMENT ENTERPRI	5/5/2020	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	7841 NORTH AVE	None	LEMON GROVE	CA	91945	1825	37	06073	32.74453149	-117.029295	San Diego County
143653	Fee-for-Service	1962588178	1962588178	1	1	ASKARIYEH-YAZDY, H MD	3/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	25165	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	25 N 14TH ST	STE 670	SAN JOSE	CA	95112	6214	43	06085	37.34293357	-121.8775187	Santa Clara County
143656	Fee-for-Service	1538711197	1538711197	1	1	APOLLO HOSPICE CARE INC	6/24/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	150 E OLIVE AVE	SUITE 214	BURBANK	CA	91502	1850	19	06037	34.18064474	-118.3089507	Los Angeles County
143661	Fee-for-Service	1033193016	1033193016	1	1	ALLINS, ALEXANDER D MD	8/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78316	02	General Surgery	0	In state provider	None	6333 WILSHIRE BLVD	STE 200	LOS ANGELES	CA	90048	5724	19	06037	34.06355697	-118.366413	Los Angeles County
143664	Fee-for-Service	1912096454	1912096454	2	1	AUSTERLITZ, MICHAEL A MD	2/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	25290	41	Internal Medicine	0	In state provider	None	4588 WHITTIER BLVD	None	LOS ANGELES	CA	90022	2430	19	06037	34.02268096	-118.1682101	Los Angeles County
143727	Fee-for-Service	1255342085	1255342085	1	1	ADAMS, SALLIE O MD	12/1/2000	207RE0101X	NA	Endocrinology	026	PHYSICIANS	47124	41	Internal Medicine	0	In state provider	None	1020 29TH ST	STE 270	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
143729	Fee-for-Service	1215248984	1215248984	1	1	ABOUTALIB, ANGELA MD	2/1/2023	207R00000X	NA	Other	026	PHYSICIANS	170548	None	None	0	In state provider	None	1680 E 120 ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
143731	Fee-for-Service	1487672374	1487672374	1	1	AJMAL, FARAH MD	9/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95506	41	Internal Medicine	0	In state provider	None	2801 K ST	STE 520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
143741	Fee-for-Service	1730510801	1730510801	1	1	ARC IMPERIAL VALLEY	10/15/2018	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	298 E ROSS AVE	None	EL CENTRO	CA	92243	9303	13	06025	32.78152815	-115.5406059	Imperial County
143747	Fee-for-Service	1710218409	1710218409	1	1	ALLIANCE MEDICAL CENTER	4/24/2014	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	8465 OLD REDWOOD HWY	SUITE 320	WINDSOR	CA	95492	8090	49	06097	38.5435006	-122.8006981	Sonoma County
143767	Fee-for-Service	1922666775	1922666775	1	1	AMADOR, EMILY C	8/23/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	22999	36	Psychiatry	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
143769	Fee-for-Service	1598361669	1598361669	1	1	ARCADIA INTENSIVIST GROUP, I	12/12/2020	207RC0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	NC.	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
143790	Fee-for-Service	1669123626	1669123626	1	3	ADVANCED RADIOLOGY AND INTER	8/16/2022	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	VENTIONAL ASSOCIATES	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
143829	Fee-for-Service	1578573572	1578573572	1	1	AUNG, TIN TUN MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76513	41	Internal Medicine	0	In state provider	None	2260 E PALMDALE BLVD	STE G-I	PALMDALE	CA	93550	4952	19	06037	34.58008951	-118.0884915	Los Angeles County
143835	Fee-for-Service	1669663597	1669663597	1	1	ALLEN NOBLE	3/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	903 S ADAMS ST	None	RITZVILLE	WA	99169	2227	00	None	47.12103402	-118.3723179	Adams County
143893	Fee-for-Service	1033378070	1033378070	1	1	AZEVEDO, RENEE LEAL	6/27/2008	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3910 W BEECHWOOD AVE	STE 146	FRESNO	CA	93711	0685	10	06019	36.83868007	-119.8646074	Fresno County
143908	Fee-for-Service	1811656549	1811656549	1	1	ABHAR, SOLANGE NP	5/9/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
143914	Fee-for-Service	1881668838	1881668838	1	1	AMBERG, JOHN A MD	9/30/1985	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	36212	30	Radiology	0	In state provider	None	7910 FROST ST	STE 202	SAN DIEGO	CA	92123	2771	37	06073	32.80027449	-117.153846	San Diego County
143916	Fee-for-Service	1609924414	1609924414	1	1	AHMAD, ASIF J MD	7/30/1990	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	49124	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
143920	Fee-for-Service	1730480096	1730480096	1	1	ANDRADE, AARON J MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119557	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 N CALIFORNIA STREET	None	STOCKTON	CA	95201	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
143926	Fee-for-Service	1538501598	1538501598	1	1	ANGUIANO, MIA M LMFT	1/23/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
143932	Fee-for-Service	1720495690	1720495690	1	1	AGUILAR, ALFONSO L LCSW	3/4/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
143935	Fee-for-Service	1821146879	1821146879	1	1	ADRIEN-EMMONS, MARIE MD	6/3/1985	207L00000X	NA	Other	026	PHYSICIANS	54908	05	Anesthesiology	0	In state provider	ATTN MGA OFFICE	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
143936	Fee-for-Service	1700943768	1700943768	1	1	AMBROSE, RICHARD R OD	4/1/1983	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12525 E CARSON ST	None	HAWAIIAN GARDENS	CA	90716	1607	19	06037	33.83168502	-118.0651861	Los Angeles County
143958	Fee-for-Service	1578847844	1578847844	1	1	ANCOCK, BENEDICT P MD	1/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118391	41	Internal Medicine	0	In state provider	None	75 ROWLAND WAY	STE 140	NOVATO	CA	94945	5037	21	06041	38.09501878	-122.5589434	Marin County
143997	Fee-for-Service	1225586142	1225586142	1	1	ACEVES, JESUS M LCSW	8/19/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	801 S GRAND STREET	SUITE 780	LOS ANGELES	CA	90017	8590	19	06037	34.04532806	-118.258462	Los Angeles County
144017	Fee-for-Service	1124259890	1124259890	1	1	ANGELAKIS, ANNA-MARIA K MD	3/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105474	41	Internal Medicine	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
144021	Fee-for-Service	1801910633	1801910633	1	1	ARVIN COMMUNITY HLTH CTR	6/1/2000	261QM2500X	NA	Other	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	ARVIN COMMUNITY HLTH CTR	1305 BEAR MOUNTAIN BLVD	None	ARVIN	CA	93203	1231	15	06029	35.20895551	-118.839294	Kern County
144026	Fee-for-Service	1124085410	1124085410	1	1	ARIFUDDIN, RAZI M MD	2/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56200	10	Gastroenterology (M.D. only)	0	In state provider	None	85 BROOKWOOD AVENUE	SUITE 10	SANTA ROSA	CA	95404	4512	49	06097	38.44242	-122.7068055	Sonoma County
144031	Fee-for-Service	1710218409	1710218409	1	1	ALLIANCE MEDICAL CENTER	4/28/2010	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	8465 OLD REDWOOD HWY	SUITE 320	WINDSOR	CA	95492	8090	49	06097	38.5435006	-122.8006981	Sonoma County
144033	Fee-for-Service	1649342171	1649342171	1	1	AHN, MARTIN T MD	10/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85576	08	Family Practice	0	In state provider	None	6301 BEACH BLVD	STE 101	BUENA PARK	CA	90621	4030	30	06059	33.86880928	-117.9983013	Orange County
144034	Fee-for-Service	1457720617	1457720617	1	1	ADVANCED HOME HEALTH	9/21/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	NORTHBAY, INC	2161 YGNACIO VALLEY RD	STE 210	WALNUT CREEK	CA	94598	3351	07	06013	37.92186295	-122.0315077	Contra Costa County
144047	Fee-for-Service	1437226347	1437226347	1	1	AKHONDI, MICHAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	60601	01	General Practice	0	In state provider	DMG MED & URGENT CARE	7257 OWENSMOUTH AVE	STE A	CANOGA PARK	CA	91303	1530	19	06037	34.20270201	-118.6015969	Los Angeles County
144075	Fee-for-Service	1831112820	1831112820	1	1	ABOUDI, SAMAN MD	12/26/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	94832	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
144078	Fee-for-Service	1760922207	1760922207	1	2	AEGIS TREATMENT CENTERS, LLC	8/1/2019	261QM2800X	NA	Other	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1129 1133, 1135, 1141, 1	None	REDDING	CA	96002	2139	45	06089	0	0	None
144096	Fee-for-Service	1437226347	1437226347	1	2	AKHONDI, MICHAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	60601	None	None	0	In state provider	None	7257 OWENSMOUTH AVE	STE A	CANOGA PARK	CA	91303	1530	19	06037	34.20270201	-118.6015969	Los Angeles County
144109	Fee-for-Service	1386048544	1386048544	1	1	ADAMS, JOANN M NP	6/6/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8080 PARKWAY DRIVE	None	LA MESA	CA	91942	2104	37	06073	32.77560706	-117.0231998	San Diego County
144179	Fee-for-Service	1033378070	1033378070	1	1	AZEVEDO, RENEE LEAL	6/27/2008	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3910 W BEECHWOOD AVE	STE 146	FRESNO	CA	93711	0685	10	06019	36.83868007	-119.8646074	Fresno County
144186	Fee-for-Service	1255398343	1255398343	1	1	AMADOR ANESTHESIA MED GR	3/23/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	INC	200 MISSION BLVD	None	JACKSON	CA	95642	2564	03	06005	38.35007723	-120.7659932	Amador County
144224	Fee-for-Service	1548395239	1548395239	1	1	ALI, MOHAMED S MD	12/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	67534	41	Internal Medicine	0	In state provider	None	9625 MONTE VISTA AVE	STE 103	MONTCLAIR	CA	91763	2234	36	06071	34.08006762	-117.6982272	San Bernardino County
144245	Fee-for-Service	1578847844	1578847844	1	1	ANCOCK, BENEDICT P MD	1/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118391	01	General Practice	0	In state provider	None	75 ROWLAND WAY	STE 140	NOVATO	CA	94945	5037	21	06041	38.09501878	-122.5589434	Marin County
144261	Fee-for-Service	1376104372	1376104372	1	1	ATWOOD, CHRISTA D	10/27/2020	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	676 1ST	STE 12	CHICO	CA	95926	3547	04	06007	39.74162154	-121.8369292	Butte County
144265	Fee-for-Service	1619196466	1619196466	1	1	AMBURGEY, ODUL A MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141970	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2577 SAMARITAN DRIVE	SUITE 705	SAN JOSE	CA	95124	4105	43	06085	37.25246494	-121.9501879	Santa Clara County
144292	Fee-for-Service	1700462546	1700462546	1	1	ASA HOSPICE CARE INC	11/26/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	18340 VENTURA BLVD	UNIT 207	TARZANA	CA	91356	4288	19	06037	34.16710415	-118.5320031	Los Angeles County
144320	Fee-for-Service	1710218409	1710218409	1	1	ALLIANCE MEDICAL CENTER	4/28/2010	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	8465 OLD REDWOOD HWY	SUITE 320	WINDSOR	CA	95492	8090	49	06097	38.5435006	-122.8006981	Sonoma County
144335	Fee-for-Service	1437226347	1437226347	1	1	AKHONDI, MICHAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	60601	41	Internal Medicine	0	In state provider	DMG MED & URGENT CARE	7257 OWENSMOUTH AVE	STE A	CANOGA PARK	CA	91303	1530	19	06037	34.20270201	-118.6015969	Los Angeles County
144366	Fee-for-Service	1760922207	1760922207	1	2	AEGIS TREATMENT CENTERS, LLC	8/1/2019	261QM2800X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1129 1133, 1135, 1141, 1	None	REDDING	CA	96002	2139	45	06089	0	0	None
144455	Fee-for-Service	1841356490	1841356490	2	1	AEGIS TREATMENT CENTERS LLC	1/11/2014	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	4129 STATE STREET	B, D, E & F	SANTA BARBARA	CA	93110	1848	42	06083	34.44047554	-119.760759	Santa Barbara County
144461	Fee-for-Service	1467751008	1467751008	1	1	ALLAK, AMIR MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143092	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
144510	Fee-for-Service	1720027501	1720027501	1	1	APUZZO, MICHAEL L J MD	7/11/1975	207T00000X	NA	General Surgery	026	PHYSICIANS	17911	14	Neurological Surgery	0	In state provider	None	1200 N STATE ST	STE 5046	LOS ANGELES	CA	90089	0265	19	06037	34.05855992	-118.209755	Los Angeles County
144527	Fee-for-Service	1740427657	1740427657	1	17	ALTAMED HEALTH SERVICES CORP	5/9/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	700 SOUTH FLOWER STREET	None	SANTA ANA	CA	92703	4818	30	06059	33.73848	-117.876467	Orange County
144548	Fee-for-Service	1083086847	1083086847	1	1	ACUPUNCTURE HEALTH CLINIC, I	11/10/2021	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	NC.	9559 LAS TUNAS DR	None	TEMPLE CITY	CA	91780	2107	19	06037	34.10660435	-118.0617328	Los Angeles County
144581	Fee-for-Service	1700462546	1700462546	1	1	ASA HOSPICE CARE INC	11/26/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18340 VENTURA BLVD	UNIT 207	TARZANA	CA	91356	4288	19	06037	34.16710415	-118.5320031	Los Angeles County
144589	Fee-for-Service	1689092215	1689092215	1	1	AGONAFER, ETSEMAYE P MD	2/19/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	153768	01	General Practice	0	In state provider	None	200 MED PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
144590	Fee-for-Service	1902103286	1902103286	2	1	AMD MEDICAL SUPPLY INC	5/30/2013	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3108 ARDEN WAY	None	SACRAMENTO	CA	95825	2002	34	06067	38.594664	-121.39182	Sacramento County
144591	Fee-for-Service	1902898869	1902898869	1	1	AIJIAN, PAUL MD	3/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	34375	41	Internal Medicine	0	In state provider	None	230 W PUEBLO ST	None	SANTA BARBARA	CA	93105	3870	42	06083	34.43081942	-119.7216759	Santa Barbara County
144613	Fee-for-Service	1568871994	1568871994	1	1	ALDAPE, SONIA LIZETTE S LCSW	6/26/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
144625	Fee-for-Service	1437226347	1437226347	1	1	AKHONDI, MICHAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	60601	66	Emergency Medicine (Urgent Care)	0	In state provider	DMG MED & URGENT CARE	7257 OWENSMOUTH AVE	STE A	CANOGA PARK	CA	91303	1530	19	06037	34.20270201	-118.6015969	Los Angeles County
144631	Fee-for-Service	1316909559	1316909559	1	1	ALTA EAST BAY PATHOLOGY	5/28/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	350 HAWTHORNE AVE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
144659	Fee-for-Service	1013018415	1013018415	1	1	ALJITAWI, OMAR S MD	7/31/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99101	68	Hematology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
144667	Fee-for-Service	1720373459	1720373459	1	1	ADKINS, CHRISTOPHER K MD	10/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122735	08	Family Practice	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
144707	Fee-for-Service	1396036331	1396036331	1	1	AU, STEPHEN R MD	7/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124086	05	Anesthesiology	0	In state provider	None	ONE HOAG DRIVE	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
144741	Fee-for-Service	1992317234	1992317234	1	1	ALL STATE PATIENT CARE	4/20/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	18345 VENTURA BLVD	STE 204	TARZANA	CA	91356	4241	19	06037	34.16738049	-118.5325057	Los Angeles County
144743	Fee-for-Service	1841356490	1841356490	2	1	AEGIS TREATMENT CENTERS LLC	3/27/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	4129 STATE STREET	B, D, E & F	SANTA BARBARA	CA	93110	1848	42	06083	34.44047554	-119.760759	Santa Barbara County
144765	Fee-for-Service	1376041962	1376041962	1	1	AMERICAN ADVANCED	3/6/2018	193400000X	NA	Other	026	PHYSICIANS	35408	10	Gastroenterology (M.D. only)	0	In state provider	GASTROENTEROLOGY	437 DEL NORTE AVE	None	YUBA CITY	CA	95991	4113	51	06101	39.14395542	-121.618944	Sutter County
144767	Fee-for-Service	1225042369	1225042369	1	1	ALM, JOHN R MD	3/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	39550	66	Emergency Medicine (Urgent Care)	0	In state provider	None	130 CEDAR RD	None	VISTA	CA	92083	5102	37	06073	33.18682732	-117.2839184	San Diego County
144776	Fee-for-Service	1548277163	1548277163	1	1	ALVAREZ, RAMIL LPT	8/2/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	29826 HAUN ROAD	SUITE 106	MENIFEE	CA	92586	6547	33	06065	33.68719818	-117.1748757	Riverside County
144784	Fee-for-Service	1710430574	1710430574	1	1	ANDERSON, JEREME G DC	10/23/2020	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	840 W OLIVE AVE	STE A	MERCED	CA	95348	2421	24	06047	37.31844909	-120.4830328	Merced County
144813	Fee-for-Service	1740427657	1740427657	1	17	ALTAMED HEALTH SERVICES CORP	5/9/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	700 SOUTH FLOWER STREET	None	SANTA ANA	CA	92703	4818	30	06059	33.73848	-117.876467	Orange County
144845	Fee-for-Service	1083859045	1083859045	1	1	ALVARADO, CLAUDIA E MD	8/10/2010	207R00000X	NA	Other	026	PHYSICIANS	106201	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4108	15	06029	35.382555	-118.970757	Kern County
144892	Fee-for-Service	1134350572	1134350572	1	1	ANG, AIMEE S MD	10/1/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	129729	-	NOT APPLICABLE	0	In state provider	None	2695 S 4TH STREET	2ND FLOOR	EL CENTRO	CA	92243	6012	13	06025	32.76973509	-115.5520629	Imperial County
144920	Fee-for-Service	1366904864	1366904864	1	1	ADEGBOYEGA, ADEDOLAPO PT	10/20/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1280 CORONA POINTE CT	STE 118	CORONA	CA	92879	1770	33	06065	33.87039079	-117.5408442	Riverside County
144953	Fee-for-Service	1457931081	1457931081	1	1	ADVENTIST HEALTH PHYSICIANS	7/28/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1801 E MARCH LANE	D400	STOCKTON	CA	95210	6629	39	06077	38.00315652	-121.2868715	San Joaquin County
144956	Fee-for-Service	1750980835	1750980835	1	1	AVERY GARDEN SENIOR CARE	6/20/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	HOME INC	26600 IRONWOOD AVE	None	MORENO VALLEY	CA	92555	1716	33	06065	33.94920762	-117.1987008	Riverside County
144966	Fee-for-Service	1588831341	1588831341	1	1	ALLYN, PAUL R III MD	5/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121315	77	Infectious Disease	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
144968	Fee-for-Service	1851306724	1851306724	1	1	AGUILUZ, JACQUELINE B DO	11/1/2001	174400000X	NA	Other	026	PHYSICIANS	7451	01	General Practice	0	In state provider	TOWNE CENTER FAMILY MED	21508 NORWALK BLVD	None	HAWAIIAN GARDENS	CA	90716	1122	19	06037	33.833862	-118.072013	Los Angeles County
145002	Fee-for-Service	1447699822	1447699822	1	1	ABBASI, RAFAY S MD	3/1/2021	207R00000X	NA	Other	026	PHYSICIANS	163388	None	None	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
145012	Fee-for-Service	1346485026	1346485026	1	1	AGRAWAL, ANURAG K MD	2/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	94871	40	Pediatrics	0	In state provider	None	3200 KEARNEY STREET	None	FREMONT	CA	94538	2299	01	06001	37.54866156	-121.9750739	Alameda County
145038	Fee-for-Service	1104051846	1104051846	1	1	AQUINO, SERWYNA D PT	9/7/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	30033 TECHNOLOGY DR	STE 104-105	MURRIETA	CA	92563	2640	33	06065	33.55982681	-117.1355341	Riverside County
145041	Fee-for-Service	1699716282	1699716282	1	1	ANDERSON, CHARLES K MD	9/28/2015	207L00000X	NA	Other	026	PHYSICIANS	128352	05	Anesthesiology	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
145068	Fee-for-Service	1083957153	1083957153	1	1	AHMAD, UMBER DO	8/29/2020	207RR0500X	NA	Other	026	PHYSICIANS	16480	83	Rheumatology	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
145079	Fee-for-Service	1881875185	1881875185	1	1	ATHERTON, NICHOLE S MD	5/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	90718	02	General Surgery	0	In state provider	None	5533 W HILLSDALE	STE C	VISALIA	CA	93291	5138	54	06107	36.329238	-119.35251	Tulare County
145107	Fee-for-Service	1710977574	1710977574	1	1	ALMARAZ, JAMES W OD INC	1/1/1979	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	41340 BIG BEAR BLVD	None	BIG BEAR LAKE	CA	92315	2820	36	06071	34.24355906	-116.9002904	San Bernardino County
145140	Fee-for-Service	1982983201	1982983201	1	1	ANDREW MILLER	10/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	222 N 7TH ST	None	BISMARCK	ND	58501	4436	00	None	46.807308	-100.782459	Burleigh County
145153	Fee-for-Service	1952927055	1952927055	1	1	ATHOME HEALTHCARE	12/8/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	18002 IRVINE BLVD	STE 208	TUSTIN	CA	92780	3366	30	06059	33.74817547	-117.8181045	Orange County
145164	Fee-for-Service	1598282600	1598282600	1	1	ABUALRUZ, ABDUL RAHMAN MD	9/3/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
145169	Fee-for-Service	1982642161	1982642161	1	1	ANTHONEY, DEANNA J MD	1/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	31941	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1212 E AVENUE S	# S	PALMDALE	CA	93550	6111	19	06037	34.5579069	-118.106329	Los Angeles County
145199	Fee-for-Service	1942418793	1942418793	1	1	ASSADI, RAMIN MD	9/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100097	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
145229	Fee-for-Service	1508957887	1508957887	1	1	ALIABADI, SAMIRA MD	8/27/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76675	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
145240	Fee-for-Service	1588922942	1588922942	1	1	ANDERSON, KRISTIN K MD	10/20/2020	208M00000X	NA	Other	026	PHYSICIANS	129549	None	None	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
145248	Fee-for-Service	1902263015	1902263015	1	1	ALL FOR HEALTH, HEALTH FOR	1/23/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ALL, INC	5855 CAPISTRANO AVE	SUITE D	ATASCADERO	CA	93422	8853	40	06079	35.48988121	-120.6645004	San Luis Obispo County
145300	Fee-for-Service	1477136745	1477136745	1	1	ANWAR, FARHANA MD	8/27/2024	208M00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
145327	Fee-for-Service	1841202074	1841202074	1	1	ASSOCIATES IN UROLOGY	11/27/1990	208800000X	NA	Other	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	3791 KATELLA AVE	STE 200	LOS ALAMITOS	CA	90720	2016	30	06059	33.80318449	-118.0672965	Orange County
145454	Fee-for-Service	1619544640	1619544640	1	1	AVENUE HOME HEALTH INC	9/13/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14402 HAYNES ST	SUITE 203	VAN NUYS	CA	91401	1482	19	06037	34.18965658	-118.4468125	Los Angeles County
145472	Fee-for-Service	1881293942	1881293942	1	1	ALAMEDA CARE HOSPICE	3/10/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1101 MARINA VILLAGE PKWY	STE 249	ALAMEDA	CA	94501	3579	01	06001	37.78594823	-122.2729465	Alameda County
145475	Fee-for-Service	1982459772	1982459772	1	1	ADVENTIST HEALTH PHYSICIANS	7/9/2024	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	4531 BUENA VISTA RD	#100	BAKERSFIELD	CA	93311	8794	15	06029	35.314173	-119.128126	Kern County
145498	Fee-for-Service	1760559678	1760559678	1	1	ALBINSKI, LAWRENCE MD	12/1/1997	204D00000X	NA	Other	026	PHYSICIANS	78342	20	Orthopedic Surgery	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
145514	Fee-for-Service	1598310872	1598310872	1	1	APOLONI NUNEZ, DENISE LMFT	6/13/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
145534	Fee-for-Service	1902263015	1902263015	1	1	ALL FOR HEALTH, HEALTH FOR	1/23/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	ALL, INC	5855 CAPISTRANO AVE	SUITE D	ATASCADERO	CA	93422	8853	40	06079	35.48988121	-120.6645004	San Luis Obispo County
145554	Fee-for-Service	1265543755	1265543755	2	1	ARFAANIA, DARIUSH MD	8/31/1979	174400000X	NA	Other	026	PHYSICIANS	34361	41	Internal Medicine	0	In state provider	None	435 ARDEN AVE	STE 510	GLENDALE	CA	91203	1137	19	06037	34.15848148	-118.2628845	Los Angeles County
145557	Fee-for-Service	1982465191	1982465191	1	1	AB SHIELD TRANS. INC.	4/2/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1201 S VICTORY BLVD	STE 200	BURBANK	CA	91502	2793	19	06037	34.16527115	-118.3059384	Los Angeles County
145565	Fee-for-Service	1437509296	1437509296	1	1	AMARI, AHMED MD	1/10/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165565	08	Family Practice	0	In state provider	None	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
145666	Fee-for-Service	1972520641	1972520641	1	1	AYAZIFAR, MITRA MD	12/26/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52250	18	Ophthalmology	0	In state provider	None	11216 TRINITY RIVER DR	None	RANCHO CORDOVA	CA	95670	2961	34	06067	38.622906	-121.2684705	Sacramento County
145696	Fee-for-Service	1952394074	1952394074	1	1	ACT HOME HEALTH INC	9/21/1998	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12431 LEWIS ST	STE 101	GARDEN GROVE	CA	92840	4653	30	06059	33.782328	-117.897486	Orange County
145697	Fee-for-Service	1225299290	1225299290	1	1	AARON VASA	8/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
145709	Fee-for-Service	1396743225	1396743225	1	1	AMERICARE MED SRVS INC	3/14/1996	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	AMERICARE AMBULANCE SRVC	1059 E BEDMAR ST	None	CARSON	CA	90746	3601	19	06037	33.84339619	-118.2564462	Los Angeles County
145732	Fee-for-Service	1932856507	1932856507	1	1	ANCA SEVERIN MFT INC	9/14/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1720 S AMPHLETT BLVD	STE 220K	SAN MATEO	CA	94402	2713	41	06081	37.55782981	-122.3010921	San Mateo County
145753	Fee-for-Service	1780189290	1780189290	1	1	ALFORD, JAKE A MD	3/19/2024	208200000X	NA	General Surgery	026	PHYSICIANS	164595	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
145761	Fee-for-Service	1881293942	1881293942	1	1	ALAMEDA CARE HOSPICE	3/10/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1101 MARINA VILLAGE PKWY	STE 249	ALAMEDA	CA	94501	3579	01	06001	37.78594823	-122.2729465	Alameda County
145765	Fee-for-Service	1457338188	1457338188	1	1	ANDREW E. AUBER M.D.	10/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7400 BARLITE BLVD	None	SAN ANTONIO	TX	78224	1308	00	None	29.352969	-98.54654098	Bexar County
145782	Fee-for-Service	1174270466	1174270466	1	1	ABOAGYE, CHRISTOPHER PT	3/9/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	17270 BEAR VALLEY RD	STE 105	VICTORVILLE	CA	92395	7751	36	06071	34.47103946	-117.2849598	San Bernardino County
145786	Fee-for-Service	1316524689	1316524689	1	1	ALCANTAR, JENNIFER MD	9/9/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	24422 AVENIDA DE LA CARL	130	LAGUNA HILLS	CA	92653	3636	30	06059	33.56726005	-117.705397	Orange County
145801	Fee-for-Service	1134315666	1134315666	1	1	ARAFOL, GERALD B OT	10/18/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
145822	Fee-for-Service	1649949371	1649949371	1	1	A TO Z HOSPICE, INC	5/26/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	212 N GLENDALE AVE	STE 100	GLENDALE	CA	91206	4735	19	06037	34.14873322	-118.2461855	Los Angeles County
145842	Fee-for-Service	1265543755	1265543755	2	1	ARFAANIA, DARIUSH MD	8/31/1979	174400000X	NA	Other	026	PHYSICIANS	34361	45	Nephrology (Renal-Kidney)	0	In state provider	None	435 ARDEN AVE	STE 510	GLENDALE	CA	91203	1137	19	06037	34.15848148	-118.2628845	Los Angeles County
145844	Fee-for-Service	1437672763	1437672763	1	1	AL-BAHRANI, SARMAD MD	1/26/2021	208M00000X	NA	Other	026	PHYSICIANS	169311	None	None	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
145862	Fee-for-Service	1770828097	1770828097	1	1	AGUILAR-JIMENEZ, JUANA LCSW	3/11/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
145863	Fee-for-Service	1730675786	1730675786	1	1	ARGAME, IVAN JEROME S CRNA	6/7/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
145903	Fee-for-Service	1841533494	1841533494	1	1	AMELN, NICHOLAS MD	11/15/2023	207L00000X	NA	Other	026	PHYSICIANS	134088	None	None	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
145960	Fee-for-Service	1790960888	1790960888	1	1	ARMIN, BOB B MD	4/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103010	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
146000	Fee-for-Service	1689009128	1689009128	1	2	ARIA HOSPICE LLC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2831 CAMINO DEL RIO ST	SUITE 207	SAN DIEGO	CA	92108	3828	37	06073	32.77303908	-117.133271	San Diego County
146024	Fee-for-Service	1851376347	1851376347	1	1	ANDERSEN, SCOTT R MD	2/8/2015	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	2	Out of state provider	None	10700 E GEDDES AVE	STE 200	ENGLEWOOD	CO	80112	3861	00	None	39.58449488	-104.8639802	Arapahoe County
146039	Fee-for-Service	1144750472	1144750472	1	1	ALBERT, MARGOT MD	9/19/2018	390200000X	NA	Other	026	PHYSICIANS	157506	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
146048	Fee-for-Service	1083167548	1083167548	1	1	ABILITY PATHWAYS	6/19/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED	5281 EAGLEDALE AVE	None	EAGLEROCK	CA	90041	1043	19	06037	34.145118	-118.228117	Los Angeles County
146071	Fee-for-Service	1891877015	1891877015	1	1	APOSTOL, JOSEPH A MD	1/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	63272	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
146080	Fee-for-Service	1437890282	1437890282	1	1	ADEBIYI, OLUWATOSIN MD	8/23/2024	390200000X	NA	Other	026	PHYSICIANS	189291	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
146084	Fee-for-Service	1669578639	1669578639	1	1	AUSTIN, MONTEITH MD	10/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98715	02	General Surgery	0	In state provider	None	784 W MANNING AVE	None	REEDLEY	CA	93654	2232	10	06019	36.60428465	-119.4558766	Fresno County
146087	Fee-for-Service	1053564187	1053564187	1	1	AMONI, MIRWAIS MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105875	01	General Practice	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
146092	Fee-for-Service	1558947606	1558947606	1	1	ATHENA HOSPICE, INC	7/6/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	18401 BURBANK BLVD	STE 216	TARZANA	CA	91356	2822	19	06037	34.17187827	-118.5339035	Los Angeles County
146096	Fee-for-Service	1215216528	1215216528	1	1	ABRAHAMIAN, SERJIK MD	12/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117584	08	Family Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
146101	Fee-for-Service	1750453700	1750453700	1	1	AZAREN, KENT H MD	6/30/1996	208600000X	NA	General Surgery	026	PHYSICIANS	40048	02	General Surgery	0	In state provider	None	2865 ATLANTIC AVE	STE 223	LONG BEACH	CA	90806	1741	19	06037	33.809418	-118.185058	Los Angeles County
146106	Fee-for-Service	1568654101	1568654101	1	1	ANTOLA LARDIZABAL, CARLA MD	4/24/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	124251	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
146112	Fee-for-Service	1649949371	1649949371	1	1	A TO Z HOSPICE, INC	5/26/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	212 N GLENDALE AVE	STE 100	GLENDALE	CA	91206	4735	19	06037	34.14873322	-118.2461855	Los Angeles County
146113	Fee-for-Service	1124618913	1124618913	1	1	ALIGNED HOME HEALTH CARE INC	8/22/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	121 W LEXINGTON DR	STE L106E	GLENDALE	CA	91203	2203	19	06037	34.1517575	-118.2560706	Los Angeles County
146130	Fee-for-Service	1841248309	1841248309	1	1	ARUTYOUNIAN, NARINE MD	8/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	72468	08	Family Practice	0	In state provider	WEST COAST DOCTORS	801 S CHEVY CHASE DR	STE 104	GLENDALE	CA	91205	4437	19	06037	34.136757	-118.2396195	Los Angeles County
146146	Fee-for-Service	1659350932	1659350932	1	1	AGOSTINO, JOHN K MD	8/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	24424	01	General Practice	0	In state provider	None	1335 CAMINO DEL MAR	None	DEL MAR	CA	92014	2507	37	06073	32.95822287	-117.2647474	San Diego County
146148	Fee-for-Service	1437336435	1437336435	1	1	AZZAM, SAMIR MD INC	2/16/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51621	08	Family Practice	0	In state provider	None	1211 WEST LA PALMA AVE	STE 707	ANAHEIM	CA	92801	2815	30	06059	33.84718298	-117.933758	Orange County
146163	Fee-for-Service	1104221712	1104221712	1	1	ANTE GONZALEZ, KARLA LMFT	8/28/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
146225	Fee-for-Service	1831956952	1831956952	1	1	ARISE HIGH SCHOOL	2/13/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	3301 E. 12TH ST	#205	OAKLAND	CA	94601	0000	01	06001	37.77617499	-122.2247899	Alameda County
146231	Fee-for-Service	1053922252	1053922252	1	1	ADAMS, BRIAN J LMFT	8/26/2022	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4700 ENTERPRISE WAY	None	MODESTO	CA	95356	0000	50	06099	37.705761	-121.072012	Stanislaus County
146232	Fee-for-Service	1275516304	1275516304	1	1	ANTHONY, ANDREW M MD	1/1/1989	207R00000X	NA	Other	026	PHYSICIANS	44962	08	Family Practice	0	In state provider	None	1235 OSOS ST	None	SAN LUIS OBISPO	CA	93401	3600	40	06079	35.27979518	-120.6596361	San Luis Obispo County
146298	Fee-for-Service	1689009128	1689009128	1	2	ARIA HOSPICE LLC	5/1/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2831 CAMINO DEL RIO ST	SUITE 207	SAN DIEGO	CA	92108	3828	37	06073	32.77303908	-117.133271	San Diego County
146339	Fee-for-Service	1225110497	1225110497	1	1	ACCU REFERENCE MEDICAL LAB,	3/1/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	LLC	1901 E LINDEN AVE	SUITE 4	LINDEN	NJ	07036	1195	00	None	40.6450879	-74.23368432	Union County
146380	Fee-for-Service	1558947606	1558947606	1	1	ATHENA HOSPICE, INC	7/6/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18401 BURBANK BLVD	STE 216	TARZANA	CA	91356	2822	19	06037	34.17187827	-118.5339035	Los Angeles County
146385	Fee-for-Service	1487660627	1487660627	1	1	ALLEN, ANNE L CNMW	2/8/2015	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	555 E VALLEY PKWY	None	ESCONDIDO	CA	92025	3048	37	06073	33.12542915	-117.0764725	San Diego County
146412	Fee-for-Service	1700825023	1700825023	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	28047 SCOTT RD	None	MURRIETA	CA	92562	7438	33	06065	33.639318	-117.169812	Riverside County
146414	Fee-for-Service	1952872301	1952872301	1	1	ANTE, MATTHEW A RCP	8/7/2020	2279P1006X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
146423	Fee-for-Service	1750152849	1750152849	1	1	AHMED, BRIANA LCSW	1/23/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
146429	Fee-for-Service	1790102481	1790102481	1	1	ABBOTT, HEATHER R PT	11/17/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3855 ALAMO ST	None	SIMI VALLEY	CA	93063	2104	56	06111	34.28644751	-118.721655	Ventura County
146436	Fee-for-Service	1437336435	1437336435	1	1	AZZAM, SAMIR MD INC	2/16/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51621	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1211 WEST LA PALMA AVE	STE 707	ANAHEIM	CA	92801	2815	30	06059	33.84718298	-117.933758	Orange County
146447	Fee-for-Service	1548254659	1548254659	1	1	ADVANCED SLEEP MEDICINE SRVS	2/14/2011	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	16260 VENTURA BLVD	# 700	ENCINO	CA	91436	2203	19	06037	34.15687678	-118.4876342	Los Angeles County
146463	Fee-for-Service	1154492122	1154492122	1	1	ABDOU, SHERIF R MD	3/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	88381	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
146479	Fee-for-Service	1932529831	1932529831	1	1	ALTURA CENTERS FOR HEALTH	2/21/2019	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	16686 ROAD 168	None	WOODVILLE	CA	93257	9246	54	06107	36.092772	-119.1967015	Tulare County
146517	Fee-for-Service	1275516304	1275516304	1	1	ANTHONY, ANDREW M MD	1/1/1989	207R00000X	NA	Other	026	PHYSICIANS	44962	01	General Practice	0	In state provider	None	1235 OSOS ST	None	SAN LUIS OBISPO	CA	93401	3600	40	06079	35.27979518	-120.6596361	San Luis Obispo County
146523	Fee-for-Service	1962542761	1962542761	1	1	ALI, MARIAM T	12/1/1997	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1233 N VERMONT AVE	STE 1	LOS ANGELES	CA	90029	1749	19	06037	34.0943999	-118.2917813	Los Angeles County
146536	Fee-for-Service	1720091911	1720091911	1	1	ABBOTT, STEPHEN L MD	9/30/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	24423	40	Pediatrics	0	In state provider	CHILDRENS MED CLINIC	15 E ARRELLAGA ST	None	SANTA BARBARA	CA	93101	2531	42	06083	34.42731739	-119.7094444	Santa Barbara County
146582	Fee-for-Service	1881772457	1881772457	1	1	AL SAGHBINI, SAMER	12/17/2003	2083P0901X	NA	Adult Primary Care	026	PHYSICIANS	84554	01	General Practice	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
146646	Fee-for-Service	1346867470	1346867470	1	1	ALONSO, KARLA A LMFT	4/18/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	122579	-	NOT APPLICABLE	0	In state provider	None	4660 EL CAJON BLVD	210,209,202,212A	SAN DIEGO	CA	92115	4450	37	06073	32.75587585	-117.093663	San Diego County
146662	Fee-for-Service	1912169061	1912169061	1	1	AKONG, KATHRYN A MD	7/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	96565	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
146671	Fee-for-Service	1144845819	1144845819	1	1	ARKA RX, INC.	8/18/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	621 E GLENOAKS	C	GLENDALE	CA	91207	1771	19	06037	34.1583091	-118.2483405	Los Angeles County
146688	Fee-for-Service	1629047808	1629047808	1	1	ARCADIA PATHOLOGY MED	3/3/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
146733	Fee-for-Service	1821441221	1821441221	1	2	ATHENA BRASFIELD OD A PROFES	8/18/2016	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORPORATION	52565 CESAR CHAVEZ ST	#105	COACHELLA	CA	92236	1534	33	06065	33.66690605	-116.1817556	Riverside County
146753	Fee-for-Service	1164540423	1164540423	1	1	ALON, LAUREN LCSW	6/27/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
146767	Fee-for-Service	1932529831	1932529831	1	1	ALTURA CENTERS FOR HEALTH	8/26/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	16686 ROAD 168	None	WOODVILLE	CA	93257	9246	54	06107	36.092772	-119.1967015	Tulare County
146770	Fee-for-Service	1225788193	1225788193	1	1	ATIBAS INC	12/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	945 SHASTA RD	STE 100	YUBA CITY	CA	95991	9705	51	06101	39.14392271	-121.6160328	Sutter County
146778	Fee-for-Service	1356882567	1356882567	1	1	ABRAHAMIAN, NATALIE C MD	2/2/2021	207R00000X	NA	Other	026	PHYSICIANS	170203	None	None	0	In state provider	None	32144 AGOURA RD.	100	WESTLAKE VILLAGE	CA	91361	4031	19	06037	34.14848408	-118.8208595	Los Angeles County
146781	Fee-for-Service	1033520895	1033520895	1	1	ALVARADO, VANEZA LMFT	6/6/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
146788	Fee-for-Service	1891169579	1891169579	1	1	AMBRIZ, CHRISTINA LMFT	1/20/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17777 VENTURA BLVD	STE 105	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
146797	Fee-for-Service	1922538172	1922538172	1	1	ASTUDILLO, MICHAEL G MD	8/31/2022	207ZP0102X	NA	Other	026	PHYSICIANS	180744	None	None	0	In state provider	None	3301 C ST	STE 200 E	SACRAMENTO	CA	95816	3363	34	06067	38.579877	-121.456143	Sacramento County
146810	Fee-for-Service	1740427657	1740427657	1	25	ALTAMED HEALTH SERVICES CORP	6/28/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	14741 NORTH B STREET	None	TUSTIN	CA	92780	2529	30	06059	33.75017943	-117.8258355	Orange County
146815	Fee-for-Service	1376792416	1376792416	1	1	AT HOME HEALTH SERVICES INC	7/25/2011	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5530 CORBIN AVENUE	SUITE 228	TARZANA	CA	91356	7113	19	06037	34.171812	-118.5621935	Los Angeles County
146843	Fee-for-Service	1043773039	1043773039	1	1	AUTHENTIC HOME HEALTH CARE	3/3/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	2667 N MOORPARK RD	STE 203	THOUSAND OAKS	CA	91360	3011	56	06111	34.21703362	-118.8684249	Ventura County
146857	Fee-for-Service	1134616766	1134616766	1	1	ALLAHDADI, BASHIR MD	10/7/2021	207R00000X	NA	Other	026	PHYSICIANS	173353	None	None	0	In state provider	None	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
146866	Fee-for-Service	1801477906	1801477906	1	1	AL-DOORI, IKRAM MD	1/6/2025	208M00000X	NA	Other	026	PHYSICIANS	192468	41	Internal Medicine	0	In state provider	None	ONE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
146903	Fee-for-Service	1811616485	1811616485	1	1	ANGELES, RYAN A PT	2/3/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
146908	Fee-for-Service	1811360811	1811360811	1	1	AYALA LARCO, ANDREA MD	4/18/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	155054	None	None	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
146910	Fee-for-Service	1790766798	1790766798	1	1	ARRAIZ, MARTIN J MD	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	25	Physical Medicine and Rehabilitation	1	Border provider	None	555 N ARLINGTON AVE	None	RENO	NV	89503	4723	00	None	39.53124039	-119.8188498	Washoe County
146930	Fee-for-Service	1609134501	1609134501	1	1	AMERICAN SPINE PC	11/10/2014	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	None	None	None	0	In state provider	None	39765 DATE STREET	SUITE 101	MURRIETA	CA	92563	2005	33	06065	33.54593179	-117.1538761	Riverside County
146951	Fee-for-Service	1912169061	1912169061	1	1	AKONG, KATHRYN A MD	7/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	96565	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
146964	Fee-for-Service	1316602519	1316602519	1	1	ASCENSION HOME HEALTH	9/18/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4605 LANKERSHIM	STE 219	NORTH HOLLYWOOD	CA	91602	1875	19	06037	34.15389329	-118.3679999	Los Angeles County
146996	Fee-for-Service	1942738471	1942738471	1	1	ALLEN, RYAN D DPM	7/27/2020	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
147020	Fee-for-Service	1104432673	1104432673	1	1	ALERACARE MEDICAL GROUP OF C	11/7/2023	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ALIFORNIA, A MEDICAL C	17777 VENTURA BLVD	200	ENCINO	CA	91316	3748	19	06037	34.16286556	-118.5200521	Los Angeles County
147031	Fee-for-Service	1821469230	1821469230	1	1	ADVENTIST HEALTH PHYSICIANS	2/1/2019	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	125 MALL DR	STE 205	HANFORD	CA	93230	5794	16	06031	36.3246477	-119.6685218	Kings County
147046	Fee-for-Service	1154558401	1154558401	1	1	AGGARWAL, DIVYA MD	11/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130936	18	Ophthalmology	0	In state provider	None	7300 WYNDHAM DRIVE	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
147051	Fee-for-Service	1134479785	1134479785	1	1	ALIX, CATHERINE LMFT	4/28/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4849 RONSON CT	SUITE 207	SAN DIEGO	CA	92111	1805	37	06073	32.83028739	-117.1459009	San Diego County
147055	Fee-for-Service	1932529831	1932529831	1	1	ALTURA CENTERS FOR HEALTH	8/26/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	16686 ROAD 168	None	WOODVILLE	CA	93257	9246	54	06107	36.092772	-119.1967015	Tulare County
147081	Fee-for-Service	1831426832	1831426832	1	2	ALERT HOME HEALTH CARE INC	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11700 DUBLIN BLVD	SUITE 200	DUBLIN	CA	94568	2801	01	06001	37.70067515	-121.9404942	Alameda County
147103	Fee-for-Service	1740427657	1740427657	1	25	ALTAMED HEALTH SERVICES CORP	6/28/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	14741 NORTH B STREET	None	TUSTIN	CA	92780	2529	30	06059	33.75017943	-117.8258355	Orange County
147129	Fee-for-Service	1568992923	1568992923	1	1	AMERICAN SPECIALTY	5/18/2018	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	PHYSICIANS GROUP INC	173 E WEBSTER ST	None	COLUSA	CA	95932	2949	06	06011	39.20739708	-122.0006099	Colusa County
147150	Fee-for-Service	1316471634	1316471634	1	1	ARTZ, JOURDAIN MD	2/20/2024	208200000X	NA	General Surgery	026	PHYSICIANS	180785	None	None	0	In state provider	None	5395 RUFFIN RD	STE 102	SAN DIEGO	CA	92123	1338	37	06073	32.832387	-117.1266225	San Diego County
147161	Fee-for-Service	1689197196	1689197196	1	1	ASVADI, NAZANIN H MD	5/3/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	185607	None	None	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
147167	Fee-for-Service	1619040292	1619040292	1	1	ABDULRAHIM, AHMED M DC	7/5/2021	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
147214	Fee-for-Service	1043359045	1043359045	1	1	ABBOTT,CHRISTOPHER MD	9/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	0000	00	None	35.08771808	-106.6192188	Bernalillo County
147239	Fee-for-Service	1912169061	1912169061	1	1	AKONG, KATHRYN A MD	7/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	96565	41	Internal Medicine	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
147277	Fee-for-Service	1255399531	1255399531	1	2	AU, VERONIQUE L MD	1/1/2017	207P00000X	NA	Other	026	PHYSICIANS	79952	66	Emergency Medicine (Urgent Care)	0	In state provider	None	180 ROWLAND WAY	None	NOVATO	CA	94945	5009	21	06041	38.09825699	-122.5598561	Marin County
147291	Fee-for-Service	1114705787	1114705787	1	1	ANAHEIM VILLA, INC.	3/1/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	3411 WEST BALL ROAD	None	ANAHEIM	CA	92804	3720	30	06059	33.81730464	-118.0082032	Orange County
147309	Fee-for-Service	1104432673	1104432673	1	1	ALERACARE MEDICAL GROUP OF C	3/27/2024	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ALIFORNIA, A MEDICAL C	17777 VENTURA BLVD	200	ENCINO	CA	91316	3748	19	06037	34.16286556	-118.5200521	Los Angeles County
147322	Fee-for-Service	1760085351	1760085351	1	1	AAA HOSPICE CARE & NURSING	10/21/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	229 N CENTRAL AVE	STE 507	GLENDALE	CA	91205	3507	19	06037	34.14910181	-118.2579537	Los Angeles County
147329	Fee-for-Service	1831293109	1831293109	1	1	AMIN, ASHOKKUMAR I MD	2/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	44111	10	Gastroenterology (M.D. only)	0	In state provider	INC	3010 W ORANGE AVE	STE 401	ANAHEIM	CA	92804	3173	30	06059	33.82472315	-117.994133	Orange County
147334	Fee-for-Service	1679544779	1679544779	1	1	ASHKENAZE, DAVID MICHAEL	1/1/1995	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	65521	20	Orthopedic Surgery	0	In state provider	None	24953 PASEO DE VALENCIA	STE 20A	LAGUNA HILLS	CA	92653	4338	30	06059	33.60028568	-117.7010887	Orange County
147345	Fee-for-Service	1184820987	1184820987	1	2	APEX HEALTHCARE MEDICAL	12/26/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER INC	29826 HAUN RD	SUITE 200	MENIFEE	CA	92586	6547	33	06065	33.68719818	-117.1748757	Riverside County
147360	Fee-for-Service	1831403211	1831403211	1	1	AL SAIF, HIND MD	5/2/2024	207SG0201X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
147399	Fee-for-Service	1720568132	1720568132	1	1	ANICHE, EBERECHUKWU O NP	10/13/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
147419	Fee-for-Service	1568992923	1568992923	1	1	AMERICAN SPECIALTY	9/21/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS GROUP INC	173 E WEBSTER ST	None	COLUSA	CA	95932	2949	06	06011	39.20739708	-122.0006099	Colusa County
147435	Fee-for-Service	1992718332	1992718332	1	1	AYAD, MAGED MD	2/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	56313	41	Internal Medicine	0	In state provider	A MEDICAL CORP	2031 W ALAMEDA AVE	STE 340	BURBANK	CA	91506	2960	19	06037	34.15972797	-118.3237055	Los Angeles County
147439	Fee-for-Service	1659483287	1659483287	1	1	ASHAM EMAD H MD	10/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94629	02	General Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
147454	Fee-for-Service	1841797248	1841797248	1	1	AHMAD, JAWAD N MD	6/28/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	177942	None	None	0	In state provider	None	100 STEIN PLZ	None	LOS ANGELES	CA	90095	7065	19	06037	34.06489065	-118.4443287	Los Angeles County
147458	Fee-for-Service	1144321522	1144321522	1	1	ARIKIAN, ANNE M MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	60910	08	Family Practice	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
147484	Fee-for-Service	1124040787	1124040787	1	1	ALONZO, JUDY A MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	79181	22	Pathology (M.D. only)	0	In state provider	None	101 S SAN MATEO DR	None	SAN MATEO	CA	94401	3819	41	06081	37.56590481	-122.325549	San Mateo County
147565	Fee-for-Service	1790709012	1790709012	1	1	ALEXANDER, MICHAEL	4/1/1999	207L00000X	NA	Other	026	PHYSICIANS	62746	05	Anesthesiology	0	In state provider	None	3857 BIRCH ST	# 709	NEWPORT BEACH	CA	92660	2616	30	06059	33.66332364	-117.8712141	Orange County
147569	Fee-for-Service	1518222876	1518222876	1	1	AMMON, DENISE L MD	6/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
147590	Fee-for-Service	1083260897	1083260897	1	1	ALL STAR PHOENIX INC	6/2/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	30125 AGOURA ROAD	SUITE 2E	AGOURA HILLS	CA	91301	4337	19	06037	34.14503881	-118.7793013	Los Angeles County
147592	Fee-for-Service	1255435517	1255435517	1	1	ATIE, PATRICIA A	5/2/2003	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2414 S FAIRVIEW ST	STE 103	SANTA ANA	CA	92704	5318	30	06059	33.71437705	-117.9079237	Orange County
147596	Fee-for-Service	1669748547	1669748547	1	1	AMIN, NEHA K MD	8/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130237	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2333 BUCHANAN ST	ATTN: EMERGENCY DEPT	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
147613	Fee-for-Service	1760085351	1760085351	1	1	AAA HOSPICE CARE & NURSING	10/21/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	229 N CENTRAL AVE	STE 507	GLENDALE	CA	91205	3507	19	06037	34.14910181	-118.2579537	Los Angeles County
147616	Fee-for-Service	1831293109	1831293109	1	1	AMIN, ASHOKKUMAR I MD	2/14/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	44111	41	Internal Medicine	0	In state provider	INC	3010 W ORANGE AVE	STE 401	ANAHEIM	CA	92804	3173	30	06059	33.82472315	-117.994133	Orange County
147633	Fee-for-Service	1184820987	1184820987	1	2	APEX HEALTHCARE MEDICAL	5/1/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	CENTER INC	29826 HAUN RD	SUITE 200	MENIFEE	CA	92586	6547	33	06065	33.68719818	-117.1748757	Riverside County
147690	Fee-for-Service	1295220002	1295220002	1	1	ALLEN, MICHAEL Z DO	8/1/2023	207XX0801X	NA	Orthopedic Surgery	026	PHYSICIANS	17724	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
147707	Fee-for-Service	1568992923	1568992923	1	1	AMERICAN SPECIALTY	3/9/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	PHYSICIANS GROUP INC	173 E WEBSTER ST	None	COLUSA	CA	95932	2949	06	06011	39.20739708	-122.0006099	Colusa County
147715	Fee-for-Service	1821036229	1821036229	1	1	ASHOK, NAGASAMUDRA S	3/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	41589	66	Emergency Medicine (Urgent Care)	0	In state provider	MD INC	229 W 7TH ST	None	SAN JACINTO	CA	92583	4662	33	06065	33.78027368	-116.9601627	Riverside County
147740	Fee-for-Service	1417921891	1417921891	1	1	ARNOLD, MICHELLE G MD	4/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	76972	None	None	0	In state provider	None	101 THE CITY DRIVE SOUTH	BLDG 25	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
147752	Fee-for-Service	1588669584	1588669584	1	1	ADAM B ALPERIN MD	6/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2545 W FRYE RD	STE 9	CHANDLER	AZ	85224	6273	00	None	33.297084	-111.8864475	Maricopa County
147764	Fee-for-Service	1982000485	1982000485	1	1	ABRAMS, GLENN L MARRIAGE	7/30/2018	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	FAMILY & CHILD COUNSELIN	133 E BONITA AVE	STE 205	SAN DIMAS	CA	91773	3098	19	06037	34.1067035	-117.806076	Los Angeles County
147802	Fee-for-Service	1548548571	1548548571	1	1	APPLE HEALTHCARE INC	11/26/2012	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	10722 ARROW ROUTE	UNIT 814A	RANCHO CUCAMONGA	CA	91730	4843	36	06071	34.09917725	-117.5708877	San Bernardino County
147808	Fee-for-Service	1669123626	1669123626	1	1	ADVANCED RADIOLOGY AND INTER	3/1/2022	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	VENTIONAL ASSOCIATES	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
147817	Fee-for-Service	1831129006	1831129006	1	1	ARJOMAND-FARD, HEIDAR MD	9/21/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	55809	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2241 WANKEL WAY	STE C	OXNARD	CA	93030	0191	56	06111	34.21679844	-119.1467863	Ventura County
147832	Fee-for-Service	1265436851	1265436851	1	1	AHMED, MARY ANN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2400 NE NEFF RD	STE A	BEND	OR	97701	6752	00	None	44.06580588	-121.2684171	Deschutes County
147900	Fee-for-Service	1629104492	1629104492	1	1	AMIRNOVIN, RAMBOD MD	7/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99850	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
147917	Fee-for-Service	1598853103	1598853103	1	1	ATHENS, DESSIE	1/31/1986	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
147951	Fee-for-Service	1437576501	1437576501	1	1	ALEGRIA, DYLAN A MD	5/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	143252	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	STE B200	LOS ANGELES	CA	90095	8346	19	06037	34.06473399	-118.445865	Los Angeles County
147974	Fee-for-Service	1477819456	1477819456	1	1	ATTENHOFER, KEVIN S MD	11/14/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	147583	13	Neurology (M.D. only)	0	In state provider	None	1180 N INDIAN CANYON DR	SUITE 200	PALM SPRINGS	CA	92262	4800	33	06065	33.839505	-116.5455735	Riverside County
147986	Fee-for-Service	1942564521	1942564521	1	1	ADAMS, MONA N OD	10/11/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
147995	Fee-for-Service	1568992923	1568992923	1	1	AMERICAN SPECIALTY	9/21/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	PHYSICIANS GROUP INC	173 E WEBSTER ST	None	COLUSA	CA	95932	2949	06	06011	39.20739708	-122.0006099	Colusa County
147999	Fee-for-Service	1073141099	1073141099	1	1	ATEFI, OMEED MD	9/22/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20566	None	None	0	In state provider	None	12 CAMINO ENCINAS	None	ORINDA	CA	94563	3304	07	06013	37.87679015	-122.1800856	Contra Costa County
148004	Fee-for-Service	1821036229	1821036229	1	1	ASHOK, NAGASAMUDRA S	3/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	41589	41	Internal Medicine	0	In state provider	MD INC	229 W 7TH ST	None	SAN JACINTO	CA	92583	4662	33	06065	33.78027368	-116.9601627	Riverside County
148052	Fee-for-Service	1982000485	1982000485	1	1	ABRAMS, GLENN L MARRIAGE	7/30/2018	261QM0801X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	FAMILY & CHILD COUNSELIN	133 E BONITA AVE	STE 205	SAN DIMAS	CA	91773	3098	19	06037	34.1067035	-117.806076	Los Angeles County
148071	Fee-for-Service	1073732673	1073732673	1	1	ANTIOCH ICF, INC	5/24/2004	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	PUTNAM ICF	1204 PUTNAM ST	None	ANTIOCH	CA	94509	5412	07	06013	37.98967998	-121.8256296	Contra Costa County
148096	Fee-for-Service	1194017210	1194017210	1	1	ALVAREZ, ELYSIA M MD	5/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	121987	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
148101	Fee-for-Service	1205020955	1205020955	1	1	ADAMIAN, KRISTINE LCSW	7/26/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	245 E OLIVE AVE	STE 400	BURBANK	CA	91502	1214	19	06037	34.18145335	-118.3081834	Los Angeles County
148125	Fee-for-Service	1457803942	1457803942	1	1	ARNOLD, KARLA M	2/23/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
148136	Fee-for-Service	1205335445	1205335445	1	1	ABUNDANCE PSYCHOTHERAPY CENT	5/5/2023	1041C0700X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD	STE 230	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
148151	Fee-for-Service	1841235223	1841235223	1	1	ARUTYUNYAN, VARDUI MD	11/26/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	70072	08	Family Practice	0	In state provider	None	1030 S GLENDALE AVE	STE 309	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
148158	Fee-for-Service	1487064515	1487064515	1	1	AVILA, LIEZL R DO	10/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14280	66	Emergency Medicine (Urgent Care)	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
148159	Fee-for-Service	1063896835	1063896835	1	1	AMERICUS HOSPICE INC	2/28/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5924 E LOS ANGELES AVE	SUITE T	SIMI VALLEY	CA	93063	5526	56	06111	34.27171481	-118.6755673	Ventura County
148177	Fee-for-Service	1487213682	1487213682	1	1	AVALIN HEALTH MEDICAL CORPOR	3/1/2020	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	None	None	0	In state provider	ATION	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	19	06037	34.15729818	-118.3277073	Los Angeles County
148198	Fee-for-Service	1417058397	1417058397	1	1	AMERICAN CAREQUEST INC	1/16/2009	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	819 COWAN RD	SUITE C-1	BURLINGAME	CA	94010	1204	41	06081	37.60215521	-122.3748143	San Mateo County
148212	Fee-for-Service	1669869384	1669869384	1	1	AFANASIEV, OLGA K MD	9/12/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	144290	07	Dermatology	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
148218	Fee-for-Service	1013369842	1013369842	2	1	ALLEGIANCE HEALTHCARE GROUP	9/8/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18455 BURBANK BLVD	STE 311	TARZANA	CA	91356	6647	19	06037	34.17237215	-118.5354469	Los Angeles County
148221	Fee-for-Service	1932179041	1932179041	1	1	AGARWALA, SANJAY MD	4/18/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	170800	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
148245	Fee-for-Service	1215145776	1215145776	1	2	ANDERSON, ORSON A MD	5/5/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	41825	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
148284	Fee-for-Service	1568992923	1568992923	1	1	AMERICAN SPECIALTY	9/21/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	PHYSICIANS GROUP INC	173 E WEBSTER ST	None	COLUSA	CA	95932	2949	06	06011	39.20739708	-122.0006099	Colusa County
148304	Fee-for-Service	1760699144	1760699144	1	1	ARCHANGEL HOME HLTH INC	3/1/2019	No Taxonomy Provided	NA	None	093	CARE COORDINATOR AGENCIES (CCA)	-	-	NOT APPLICABLE	0	In state provider	None	16446 WOODRUFF AVE	SUITE A	BELLFLOWER	CA	90706	4975	19	06037	33.883902	-118.1173145	Los Angeles County
148310	Fee-for-Service	1568532737	1568532737	1	1	ANTELOPE VALLEY SURGICAL INS	1/14/2021	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	TITUTE, LLC	1720 WEST AVENUE J	None	LANCASTER	CA	93534	2700	19	06037	34.68938955	-118.161981	Los Angeles County
148315	Fee-for-Service	1316547250	1316547250	1	1	ALANIZ, ERMINILLA D LMFT	6/14/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	151 N BUENA VISTA ST	None	HEMET	CA	92543	4323	33	06065	33.74899502	-116.9673682	Riverside County
148339	Fee-for-Service	1407101447	1407101447	1	1	ADVENTIST HEALTH PHYSICIANS	6/17/2013	261QU0200X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	801 S CHEVY CHASE DRIVE	STE 105	GLENDALE	CA	91205	4431	19	06037	34.136757	-118.2396195	Los Angeles County
148353	Fee-for-Service	1811287311	1811287311	1	1	ABBASI, CAROLYN MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125641	05	Anesthesiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
148360	Fee-for-Service	1619324936	1619324936	1	1	ABUGROUN, ASHRAF H MD	1/14/2022	208M00000X	NA	Other	026	PHYSICIANS	174588	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
148374	Fee-for-Service	1922186402	1922186402	1	1	ALLEN, JONATHAN W MD	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	76225	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
148422	Fee-for-Service	1205335445	1205335445	1	1	ABUNDANCE PSYCHOTHERAPY CENT	10/26/2023	1041C0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4221 WILSHIRE BLVD	STE 230	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
148427	Fee-for-Service	1033386479	1033386479	1	1	ADAM FRANKILN CHANDLER, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4301 W MARKHAM ST	SLOT 521	LITTLE ROCK	AR	72205	7101	00	None	34.749009	-92.320101	Pulaski County
148441	Fee-for-Service	1003259219	1003259219	1	1	ANGARITA, STEPHANIE A MD	11/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132729	02	General Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
148450	Fee-for-Service	1063896835	1063896835	1	1	AMERICUS HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5924 E LOS ANGELES AVE	SUITE T	SIMI VALLEY	CA	93063	5526	56	06111	34.27171481	-118.6755673	Ventura County
148505	Fee-for-Service	1932102530	1932102530	1	1	AMIR MOASSER M.D.	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	18701 N 67TH AVE	None	GLENDALE	AZ	85308	7100	00	None	33.655734	-112.201416	Maricopa County
148508	Fee-for-Service	1104191121	1104191121	1	1	APOSTOL, ALLAN P DO	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14686	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
148521	Fee-for-Service	1225359763	1225359763	1	1	ALAMITOS REAGAN ANESTHESIA	9/21/2010	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	CORPORATION	3751 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3101	30	06059	33.80318353	-118.0666665	Orange County
148557	Fee-for-Service	1366499832	1366499832	1	1	ABED-AMOLI, HOSSEIN MD	9/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	56121	01	General Practice	0	In state provider	None	6170 THORNTON AVE	STE H	NEWARK	CA	94560	3700	01	06001	37.5360754	-122.0311695	Alameda County
148579	Fee-for-Service	1487064150	1487064150	1	1	ALLURI, RAM K MD	9/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141581	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
148589	Fee-for-Service	1144838012	1144838012	1	1	ALLCARE HEALTH SERVICES LLC	7/31/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	360 S MILLIKEN AVE	STE F & G	ONTARIO	CA	91761	7847	36	06071	34.059888	-117.559215	San Bernardino County
148591	Fee-for-Service	1760699144	1760699144	1	1	ARCHANGEL HOME HLTH INC	9/26/2008	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	16446 WOODRUFF AVE	SUITE A	BELLFLOWER	CA	90706	4975	19	06037	33.883902	-118.1173145	Los Angeles County
148597	Fee-for-Service	1750926879	1750926879	1	1	AMBROSE, HEATHER CRNA	1/6/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
148613	Fee-for-Service	1164576815	1164576815	1	1	ANDERSON-WILLIAMS, ELEAN	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72795	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
148633	Fee-for-Service	1497854178	1497854178	1	1	AMBULATORY ANESTHESIA	4/21/2010	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	4650 LINCOLN BLVD	None	MARINA DEL REY	CA	90292	6306	19	06037	33.98160766	-118.4400667	Los Angeles County
148664	Fee-for-Service	1700151982	1700151982	1	1	ALEXANDRE, STEPHANIE	2/7/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	10428 DUXBURY LN, 14	None	SAN DIEGO	CA	92127	6880	37	06073	33.02197462	-117.1093183	San Diego County
148696	Fee-for-Service	1245278415	1245278415	1	1	ANTIQUE, MARIA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	708 W FOREST AVE	None	JACKSON	TN	38301	3901	00	None	35.63557288	-88.83180943	Madison County
148714	Fee-for-Service	1205335445	1205335445	1	1	ABUNDANCE PSYCHOTHERAPY CENT	10/15/2021	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD	STE 230	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
148754	Fee-for-Service	1013076850	1013076850	1	1	ARTHRITIS CENTER OF	11/13/2007	207RR0500X	NA	Other	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	RIVERSIDE MEDICAL CORP	4000 14TH ST	STE 511	RIVERSIDE	CA	92501	4019	33	06065	33.97771007	-117.3818381	Riverside County
148774	Fee-for-Service	1306035399	1306035399	1	1	ARMSTEAD, BAILEY V LMFT	10/29/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
148794	Fee-for-Service	1588707178	1588707178	1	1	ABRAMSON, RACHEL A MD	2/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104918	40	Pediatrics	0	In state provider	None	6475 ALVARADO RD	STE 120	SAN DIEGO	CA	92120	5003	37	06073	32.77826653	-117.061265	San Diego County
148799	Fee-for-Service	1750439642	1750439642	1	1	ASEMI, NEGIN OD	2/3/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6 WILLARD	None	IRVINE	CA	92604	4694	30	06059	33.67534801	-117.7900415	Orange County
148824	Fee-for-Service	1376077578	1376077578	1	1	AARON D CHRISTIANS	8/15/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1910 SOUTH AVE	None	LA CROSSE	WI	54601	5467	00	None	43.79473653	-91.24623835	La Crosse County
148907	Fee-for-Service	1083979116	1083979116	1	3	A COZY RETIREMENT HOME	2/3/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	8616 BANFF VISTA DR	None	ELK GROVE	CA	95624	1707	34	06067	38.412693	-121.3863615	Sacramento County
148951	Fee-for-Service	1700151982	1700151982	1	1	ALEXANDRE, STEPHANIE	2/7/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	10428 DUXBURY LN, 14	None	SAN DIEGO	CA	92127	6880	37	06073	33.02197462	-117.1093183	San Diego County
148997	Fee-for-Service	1205335445	1205335445	1	1	ABUNDANCE PSYCHOTHERAPY CENT	10/15/2021	1041C0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD	STE 230	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
149013	Fee-for-Service	1538401013	1538401013	1	1	AGUIRRE, DAVID A MD	4/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138602	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
149026	Fee-for-Service	1083868541	1083868541	1	1	ALARCON, MARY OT	11/20/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	75100 MEDITERRANEAN	None	PALM DESERT	CA	92211	9069	33	06065	33.74397149	-116.3546505	Riverside County
149040	Fee-for-Service	1013076850	1013076850	1	1	ARTHRITIS CENTER OF	11/13/2007	207RR0500X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	RIVERSIDE MEDICAL CORP	4000 14TH ST	STE 511	RIVERSIDE	CA	92501	4019	33	06065	33.97771007	-117.3818381	Riverside County
149075	Fee-for-Service	1003987660	1003987660	1	1	ARONSON, NOLA C	1/16/2008	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	23861 MCBEAN PKWY	STE E-16	VALENCIA	CA	91355	2058	19	06037	34.39567343	-118.5542698	Los Angeles County
149077	Fee-for-Service	1831462365	1831462365	1	1	ATTARWALA, ALIFEYA M MD	8/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120180	41	Internal Medicine	0	In state provider	None	900 HYDE STREET	None	SAN FRANCISCO	CA	94109	4899	38	06075	37.78956486	-122.417072	San Francisco County
149095	Fee-for-Service	1760648646	1760648646	1	1	ADAMS, BENJAMIN D DO	7/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	15758	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
149098	Fee-for-Service	1528055886	1528055886	1	1	ALISON LYNCH MD	9/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
149104	Fee-for-Service	1558114850	1558114850	1	1	ADVENTIST HEALTH PHYSICIANS	8/7/2024	207V00000X	NA	Obstetrics & Gynecology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	35 CASA ST	270	SAN LUIS OBISPO	CA	93405	1899	40	06079	35.29359615	-120.6654304	San Luis Obispo County
149105	Fee-for-Service	1376190405	1376190405	1	1	ADAMS, MONIQUE M PT	4/13/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
149119	Fee-for-Service	1942734595	1942734595	1	1	ANITA HOSPICE, INC	8/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	201 S ANITA DR	STE 105	ORANGE	CA	92868	3312	30	06059	33.786144	-117.881161	Orange County
149122	Fee-for-Service	1427327766	1427327766	1	1	ASSADI, KHATEREH A MD	3/3/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	154956	None	None	0	In state provider	None	191 S BUENA VISTA STREET	SUITE 200-240	BURBANK	CA	91505	4542	19	06037	34.15872557	-118.3283863	Los Angeles County
149125	Fee-for-Service	1801465554	1801465554	1	1	ANGELS HOME HEALTH AGENCY	8/23/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	3353 BRADSHAW RD	STE 211	SACRAMENTO	CA	95827	2610	34	06067	38.562822	-121.335534	Sacramento County
149147	Fee-for-Service	1588350854	1588350854	1	1	AKILO, VICTORIA IYABO	4/20/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	9083 RICHBOROUGH WAY	None	ELK GROVE	CA	95624	1304	34	06067	38.391633	-121.363182	Sacramento County
149162	Fee-for-Service	1578760633	1578760633	1	1	AL HARAKEH, AYMAN MD	8/11/2017	208600000X	NA	General Surgery	026	PHYSICIANS	135324	02	General Surgery	0	In state provider	None	432 LEXINGTON AVE	UNIT A	DELANO	CA	93215	3697	15	06029	35.762706	-119.2407725	Kern County
149203	Fee-for-Service	1649951328	1649951328	1	1	ASTORIA GARDENS TRACY LLC;	8/15/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	AGEMARK MANAGEMENT LLC	1960 WEST LOWELL	None	TRACY	CA	95376	2239	39	06077	37.74699029	-121.4525499	San Joaquin County
149343	Fee-for-Service	1467817510	1467817510	1	1	ABILLE, GINEVEVE CHARMAINE V	12/12/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
149350	Fee-for-Service	1790841849	1790841849	1	1	AMRSTRONG, DUSTIN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8TH AVE + C ST	None	SALT LAKE CTY	UT	84143	0001	00	None	40.779063	-111.8805548	Salt Lake County
149375	Fee-for-Service	1326484577	1326484577	1	1	AMIN, VISHAR H MD	11/16/2018	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	133672	38	Geriatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
149378	Fee-for-Service	1144728627	1144728627	1	1	ADVENTIST HEALTH PHYSICIANS	2/1/2019	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	125 MALL DR	STE 303	HANFORD	CA	93230	5794	16	06031	36.3246477	-119.6685218	Kings County
149406	Fee-for-Service	1154346823	1154346823	1	1	ASHKER,LAWRENCE DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	ONE GENESYS PARKWAY	None	GRAND BLANC	MI	48439	0000	00	None	42.89245321	-83.64137612	Genesee County
149408	Fee-for-Service	1942734595	1942734595	1	1	ANITA HOSPICE, INC	8/1/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	201 S ANITA DR	STE 105	ORANGE	CA	92868	3312	30	06059	33.786144	-117.881161	Orange County
149414	Fee-for-Service	1609104769	1609104769	1	2	ALPHA RESIDENTIAL INC	6/28/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	692 SAN BERNARDINO AVE	None	POMONA	CA	91767	3244	19	06037	34.07578253	-117.7389765	Los Angeles County
149429	Fee-for-Service	1629170428	1629170428	1	1	AMANZADEH, JAMSHID MD	3/31/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	53367	None	None	0	In state provider	None	1100 N PALM CANYON DR	STE 211	PALM SPRINGS	CA	92262	4426	33	06065	33.838182	-116.546744	Riverside County
149435	Fee-for-Service	1588350854	1588350854	1	1	AKILO, VICTORIA IYABO	4/20/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	9083 RICHBOROUGH WAY	None	ELK GROVE	CA	95624	1304	34	06067	38.391633	-121.363182	Sacramento County
149456	Fee-for-Service	1598731788	1598731788	1	1	AGUILAR, DOLORES NP	10/2/2019	363LC1500X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
149497	Fee-for-Service	1205946282	1205946282	1	1	AGUIRRE, WENDY LCSW	8/4/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
149521	Fee-for-Service	1669932588	1669932588	1	1	ABED, FARZANA NP	7/15/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
149544	Fee-for-Service	1598923526	1598923526	1	1	AHDOOT, HALEH MD	3/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	62535	30	Radiology	0	In state provider	None	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	0001	19	06037	34.06373445	-118.443537	Los Angeles County
149545	Fee-for-Service	1306140801	1306140801	1	1	ANNETTE TAMRAZ PHYSICAL THER	4/15/2011	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	THERAPY INC	1000 N CENTRAL AVE	STE 220	GLENDALE	CA	91202	2957	19	06037	34.15992057	-118.2572221	Los Angeles County
149560	Fee-for-Service	1699235804	1699235804	1	1	ARAUJO, ROBYN D OT	4/5/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
149567	Fee-for-Service	1184129017	1184129017	1	1	AYEROFF, EVE A MD	7/19/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	165163	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
149574	Fee-for-Service	1205195716	1205195716	1	1	ADVANCED ENDOSCOPY AND PAIN	5/1/2012	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER LLC	1753 W AVENUE J	STE A	LANCASTER	CA	93534	9823	19	06037	34.6894465	-118.163097	Los Angeles County
149620	Fee-for-Service	1508248337	1508248337	1	1	ALALI, ABDALLAH MD	5/18/2020	207RN0300X	NA	Nephrology	026	PHYSICIANS	-	45	Nephrology (Renal-Kidney)	1	Border provider	None	2545 S BRUCE ST	STE 200	LAS VEGAS	NV	89169	1731	00	None	36.143271	-115.1254975	Clark County
149672	Fee-for-Service	1356477087	1356477087	1	1	ARMSTRONG, APRIL W	6/25/2008	207N00000X	NA	Dermatology	026	PHYSICIANS	103777	None	None	0	In state provider	None	3301 C STREET	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
149707	Fee-for-Service	1851307219	1851307219	2	1	ADUCAYEN, PACITA R MD	3/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	49795	08	Family Practice	0	In state provider	None	2250 GLADSTONE DRIVE	SUITE 2	PITTSBURG	CA	94565	5124	07	06013	38.00610511	-121.8669076	Contra Costa County
149713	Fee-for-Service	1023242245	1023242245	1	1	ANGEL VIEW INC	4/22/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	16-620 VIA VISTA	None	DESERT HOT SPRING	CA	92240	5100	33	06065	33.93278649	-116.4964018	Riverside County
149719	Fee-for-Service	1649754292	1649754292	1	1	ADEYEYE, SUNDAY NP	9/24/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
149722	Fee-for-Service	1336826445	1336826445	1	1	ALCANTARA, KAREN NP	11/7/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	19	06037	34.148637	-118.4312035	Los Angeles County
149732	Fee-for-Service	1811491194	1811491194	1	1	AASERUDE, ERIC MD	7/22/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
149745	Fee-for-Service	1033556121	1033556121	1	1	AMERICAN GROUND TRANSPORTATI	3/9/2023	344600000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ON, INC.	1767 N BATAVIA ST	None	ORANGE	CA	92865	4103	30	06059	33.817365	-117.862004	Orange County
149809	Fee-for-Service	1003897349	1003897349	1	1	AGIUS, MARK A MD	1/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	43004	13	Neurology (M.D. only)	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
149813	Fee-for-Service	1881665933	1881665933	1	3	ARGUELLO, JUAN CARLOS DO	3/18/2019	2084P0804X	NA	Psychiatry	086	MEDICAL DIRECTORS	9233	-	NOT APPLICABLE	0	In state provider	None	10877 CONDUCTOR BLVD	STE 300	SUTTER CREEK	CA	95685	9682	03	06005	38.36440771	-120.8174749	Amador County
149897	Fee-for-Service	1538300595	1538300595	1	1	ABIR, GILLIAN M MD	11/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	123672	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
149930	Fee-for-Service	1235459793	1235459793	1	1	AGGARWAL, POOJA MD	11/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138601	41	Internal Medicine	0	In state provider	None	271 TURN PIKE DR	None	FOLSOM	CA	95630	8098	34	06067	38.65509	-121.170042	Sacramento County
149939	Fee-for-Service	1821292079	1821292079	1	1	AZIMI, WAHIDA DO	6/1/2018	207R00000X	NA	Other	026	PHYSICIANS	14031	41	Internal Medicine	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
149957	Fee-for-Service	1962511766	1962511766	1	1	ADAMS, JODI L MD	6/29/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	75474	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4500 W 116TH ST	None	HAWTHORNE	CA	90250	2209	19	06037	33.92906042	-118.3548882	Los Angeles County
149992	Fee-for-Service	1891317855	1891317855	1	1	ADVENTIST HEALTH PHYSICIANS	9/22/2020	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	9508 STOCKDALE HWY	120	BAKERSFIELD	CA	93311	3622	15	06029	35.35453237	-119.1086014	Kern County
150012	Fee-for-Service	1851648133	1851648133	1	1	ABELE, JESSICA C	6/11/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	801 TRAEGER AVE	STE 304	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
150054	Fee-for-Service	1750404406	1750404406	1	1	ALLEN, CORALYN LCSW	7/13/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	132 S THOMPSON ST	None	HEMET	CA	92543	4351	33	06065	33.74675899	-116.9651207	Riverside County
150059	Fee-for-Service	1184019267	1184019267	1	1	AGUIRRE, ALFREDO MD	6/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145432	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
150071	Fee-for-Service	1861477366	1861477366	1	1	AHBEL, DORRIT E MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	41168	20	Orthopedic Surgery	0	In state provider	None	7551 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7449	34	06067	38.664333	-121.2879735	Sacramento County
150072	Fee-for-Service	1437798543	1437798543	1	1	AVILA HOSPICE INC	1/22/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	167 N 3RD AVE	STE O	UPLAND	CA	91786	6052	36	06071	34.095618	-117.647108	San Bernardino County
150105	Fee-for-Service	1851590053	1851590053	1	1	AMIN, SHUKUH M PHD	3/16/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
150118	Fee-for-Service	1144478306	1144478306	1	1	AU, KAREN M MD	5/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100616	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90024	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
150143	Fee-for-Service	1689970931	1689970931	1	1	AVILA, ROSSANA	11/6/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
150199	Fee-for-Service	1992238992	1992238992	1	1	ATHANS, BRETT S MD	5/7/2021	207L00000X	NA	Other	026	PHYSICIANS	157020	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
150201	Fee-for-Service	1285679977	1285679977	1	1	ARCADIA ADULT DAY HEALTH	6/19/2000	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	ARCADIA OF HOLLYWOOD ADH	860 N HIGHLAND AVE	None	LOS ANGELES	CA	90038	3417	19	06037	34.086879	-118.338571	Los Angeles County
150203	Fee-for-Service	1932421559	1932421559	1	1	AHAD, GEORGE MD	7/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111064	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3975 JACKSON ST	STE 110	RIVERSIDE	CA	92503	3946	33	06065	33.92729721	-117.4413503	Riverside County
150218	Fee-for-Service	1205089547	1205089547	1	1	ADVANCED SLEEP MEDICINE SRVS	2/14/2011	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	INC	12391 LEWIS STREET	# 101	GARDEN GROVE	CA	92840	4668	30	06059	33.782481	-117.899534	Orange County
150220	Fee-for-Service	1689306219	1689306219	1	1	AUSTIN, TARA C	2/16/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	628 RYAN STREET	None	REDLANDS	CA	92374	4165	36	06071	34.06168934	-117.1528344	San Bernardino County
150263	Fee-for-Service	1740650803	1740650803	1	1	AGUSTIN, VALERIE	10/2/2015	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	7020 GUNZAN STREET	None	SAN DIEGO	CA	92139	2112	37	06073	32.68400105	-117.0401868	San Diego County
150298	Fee-for-Service	1497216428	1497216428	1	1	AGGARWAL, SAHIL MD	5/27/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	13010 HESPERIA RD	STE 101	VICTORVILLE	CA	92395	5837	36	06071	34.48843676	-117.2909745	San Bernardino County
150359	Fee-for-Service	1437798543	1437798543	1	1	AVILA HOSPICE INC	1/22/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	167 N 3RD AVE	STE O	UPLAND	CA	91786	6052	36	06071	34.095618	-117.647108	San Bernardino County
150375	Fee-for-Service	1619980406	1619980406	1	1	ALBAN, BLAKE M MD	5/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74491	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	BLDG 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
150401	Fee-for-Service	1144478306	1144478306	1	1	AU, KAREN M MD	5/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	100616	83	Rheumatology	0	In state provider	None	200 MEDICAL PLAZA	#365	LOS ANGELES	CA	90024	7001	19	06037	34.06527974	-118.4462792	Los Angeles County
150415	Fee-for-Service	1164054607	1164054607	1	1	ASTURIAS, GEOVANNA LCSW	3/31/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 HOLE AVENUE,	SUITE 7	RIVERSIDE	CA	92505	2759	33	06065	33.91809317	-117.4819177	Riverside County
150425	Fee-for-Service	1356389050	1356389050	1	1	ALLEYNE, REBECCA S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79024	78	Neoplastic Diseases/Oncology	0	In state provider	REBECCA ALLEYNE MD INC	1045 ATLANTIC AVE	STE 712	LONG BEACH	CA	90813	3411	19	06037	33.780267	-118.1850795	Los Angeles County
150457	Fee-for-Service	1417541350	1417541350	1	2	AJEETH, INC.	5/11/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	28041 HAWTHORNE BOULEVAR	SUITE 210 & 211	RANCHO PALOS VERD	CA	90275	3280	19	06037	33.77925453	-118.3908803	Los Angeles County
150467	Fee-for-Service	1427322635	1427322635	1	2	ADVANCED PAIN DIAGNOSTIC & S	10/11/2019	261QP3300X	NA	Other	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	OLUTIONS INC	729 SUNRISE AVE	SUITE 602	ROSEVILLE	CA	95661	4542	31	06061	38.73444822	-121.2720033	Placer County
150475	Fee-for-Service	1801899158	1801899158	1	1	ALI, ABBAS S MD	8/22/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
150507	Fee-for-Service	1689306219	1689306219	1	1	AUSTIN, TARA C	2/16/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	628 RYAN STREET	None	REDLANDS	CA	92374	4165	36	06071	34.06168934	-117.1528344	San Bernardino County
150526	Fee-for-Service	1306597323	1306597323	1	1	ANGEL WINGS HOME HEALTH	4/26/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY	1443 N HIGHLAND AVE	SUITE 1	LOS ANGELES	CA	90028	7622	19	06037	34.09723327	-118.3386755	Los Angeles County
150550	Fee-for-Service	1740650803	1740650803	1	1	AGUSTIN, VALERIE	10/2/2015	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	7020 GUNZAN STREET	None	SAN DIEGO	CA	92139	2112	37	06073	32.68400105	-117.0401868	San Diego County
150611	Fee-for-Service	1144431438	1144431438	1	1	AMY ARGUS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 GOODMAN ST	None	CINCINNATI	OH	45219	2364	00	None	39.13677965	-84.5023814	Hamilton County
150616	Fee-for-Service	1437460177	1437460177	1	1	ASUQUO, STELLA E MD	8/1/2018	2086S0129X	NA	General Surgery	026	PHYSICIANS	156838	02	General Surgery	0	In state provider	None	236 SAN JOSE	None	SALINAS	CA	93901	3901	27	06053	36.6582359	-121.6463252	Monterey County
150618	Fee-for-Service	1619110954	1619110954	1	1	ANIKINA, OLGA V	1/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120306	None	None	0	In state provider	None	350 HAWTHORNE AVENUE	None	OAKLAND	CA	94609	3108	01	06001	37.819368	-122.263902	Alameda County
150640	Fee-for-Service	1780024851	1780024851	1	1	ASPIRE HEALTHCARE SERVICES	9/13/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	222 N MOUNTAIN AVE	SUITE 201A	UPLAND	CA	91786	5714	36	06071	34.096401	-117.6700615	San Bernardino County
150686	Fee-for-Service	1023367422	1023367422	1	1	ALSHEIKH, BATOOL J MD	9/24/2018	2080P0203X	NA	Other	026	PHYSICIANS	136923	40	Pediatrics	0	In state provider	None	6235 N FRESNO ST	STE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
150700	Fee-for-Service	1912430919	1912430919	1	1	AGUIAR, BONNIE A LCSW	4/12/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
150706	Fee-for-Service	1548302326	1548302326	1	1	A KARP MD	2/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	EL PASO GASTROENTEROLOGY	125 W HAGUE SUITE 590	None	EL PASO	TX	79902	0000	00	None	31.77017683	-106.4996599	El Paso County
150713	Fee-for-Service	1356389050	1356389050	1	1	ALLEYNE, REBECCA S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79024	02	General Surgery	0	In state provider	REBECCA ALLEYNE MD INC	1045 ATLANTIC AVE	STE 712	LONG BEACH	CA	90813	3411	19	06037	33.780267	-118.1850795	Los Angeles County
150744	Fee-for-Service	1710318878	1710318878	1	1	ALL FOR HEALTH HEALTH FOR	7/10/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	ALL INC	8134 FOOTHILL BLVD	None	SUNLAND	CA	91040	2941	19	06037	34.25963611	-118.3103495	Los Angeles County
150748	Fee-for-Service	1386860765	1386860765	1	1	ADUBOFOUR, KWABENA MD INC	5/2/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52394	41	Internal Medicine	0	In state provider	None	2524 E MAIN STREET	None	STOCKTON	CA	95205	6523	39	06077	37.95478956	-121.251428	San Joaquin County
150782	Fee-for-Service	1528298874	1528298874	1	1	AHN, CHISHIN LAC	5/15/2024	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	615 SOUTH BROADWAY	None	SANTA MARIA	CA	93454	5110	42	06083	34.94639295	-120.4360158	Santa Barbara County
150801	Fee-for-Service	1326414996	1326414996	2	1	ALLIED PACIFIC HOSPICE LLC	2/4/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1680 S GARFIELD AVE	SUITE 205	ALHAMBRA	CA	91801	5413	19	06037	34.07502947	-118.1229775	Los Angeles County
150803	Fee-for-Service	1073583886	1073583886	2	1	AZEVEDO, MICHAEL P MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	66383	25	Physical Medicine and Rehabilitation	0	In state provider	None	2071 EAST HERNDON	None	CLOVIS	CA	93611	6101	10	06019	36.8375685	-119.6781105	Fresno County
150804	Fee-for-Service	1497174007	1497174007	1	1	ARTURO, CAESAR J III MD	9/5/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139902	01	General Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
150819	Fee-for-Service	1144804691	1144804691	1	1	AGUILAR-PORTILLO, GEORGINA	10/24/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184608	08	Family Practice	0	In state provider	MD	26520 CACTUS AVE	# B2018	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
150824	Fee-for-Service	1841351053	1841351053	1	1	ARDEN, JOHN B PHD	7/5/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	49	06097	38.2304311	-122.5827918	Sonoma County
150848	Fee-for-Service	1568998557	1568998557	1	1	ANCHOR COUNSELING GROUP A	8/7/2018	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONL CORPORATION	138 N BRAND BLVD	STE 303	GLENDALE	CA	91203	4621	19	06037	34.147755	-118.2549335	Los Angeles County
150857	Fee-for-Service	1144614330	1144614330	1	1	ANDERSON, ANGELA M	8/9/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
150873	Fee-for-Service	1053975086	1053975086	1	1	AHMED, ANJUM M MD	1/30/2025	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
150900	Fee-for-Service	1750056883	1750056883	1	2	ARCHER MED-TRANS LLC	8/18/2021	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1607 E. PALMDALE BLVD	SUITE D	PALMDALE	CA	93550	4880	19	06037	34.57967647	-118.1007765	Los Angeles County
150901	Fee-for-Service	1861810558	1861810558	1	1	ALESHIN, MARIA A MD	7/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	137604	07	Dermatology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
150944	Fee-for-Service	1629431192	1629431192	1	1	ALEXANDER KACZENSKI	2/24/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
150954	Fee-for-Service	1225467590	1225467590	1	1	ALLERGY AND ASTHMA TREATMENT	3/20/2023	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER P C	1131 N PACIFIC AVE	None	GLENDALE	CA	91202	2358	19	06037	34.1620727	-118.2647253	Los Angeles County
150955	Fee-for-Service	1598876849	1598876849	1	1	AYAP, HEIDI P MD INC	11/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	52631	40	Pediatrics	0	In state provider	None	115 N JACKSON AVE	STE 101C	SAN JOSE	CA	95116	1924	43	06085	37.36112479	-121.8461743	Santa Clara County
150966	Fee-for-Service	1881706935	1881706935	1	1	ALPERS, LEILA S MD	7/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81773	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
150969	Fee-for-Service	1902079452	1902079452	1	4	ABLE PHYSICAL THERAPY CORP	5/25/2018	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2101 E 4TH ST	A-140	SANTA ANA	CA	92705	3814	30	06059	33.74827724	-117.8368641	Orange County
151016	Fee-for-Service	1760649305	1760649305	1	1	AU, ERIC S MD	9/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106913	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
151023	Fee-for-Service	1881937720	1881937720	1	1	ABBASSI, SAM MD	1/21/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	133231	18	Ophthalmology	0	In state provider	None	36949 COOK ST	STE 101	PALM DESERT	CA	92211	6080	33	06065	33.779889	-116.358264	Riverside County
151031	Fee-for-Service	1710318878	1710318878	1	1	ALL FOR HEALTH HEALTH FOR	7/10/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ALL INC	8134 FOOTHILL BLVD	None	SUNLAND	CA	91040	2941	19	06037	34.25963611	-118.3103495	Los Angeles County
151038	Fee-for-Service	1265552830	1265552830	1	1	ANJUM, FARZANA	8/13/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
151048	Fee-for-Service	1073193603	1073193603	1	1	ADVENTIST HEALTH PHYSICIANS	3/15/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	845 S FAIRMONT AVE	11	LODI	CA	95240	5113	39	06077	38.123217	-121.285878	San Joaquin County
151074	Fee-for-Service	1437105939	1437105939	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2500 E IMPERIAL HWY	None	BREA	CA	92821	6122	30	06059	33.91089485	-117.8664611	Orange County
151087	Fee-for-Service	1326414996	1326414996	2	1	ALLIED PACIFIC HOSPICE LLC	2/4/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1680 S GARFIELD AVE	SUITE 205	ALHAMBRA	CA	91801	5413	19	06037	34.07502947	-118.1229775	Los Angeles County
151088	Fee-for-Service	1740427657	1740427657	1	22	ALTAMED HEALTH SERVICES CORP	7/10/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1951 MABURY STREET	None	SANTA ANA	CA	92705	7147	30	06059	33.7634553	-117.8440718	Orange County
151093	Fee-for-Service	1679782049	1679782049	1	1	AGUILERA, AMANDA L	10/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	103775	30	Radiology	0	In state provider	None	2 WEST FERN AVE.	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
151110	Fee-for-Service	1386084077	1386084077	1	1	ADEGBOYEGA, ADETUNJI F MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139622	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
151134	Fee-for-Service	1407312226	1407312226	1	1	ARASH ZARIMANI MD INC.	6/6/2019	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	1127 WILSHIRE BLVD	909	LOS ANGELES	CA	90017	3910	19	06037	34.05270508	-118.2641005	Los Angeles County
151138	Fee-for-Service	1568998557	1568998557	1	1	ANCHOR COUNSELING GROUP A	10/23/2023	106H00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONL CORPORATION	138 N BRAND BLVD	STE 303	GLENDALE	CA	91203	4621	19	06037	34.147755	-118.2549335	Los Angeles County
151189	Fee-for-Service	1306357843	1306357843	1	1	ADVANCE PHARMACY SERVICES	2/1/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	INC	5404 MORENO ST	UNIT F	MONTCLAIR	CA	91763	1665	36	06071	34.08877098	-117.6870627	San Bernardino County
151194	Fee-for-Service	1437116563	1437116563	1	1	ADVANCED HEALTHCARE	11/9/2004	332BP3500X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	SOLUTIONS LLC	8900 N CENTRAL AVE	STE 180D	PHOENIX	AZ	85020	2845	00	None	33.5656756	-112.0740479	Maricopa County
151198	Fee-for-Service	1174665905	1174665905	1	1	ARROYO VISTA FAMILY	10/21/2005	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HEALTH CTR-LINCOLN HGHTS	2411 N BROADWAY	None	LOS ANGELES	CA	90031	2218	19	06037	34.07365551	-118.216431	Los Angeles County
151259	Fee-for-Service	1902079452	1902079452	1	4	ABLE PHYSICAL THERAPY CORP	5/25/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2101 E 4TH ST	A-140	SANTA ANA	CA	92705	3814	30	06059	33.74827724	-117.8368641	Orange County
151271	Fee-for-Service	1174722508	1174722508	1	1	AUSTIN, AMY LMFT	6/5/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	69844 HIGHWAY 111	H	RANCHO MIRAGE	CA	92270	2849	33	06065	33.76988393	-116.4463473	Riverside County
151321	Fee-for-Service	1013543933	1013543933	1	1	ABOUSHAAR, REEM MD	10/17/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	190578	None	None	0	In state provider	None	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	10	06019	36.74333844	-119.7831874	Fresno County
151376	Fee-for-Service	1740427657	1740427657	1	22	ALTAMED HEALTH SERVICES CORP	7/10/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1951 MABURY STREET	None	SANTA ANA	CA	92705	7147	30	06059	33.7634553	-117.8440718	Orange County
151438	Fee-for-Service	1205185600	1205185600	1	1	ABDULHADI, MIRAN B MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	2640 E BARNETT ROAD	E333	MEDFORD	OR	97504	4301	00	None	42.31645852	-122.834421	Jackson County
151443	Fee-for-Service	1922371962	1922371962	1	1	ARAUJO, GERSON MD	2/3/2025	208600000X	NA	General Surgery	026	PHYSICIANS	153886	02	General Surgery	0	In state provider	None	1247 E ALLUVIAL AVE	SUITE 101	FRESNO	CA	93720	2686	10	06019	36.84470048	-119.7606195	Fresno County
151473	Fee-for-Service	1588239685	1588239685	1	1	A & A HOME HEALTH CARE	9/18/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES	18607 VENTURA BLVD	STE 212	TARZANA	CA	91356	4159	19	06037	34.16995274	-118.5388841	Los Angeles County
151488	Fee-for-Service	1174665905	1174665905	1	1	ARROYO VISTA FAMILY	10/21/2005	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HEALTH CTR-LINCOLN HGHTS	2411 N BROADWAY	None	LOS ANGELES	CA	90031	2218	19	06037	34.07365551	-118.216431	Los Angeles County
151495	Fee-for-Service	1689978983	1689978983	1	1	AFSHAR, POUYA M D INC	1/11/2011	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	107069	41	Internal Medicine	0	In state provider	None	7801 MISSION CENTER CT	STE 310	SAN DIEGO	CA	92108	1316	37	06073	32.77316501	-117.1558281	San Diego County
151519	Fee-for-Service	1467436204	1467436204	1	1	AQUINO, REY T PT	5/1/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	50-225 CESAR CHAVEZ ST.	SUITE 103	COACHELLA	CA	92253	7243	33	06065	33.67309459	-116.181558	Riverside County
151536	Fee-for-Service	1649772591	1649772591	1	1	ALVES DA SILVA, SALVIO LCSW	2/24/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	415 KNOLLCREST DR	STE 101	REDDING	CA	96002	0181	45	06089	40.57267376	-122.3643496	Shasta County
151550	Fee-for-Service	1700065901	1700065901	1	2	ALONSO, LAZARO V MD AMC	1/1/1997	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ALONSO MEDICAL GROUP	11349 SATICOY ST	None	SUN VALLEY	CA	91352	4700	19	06037	34.20849651	-118.3784985	Los Angeles County
151551	Fee-for-Service	1174719181	1174719181	1	1	ALTAMED HEALTH SVS CORP	5/2/2007	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	ALTAMED E LA ADHC	6210 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4506	19	06037	34.01620728	-118.1375217	Los Angeles County
151601	Fee-for-Service	1730610403	1730610403	1	1	ALLEN, ROBERT MD	9/12/2023	208600000X	NA	General Surgery	026	PHYSICIANS	176876	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
151665	Fee-for-Service	1194158931	1194158931	1	1	ACEVEDO, CHRISTINA LCSW	8/24/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
151689	Fee-for-Service	1336316421	1336316421	1	1	AGUILAR, ALEXANDRA L MD	11/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	67	Endocrinology	1	Border provider	None	3006 S MARYLAND PARKWAY	SUITE 315	LAS VEGAS	NV	89109	2225	00	None	36.135288	-115.1368705	Clark County
151718	Fee-for-Service	1902442635	1902442635	1	1	AKSU, HAMZA MD	8/3/2023	208M00000X	NA	Other	026	PHYSICIANS	186112	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
151729	Fee-for-Service	1205185600	1205185600	1	1	ABDULHADI, MIRAN B MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2640 E BARNETT ROAD	E333	MEDFORD	OR	97504	4301	00	None	42.31645852	-122.834421	Jackson County
151756	Fee-for-Service	1528130374	1528130374	1	1	ABELA, PHILIP P MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	65604	08	Family Practice	0	In state provider	None	1008 FOWLER WAY	None	PLACERVILLE	CA	95667	5701	09	06017	38.72648857	-120.791716	El Dorado County
151772	Fee-for-Service	1174665905	1174665905	1	1	ARROYO VISTA FAMILY	10/21/2005	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	HEALTH CTR-LINCOLN HGHTS	2411 N BROADWAY	None	LOS ANGELES	CA	90031	2218	19	06037	34.07365551	-118.216431	Los Angeles County
151792	Fee-for-Service	1710177795	1710177795	1	1	ASPEN SURGERY CENTER, LLC	2/25/2008	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	133 LA CASA VIA	None	WALNUT CREEK	CA	94598	3005	07	06013	37.91192269	-122.0414802	Contra Costa County
151818	Fee-for-Service	1821035940	1821035940	1	1	AKRON GENERAL MED CTR	12/8/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	400 WABASH AVE	None	AKRON	OH	44307	2463	00	None	41.07800425	-81.53114513	Summit County
151833	Fee-for-Service	1558364596	1558364596	1	1	AKBAR, TANVEER MD	12/21/2018	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
151834	Fee-for-Service	1124097100	1124097100	1	1	ABDELHADI, JANE A MD	7/1/2001	207R00000X	NA	Other	026	PHYSICIANS	70158	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
151837	Fee-for-Service	1619471661	1619471661	1	1	ARONS, ABIGAIL R MD	7/13/2022	207R00000X	NA	Other	026	PHYSICIANS	166497	None	None	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
151839	Fee-for-Service	1174719181	1174719181	1	1	ALTAMED HEALTH SVS CORP	5/2/2007	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ALTAMED E LA ADHC	6210 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4506	19	06037	34.01620728	-118.1375217	Los Angeles County
151840	Fee-for-Service	1700065901	1700065901	1	2	ALONSO, LAZARO V MD AMC	1/1/1997	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	ALONSO MEDICAL GROUP	11349 SATICOY ST	None	SUN VALLEY	CA	91352	4700	19	06037	34.20849651	-118.3784985	Los Angeles County
151874	Fee-for-Service	1902102767	1902102767	1	1	ANDREW H BALK MD	3/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2301 HOLMES ST	None	KANSAS CITY	MO	64108	2602	00	None	39.08455286	-94.57578107	Jackson County
151895	Fee-for-Service	1730484981	1730484981	1	1	ASGARI, AMIR A MD	1/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115180	41	Internal Medicine	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
151940	Fee-for-Service	1619310737	1619310737	1	1	ACERA-POZZI, ROCIO MD	5/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148389	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1552 COFFEE ROAD	1ST FLOOR	MODESTO	CA	95355	3122	50	06099	37.666872	-120.975684	Stanislaus County
151946	Fee-for-Service	1619101565	1619101565	1	1	ALTAMED HEALTH SERVICES	5/1/2009	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	DAY HEALTH CARE	5175 BALL RD	None	CYPRESS	CA	90630	0000	30	06059	33.81705821	-118.0423439	Orange County
151951	Fee-for-Service	1790192987	1790192987	1	1	ABBOTT, CASSANDRA LCSW	2/10/2025	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	349 E BULLARD AVE	STE 102	FRESNO	CA	93710	5298	10	06019	36.82285854	-119.7825885	Fresno County
151975	Fee-for-Service	1336316421	1336316421	1	1	AGUILAR, ALEXANDRA L MD	11/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3006 S MARYLAND PARKWAY	SUITE 315	LAS VEGAS	NV	89109	2225	00	None	36.135288	-115.1368705	Clark County
151978	Fee-for-Service	1073016499	1073016499	1	1	ALEXANDER JY KIM MD INC	5/21/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	9850 GENESEE AVE	SUITE 700	LA JOLLA	CA	92037	1218	37	06073	32.882913	-117.226341	San Diego County
152021	Fee-for-Service	1336375534	1336375534	1	1	ALLAF, M. BARAA MD	3/12/2018	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	140059	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
152034	Fee-for-Service	1174803043	1174803043	1	1	ABC MEDICAL CORPORATION	5/22/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	1701 E FLORIDA AVE	None	HEMET	CA	92544	4632	33	06065	33.74755247	-116.9539875	Riverside County
152052	Fee-for-Service	1659303998	1659303998	1	1	AHMED, KELLY J MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	51407	08	Family Practice	0	In state provider	None	15201 11TH ST	STE 400	VICTORVILLE	CA	92395	3735	36	06071	34.52725895	-117.2925031	San Bernardino County
152065	Fee-for-Service	1174665905	1174665905	1	1	ARROYO VISTA FAMILY	8/15/2013	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	HEALTH CTR-LINCOLN HGHTS	2411 N BROADWAY	None	LOS ANGELES	CA	90031	2218	19	06037	34.07365551	-118.216431	Los Angeles County
152073	Fee-for-Service	1417919531	1417919531	1	1	ANMED HEALTH	9/22/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	800 N FANT ST	None	ANDERSON	SC	29621	5708	00	None	34.51140542	-82.64743236	Anderson County
152076	Fee-for-Service	1982099115	1982099115	1	1	AMMAR, MICHAEL MD	8/12/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	172267	None	None	0	In state provider	None	12630 MONTE VISTA RD	STE 104	POWAY	CA	92064	2526	37	06073	32.99533582	-117.0560031	San Diego County
152107	Fee-for-Service	1821035940	1821035940	1	1	AKRON GENERAL MED CTR	6/22/2004	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	400 WABASH AVE	None	AKRON	OH	44307	2463	00	None	41.07800425	-81.53114513	Summit County
152127	Fee-for-Service	1043840465	1043840465	1	2	AGOURA HILLS URGENTOCARE PC	3/11/2025	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	LLS	475 E AVENIDA DE LOS ARB	STE B	THOUSAND OAKS	CA	91360	2993	56	06111	34.21812166	-118.8686039	Ventura County
152135	Fee-for-Service	1134539711	1134539711	1	1	ABDELFATTAH, MOHAMAD B MD	8/1/2020	207R00000X	NA	Other	026	PHYSICIANS	167027	41	Internal Medicine	0	In state provider	None	1680 E 120 ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
152165	Fee-for-Service	1013023498	1013023498	1	1	AHMED, NAZLI MD	4/1/1983	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	34744	08	Family Practice	0	In state provider	None	275 VICTORIA ST	STE 2M	COSTA MESA	CA	92627	6024	30	06059	33.6526055	-117.910746	Orange County
152194	Fee-for-Service	1831198043	1831198043	1	1	ADASHEK, JOSEPH A MD	3/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	9280 W SUNSET RD	STE 236	LAS VEGAS	NV	89148	4861	00	None	36.07027746	-115.29495	Clark County
152234	Fee-for-Service	1619101565	1619101565	1	1	ALTAMED HEALTH SERVICES	5/1/2009	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	DAY HEALTH CARE	5175 BALL RD	None	CYPRESS	CA	90630	0000	30	06059	33.81705821	-118.0423439	Orange County
152313	Fee-for-Service	1093049942	1093049942	1	2	AKHAVAN, RAMIN MD	2/1/2019	207LC0200X	NA	Other	026	PHYSICIANS	100615	None	None	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92881	3420	33	06065	33.872958	-117.568359	Riverside County
152315	Fee-for-Service	1528223286	1528223286	1	1	AVIK, ELISA L MD	12/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114011	66	Emergency Medicine (Urgent Care)	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
152325	Fee-for-Service	1902182421	1902182421	1	1	AMINI, SANAZ MD	11/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132557	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11370 ANDERSON ST	STE 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
152360	Fee-for-Service	1417919531	1417919531	1	1	ANMED HEALTH	12/1/2006	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	800 N FANT ST	None	ANDERSON	SC	29621	5708	00	None	34.51140542	-82.64743236	Anderson County
152369	Fee-for-Service	1699828848	1699828848	2	1	ATLURI, RAO L	11/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	29778	41	Internal Medicine	0	In state provider	None	14051 E RAMONA PKWY	None	BALDWIN PARK	CA	91706	4114	19	06037	34.08521541	-117.9674931	Los Angeles County
152398	Fee-for-Service	1689308132	1689308132	1	1	ALAMITOS RIDGE HEALTHCARE	8/1/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	3850 E ESTHER ST	None	LONG BEACH	CA	90804	2009	19	06037	33.78897446	-118.1468708	Los Angeles County
152413	Fee-for-Service	1598776478	1598776478	1	1	ALBERT, GIYA MD	9/30/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
152415	Fee-for-Service	1225234529	1225234529	1	1	AZIZI, ALI MD	8/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116224	08	Family Practice	0	In state provider	None	2801 K STREET	520	SACRAMENTO	CA	95816	5119	34	06067	38.572947	-121.46904	Sacramento County
152453	Fee-for-Service	1902928260	1902928260	1	1	ARABO, RAFID B MD	6/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108311	41	Internal Medicine	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
152473	Fee-for-Service	1649204942	1649204942	1	1	AUNG, HTOO MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78804	05	Anesthesiology	0	In state provider	None	9212 MIRA ESTE CT	STE 204	SAN DIEGO	CA	92126	6337	37	06073	32.88927901	-117.1482338	San Diego County
152488	Fee-for-Service	1356644439	1356644439	1	1	AMERIPRIDE AMBULANCE SERVICE	5/31/2012	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	13509 S RAYMOND AVE	None	GARDENA	CA	90247	2007	19	06037	33.90899201	-118.2982777	Los Angeles County
152495	Fee-for-Service	1417045113	1417045113	1	1	ARORA, VIJAY MD	10/30/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	41663	None	None	0	In state provider	None	16167 SISKIYOU ROAD	SUITE A	APPLE VALLEY	CA	92307	0837	36	06071	34.54496692	-117.2664417	San Bernardino County
152513	Fee-for-Service	1649593385	1649593385	1	1	AGC MEDICAL SUPPLY INC	3/1/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	AGC MEDICAL SUPPLY INC	15366 11TH STREET	SUITE C	VICTORVILLE	CA	92395	3726	36	06071	34.530156	-117.292539	San Bernardino County
152529	Fee-for-Service	1861485005	1861485005	1	1	AMIRREZVANI, ALI MD	11/5/2008	207R00000X	NA	Other	026	PHYSICIANS	88284	41	Internal Medicine	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
152530	Fee-for-Service	1568834653	1568834653	1	1	ACCENTCARE HOME HEALTH AT UC	5/25/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SAN DIEGO HEALTH, LLC	5060 SHOREHAM PLACE	SUITE 220	SAN DIEGO	CA	92122	5977	37	06073	32.85193058	-117.1851922	San Diego County
152558	Fee-for-Service	1982179008	1982179008	1	1	ALL-INCLUSIVE COMMUNITY	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	17114 DEVONSHIRE STREET	SUITE 200	NORTHRIDGE	CA	91325	1619	19	06037	34.2575111	-118.5060271	Los Angeles County
152585	Fee-for-Service	1295755734	1295755734	1	1	ARIK, TALI H MD	2/6/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	66627	None	None	0	In state provider	None	2780 EUREKA WAY	None	REDDING	CA	96001	0223	45	06089	40.58585835	-122.4124086	Shasta County
152593	Fee-for-Service	1053791517	1053791517	1	1	AN, JOSIAH MD	3/27/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	192360	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
152603	Fee-for-Service	1164837670	1164837670	1	1	ALTADENA RECOVERY CENTER	1/31/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3025 LINCOLN AVE	None	ALTADENA	CA	91001	4534	19	06037	34.19757984	-118.1590195	Los Angeles County
152629	Fee-for-Service	1396124145	1396124145	1	1	ALDERSON, CHEVON MD	10/10/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	155746	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
152641	Fee-for-Service	1518666213	1518666213	1	1	APPLE URGENT CARE, INC	7/14/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	284 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	3706	36	06071	34.13595745	-117.279432	San Bernardino County
152659	Fee-for-Service	1497043558	1497043558	1	1	ARNOLD, THOMAS B DO	6/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14842	02	General Surgery	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
152662	Fee-for-Service	1831724509	1831724509	1	1	ALVARADO TERRACE CARE CENTER	1/1/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	1154 S ALVARADO ST	None	LOS ANGELES	CA	90006	4110	19	06037	34.04896346	-118.2815732	Los Angeles County
152672	Fee-for-Service	1447304308	1447304308	1	1	ALSIP, MURRAY W DO	5/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	8505	66	Emergency Medicine (Urgent Care)	0	In state provider	None	41870 GARSTIN RD	None	BIG BEAR LAKE	CA	92315	9999	36	06071	34.24602097	-116.8885243	San Bernardino County
152683	Fee-for-Service	1104903046	1104903046	1	1	ASLAN, ANDREA MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	81102	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
152688	Fee-for-Service	1386101913	1386101913	1	1	ALLEN, KRISTA R DO	8/16/2023	207P00000X	NA	Other	026	PHYSICIANS	21115	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
152705	Fee-for-Service	1477704518	1477704518	1	1	ALLEN, RENE B MD PC	11/1/2011	207VE0102X	NA	Obstetrics & Gynecology	026	PHYSICIANS	81775	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	536 E ARRELLAGA ST	STE 201	SANTA BARBARA	CA	93103	2255	42	06083	34.43335006	-119.702891	Santa Barbara County
152735	Fee-for-Service	1619937521	1619937521	1	1	AGGARWAL, GAURAV MD	12/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108069	None	None	0	In state provider	None	555 SOUTH 7TH AVE	None	BARSTOW	CA	92311	3043	36	06071	34.894062	-117.0196215	San Bernardino County
152742	Fee-for-Service	1457338683	1457338683	1	1	AHNN, WILLIAM B MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31405	05	Anesthesiology	0	In state provider	None	399 E HIGHLAND AVE	STE 314	SAN BERNARDINO	CA	92404	3883	36	06071	34.1358627	-117.2757898	San Bernardino County
152769	Fee-for-Service	1740427657	1740427657	1	16	ALTAMED HEALTH SERVICES CORP	5/13/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	408 E SANTA CLARA AVENUE	None	SANTA ANA	CA	92706	2957	30	06059	33.76651928	-117.8632886	Orange County
152781	Fee-for-Service	1538512744	1538512744	1	1	AZILA KATHERINE S ORTIZ	9/7/2016	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	15260 AMALIA ST	None	SAN DIEGO	CA	92129	1228	37	06073	32.99037064	-117.0884377	San Diego County
152784	Fee-for-Service	1548506777	1548506777	1	1	AQUA PHARMACY INC	4/24/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4336 MARKET ST	None	RIVERSIDE	CA	92501	3518	33	06065	33.97735332	-117.3791174	Riverside County
152785	Fee-for-Service	1144483819	1144483819	1	1	ALLIS, TERAH J MD	8/26/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	127842	04	Otology, Laryngology, Rhinology	0	In state provider	None	2030 SUTTER PL	STE 1300	DAVIS	CA	95616	6201	57	06113	38.56292466	-121.7715423	Yolo County
152787	Fee-for-Service	1235243429	1235243429	2	1	AHMADINIA, MOHAMMAD R MD	2/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	85204	01	General Practice	0	In state provider	None	18112 OUTER HWY 18	STE 101	APPLE VALLEY	CA	92307	0840	36	06071	34.54079736	-117.2688963	San Bernardino County
152794	Fee-for-Service	1376734806	1376734806	1	1	AKHTER, JAVAID MD	2/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115047	08	Family Practice	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
152815	Fee-for-Service	1295705028	1295705028	1	1	AUFRICHTIG, DAVID MD	10/31/1983	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	35645	30	Radiology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
152844	Fee-for-Service	1982179008	1982179008	1	1	ALL-INCLUSIVE COMMUNITY	7/1/2020	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	17114 DEVONSHIRE STREET	SUITE 200	NORTHRIDGE	CA	91325	1619	19	06037	34.2575111	-118.5060271	Los Angeles County
152849	Fee-for-Service	1811051477	1811051477	1	1	ALLEY, JANICE L PSYD	8/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY ST	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
152854	Fee-for-Service	1114073145	1114073145	1	1	ANDERSON, GARELD W MD	1/1/1994	174400000X	NA	Other	026	PHYSICIANS	55893	05	Anesthesiology	0	In state provider	None	4525 QUAIL LAKES DR	None	STOCKTON	CA	95207	5257	39	06077	37.98806683	-121.3402906	San Joaquin County
152874	Fee-for-Service	1164782710	1164782710	1	1	AGUILAR TAITAGUE, ARRIONNE C	5/16/2020	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
152890	Fee-for-Service	1063954683	1063954683	1	1	ARCH HEALTH PARTNERS	2/21/2017	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	28743 VALLEY CENTER RD	SUITE B	VALLEY CENTER	CA	92082	6530	37	06073	33.23089256	-117.0333217	San Diego County
152905	Fee-for-Service	1891965133	1891965133	1	1	ACHILLES, JENNIFER S MD	3/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	96703	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
152925	Fee-for-Service	1518666213	1518666213	1	1	APPLE URGENT CARE, INC	7/14/2023	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	284 E HIGHLAND AVE	None	SAN BERNARDINO	CA	92404	3706	36	06071	34.13595745	-117.279432	San Bernardino County
152967	Fee-for-Service	1811444631	1811444631	1	1	ASSISTED HOME CARE INC	7/17/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1900 W GARVEY AVE SOUTH	STE 229	W COVINA	CA	91790	2656	19	06037	34.07079031	-117.9466404	Los Angeles County
152969	Fee-for-Service	1174517650	1174517650	1	1	AG MURRIETA SNF LLC	10/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HEALTHCARE CENTER	24100 MONROE AVE	None	MURRIETA	CA	92562	9507	33	06065	33.57682061	-117.2120133	Riverside County
152970	Fee-for-Service	1932342300	1932342300	1	1	AMT CHAKRABORTY	9/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	400 S 43RD ST	None	RENTON	WA	98055	5714	00	None	47.44115887	-122.2138846	King County
152990	Fee-for-Service	1225179641	1225179641	1	1	ASIAN HEALTH SERVICE	10/23/1996	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	835 WEBSTER ST	None	OAKLAND	CA	94607	4219	01	06001	37.79952814	-122.2712597	Alameda County
153048	Fee-for-Service	1518121235	1518121235	1	1	ABUZEID, AL-WALEED M MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122994	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	MC5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
153058	Fee-for-Service	1740427657	1740427657	1	16	ALTAMED HEALTH SERVICES CORP	5/13/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	408 E SANTA CLARA AVENUE	None	SANTA ANA	CA	92706	2957	30	06059	33.76651928	-117.8632886	Orange County
153073	Fee-for-Service	1235243429	1235243429	2	1	AHMADINIA, MOHAMMAD R MD	2/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	85204	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	18112 OUTER HWY 18	STE 101	APPLE VALLEY	CA	92307	0840	36	06071	34.54079736	-117.2688963	San Bernardino County
153110	Fee-for-Service	1174564629	1174564629	1	1	ALBERS, HARRY R MD	2/28/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	76224	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
153112	Fee-for-Service	1669408415	1669408415	1	1	ASHOK, SEETHARAMAN MD	2/8/2015	208800000X	NA	Other	026	PHYSICIANS	54457	34	Urology and Urological Surgery	0	In state provider	None	804 W 7TH ST	None	HANFORD	CA	93230	4926	16	06031	36.32523147	-119.656845	Kings County
153113	Fee-for-Service	1750582268	1750582268	1	1	AFRAMIAN, DAVID MD	9/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	55720	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
153127	Fee-for-Service	1801390802	1801390802	1	1	ATIS, PATRICK D MD	8/10/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	167093	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
153128	Fee-for-Service	1487070645	1487070645	1	1	APPLIED HEALTHCARE SOLUTIONS	7/21/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	2865 SUNRISE BLVD	SUITE 104	RANCHO CORDOVA	CA	95742	6104	34	06067	38.599254	-121.264812	Sacramento County
153134	Fee-for-Service	1982179008	1982179008	1	1	ALL-INCLUSIVE COMMUNITY	10/4/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	17114 DEVONSHIRE STREET	SUITE 200	NORTHRIDGE	CA	91325	1619	19	06037	34.2575111	-118.5060271	Los Angeles County
153164	Fee-for-Service	1881011963	1881011963	1	1	AUYEUNG, VINCENT C MD	3/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138787	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94409	4364	41	06081	37.53039072	-122.2987772	San Mateo County
153193	Fee-for-Service	1609118983	1609118983	1	1	ALKASSPOOLES, SALAM F MD	1/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	81802	77	Infectious Disease	0	In state provider	AMC	11633 SAN VICENTE BLVD	STE 314	LOS ANGELES	CA	90049	6514	19	06037	34.05402447	-118.4632335	Los Angeles County
153244	Fee-for-Service	1780884015	1780884015	1	1	ABOUNASR, KHADER K MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115146	41	Internal Medicine	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3042	19	06037	34.07771682	-117.7485431	Los Angeles County
153247	Fee-for-Service	1710064480	1710064480	1	1	AHMADZAI, SONIA R LMFT	5/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
153260	Fee-for-Service	1811444631	1811444631	1	1	ASSISTED HOME CARE INC	7/17/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1900 W GARVEY AVE SOUTH	STE 229	W COVINA	CA	91790	2656	19	06037	34.07079031	-117.9466404	Los Angeles County
153269	Fee-for-Service	1346617594	1346617594	1	2	AKHIMIEN, PATIENCE R NP	3/15/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95002442	-	NOT APPLICABLE	0	In state provider	None	1021 W LA CADENA DR	None	RIVERSIDE	CA	92501	1413	33	06065	34.00415437	-117.3504456	Riverside County
153278	Fee-for-Service	1225179641	1225179641	1	1	ASIAN HEALTH SERVICE	10/23/1996	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	835 WEBSTER ST	None	OAKLAND	CA	94607	4219	01	06001	37.79952814	-122.2712597	Alameda County
153298	Fee-for-Service	1720440241	1720440241	1	1	AMIN, RIMA P MD	3/3/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	165243	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
153359	Fee-for-Service	1023400538	1023400538	1	1	AGAPE CONGREGATE LIVING LLC	5/31/2017	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	302 FAIRWAY LANE	None	PLACENTIA	CA	92870	4442	30	06059	33.88184887	-117.8627202	Orange County
153360	Fee-for-Service	1598170938	1598170938	1	1	ALI, FARAZ MD	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145774	41	Internal Medicine	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
153396	Fee-for-Service	1750411708	1750411708	1	1	ALLEN, EARNEST W DC	1/27/1990	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	5561 AUBURN BLVD	None	SACRAMENTO	CA	95841	2947	34	06067	38.66925007	-121.3343773	Sacramento County
153403	Fee-for-Service	1174564629	1174564629	1	1	ALBERS, HARRY R MD	2/28/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	76224	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
153414	Fee-for-Service	1700985496	1700985496	1	1	AVERY, ROBERT L MD	1/1/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	52052	18	Ophthalmology	0	In state provider	None	23861 MCBEAN PKWY	STE E28	VALENCIA	CA	91355	4457	19	06037	34.39567343	-118.5542698	Los Angeles County
153532	Fee-for-Service	1780884015	1780884015	1	1	ABOUNASR, KHADER K MD	7/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115146	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1866 N ORANGE GROVE AVE	STE 202	POMONA	CA	91767	3042	19	06037	34.07771682	-117.7485431	Los Angeles County
153573	Fee-for-Service	1740618420	1740618420	1	1	ANTONIO, ANTONETTE NP	2/20/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8590 RIO SAN DIEGO DR	111	SAN DIEGO	CA	92108	5507	37	06073	32.77472926	-117.1448295	San Diego County
153615	Fee-for-Service	1639587850	1639587850	1	1	ABIGAIL GABRIEL	4/2/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
153669	Fee-for-Service	1982027959	1982027959	1	1	AGUIRRE, ALICIA G LMFT	12/7/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14500 ROSCOE BLVD	STE 400	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
153686	Fee-for-Service	1487638698	1487638698	1	1	ACCOLADES PROSTHETIC AND	1/13/1994	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ORTHOTIC DESIGN	3855 PRINCETON DR	None	SANTA ROSA	CA	95405	7061	49	06097	38.443581	-122.675679	Sonoma County
153696	Fee-for-Service	1295806255	1295806255	1	1	AGUIRRE, MARIA G MD	12/1/1995	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	31218	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
153702	Fee-for-Service	1700985496	1700985496	1	1	AVERY, ROBERT L MD	1/1/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	52052	02	General Surgery	0	In state provider	None	23861 MCBEAN PKWY	STE E28	VALENCIA	CA	91355	4457	19	06037	34.39567343	-118.5542698	Los Angeles County
153732	Fee-for-Service	1871584185	1871584185	1	1	ANSLEY, VINCENT A MD	11/30/1982	207P00000X	NA	Other	026	PHYSICIANS	41598	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1974 SANTA FE AVE	None	LONG BEACH	CA	90810	4064	19	06037	33.793137	-118.2153705	Los Angeles County
153762	Fee-for-Service	1518489996	1518489996	1	1	AMAN DEEP, FNU MD	4/13/2023	174400000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	760 GOLF VIEW DRIVE	SUITE 200	MEDFORD	OR	97504	9685	00	None	42.315228	-122.8230985	Jackson County
153770	Fee-for-Service	1376906180	1376906180	1	1	AQUINO-ALMACEN, AMANDA G	4/28/2023	207P00000X	NA	Other	026	PHYSICIANS	185453	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
153790	Fee-for-Service	1275630154	1275630154	1	1	ASHOURI, NEGAR MD	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76007	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
153799	Fee-for-Service	1659427235	1659427235	1	1	ALIZADEH, RAMIN I MD	5/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109070	41	Internal Medicine	0	In state provider	None	1499 WEST 1ST STREET	None	SAN PEDRO	CA	90732	3255	19	06037	33.74333957	-118.3093406	Los Angeles County
153801	Fee-for-Service	1861610172	1861610172	1	1	AFTER HOURS MED GROUP INC	12/31/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	9200 COLIMA RD	#101	WHITTIER	CA	90605	1814	19	06037	33.95015827	-118.0054753	Los Angeles County
153832	Fee-for-Service	1336645852	1336645852	1	1	APARICIO, ALBERT W MD	7/21/2021	390200000X	NA	Other	026	PHYSICIANS	167108	None	None	0	In state provider	None	3600 W FLAGSTAFF AVE	None	VISALIA	CA	93277	0000	54	06107	36.359649	-119.331567	Tulare County
153843	Fee-for-Service	1053809426	1053809426	1	1	ADVENTIST HEALTH PHYSICIANS	10/3/2019	207RI0011X	NA	Cardiology/Interventional Cardiology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	414 G ST	STE 221	MARYSVILLE	CA	95901	5670	58	06115	39.13913942	-121.5934649	Yuba County
153870	Fee-for-Service	1033307251	1033307251	1	1	ADDO, RAYCHELLE H LCSW	7/29/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	473 E. CARNEGIE DR.	STE 200	SAN BERNARDINO	CA	92408	0000	36	06071	34.0683677	-117.2746246	San Bernardino County
153902	Fee-for-Service	1376654756	1376654756	1	4	ADOBE MEDICAL GROUP INC	6/19/2018	193200000X	NA	Other	026	PHYSICIANS	41039	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2010 E 1ST ST	STE 270	SANTA ANA	CA	92705	4083	30	06059	33.74554507	-117.8387522	Orange County
153928	Fee-for-Service	1417067760	1417067760	1	1	ANTIMARINO, JEFFREY R MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	81237	24	Plastic Surgery	0	In state provider	None	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	19	06037	33.929829	-118.157607	Los Angeles County
153936	Fee-for-Service	1083853667	1083853667	1	1	ANIMAS DIALYSIS LLC	1/1/2009	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	950 S EASTERN AVE	None	LOS ANGELES	CA	90022	4801	19	06037	34.022583	-118.173903	Los Angeles County
154000	Fee-for-Service	1154453579	1154453579	1	1	ALAMEDA HEALTH SYSTEM	6/12/2008	No Taxonomy Provided	NA	None	060	COUNTY HOSPITAL INPATIENT	-	-	NOT APPLICABLE	0	In state provider	CENTER	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1009	01	06001	37.7069698	-122.1191104	Alameda County
154013	Fee-for-Service	1114123213	1114123213	1	1	AULWES, JULIENNE O MD	1/10/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	115289	-	NOT APPLICABLE	0	In state provider	None	720 WOOD STREET	ROOM 320	EUREKA	CA	95501	4413	12	06023	40.78118068	-124.1607622	Humboldt County
154018	Fee-for-Service	1619304748	1619304748	1	1	ARONLEE, TRACY S LCSW	4/10/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14340 MINYA LN	None	POWAY	CA	92064	5934	37	06073	32.95004211	-117.0193097	San Diego County
154020	Fee-for-Service	1871584185	1871584185	1	1	ANSLEY, VINCENT A MD	11/30/1982	207P00000X	NA	Other	026	PHYSICIANS	41598	08	Family Practice	0	In state provider	None	1974 SANTA FE AVE	None	LONG BEACH	CA	90810	4064	19	06037	33.793137	-118.2153705	Los Angeles County
154022	Fee-for-Service	1114123213	1114123213	1	2	AULWES, JULIENNE O MD	2/15/2022	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	115289	-	NOT APPLICABLE	0	In state provider	None	734 RUSS STREET	SUITES 104,106,107,110	EUREKA	CA	95501	4540	12	06023	40.7819667	-124.1609055	Humboldt County
154082	Fee-for-Service	1447673124	1447673124	1	1	ACCESS SURGICAL CARE GROUP	6/28/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	INC	5 MEDICAL PLAZA DRIVE	SUITE 120	ROSEVILLE	CA	95661	2866	31	06061	38.76604411	-121.2466761	Placer County
154114	Fee-for-Service	1235224122	1235224122	1	1	AUSTIN PETER HORN	3/29/2004	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	THE DRUG STORE	111 PIUTE DRIVE	None	KERNVILLE	CA	93238	0097	15	06029	35.75507296	-118.4254867	Kern County
154147	Fee-for-Service	1649414855	1649414855	1	2	ABDELMELEK, SAM W MD	11/30/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	106876	-	NOT APPLICABLE	0	In state provider	None	13079 ARTESIA BLVD	SUITE B106	CERRITOS	CA	90703	1370	19	06037	33.87328747	-118.0544355	Los Angeles County
154170	Fee-for-Service	1710054127	1710054127	1	1	AHUJA, RENA MD	12/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90836	41	Internal Medicine	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
154172	Fee-for-Service	1467511881	1467511881	1	1	AUSTIN, LEE CRNA	2/8/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10 WOODLAND RD	None	SAINT HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
154199	Fee-for-Service	1679902811	1679902811	1	1	ANDERSON, KATHLEEN M LMFT	8/27/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	930 SHILOH RD	BLDG 44 STE G	WINDSOR	CA	95492	9664	49	06097	38.52572847	-122.794542	Sonoma County
154233	Fee-for-Service	1295323947	1295323947	1	1	AYDEN & KENNY PHARMACY,INC	3/5/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7221 RESEDA BLVD	None	RESEDA	CA	91335	3046	19	06037	34.201791	-118.5360655	Los Angeles County
154245	Fee-for-Service	1083051080	1083051080	1	1	ANSON MEDICAL INC	7/22/2015	261QP2300X	NA	Other	026	PHYSICIANS	45814	01	General Practice	0	In state provider	None	2350 MCKEE RD	SUITE 1	SAN JOSE	CA	95116	1606	43	06085	37.36631785	-121.848368	Santa Clara County
154247	Fee-for-Service	1285766253	1285766253	1	1	AHN, WOO SUNG MD INC	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	51408	41	Internal Medicine	0	In state provider	None	20145 PIONEER BLVD	None	LAKEWOOD	CA	90715	1051	19	06037	33.846669	-118.0820875	Los Angeles County
154256	Fee-for-Service	1265458640	1265458640	1	1	ALALI, ALBORZ MD	9/9/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71691	41	Internal Medicine	0	In state provider	None	2770 W COVELL BLVD	None	DAVIS	CA	95616	5661	57	06113	38.56100429	-121.7834158	Yolo County
154260	Fee-for-Service	1093901365	1093901365	1	1	ALAAMA, ABDUL M MD INC	9/25/1975	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	25455	None	None	0	In state provider	None	101 E BEVERLY BLVD	STE. 204	MONTEBELLO	CA	90640	4300	19	06037	34.01556395	-118.0983878	Los Angeles County
154270	Fee-for-Service	1578507638	1578507638	1	1	AZAD, ARMIN	6/21/2000	207L00000X	NA	Other	026	PHYSICIANS	50503	05	Anesthesiology	0	In state provider	None	400 E MAIN ST	STE 200	STOCKTON	CA	95202	3000	39	06077	37.95344497	-121.2852303	San Joaquin County
154275	Fee-for-Service	1235124108	1235124108	2	1	ABOUSAIF, ALAA MD	2/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	52710	None	None	0	In state provider	None	1010 W LA VETA AVE	STE 570	ORANGE	CA	92868	4300	30	06059	33.78028244	-117.8635552	Orange County
154304	Fee-for-Service	1912442724	1912442724	1	1	ALVARADO, DANIELA Y LCSW	10/20/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3166 ZOE AVE	None	HUNTINGTON PARK	CA	90255	5343	19	06037	33.97850015	-118.2108763	Los Angeles County
154312	Fee-for-Service	1285163998	1285163998	1	1	ADEEL, MARYAM MD	12/18/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166666	None	None	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
154313	Fee-for-Service	1679579726	1679579726	1	1	AHMAD, ALYA Z MD	10/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	55900	40	Pediatrics	0	In state provider	None	290 NORTH WAYTE LANE	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
154319	Fee-for-Service	1851869705	1851869705	1	1	APPLE MEDICAL CLINIC INC	5/24/2021	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	15201 ELEVENTH ST	100	VICTORVILLE	CA	92395	3735	36	06071	34.52725895	-117.2925031	San Bernardino County
154370	Fee-for-Service	1447673124	1447673124	1	1	ACCESS SURGICAL CARE GROUP	6/28/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INC	5 MEDICAL PLAZA DRIVE	SUITE 120	ROSEVILLE	CA	95661	2866	31	06061	38.76604411	-121.2466761	Placer County
154382	Fee-for-Service	1487188124	1487188124	1	1	ASMAR, MELISSA MD	9/5/2023	2084N0600X	NA	Neurology	026	PHYSICIANS	188322	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
154387	Fee-for-Service	1760895312	1760895312	1	1	ASHRAF, HUZAIFA MD	9/6/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	151440	None	None	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
154393	Fee-for-Service	1124522677	1124522677	1	1	AVILA, ROSA L MD	7/21/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	175718	None	None	0	In state provider	None	1701 CESAR CHAVEZ AVENUE	STE 200 225	LOS ANGELES	CA	90033	6720	19	06037	34.05112725	-118.2173921	Los Angeles County
154418	Fee-for-Service	1558720516	1558720516	1	2	AYAZ O KHAN INC	2/6/2017	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
154420	Fee-for-Service	1447438734	1447438734	1	1	ALLIANT HOME HEALTH CARE	10/6/2009	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES	2149 E GARVEY AVE NORTH	STE A-4	WEST COVINA	CA	91791	1538	19	06037	34.07283575	-117.8994346	Los Angeles County
154433	Fee-for-Service	1740427657	1740427657	1	10	ALTAMED HEALTH SERVICES CORP	2/5/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1111 W CIVIC CENTER DR	None	SANTA ANA	CA	92703	2229	30	06059	33.75154753	-117.881496	Orange County
154453	Fee-for-Service	1760773725	1760773725	1	1	AL-JANABI, MOHAMMED G	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143247	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
154473	Fee-for-Service	1376799858	1376799858	1	1	ALI, SYED A MD	5/14/2019	207R00000X	NA	Other	026	PHYSICIANS	121525	45	Nephrology (Renal-Kidney)	0	In state provider	None	777 CAMPUS COMMONS RD	SUITE 120	SACRAMENTO	CA	95825	8343	34	06067	38.571021	-121.416786	Sacramento County
154495	Fee-for-Service	1457556102	1457556102	1	1	AVISHEH STIMSONRIAHI M.D.	10/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9225 N 3RD ST	STE 304	PHOENIX	AZ	85020	2466	00	None	33.57054	-112.0692465	Maricopa County
154514	Fee-for-Service	1407239403	1407239403	1	1	AFSHAR, NEDA	5/8/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	7600 HOSPITAL DR	J1	SACRAMENTO	CA	95823	5406	34	06067	38.463876	-121.414698	Sacramento County
154533	Fee-for-Service	1083051080	1083051080	1	1	ANSON MEDICAL INC	7/22/2015	261QP2300X	NA	Other	026	PHYSICIANS	45814	40	Pediatrics	0	In state provider	None	2350 MCKEE RD	SUITE 1	SAN JOSE	CA	95116	1606	43	06085	37.36631785	-121.848368	Santa Clara County
154539	Fee-for-Service	1891989570	1891989570	1	1	ANDRADE, SANDRA PSYD	8/2/2024	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	SMENTS	650 HAMPSHIRE RD	SUITE 118	WESTLAKE VILLAGE	CA	91361	2536	56	06111	34.15918414	-118.8359242	Ventura County
154545	Fee-for-Service	1265458640	1265458640	1	1	ALALI, ALBORZ MD	9/9/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71691	68	Hematology	0	In state provider	None	2770 W COVELL BLVD	None	DAVIS	CA	95616	5661	57	06113	38.56100429	-121.7834158	Yolo County
154586	Fee-for-Service	1851310973	1851310973	1	1	ANDERS, THOMAS F MD	2/28/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	7595	36	Psychiatry	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
154591	Fee-for-Service	1013222066	1013222066	1	1	ARIANJAM, AFSHIN	11/18/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113834	20	Orthopedic Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
154595	Fee-for-Service	1275918674	1275918674	1	1	AVENAL COMMUNITY HEALTH	6/22/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER	304 BECKY PEASE ST	None	KETTLEMAN CITY	CA	93239	0000	16	06031	36.009459	-119.9602025	Kings County
154710	Fee-for-Service	1417920919	1417920919	1	1	ASHLEY, EDWIN M MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	60846	01	General Practice	0	In state provider	None	6124 DAMASK AVE	None	LOS ANGELES	CA	90056	1731	19	06037	33.98438673	-118.3625275	Los Angeles County
154717	Fee-for-Service	1740427657	1740427657	1	10	ALTAMED HEALTH SERVICES CORP	2/5/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1111 W CIVIC CENTER DR	None	SANTA ANA	CA	92703	2229	30	06059	33.75154753	-117.881496	Orange County
154734	Fee-for-Service	1871742114	1871742114	1	1	ADOBE HOME HEALTH INC	2/17/2010	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	19045 PORTOLA DR	STE E	SALINAS	CA	93908	1204	27	06053	36.62329308	-121.6855515	Monterey County
154748	Fee-for-Service	1700083771	1700083771	1	1	ANDERSON, ALBERT MEDICAL	12/14/2018	174400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CORPORATION	552 S PASEO DOROTEA	STE 2	PALM SPRINGS	CA	92264	1437	33	06065	33.81460283	-116.5017722	Riverside County
154818	Fee-for-Service	1750035945	1750035945	1	1	AVIVA WOLFSON MARRIAGE AND F	5/31/2023	261QM0801X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	690 E GREEN ST	SUITE 202	PASADENA	CA	91101	2197	19	06037	34.14449605	-118.1361004	Los Angeles County
154830	Fee-for-Service	1265458640	1265458640	1	1	ALALI, ALBORZ MD	9/9/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71691	78	Neoplastic Diseases/Oncology	0	In state provider	None	2770 W COVELL BLVD	None	DAVIS	CA	95616	5661	57	06113	38.56100429	-121.7834158	Yolo County
154850	Fee-for-Service	1518103910	1518103910	1	1	ALL AMERICAN MEDICAL	12/26/2006	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TRANSPORTATION	230 N BLACKSTONE AVE	None	FRESNO	CA	93701	1913	10	06019	36.745704	-119.7905135	Fresno County
154858	Fee-for-Service	1710560495	1710560495	1	1	ATLANTIS SAC OPCO LLC	3/1/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1922 MORSE AVE	None	SACRAMENTO	CA	95825	2114	34	06067	38.600208	-121.391613	Sacramento County
154859	Fee-for-Service	1215352158	1215352158	1	1	AUNG, SANDAR MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139988	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
154860	Fee-for-Service	1811129091	1811129091	1	1	ASIAN PACIFIC HEALTH CARE	5/31/2011	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	VENTURE INC	1575 W 2ND STREET	None	LOS ANGELES	CA	90026	5701	19	06037	34.06123993	-118.2631133	Los Angeles County
154878	Fee-for-Service	1659925998	1659925998	1	1	ALCAM MEDICAL INC	11/3/2020	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	44439 17TH ST W	SUITE 103	LANCASTER	CA	93534	2854	19	06037	34.69070437	-118.161312	Los Angeles County
154884	Fee-for-Service	1275918674	1275918674	1	1	AVENAL COMMUNITY HEALTH	6/22/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CENTER	304 BECKY PEASE ST	None	KETTLEMAN CITY	CA	93239	0000	16	06031	36.009459	-119.9602025	Kings County
154904	Fee-for-Service	1417665035	1417665035	1	1	AARON, TRINYTEI A BIRTH DOUL	2/14/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	30	06059	0	0	None
154907	Fee-for-Service	1497718324	1497718324	1	1	ARNSTEIN, DAYNA G	11/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	70193	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
154909	Fee-for-Service	1770563108	1770563108	1	1	AMMON,JOHN R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 N CENTRAL AVE	STE 500	PHOENIX	AZ	85012	2738	00	None	33.480666	-112.0729905	Maricopa County
154919	Fee-for-Service	1558964155	1558964155	1	1	AHG HOME HEALTH INC	6/22/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	229 N CENTRAL AVE	STE 505	GLENDALE	CA	91203	3540	19	06037	34.14910181	-118.2579537	Los Angeles County
154927	Fee-for-Service	1578764379	1578764379	1	1	ALAMEDA HEALTH SYSTEM	1/31/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
154930	Fee-for-Service	1831141845	1831141845	1	1	ASSISTED HOME RECOVERY, INC	1/30/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	72 MOODY CT	SUITE 200	THOUSAND OAKS	CA	91360	6067	56	06111	34.17787495	-118.8657233	Ventura County
154978	Fee-for-Service	1174148829	1174148829	1	1	ANDERSON, SARAH E PT	11/7/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
154998	Fee-for-Service	1417920919	1417920919	1	1	ASHLEY, EDWIN M MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	60846	20	Orthopedic Surgery	0	In state provider	None	6124 DAMASK AVE	None	LOS ANGELES	CA	90056	1731	19	06037	33.98438673	-118.3625275	Los Angeles County
155012	Fee-for-Service	1629281779	1629281779	2	1	ACTIVE MOBILITY CNT INC	12/7/2007	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	14330 7TH ST	None	VICTORVILLE	CA	92395	4212	36	06071	34.5110609	-117.3190146	San Bernardino County
155034	Fee-for-Service	1548747108	1548747108	1	1	AVENT-JOHNSON, JESHANA E PSY	8/21/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	D	13193 CENTRAL AVENUE	SUITE 200	CHINO	CA	91710	4179	36	06071	34.01406506	-117.6891684	San Bernardino County
155037	Fee-for-Service	1700083771	1700083771	1	1	ANDERSON, ALBERT MEDICAL	12/14/2018	174400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	552 S PASEO DOROTEA	STE 2	PALM SPRINGS	CA	92264	1437	33	06065	33.81460283	-116.5017722	Riverside County
155042	Fee-for-Service	1508944109	1508944109	1	1	ANGELES, CHRISTINE E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32879	01	General Practice	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
155051	Fee-for-Service	1740235092	1740235092	1	1	ADLER GERALD P MD	5/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1700 TREE LANE STE 450	None	SNELLVILLE	GA	30078	0000	00	None	33.87595381	-84.02326211	Gwinnett County
155061	Fee-for-Service	1538192984	1538192984	1	1	ACKROYD, GREGORY T MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	84348	13	Neurology (M.D. only)	0	In state provider	None	500 DOYLE PARK	SUITE G-04	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
155073	Fee-for-Service	1194983627	1194983627	1	1	AMIRAULT, REBECCA H CNM	6/8/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
155128	Fee-for-Service	1588064646	1588064646	1	1	ADVANCED PRACTICE PRIMARY	1/30/2015	261QP2300X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	CARE A REGISTERED	9267 GREENBACK LANE	SUITE C2	ORANGEVALE	CA	95662	4865	34	06067	38.678733	-121.208598	Sacramento County
155170	Fee-for-Service	1275918674	1275918674	1	1	AVENAL COMMUNITY HEALTH	4/18/2018	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CENTER	304 BECKY PEASE ST	None	KETTLEMAN CITY	CA	93239	0000	16	06031	36.009459	-119.9602025	Kings County
155173	Fee-for-Service	1922367028	1922367028	1	1	AGUINALDO, PATRICIA NP	12/11/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
155201	Fee-for-Service	1194739631	1194739631	1	1	ANDAL, JEFFREY C MD	3/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	98558	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
155205	Fee-for-Service	1861540726	1861540726	1	1	ATTAI, SHERWIN F MD	2/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82132	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
155250	Fee-for-Service	1144480252	1144480252	1	1	AMINI, KAMYAR MD	4/16/2009	261QM2500X	NA	Other	026	PHYSICIANS	99444	04	Otology, Laryngology, Rhinology	0	In state provider	A MEDICAL CORP	8435 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4625	19	06037	34.223724	-118.536109	Los Angeles County
155254	Fee-for-Service	1942206289	1942206289	1	1	ALLGOOD, MARK R MD	1/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	77 PRINGLE WAY	None	RENO	NV	89502	1474	00	None	39.52484706	-119.7951825	Washoe County
155255	Fee-for-Service	1861748857	1861748857	1	1	AN, HYUNMI	8/6/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	501 S FAIRFAX AVE	STE 214	LOS ANGELES	CA	90036	3179	19	06037	34.06725156	-118.3614386	Los Angeles County
155283	Fee-for-Service	1306328794	1306328794	1	1	ASK DO INC	2/19/2019	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	14779	01	General Practice	0	In state provider	None	4320 MARICOPA ST	None	TORRANCE	CA	90503	4314	19	06037	33.83949675	-118.3597243	Los Angeles County
155291	Fee-for-Service	1396062881	1396062881	1	1	ALFORD, RAPHAEL E MD	7/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136538	30	Radiology	0	In state provider	None	10833 LE CONTE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
155315	Fee-for-Service	1700041043	1700041043	1	1	AKAMINE DAVIDSON, SANDRA	7/19/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OD INC	4515 CENTRAL AVE	STE 101	RIVERSIDE	CA	92506	2374	33	06065	33.9535052	-117.4014216	Riverside County
155317	Fee-for-Service	1841245149	1841245149	1	1	ARBABZADEH, MASSOUD MD	9/27/2023	2085R0204X	NA	Other	026	PHYSICIANS	171331	None	None	0	In state provider	None	12827 HARBOR BLVD	G1	GARDEN GROVE	CA	92840	5837	30	06059	33.77737896	-117.9151828	Orange County
155336	Fee-for-Service	1326199449	1326199449	1	1	AGNETTI, JASON R LMFT	7/17/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	29748 RANCHO CALIFORNIA	RD	TEMECULA	CA	92591	5286	33	06065	33.50662849	-117.1428887	Riverside County
155373	Fee-for-Service	1053725317	1053725317	1	1	AKHAVAN, PARVIZ DO A MEDICAL	12/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	7522	01	General Practice	0	In state provider	CORP	5113 S VERMONT AVE	None	LOS ANGELES	CA	90037	3515	19	06037	33.996375	-118.291558	Los Angeles County
155408	Fee-for-Service	1780020578	1780020578	1	1	AL ATASSI, KAOSAR DALIA MD	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122651	40	Pediatrics	0	In state provider	None	1701 E CESAR E CHAVEZ AV	SUITE 456	LOS ANGELES	CA	90033	2464	19	06037	34.05112725	-118.2173921	Los Angeles County
155459	Fee-for-Service	1275918674	1275918674	1	1	AVENAL COMMUNITY HEALTH	6/22/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER	304 BECKY PEASE ST	None	KETTLEMAN CITY	CA	93239	0000	16	06031	36.009459	-119.9602025	Kings County
155490	Fee-for-Service	1720548969	1720548969	1	1	ADVANCED QUALITY HOSPICE INC	5/14/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3212 LOMA VISTA RD	SUITE 250	VENTURA	CA	93003	3043	56	06111	34.2760182	-119.2530926	Ventura County
155493	Fee-for-Service	1346600699	1346600699	1	1	AGIRI, ELIZABETH A NP	9/15/2023	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 CORPORATE POINTE	STE 465	CULVER CITY	CA	90230	8706	19	06037	33.98867148	-118.3837334	Los Angeles County
155522	Fee-for-Service	1528398732	1528398732	1	1	ABELL-DAVIS, JENNIFER A	5/27/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	250 TRAVELODGE DRIVE	None	EL CAJON	CA	92020	4126	37	06073	32.79312432	-116.980275	San Diego County
155533	Fee-for-Service	1376574616	1376574616	1	1	ABRAHAM, SUSAN M MD	10/12/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	53606	01	General Practice	0	In state provider	None	1999 MOWRY AVE	None	FREMONT	CA	94538	1738	01	06001	37.55783419	-121.9808484	Alameda County
155546	Fee-for-Service	1104020262	1104020262	1	1	AHMAD, YUSUF H MD	9/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116785	05	Anesthesiology	0	In state provider	None	1200B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3587	48	06095	38.26109552	-122.0470245	Solano County
155549	Fee-for-Service	1306088711	1306088711	1	1	ALPERN, ANA F MD	6/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105873	40	Pediatrics	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
155583	Fee-for-Service	1306264205	1306264205	1	1	ANGEL HOSPICE CARE INC	6/22/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	142 SHOPPERS LN	None	COVINA	CA	91723	3535	19	06037	34.07753031	-117.8891176	Los Angeles County
155643	Fee-for-Service	1780743369	1780743369	1	1	ALS, JOANNE DAVID MD	12/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	64605	36	Psychiatry	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
155665	Fee-for-Service	1619451184	1619451184	1	2	ALGOS INC., A MEDICAL CORPOR	12/13/2018	208VP0000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	1125 E 17TH ST	SUITE N-452	SANTA ANA	CA	92701	2201	30	06059	33.76004145	-117.854838	Orange County
155685	Fee-for-Service	1932355146	1932355146	1	1	APPIS, ANDREW W MD	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143251	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
155778	Fee-for-Service	1720548969	1720548969	1	1	ADVANCED QUALITY HOSPICE INC	5/14/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3212 LOMA VISTA RD	SUITE 250	VENTURA	CA	93003	3043	56	06111	34.2760182	-119.2530926	Ventura County
155825	Fee-for-Service	1437305901	1437305901	1	1	ARROZ, VICENTE B PT	2/24/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
155829	Fee-for-Service	1679927016	1679927016	1	1	AUTUMN RIDGE LP	2/27/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	14280 W STANISLAUS AVE	None	KERMAN	CA	93630	9758	10	06019	36.73098348	-120.0475935	Fresno County
155871	Fee-for-Service	1306264205	1306264205	1	1	ANGEL HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	142 SHOPPERS LN	None	COVINA	CA	91723	3535	19	06037	34.07753031	-117.8891176	Los Angeles County
155911	Fee-for-Service	1437535721	1437535721	1	1	ALVARADO, YESSENIA LMFT	11/2/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
155925	Fee-for-Service	1891873659	1891873659	1	1	ABORN, LYN S MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92202	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
155948	Fee-for-Service	1184370959	1184370959	1	1	APPLEDOORN, LOGAN J PT	4/7/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1252 BROADWAY	SUITE B	PLACERVILLE	CA	95667	5806	09	06017	38.73128098	-120.7852781	El Dorado County
155959	Fee-for-Service	1508981085	1508981085	1	1	AVILA, RUTH J MD	12/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	76868	08	Family Practice	0	In state provider	None	1245 R ST	None	FRESNO	CA	93721	1314	10	06019	36.74145282	-119.7839794	Fresno County
155974	Fee-for-Service	1932355146	1932355146	1	1	APPIS, ANDREW W MD	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143251	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
155994	Fee-for-Service	1972581387	1972581387	1	1	AFLATOONI, ROBERTA NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1135 116TH AVE NE	STE 560	BELLEVUE	WA	98004	4631	00	None	47.62130171	-122.1857045	King County
155996	Fee-for-Service	1558879452	1558879452	1	1	AVILA, JORGE MD	7/1/2023	207L00000X	NA	Other	026	PHYSICIANS	183440	None	None	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
156000	Fee-for-Service	1225423353	1225423353	1	1	AKAMNONU, CHUKWUKA MD	12/12/2018	207R00000X	NA	Other	026	PHYSICIANS	153880	41	Internal Medicine	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
156022	Fee-for-Service	1467883272	1467883272	1	1	AHMED ALSADEK, MD INC.	1/10/2020	207R00000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	17050 BUSHARD ST	205	FOUNTAIN VALLEY	CA	92708	2832	30	06059	33.71510531	-117.9630777	Orange County
156030	Fee-for-Service	1164695425	1164695425	1	1	ARSHAD, SAAIMA MD	10/30/2017	207R00000X	NA	Other	026	PHYSICIANS	145277	41	Internal Medicine	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
156035	Fee-for-Service	1275822850	1275822850	1	1	AZER, JOANNE M I MD	12/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12855	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
156047	Fee-for-Service	1407879257	1407879257	1	1	ABD-ALLAH, SHAMEL A MD	11/30/1992	207P00000X	NA	Other	026	PHYSICIANS	73462	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	# 100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
156073	Fee-for-Service	1225363724	1225363724	1	1	ANDREW MICHAEL WILKIS M.D.	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 N BEAVER ST	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
156085	Fee-for-Service	1346211877	1346211877	1	1	AHN, SUNGKEE S MD	6/14/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	134089	30	Radiology	0	In state provider	None	10101 RIVERSIDE DR	None	TOLUCA LAKE	CA	91602	2517	19	06037	34.15223753	-118.3508865	Los Angeles County
156094	Fee-for-Service	1538763800	1538763800	1	1	AURORA SPRING HOSPICE CARE,	8/5/2023	251G00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	INC.	435 ORANGE SHOW LN	STE 205	SAN BERNARDINO	CA	92408	2017	36	06071	34.08100788	-117.2922379	San Bernardino County
156097	Fee-for-Service	1629156120	1629156120	1	1	AIKEN, LESLEY A MD	11/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84452	41	Internal Medicine	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
156119	Fee-for-Service	1841547957	1841547957	1	1	ACHJIAN, TAMAR MD	12/27/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	172424	None	None	0	In state provider	None	2105 FOREST AVE	None	SAN JOSE	CA	95128	1425	43	06085	37.32710433	-121.9386474	Santa Clara County
156166	Fee-for-Service	1962933499	1962933499	1	1	AGRAWAL, GARIMA MD	6/11/2020	390200000X	NA	Other	026	PHYSICIANS	157474	41	Internal Medicine	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
156226	Fee-for-Service	1689684151	1689684151	1	1	AGARWAL, ULKA MD	8/14/2008	2084P0800X	NA	Psychiatry	026	PHYSICIANS	93049	36	Psychiatry	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
156234	Fee-for-Service	1154302529	1154302529	1	1	ASSAAD, NAHED S MD	10/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	43143	40	Pediatrics	0	In state provider	None	3660 ARLINGTON AVE	None	RIVERSIDE	CA	92506	3912	33	06065	33.94621853	-117.3953655	Riverside County
156243	Fee-for-Service	1881024669	1881024669	1	1	AIDS HEALTHCARE FOUNDATION	7/18/2019	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	3940 4TH AVENUE	STE 140	SAN DIEGO	CA	92103	3193	37	06073	32.74912549	-117.161641	San Diego County
156247	Fee-for-Service	1801842349	1801842349	1	1	ALLSTATE MED EQUIP INC	8/5/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ALLSTATE MED EQUIP INC	2655 PARK CENTER DRIVE	STE C	SIMI VALLEY	CA	93065	6209	56	06111	34.2838825	-118.7974465	Ventura County
156269	Fee-for-Service	1144261710	1144261710	1	1	ATMAJIAN, PAUL H MD	10/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	72556	22	Pathology (M.D. only)	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
156285	Fee-for-Service	1821276833	1821276833	1	1	AMIN, AMI K MD	10/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104573	03	Allergy	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
156346	Fee-for-Service	1245289339	1245289339	1	1	ABRAMOWITZ, BRYAN L MD	11/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	63977	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	4282 GENESEE AVE	STE 102	SAN DIEGO	CA	92117	4986	37	06073	32.82092667	-117.1828683	San Diego County
156374	Fee-for-Service	1316327182	1316327182	1	1	ADVENTIST HEALTH PHYSICIANS	4/11/2016	193200000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1560 E CHEVY CHASE DRIVE	SUITE 430	GLENDALE	CA	91206	4140	19	06037	34.15290734	-118.2302295	Los Angeles County
156403	Fee-for-Service	1457566036	1457566036	1	1	AHMED, SHADIA MD	4/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93769	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
156410	Fee-for-Service	1710088349	1710088349	1	1	AIYEGBUSI, MODUPE A	3/13/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	65390	None	None	0	In state provider	None	21350 HAWTHORNE BLVD	STE 157	TORRANCE	CA	90503	5628	19	06037	33.8344453	-118.3529294	Los Angeles County
156435	Fee-for-Service	1972673846	1972673846	2	1	AZAR, NASER W MD INC	11/14/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2071 COMPTON AVE	STE 102	CORONA	CA	92881	7279	33	06065	33.848487	-117.5361705	Riverside County
156452	Fee-for-Service	1083805311	1083805311	1	1	AKPAMGBO, DOROTHY	10/8/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	CHIKANEL MEDICAL SUPPLIE	6207 ORANGE AVENUE	None	LONG BEACH	CA	90805	2434	19	06037	33.8676326	-118.1773735	Los Angeles County
156453	Fee-for-Service	1659377836	1659377836	1	1	ACHILLES PROSTHETICS &	7/1/2004	335E00000X	NA	Other	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	ORTHOTICS INC	2624 F ST	None	BAKERSFIELD	CA	93301	1816	15	06029	35.38353776	-119.0234458	Kern County
156454	Fee-for-Service	1750390829	1750390829	2	2	ADVANTAGE HEALTH CARE SERVIC	12/13/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	27800 MEDICAL CENTER RD	#99	MISSION VIEJO	CA	92691	6415	30	06059	33.55952733	-117.6645199	Orange County
156459	Fee-for-Service	1194998104	1194998104	1	1	AGUIRRE-BASHYAM, MYRNA I LMF	3/9/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
156461	Fee-for-Service	1295194827	1295194827	1	1	AIKINS, HAILEY E	5/23/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
156484	Fee-for-Service	1881929073	1881929073	1	1	ALMANZA, REBECCA R LMFT	1/22/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
156514	Fee-for-Service	1740427657	1740427657	1	15	ALTAMED HEALTH SERVICES CORP	5/9/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	425 S SULLIVAN STREET	None	SANTA ANA	CA	92704	1631	30	06059	33.74086388	-117.902544	Orange County
156541	Fee-for-Service	1386723971	1386723971	1	1	AKALAL, MELANIE G MD	1/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	56049	36	Psychiatry	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
156574	Fee-for-Service	1700836921	1700836921	1	1	ALBERT, OLGA N MD	5/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	79818	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
156633	Fee-for-Service	1659319614	1659319614	1	1	AGRAWAL, RANJEESH MD	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LN	STE 100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
156634	Fee-for-Service	1245289339	1245289339	1	1	ABRAMOWITZ, BRYAN L MD	11/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	63977	41	Internal Medicine	0	In state provider	INC	4282 GENESEE AVE	STE 102	SAN DIEGO	CA	92117	4986	37	06073	32.82092667	-117.1828683	San Diego County
156643	Fee-for-Service	1821545484	1821545484	1	1	ABBASI, HAMZA A MD	6/27/2023	208M00000X	NA	Other	026	PHYSICIANS	177853	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
156667	Fee-for-Service	1902079452	1902079452	1	3	ABLE PHYSICAL THERAPY CORP	5/28/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12562 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1907	30	06059	33.77431052	-117.913446	Orange County
156719	Fee-for-Service	1942294038	1942294038	1	1	AHMADI, ADAM Z MD	12/26/2008	207W00000X	NA	Ophthalmology	026	PHYSICIANS	89874	None	None	0	In state provider	None	21675 REDWOOD RD	None	CASTRO VALLEY	CA	94546	6431	01	06001	37.6896228	-122.0737778	Alameda County
156724	Fee-for-Service	1972673846	1972673846	2	1	AZAR, NASER W MD INC	11/14/2018	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	2071 COMPTON AVE	STE 102	CORONA	CA	92881	7279	33	06065	33.848487	-117.5361705	Riverside County
156732	Fee-for-Service	1902079452	1902079452	1	6	ABLE PHYSICAL THERAPY CORP	8/20/2019	171100000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	101 E LINCOLN AVE	SUITE 111	ANAHEIM	CA	92805	3202	30	06059	33.8368447	-117.9138391	Orange County
156743	Fee-for-Service	1659377836	1659377836	1	1	ACHILLES PROSTHETICS &	7/1/1996	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ORTHOTICS INC	2624 F ST	None	BAKERSFIELD	CA	93301	1816	15	06029	35.38353776	-119.0234458	Kern County
156803	Fee-for-Service	1740427657	1740427657	1	15	ALTAMED HEALTH SERVICES CORP	5/9/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	425 S SULLIVAN STREET	None	SANTA ANA	CA	92704	1631	30	06059	33.74086388	-117.902544	Orange County
156804	Fee-for-Service	1942219167	1942219167	1	1	ALL VALLEY PEDIATRICS	8/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	INC	14901 RINALDI ST	STE 300	MISSION HILLS	CA	91345	1255	19	06037	34.27903452	-118.457433	Los Angeles County
156819	Fee-for-Service	1114438520	1114438520	1	1	ALVAREZ CONEJO, JOHNNY A LMF	3/15/2023	106H00000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
156830	Fee-for-Service	1780820472	1780820472	1	1	ARIEL ANESTHESIA SERVICES	9/3/2010	193400000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	INC	1100 MARSHALL WY	None	PLACERVILLE	CA	95667	6533	09	06017	38.72453536	-120.7921649	El Dorado County
156879	Fee-for-Service	1154353829	1154353829	1	1	AL-SADEK, MOHAMED F	10/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89182	41	Internal Medicine	0	In state provider	None	345 S HALCYON RD	None	ARROYO GRANDE	CA	93420	3896	40	06079	35.113419	-120.5915945	San Luis Obispo County
156884	Fee-for-Service	1518439827	1518439827	1	1	ABSALOM HOME HEALTH AGENCY	8/23/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	1283 E MAIN STREET	SUITE 201	EL CAJON	CA	92021	7252	37	06073	32.79499827	-116.9368953	San Diego County
156931	Fee-for-Service	1154021368	1154021368	1	1	ANAIS CHORBADJIAN O.D., A PR	7/8/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OFESSIONAL CORP	602 N MACLAY AVE.	None	SAN FERNANDO	CA	91340	2137	19	06037	34.28899304	-118.433481	Los Angeles County
156956	Fee-for-Service	1902079452	1902079452	1	3	ABLE PHYSICAL THERAPY CORP	5/28/2018	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12562 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1907	30	06059	33.77431052	-117.913446	Orange County
157005	Fee-for-Service	1528116456	1528116456	1	1	AKMAKJI, KRIKOR A MD	10/23/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	46631	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
157017	Fee-for-Service	1346490653	1346490653	1	1	ABRIL, ADRIANA LMFT	3/1/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
157018	Fee-for-Service	1902079452	1902079452	1	6	ABLE PHYSICAL THERAPY CORP	8/20/2019	171100000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 E LINCOLN AVE	SUITE 111	ANAHEIM	CA	92805	3202	30	06059	33.8368447	-117.9138391	Orange County
157046	Fee-for-Service	1245966092	1245966092	1	1	AGUILA, YESENIA NP	11/2/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	292 EUCLID AVE	STE 115	SAN DIEGO	CA	92114	3629	37	06073	32.70706919	-117.0850896	San Diego County
157120	Fee-for-Service	1134419021	1134419021	1	1	AHDOOT, JACOB J MD APC	3/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	98763	None	None	0	In state provider	None	1711 W TEMPLE ST	1050	LOS ANGELES	CA	90026	5421	19	06037	34.06891181	-118.2638033	Los Angeles County
157146	Fee-for-Service	1700851482	1700851482	1	1	ANDREY, JEFFREY W MD	5/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	84047	None	None	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
157169	Fee-for-Service	1932455789	1932455789	1	1	ASSOCIATED HISPANIC PHYSICIA	5/16/2017	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	NS MEDICAL GROUP	3357 E GAGE AVENUE	1	HUNTINGTON PARK	CA	90255	5530	19	06037	33.98003459	-118.2054802	Los Angeles County
157177	Fee-for-Service	1770001992	1770001992	1	1	AMS MOBILE HEALTH DIAGNOSTIC	11/2/2017	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1750 VALLEJO STREET	SUITE 601	SAN FRANCISCO	CA	94123	5009	38	06075	37.79641364	-122.4260663	San Francisco County
157188	Fee-for-Service	1245698984	1245698984	1	1	AT LAST BRA AND LINGERIE	4/24/2019	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	BOUTIQUE LLC	1325 HOWE AVE	SUITE 100	SACRAMENTO	CA	95825	3201	34	06067	38.590191	-121.416624	Sacramento County
157190	Fee-for-Service	1639895741	1639895741	1	1	ALLO INTEGRATIVE HEALTH CENT	1/25/2023	363LF0000X	NA	Nurse Practitioner	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	ER	180 MAIN ST	203	TUSTIN	CA	92780	4489	30	06059	33.74206452	-117.82278	Orange County
157200	Fee-for-Service	1114323755	1114323755	1	1	ADEYEMI, OLAJUMOKE CNP	2/21/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
157241	Fee-for-Service	1154519254	1154519254	1	1	ANANTHANARAYANAN, SOWMYA MD	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112431	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
157286	Fee-for-Service	1194947200	1194947200	2	1	A.M. PALANCA-CAPISTRANO,M.D.	1/2/2020	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC.	720 MAGNOLIA AVENUE	SUITE A-4	CORONA	CA	92879	3119	33	06065	33.8581661	-117.5555574	Riverside County
157301	Fee-for-Service	1043840465	1043840465	1	1	AGOURA HILLS URGENTOCARE PC	3/27/2025	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	LLS	5825 KANAN RD	B	AGOURA HILLS	CA	91301	1651	19	06037	34.15592291	-118.7563824	Los Angeles County
157317	Fee-for-Service	1609360536	1609360536	1	1	A-Z HOSPICE INC	9/24/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1445 E LOS ANGELES AVE	SUITE 301-D	SIMI VALLEY	CA	93065	7847	56	06111	34.27182353	-118.771659	Ventura County
157328	Fee-for-Service	1528024056	1528024056	1	1	AGUILAR, RICHARD B MD	1/27/2022	207R00000X	NA	Other	026	PHYSICIANS	62147	None	None	0	In state provider	None	6201 WHITTIER BLVD	#15	LOS ANGELES	CA	90022	4661	19	06037	34.01625175	-118.1374784	Los Angeles County
157332	Fee-for-Service	1720077365	1720077365	1	1	AMIN, JAY R. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	455 PINELLAS ST	STE 400	CLEARWATER	FL	33756	3356	00	None	27.95178047	-82.8005715	Pinellas County
157345	Fee-for-Service	1972657781	1972657781	1	1	ARAHMAN, ENASS A MD	11/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103955	08	Family Practice	0	In state provider	None	3733 SAN DIMAS STREET	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
157349	Fee-for-Service	1942838222	1942838222	1	1	AHMED, BLAND MD	7/13/2023	208M00000X	NA	Other	026	PHYSICIANS	187404	None	None	0	In state provider	None	1180 N INDIAN CANYON DR	SUITE E205	PALM SPRINGS	CA	92262	4402	33	06065	33.839505	-116.5455735	Riverside County
157420	Fee-for-Service	1528265881	1528265881	1	1	ALEJANDRO, MARLYN M	8/26/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
157437	Fee-for-Service	1790396794	1790396794	1	1	AGUILAR, HEIDI J CNP	7/6/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	17782 COWAN STE A	None	IRVINE	CA	92614	6041	30	06059	33.69590054	-117.862371	Orange County
157449	Fee-for-Service	1578786000	1578786000	1	1	AURON, ARI MD	9/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149478	40	Pediatrics	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
157498	Fee-for-Service	1508008434	1508008434	1	1	ABDEL-KARIEM, REHAB MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126279	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
157499	Fee-for-Service	1912212697	1912212697	1	1	AZAD, SHAHZAD M PT	3/17/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	17095 MAIN ST	None	HESPERIA	CA	92345	6004	36	06071	34.41984761	-117.2904344	San Bernardino County
157536	Fee-for-Service	1386718625	1386718625	1	1	AARON YU	11/14/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	125 N 18TH ST	STE C	MOUNT VERNON	WA	98273	3902	00	None	48.422061	-122.318878	Skagit County
157547	Fee-for-Service	1023122587	1023122587	1	1	ARAGON, JOSEPH R JR MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	71603	41	Internal Medicine	0	In state provider	None	1127 WILSHIRE BLVD	STE 600	LOS ANGELES	CA	90017	3907	19	06037	34.05270508	-118.2641005	Los Angeles County
157569	Fee-for-Service	1366215683	1366215683	1	1	ADVOCATE FAMILY MEDICINE CLI	4/11/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	NIC	1330 W COVINA BLVD	STE 201	SAN DIMAS	CA	91773	3200	19	06037	34.09894509	-117.8340464	Los Angeles County
157573	Fee-for-Service	1194947200	1194947200	2	1	A.M. PALANCA-CAPISTRANO,M.D.	1/2/2020	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC.	720 MAGNOLIA AVENUE	SUITE A-4	CORONA	CA	92879	3119	33	06065	33.8581661	-117.5555574	Riverside County
157588	Fee-for-Service	1043840465	1043840465	1	1	AGOURA HILLS URGENTOCARE PC	6/10/2020	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	LLS	5825 KANAN RD	B	AGOURA HILLS	CA	91301	1651	19	06037	34.15592291	-118.7563824	Los Angeles County
157599	Fee-for-Service	1508398769	1508398769	1	1	AKHTAR, SUJI LMFT	1/31/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
157603	Fee-for-Service	1609360536	1609360536	1	1	A-Z HOSPICE INC	9/24/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1445 E LOS ANGELES AVE	SUITE 301-D	SIMI VALLEY	CA	93065	7847	56	06111	34.27182353	-118.771659	Ventura County
157634	Fee-for-Service	1972657781	1972657781	1	1	ARAHMAN, ENASS A MD	11/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103955	01	General Practice	0	In state provider	None	3733 SAN DIMAS STREET	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
157641	Fee-for-Service	1780139576	1780139576	1	1	AGUILAR, GABRIELA LCSW	2/15/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
157642	Fee-for-Service	1922207638	1922207638	1	1	ARNDAL, LARA J MD	9/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99365	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	153B PIONEER LN	None	BISHOP	CA	93514	2557	14	06027	37.36214662	-118.4074305	Inyo County
157644	Fee-for-Service	1164129581	1164129581	1	1	AVITAL, VICTORIA CNP	3/9/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	19	06037	34.148637	-118.4312035	Los Angeles County
157668	Fee-for-Service	1326218249	1326218249	1	1	ARASU, AARTHI MD	3/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98764	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
157684	Fee-for-Service	1164599718	1164599718	1	1	ADHIKARI, LEENA G OD	6/27/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	8003 ARCHIBALD AVE	None	RANCHO CUCAMONGA	CA	91730	2892	36	06071	34.10833168	-117.5934666	San Bernardino County
157707	Fee-for-Service	1205147600	1205147600	1	1	ALEXANDER ST JOHN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	None	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
157712	Fee-for-Service	1508278755	1508278755	1	1	ALLIED CARE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	12362 BEACH BLVD	STE 26	STANTON	CA	90680	9998	30	06059	33.78298855	-117.9927453	Orange County
157727	Fee-for-Service	1700382231	1700382231	1	1	AWAN, MAHAM MD	7/26/2021	208M00000X	NA	Other	026	PHYSICIANS	165584	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
157730	Fee-for-Service	1972674877	1972674877	1	1	ALAMSHAW, FREDDY DO	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	7005	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
157731	Fee-for-Service	1598748410	1598748410	1	1	ALJILANI, NAHEED H MD	5/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	47859	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
157735	Fee-for-Service	1033490453	1033490453	1	1	ARROYO NEPHROLOGY ASSOCIATES	3/21/2017	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	301 S FAIR OAKS AVE	STE 405	PASADENA	CA	91105	2541	19	06037	34.140348	-118.1504565	Los Angeles County
157737	Fee-for-Service	1578786000	1578786000	1	1	AURON, ARI MD	9/26/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149478	45	Nephrology (Renal-Kidney)	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
157738	Fee-for-Service	1184263576	1184263576	1	1	AKHTER, MUTAAL M MD	9/30/2024	208M00000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
157755	Fee-for-Service	1366025926	1366025926	1	1	ARTMED HEALTH CARE INC	8/2/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	261 E COLORADO BLVD	SUITE 203	PASADENA	CA	91101	6123	19	06037	34.14584353	-118.145043	Los Angeles County
157790	Fee-for-Service	1720170186	1720170186	1	1	AL-JUBURI, ANAN PSYD	1/3/2022	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
157797	Fee-for-Service	1578542676	1578542676	1	1	ATKINS, ELISE F MD	11/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87393	08	Family Practice	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
157803	Fee-for-Service	1851836084	1851836084	1	3	ANKUR GUPTA MD INC	9/19/2018	2086S0129X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	1050 LINDEN AVENUE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
157806	Fee-for-Service	1548660434	1548660434	1	1	ALVAREZ, APRIL B LCSW	9/3/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
157845	Fee-for-Service	1679968978	1679968978	1	1	ADAN, ALEXEI MD	6/25/2019	207P00000X	NA	Other	026	PHYSICIANS	161408	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
157887	Fee-for-Service	1013637032	1013637032	1	1	APEX PHARMACY SERVICES	11/7/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2485 HIGH SCHOOL AVE	STE 114	CONCORD	CA	94520	1816	07	06013	37.98507961	-122.034189	Contra Costa County
157910	Fee-for-Service	1194081786	1194081786	1	1	AFSHAR, MARYAM MD	12/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120269	40	Pediatrics	0	In state provider	None	276 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
157926	Fee-for-Service	1871531590	1871531590	1	1	AGHILI, SHAHRIAR MD	9/30/1992	207RP1001X	NA	Pulmonology	026	PHYSICIANS	51616	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
157932	Fee-for-Service	1639696412	1639696412	1	1	ARCHIS DESAI MD, INC.	3/27/2021	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1030 NEVADA	STE #101	REDLANDS	CA	92374	2957	36	06071	34.064172	-117.217431	San Bernardino County
157973	Fee-for-Service	1245281856	1245281856	1	1	ABITBOL, JEAN-JACQUES MD	11/16/2018	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	55587	20	Orthopedic Surgery	0	In state provider	None	5395 RUFFIN RD	STE 102	SAN DIEGO	CA	92123	1338	37	06073	32.832387	-117.1266225	San Diego County
157978	Fee-for-Service	1295940492	1295940492	1	1	ARTHUR, CURTIS LMFT	1/10/2020	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
158002	Fee-for-Service	1508278755	1508278755	1	1	ALLIED CARE HOSPICE INC	9/29/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	12362 BEACH BLVD	STE 26	STANTON	CA	90680	9998	30	06059	33.78298855	-117.9927453	Orange County
158019	Fee-for-Service	1326039637	1326039637	1	1	ALLDRIN, GORDON E MD INC	12/1/1987	207P00000X	NA	Other	026	PHYSICIANS	42506	01	General Practice	0	In state provider	None	870 MOUNTAIN RANCH RD	None	SAN ANDREAS	CA	95249	9713	05	06009	38.18981145	-120.6674738	Calaveras County
158020	Fee-for-Service	1972674877	1972674877	1	1	ALAMSHAW, FREDDY DO	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	7005	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
158025	Fee-for-Service	1467419523	1467419523	1	1	ALDERMAN, DAVID M MD	3/11/1999	174400000X	NA	Other	026	PHYSICIANS	50964	45	Nephrology (Renal-Kidney)	0	In state provider	None	1180 N INDIAN CANYON DR	STE W303	PALM SPRINGS	CA	92262	4856	33	06065	33.839505	-116.5455735	Riverside County
158026	Fee-for-Service	1568721355	1568721355	1	1	AIDS HEALTHCARE FOUNDATION	8/20/2012	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3580 5TH AVE	STE 200	SAN DIEGO	CA	92103	5017	37	06073	32.74286786	-117.160418	San Diego County
158051	Fee-for-Service	1528094828	1528094828	2	1	ALEMZADEH, FARROKH MD	11/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	55448	01	General Practice	0	In state provider	None	4950 BARRANCA PKWY	STE 107	IRVINE	CA	92604	8650	30	06059	33.67620851	-117.7948348	Orange County
158053	Fee-for-Service	1528018470	1528018470	1	1	ANDERSON, BRADLEY T MD	3/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89184	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	STE 3150	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
158076	Fee-for-Service	1073625067	1073625067	1	1	ANEROL INC	12/18/1989	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3400 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1785	19	06037	34.02767826	-118.2008037	Los Angeles County
158078	Fee-for-Service	1710158522	1710158522	1	1	ALDAPE, DANYELLE LCSW	7/2/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
158087	Fee-for-Service	1922318740	1922318740	1	1	APRIA HEALTHCARE LLC	10/26/2012	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	7929 RUFFNER AVE	None	VAN NUYS	CA	91406	1633	19	06037	34.21438043	-118.4968779	Los Angeles County
158117	Fee-for-Service	1780955922	1780955922	1	1	ADVANCED CENTER FOR EYE CARE	2/29/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	1701 WESTWIND DRIVE	SUITE 101	BAKERSFIELD	CA	93301	3045	15	06029	35.374239	-119.042547	Kern County
158118	Fee-for-Service	1205071776	1205071776	1	1	ALPINE EMERGENCY PHYSICI	12/1/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
158143	Fee-for-Service	1326411067	1326411067	1	1	AMIGO BABY, INC	11/22/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1901 N RICE AVE	STE 325	OXNARD	CA	93030	7912	56	06111	34.21960355	-119.1421345	Ventura County
158155	Fee-for-Service	1316981061	1316981061	1	1	AZIMI, PARVIN H MD	8/24/2004	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	24963	77	Infectious Disease	0	In state provider	CHILDRENS HOSP	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
158162	Fee-for-Service	1093740227	1093740227	1	1	ALI, ZULFIQAR MD	5/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38449	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1900 MOWRY AVE	STE 105	FREMONT	CA	94538	1722	01	06001	37.55862396	-121.9799952	Alameda County
158178	Fee-for-Service	1366861601	1366861601	1	1	AUDIE ADERHOLT	2/24/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
158186	Fee-for-Service	1932342854	1932342854	1	1	ALTA EAST BAY PATHOLOGY	6/12/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	INC	3300 WEBSTER ST	# 1201	OAKLAND	CA	94609	3117	01	06001	37.82132826	-122.2621843	Alameda County
158208	Fee-for-Service	1225086192	1225086192	1	1	ALBERT, TIMOTHY S MD	10/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94873	40	Pediatrics	0	In state provider	None	203 SAN JOSE STREET	None	SALINAS	CA	93901	3901	27	06053	36.6586661	-121.6477807	Monterey County
158227	Fee-for-Service	1508092008	1508092008	1	1	ARTHUR HESS	5/4/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7301 HENNESSY BLVD	STE 200	BATON ROUGE	LA	70808	4794	00	None	30.405366	-91.111536	East Baton Rouge Parish
158243	Fee-for-Service	1679565642	1679565642	1	1	AJO AMBULANCE	4/14/2013	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1850 N AJO GILA BEND HWY	None	AJO	AZ	85321	1117	00	None	32.390559	-112.871781	Pima County
158245	Fee-for-Service	1659935823	1659935823	1	1	ABUNDANT GRACE HOME HEALTH	12/3/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	510 E FOOTHILL BLVD	STE 102	SAN DIMAS	CA	91773	1254	19	06037	34.12305749	-117.7979452	Los Angeles County
158252	Fee-for-Service	1770920787	1770920787	1	1	ALLAN HANCOCK JOINT	12/23/2013	261QS1000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	COMMUNITY COLLEGE DIST	800 S COLLEGE DRIVE	None	SANTA MARIA	CA	93454	6399	42	06083	34.94385	-120.421485	Santa Barbara County
158279	Fee-for-Service	1821607789	1821607789	1	1	ADVANCED CARE MEDICAL INC	6/19/2024	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	400 NEWPORT CENTER DR	301	NEWPORT BEACH	CA	92660	7604	30	06059	33.6142606	-117.8726808	Orange County
158282	Fee-for-Service	1770163222	1770163222	1	1	AMIN, MUBASHARA	9/13/2024	207R00000X	NA	Other	026	PHYSICIANS	192329	41	Internal Medicine	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
158284	Fee-for-Service	1285959858	1285959858	1	1	ALDERWISH, EDRIS Z MD	1/3/2022	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	172624	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
158295	Fee-for-Service	1689685711	1689685711	1	1	ANAHEIM UROLOGIC MED GRP	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	None	1211 W LA PALMA AVE	STE 307	ANAHEIM	CA	92801	2811	30	06059	33.84718298	-117.933758	Orange County
158303	Fee-for-Service	1972673846	1972673846	2	2	AZAR, NASER W MD INC	11/14/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	12488 CENTRAL AVE	STE B	CHINO	CA	91710	3569	36	06071	34.026552	-117.6895065	San Bernardino County
158312	Fee-for-Service	1467419523	1467419523	1	1	ALDERMAN, DAVID M MD	3/11/1999	174400000X	NA	Other	026	PHYSICIANS	50964	41	Internal Medicine	0	In state provider	None	1180 N INDIAN CANYON DR	STE W303	PALM SPRINGS	CA	92262	4856	33	06065	33.839505	-116.5455735	Riverside County
158317	Fee-for-Service	1467878447	1467878447	1	1	ABOVWE, NKEIRU U NP	8/14/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
158338	Fee-for-Service	1447583877	1447583877	1	1	ALTSHULER, ANNA L MD	7/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124503	None	None	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
158342	Fee-for-Service	1528094828	1528094828	2	1	ALEMZADEH, FARROKH MD	11/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	55448	08	Family Practice	0	In state provider	None	4950 BARRANCA PKWY	STE 107	IRVINE	CA	92604	8650	30	06059	33.67620851	-117.7948348	Orange County
158355	Fee-for-Service	1497886584	1497886584	1	1	ALUM ROCK UNION SD	12/5/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	2930 GAY AVE	None	SAN JOSE	CA	95127	2322	43	06085	37.36970014	-121.8334343	Santa Clara County
158371	Fee-for-Service	1457470700	1457470700	1	1	ANAHEIM GLOBAL MEDICAL	3/8/2005	282N00000X	NA	Hospitals	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	1025 S ANAHEIM BLVD	None	ANAHEIM	CA	92805	5806	30	06059	33.81994338	-117.9087416	Orange County
158417	Fee-for-Service	1962660175	1962660175	1	1	ALLEN, RICHARD T MD	9/3/2008	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	83513	20	Orthopedic Surgery	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
158439	Fee-for-Service	1043571045	1043571045	1	1	AISAGBONHI, OMONIGHO A MD	8/21/2018	207ZP0102X	NA	Other	026	PHYSICIANS	151237	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
158443	Fee-for-Service	1194723486	1194723486	1	1	AMY J RONGSTAD F.N.P.	10/30/2022	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	824 N 11TH ST	None	MONTEVIDEO	MN	56265	1629	00	None	44.95361546	-95.7135587	Chippewa County
158446	Fee-for-Service	1093806119	1093806119	1	1	ALLEN-HARDEY, KIMBERLY L MFT	5/23/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	44614	-	NOT APPLICABLE	0	In state provider	None	8626 LOWER SACRAMENTO RD	SUITE 41	STOCKTON	CA	95210	1835	39	06077	38.02905449	-121.3226622	San Joaquin County
158452	Fee-for-Service	1992983282	1992983282	1	1	ACHIRILOAIE, ADINA F MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	103603	30	Radiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino County
158494	Fee-for-Service	1477761914	1477761914	1	1	ANKROM, DOUGLAS W MD	2/27/2008	208800000X	NA	Other	026	PHYSICIANS	52517	34	Urology and Urological Surgery	0	In state provider	None	680 GUZZI LANE	SUITE 205	SONORA	CA	95370	5288	55	06109	37.97611058	-120.3719921	Tuolumne County
158498	Fee-for-Service	1225086192	1225086192	1	1	ALBERT, TIMOTHY S MD	10/16/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94873	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	203 SAN JOSE STREET	None	SALINAS	CA	93901	3901	27	06053	36.6586661	-121.6477807	Monterey County
158501	Fee-for-Service	1982632675	1982632675	1	1	APOLINARIO, PATRICIA MD	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52019	40	Pediatrics	0	In state provider	None	500 WEST HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
158506	Fee-for-Service	1356559512	1356559512	1	1	ALPUERTO MARCHENA, CELINA J	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	12501 IMPERIAL HWY	SUITE 400	NORWALK	CA	90650	1419	19	06037	33.91723852	-118.065834	Los Angeles County
158523	Fee-for-Service	1497173694	1497173694	1	1	AIKOYE, SALISU A	4/20/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	154761	None	None	0	In state provider	None	13132 STUDEBAKER RD	10	NORWALK	CA	90650	2562	19	06037	33.911874	-118.099151	Los Angeles County
158563	Fee-for-Service	1821607789	1821607789	1	1	ADVANCED CARE MEDICAL INC	3/15/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	400 NEWPORT CENTER DR	301	NEWPORT BEACH	CA	92660	7604	30	06059	33.6142606	-117.8726808	Orange County
158591	Fee-for-Service	1972673846	1972673846	2	2	AZAR, NASER W MD INC	11/14/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	12488 CENTRAL AVE	STE B	CHINO	CA	91710	3569	36	06071	34.026552	-117.6895065	San Bernardino County
158592	Fee-for-Service	1326417916	1326417916	1	1	ANGELI, DANIEL G MD	7/23/2020	207R00000X	NA	Other	026	PHYSICIANS	168749	45	Nephrology (Renal-Kidney)	0	In state provider	None	1498 SOUTHGATE AVE	STE 102	DALY CITY	CA	94015	4015	41	06081	37.67558947	-122.4761175	San Mateo County
158597	Fee-for-Service	1386694529	1386694529	1	1	ANGST, MARTIN S MD	12/1/1999	207L00000X	NA	Other	026	PHYSICIANS	70346	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
158609	Fee-for-Service	1366785842	1366785842	1	1	ARDENT HOSPICE OF THE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	DESERT INC	1750 E. ARENAS RD.	STE 21	PALM SPRINGS	CA	92262	7137	33	06065	33.8214229	-116.5268939	Riverside County
158625	Fee-for-Service	1033319215	1033319215	1	1	ABOUTALEBI-SIMON, SANAZ OD	11/26/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
158630	Fee-for-Service	1467210740	1467210740	1	1	ADVENTIST HEALTH PHYSICIANS	8/7/2024	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	2727 BUENA VISTA DR	201	PASO ROBLES	CA	93446	8581	40	06079	35.6484081	-120.6722826	San Luis Obispo County
158647	Fee-for-Service	1699228205	1699228205	1	1	ANCENO, MARLENE J	6/30/2021	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1255 W COLTON AVE STE 58	None	REDLANDS	CA	92374	2861	36	06071	34.06285254	-117.20178	San Bernardino County
158657	Fee-for-Service	1407885577	1407885577	1	1	ARTAVIA, LUIS A MD	8/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	76188	01	General Practice	0	In state provider	None	191 S BUENA VISTA ST	STE 420	BURBANK	CA	91505	4551	19	06037	34.15872557	-118.3283863	Los Angeles County
158683	Fee-for-Service	1518075449	1518075449	1	1	AMERICAN MEDICAL RESPONSE	1/1/1999	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	OF INLAND EMPIRE	7925 CENTER AVE	None	RANCHO CUCAMONGA	CA	91730	3007	36	06071	34.110459	-117.579066	San Bernardino County
158704	Fee-for-Service	1982960126	1982960126	1	1	AYOUB, CHRISTINE A DO	7/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14564	05	Anesthesiology	0	In state provider	None	1100 WEST STEWART DRIVE	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
158717	Fee-for-Service	1376055673	1376055673	1	1	ABBA HOSPICE INC	12/12/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11030 ARROW ROUTE	SUITE 211	RANCHO CUCAMONGA	CA	91730	4837	36	06071	34.0991145	-117.563265	San Bernardino County
158734	Fee-for-Service	1639356678	1639356678	1	1	AKABIKE, NKIRUKA J MD	12/8/2008	207R00000X	NA	Other	026	PHYSICIANS	103055	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
158770	Fee-for-Service	1538409818	1538409818	1	1	ADVENTIST HEALTH PHYSICIANS	5/23/2013	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	18990 COYOTE VALLEY RD	STE 8	HIDDEN VALLEY LKE	CA	85467	8339	17	06033	38.79462138	-122.5574782	Lake County
158771	Fee-for-Service	1811347511	1811347511	1	1	AGAFONOFF, STEVEN S	6/27/2024	208600000X	NA	General Surgery	026	PHYSICIANS	22729	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
158775	Fee-for-Service	1922175892	1922175892	1	1	AMELI, NADER DO	12/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8901	18	Ophthalmology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
158781	Fee-for-Service	1275241986	1275241986	1	1	ABOUELJOUD, ROLA PT	12/16/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
158782	Fee-for-Service	1477850568	1477850568	1	1	ADVENTIST HEALTH PHYSICIANS	3/30/2011	207Y00000X	NA	ENT/Otolaryngology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1485 MAIN ST	STE 101	ST HELENA	CA	94574	1850	28	06055	38.50614525	-122.4718005	Napa County
158803	Fee-for-Service	1235515586	1235515586	1	1	AHLUWALIA, AMRIT S MD	10/14/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	173095	None	None	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
158810	Fee-for-Service	1578814638	1578814638	2	1	A SPRIT OF SUPPORT, INC	5/8/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	425 W BONITA AVE	STE 209	SAN DIMAS	CA	91773	2542	19	06037	34.10669347	-117.814932	Los Angeles County
158830	Fee-for-Service	1689137226	1689137226	1	1	ABLE, BRANDEE N LCSW	2/28/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
158844	Fee-for-Service	1033492194	1033492194	1	1	ARRINGTON, HEATHER M LMFT	8/21/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
158850	Fee-for-Service	1891027314	1891027314	1	1	ALCANTAR, SANDY LCSW	8/20/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25 S RAYMOND AVE	STE 201	ALHAMBRA	CA	91801	7143	19	06037	34.09042452	-118.1450725	Los Angeles County
158878	Fee-for-Service	1326417916	1326417916	1	1	ANGELI, DANIEL G MD	7/23/2020	207R00000X	NA	Other	026	PHYSICIANS	168749	41	Internal Medicine	0	In state provider	None	1498 SOUTHGATE AVE	STE 102	DALY CITY	CA	94015	4015	41	06081	37.67558947	-122.4761175	San Mateo County
158896	Fee-for-Service	1366785842	1366785842	1	1	ARDENT HOSPICE OF THE	7/13/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	DESERT INC	1750 E. ARENAS RD.	STE 21	PALM SPRINGS	CA	92262	7137	33	06065	33.8214229	-116.5268939	Riverside County
158936	Fee-for-Service	1417445537	1417445537	1	1	ALVAREZ, KIMBERLY J LCSW	5/3/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
158957	Fee-for-Service	1336535897	1336535897	1	1	ANDERSON, TRAVIS J MD	6/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
158973	Fee-for-Service	1033275243	1033275243	1	1	AMADOR CO OFFICE OF EDU	4/25/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	SPECIAL ED	217 REX AVE	None	JACKSON	CA	95642	2020	03	06005	38.35258503	-120.7772118	Amador County
158996	Fee-for-Service	1609067719	1609067719	1	1	APALARA, JELILI A MD	2/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	102070	38	Geriatrics	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
159007	Fee-for-Service	1376055673	1376055673	1	1	ABBA HOSPICE INC	12/12/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11030 ARROW ROUTE	SUITE 211	RANCHO CUCAMONGA	CA	91730	4837	36	06071	34.0991145	-117.563265	San Bernardino County
159044	Fee-for-Service	1033241633	1033241633	1	1	ALAMEDA HEALTH SYSTEM	7/1/1998	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	664 SOUTHLAND MALL	None	HAYWARD	CA	94545	2150	01	06001	37.64923768	-122.1020017	Alameda County
159098	Fee-for-Service	1578814638	1578814638	2	1	A SPRIT OF SUPPORT, INC	5/8/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	425 W BONITA AVE	STE 209	SAN DIMAS	CA	91773	2542	19	06037	34.10669347	-117.814932	Los Angeles County
159105	Fee-for-Service	1114429503	1114429503	1	1	ALVAREZ, SYLVIA L	1/12/2021	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
159108	Fee-for-Service	1215596903	1215596903	1	1	AAA PHARMACY	9/9/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11234 LAUREL CANYON BLVD	None	SAN FERNANDO	CA	91340	4312	19	06037	34.274246	-118.448563	Los Angeles County
159148	Fee-for-Service	1649308149	1649308149	1	1	ASHORI, MOHAMMAD MD	6/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97831	None	None	0	In state provider	None	1920 COLORADO AVE	None	SANTA MONICA	CA	90404	7002	19	06037	34.02564555	-118.477319	Los Angeles County
159157	Fee-for-Service	1285660233	1285660233	1	1	ALONZO-DOWALTER, JENNIFE	1/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96391	41	Internal Medicine	0	In state provider	H MD	225 N JACKSON AVE	# AC	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
159165	Fee-for-Service	1750931937	1750931937	1	1	ATHENA CARE INC	9/16/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7636 N INGRAM AVE	SUITE 107	FRESNO	CA	93711	6200	10	06019	36.84906	-119.801783	Fresno County
159170	Fee-for-Service	1689931644	1689931644	1	1	ABDEL MESSEH, HANY MD	7/28/2023	207R00000X	NA	Other	026	PHYSICIANS	162148	None	None	0	In state provider	None	1206 AVENUE J	STE 100	LANCASTER	CA	93534	2956	19	06037	34.68937853	-118.1525805	Los Angeles County
159175	Fee-for-Service	1992754832	1992754832	1	1	ABESAMIS, WILFREDO R MD	4/29/2011	207R00000X	NA	Other	026	PHYSICIANS	52129	41	Internal Medicine	0	In state provider	None	6386 ALVARADO CT	STE 310	SAN DIEGO	CA	92120	4908	37	06073	32.77666838	-117.0614255	San Diego County
159232	Fee-for-Service	1285682377	1285682377	1	1	ANDERSON, JON E MD	7/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54010	30	Radiology	0	In state provider	None	2800 L STREET	STE 610	SACRAMENTO	CA	95816	5126	34	06067	38.571237	-121.469958	Sacramento County
159246	Fee-for-Service	1295798692	1295798692	1	1	ALBERT HUANG, M.D.	4/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8900 VAN WYCK EXPY	None	JAMAICA	NY	11418	2832	00	None	40.700268	-73.8157905	Queens County
159280	Fee-for-Service	1790945632	1790945632	1	1	A-ONE MEDICAL GROUP INC	9/23/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	7715	08	Family Practice	0	In state provider	None	1818 SIERRA LEONE AVE	STE B	ROWLAND HEIGHTS	CA	91748	3691	19	06037	33.98551218	-117.9014341	Los Angeles County
159284	Fee-for-Service	1609067719	1609067719	1	1	APALARA, JELILI A MD	2/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	102070	41	Internal Medicine	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
159288	Fee-for-Service	1558823674	1558823674	1	1	ABEBE, BEZA	8/17/2023	207P00000X	NA	Other	026	PHYSICIANS	180660	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
159297	Fee-for-Service	1417576638	1417576638	1	1	ALBRECHTSEN, CORY DO	3/19/2025	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	1093 ROYAL COURT	None	MEDFORD	OR	97504	8383	00	None	42.34017467	-122.8666022	Jackson County
159312	Fee-for-Service	1821462771	1821462771	1	1	ALARCON, HEYZEL F LMFT	12/4/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
159316	Fee-for-Service	1518565704	1518565704	1	1	ANGEL LOVE HOSPICE INC	8/24/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	20847 SHERMAN WAY	STE 246	WINNETKA	CA	91306	2706	19	06037	34.2011495	-118.587888	Los Angeles County
159331	Fee-for-Service	1033241633	1033241633	1	1	ALAMEDA HEALTH SYSTEM	7/1/1998	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	664 SOUTHLAND MALL	None	HAYWARD	CA	94545	2150	01	06001	37.64923768	-122.1020017	Alameda County
159356	Fee-for-Service	1619636065	1619636065	1	1	ALAYNA PUCCINELLI DPM PC	9/26/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	E	340 4TH AVE	STE 6	CHULA VISTA	CA	91910	3813	37	06073	32.63831293	-117.0833536	San Diego County
159365	Fee-for-Service	1154384105	1154384105	1	1	AKHAVAN, DANIEL A MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	72347	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	8135 PAINTER AVE	STE 102	WHITTIER	CA	90602	3157	19	06037	33.965829	-118.032738	Los Angeles County
159366	Fee-for-Service	1912344342	1912344342	1	1	ADY, KAREN E CNM	3/12/2021	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
159375	Fee-for-Service	1003968017	1003968017	1	1	ADVANCED EYE MEDICAL GROUP	1/3/2017	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	APC	26701 CROWN VALLEY PKWY	None	MISSION VIEJO	CA	92691	6356	30	06059	33.56398525	-117.6644458	Orange County
159397	Fee-for-Service	1013379031	1013379031	1	1	ALVAREZ, SERGIO MD	1/2/2020	207P00000X	NA	Other	026	PHYSICIANS	154322	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1038 E BROKAW ROAD	SUITE 30	SAN JOSE	CA	95131	2309	43	06085	37.3827822	-121.8982439	Santa Clara County
159458	Fee-for-Service	1831414556	1831414556	1	1	AHMAD, SYED S MD	7/11/2017	207P00000X	NA	Other	026	PHYSICIANS	144724	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92193	2410	37	06073	32.7537975	-117.1658298	San Diego County
159466	Fee-for-Service	1346325016	1346325016	1	1	ASGEDOM, MEHERET M	12/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78504	41	Internal Medicine	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
159488	Fee-for-Service	1689878852	1689878852	1	1	AHDOOT, JACOB J MD	11/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98763	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
159497	Fee-for-Service	1760604979	1760604979	1	2	AKBARPOUR, BEHDAD MD	6/26/2023	207R00000X	NA	Other	026	PHYSICIANS	77153	None	None	0	In state provider	None	22 ODYSSEY	STE 240	IRVINE	CA	92618	7700	30	06059	33.66719598	-117.7642461	Orange County
159506	Fee-for-Service	1780411504	1780411504	1	1	ANDY, CHAD NP	1/22/2025	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
159516	Fee-for-Service	1669111365	1669111365	1	1	AMPLA HEALTH	6/16/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	355 SAMUEL DR	None	YUBA CITY	CA	95991	6324	51	06101	39.12322541	-121.6100736	Sutter County
159547	Fee-for-Service	1528518537	1528518537	2	1	ADVANCED INVESTMENT GROUP	4/22/2019	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	17155 NEWHOPE ST	STE G	FOUNTAIN VALLEY	CA	92708	4232	30	06059	33.71537063	-117.9284822	Orange County
159556	Fee-for-Service	1811178981	1811178981	1	1	AJEET R SINGHVI, MD	12/17/1996	207RG0100X	NA	Gastroenterology	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	397 N SAN JACINTO ST	None	HEMET	CA	92543	3118	33	06065	33.752808	-116.9586855	Riverside County
159566	Fee-for-Service	1922611870	1922611870	1	1	ALL STAR HOSPICE CARE INC	7/27/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	7100 HAYVENHURST AVE	SUITE 320	VAN NUYS	CA	91406	3849	19	06037	34.199064	-118.4923845	Los Angeles County
159581	Fee-for-Service	1578899662	1578899662	1	1	ALEXANDER, MATTHEW D MD	4/22/2015	2085R0204X	NA	Other	026	PHYSICIANS	113572	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
159605	Fee-for-Service	1518565704	1518565704	1	1	ANGEL LOVE HOSPICE INC	8/24/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	20847 SHERMAN WAY	STE 246	WINNETKA	CA	91306	2706	19	06037	34.2011495	-118.587888	Los Angeles County
159606	Fee-for-Service	1821123456	1821123456	1	1	ABOUKHALIL, NASSER	10/7/1997	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	785 OAK GROVE RD	STE G2	CONCORD	CA	94518	3605	07	06013	37.93740134	-122.0238783	Contra Costa County
159610	Fee-for-Service	1801057633	1801057633	1	1	AMENHOTEP, ZANE D MD	12/12/2018	207ZP0102X	NA	Other	026	PHYSICIANS	98298	22	Pathology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
159631	Fee-for-Service	1306835848	1306835848	1	1	ADVANI, SHARMEELA R MD	1/25/2008	174400000X	NA	Other	026	PHYSICIANS	101674	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10200 SEPULVEDA BLVD	SUITE 200	MISSION HILLS	CA	91345	2657	19	06037	34.25572562	-118.4673156	Los Angeles County
159635	Fee-for-Service	1083835920	1083835920	1	1	ANESTHESIA MEDICAL	9/25/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	ASSOCIATES OF LAKEWOOD	3700 SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.86019848	-118.148166	Los Angeles County
159697	Fee-for-Service	1922196583	1922196583	1	1	ADAIR, BRIAN LCSW	1/22/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	21180	-	NOT APPLICABLE	0	In state provider	None	2521 LONG BEACH AVE	None	LOS ANGELES	CA	90058	1324	19	06037	34.01372454	-118.2432255	Los Angeles County
159733	Fee-for-Service	1285307561	1285307561	1	1	ARBELOS GENOMICS INC	7/6/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	13768 ROSWELL AVE	STE 121	CHINO	CA	91710	1404	36	06071	34.0038	-117.7218555	San Bernardino County
159739	Fee-for-Service	1982784047	1982784047	1	1	ALBERS, C GREGORY MD	11/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	65553	10	Gastroenterology (M.D. only)	0	In state provider	None	1201 W LAMBERT RD	None	LA HABRA	CA	90631	6614	30	06059	33.92469151	-117.9595485	Orange County
159757	Fee-for-Service	1760725568	1760725568	1	1	ABSOLUTE HOSPICE &	8/7/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE, INC	17215 STUDEBAKER RD	SUITE 215	CERRITOS	CA	90703	2548	19	06037	33.874686	-118.0998595	Los Angeles County
159765	Fee-for-Service	1457334344	1457334344	1	1	AIDS HEALTHCARE	4/28/2009	261QH0100X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	FOUNDATION	1025 HOWARD ST	None	SAN FRANCISCO	CA	94103	2823	38	06075	37.77917967	-122.4078176	San Francisco County
159823	Fee-for-Service	1013029586	1013029586	1	1	AGGARWAL, SHELLEY MD	9/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90889	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
159853	Fee-for-Service	1922611870	1922611870	1	1	ALL STAR HOSPICE CARE INC	7/27/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	7100 HAYVENHURST AVE	SUITE 320	VAN NUYS	CA	91406	3849	19	06037	34.199064	-118.4923845	Los Angeles County
159854	Fee-for-Service	1477175321	1477175321	1	1	ASHRAF, JAHANZEB MD	4/1/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	182981	None	None	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
159920	Fee-for-Service	1851777999	1851777999	1	1	ANDERSON, KELLEY E PSYD	5/21/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
159947	Fee-for-Service	1265488266	1265488266	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2899 JAMACHA RD	None	EL CAJON	CA	92019	4397	37	06073	32.74085921	-116.9385361	San Diego County
159980	Fee-for-Service	1740783570	1740783570	1	1	AINTABLIAN, HAIG K MD	3/16/2022	207P00000X	NA	Other	026	PHYSICIANS	163924	None	None	0	In state provider	None	757 WESTWOOD PLAZA	STE 1517	LOS ANGELES	CA	90095	7402	19	06037	34.06633051	-118.4452686	Los Angeles County
160023	Fee-for-Service	1275632887	1275632887	1	2	AGARWAL, DIMPLE MD	4/29/2021	207R00000X	NA	Other	086	MEDICAL DIRECTORS	66261	-	NOT APPLICABLE	0	In state provider	None	81709 DR CARREON BLVD	B1	INDIO	CA	92201	5510	33	06065	33.70733082	-116.2400326	Riverside County
160032	Fee-for-Service	1689978991	1689978991	1	1	ALEXANDER, SANDRA A	12/26/2013	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
160044	Fee-for-Service	1760725568	1760725568	1	1	ABSOLUTE HOSPICE &	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE, INC	17215 STUDEBAKER RD	SUITE 215	CERRITOS	CA	90703	2548	19	06037	33.874686	-118.0998595	Los Angeles County
160054	Fee-for-Service	1457334344	1457334344	1	1	AIDS HEALTHCARE	4/28/2009	261QH0100X	NA	Other	022	PHYSICIANS GROUP	-	77	Infectious Disease	0	In state provider	FOUNDATION	1025 HOWARD ST	None	SAN FRANCISCO	CA	94103	2823	38	06075	37.77917967	-122.4078176	San Francisco County
160066	Fee-for-Service	1780456194	1780456194	1	1	ALVAREZ, JOE CRNA	5/23/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
160076	Fee-for-Service	1568702017	1568702017	1	1	AFFILIATED PATHOLOGISTS OF	4/5/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	THE CENTRAL COAST	1010 MURRAY AVE	None	SAN LUIS OBISPO	CA	93405	1806	40	06079	35.292168	-120.6658665	San Luis Obispo County
160116	Fee-for-Service	1982009205	1982009205	1	1	ARATA, MICHAEL A MD PC	12/21/2015	2085R0204X	NA	Other	026	PHYSICIANS	70967	None	None	0	In state provider	None	4501 BIRCH ST	None	NEWPORT BEACH	CA	92660	1990	30	06059	33.66902484	-117.8655315	Orange County
160148	Fee-for-Service	1952936395	1952936395	1	1	ASMB LLC	10/1/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2021 ARIZONA AVE	None	SANTA MONICA	CA	90404	1335	19	06037	34.03058142	-118.4809897	Los Angeles County
160175	Fee-for-Service	1134390990	1134390990	1	1	ALGARIN, MICHELLE M MD INC	2/11/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	85189	None	None	0	In state provider	None	23961 MAGDALENA	STE 520	LAGUNA HILLS	CA	92653	7622	30	06059	33.60918911	-117.7104355	Orange County
160192	Fee-for-Service	1659344158	1659344158	1	1	APIDES, JOEL M MD	11/26/2018	2084N0400X	NA	Neurology	026	PHYSICIANS	50998	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
160220	Fee-for-Service	1730640707	1730640707	1	1	ANDERSON, KATHRYN L MD	9/27/2022	207P00000X	NA	Other	026	PHYSICIANS	177926	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
160235	Fee-for-Service	1295267714	1295267714	1	1	AHMAD, MELEHA T MD	6/8/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	172879	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
160237	Fee-for-Service	1376610287	1376610287	1	1	AMIS, MARILYN MD	7/31/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60948	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
160256	Fee-for-Service	1588643217	1588643217	1	1	AYERS, KATHLEEN M PSYD	3/29/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1353	34	06067	38.555631	-121.459203	Sacramento County
160263	Fee-for-Service	1477717338	1477717338	1	1	ASH, ADAM P MD	1/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	104624	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
160271	Fee-for-Service	1033278783	1033278783	1	1	APARICIO, ALFREDO C MD	10/31/1993	208800000X	NA	Other	026	PHYSICIANS	68734	34	Urology and Urological Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
160277	Fee-for-Service	1609959683	1609959683	1	1	ANNUNZIATA, JENNIFER E MD	1/21/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	73165	-	NOT APPLICABLE	0	In state provider	None	1601 QUESADA AVENUE	None	SAN FRANCISCO	CA	94124	2334	38	06075	37.73238125	-122.3898116	San Francisco County
160290	Fee-for-Service	1013116714	1013116714	1	1	ALJAWADI, GEORGIA DO	3/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	11376	08	Family Practice	0	In state provider	None	480 FOURTH AVENUE	STE 202	CHULA VISTA	CA	91910	4412	37	06073	32.63411298	-117.0816772	San Diego County
160320	Fee-for-Service	1447817887	1447817887	1	1	ANEM, GAUTAM MD	12/20/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	188324	None	None	0	In state provider	None	11878 AVENUE OF INDUSTRY	None	SAN DIEGO	CA	92128	3423	37	06073	32.99058739	-117.0752486	San Diego County
160326	Fee-for-Service	1669585618	1669585618	1	1	ABID HUSAIN MD	4/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	65 JAMES ST	None	EDISON	NJ	08820	3947	00	None	40.55777412	-74.35056125	Middlesex County
160400	Fee-for-Service	1720422736	1720422736	1	1	ATHER, NIMAH MD	6/5/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	134980	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
160403	Fee-for-Service	1144648262	1144648262	1	1	ATCHABAHIAN, LARA MD	10/12/2017	207R00000X	NA	Other	026	PHYSICIANS	138400	41	Internal Medicine	0	In state provider	None	938 N CHERRY ST	None	VISALIA	CA	93274	2210	54	06107	36.221211	-119.337643	Tulare County
160405	Fee-for-Service	1669959086	1669959086	1	1	ASTON, PETER PSYD	9/21/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
160412	Fee-for-Service	1942883798	1942883798	1	2	ALIGN MEDICAL GROUP INC	6/3/2024	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	18419 US HIGHWAY 18	STE 6	APPLE VALLEY	CA	92307	2333	36	06071	34.53946944	-117.2621779	San Bernardino County
160417	Fee-for-Service	1306574116	1306574116	1	1	ADVENTIST HEALTH PHYSICIANS	4/13/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1100 TRANCAS ST	STE 240	NAPA	CA	94558	2900	28	06055	38.32316569	-122.2981938	Napa County
160437	Fee-for-Service	1265461081	1265461081	1	1	AHANGAR, BRIAN A MD APC	10/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	81555	25	Physical Medicine and Rehabilitation	0	In state provider	None	2625 E 4TH ST	None	LONG BEACH	CA	90814	1205	19	06037	33.77172202	-118.1604351	Los Angeles County
160438	Fee-for-Service	1255388054	1255388054	1	1	AMBEKAR, ANJALI MD	8/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	109721	78	Neoplastic Diseases/Oncology	0	In state provider	None	7130 N MILLBROOK	STE 100	FRESNO	CA	93720	3347	10	06019	36.83832032	-119.7632391	Fresno County
160453	Fee-for-Service	1619451184	1619451184	1	1	ALGOS INC., A MEDICAL CORPOR	11/29/2021	103TB0200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1125 E 17TH ST	UNIT N-452	SANTA ANA	CA	92701	2201	30	06059	33.76004145	-117.854838	Orange County
160460	Fee-for-Service	1053486605	1053486605	1	1	ALLAM, AFDAL I MD	11/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	41057	08	Family Practice	0	In state provider	None	8970 WARNER AVE	None	FOUNTAIN VALLEY	CA	92708	3211	30	06059	33.71571347	-117.972747	Orange County
160506	Fee-for-Service	1457687642	1457687642	1	1	ALSTON, RAKHEE LMFT	7/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15335 MORRISON ST	STE 205	SHERMAN OAKS	CA	91403	1585	19	06037	34.16081721	-118.4680458	Los Angeles County
160523	Fee-for-Service	1962607697	1962607697	1	1	ALORE, PATRICK L MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121139	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
160541	Fee-for-Service	1467744367	1467744367	1	1	AMWEST INC	12/21/2012	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	13257 SATICOY ST	None	NORTH HOLLYWOOD	CA	91605	3401	19	06037	34.20811942	-118.4218375	Los Angeles County
160542	Fee-for-Service	1669691507	1669691507	1	1	ARVIDSON, TODD LMFT	2/22/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	251 AUBURN RAVINE RD	210	AUBURN	CA	95603	3719	31	06061	38.90561908	-121.0746639	Placer County
160576	Fee-for-Service	1649273475	1649273475	1	1	ALLAMA, CHRISTEN MD	11/1/1998	207W00000X	NA	Ophthalmology	026	PHYSICIANS	82234	18	Ophthalmology	0	In state provider	None	1665 DOMINICAN WAY	None	SANTA CRUZ	CA	95065	1528	44	06087	36.99032886	-121.9811968	Santa Cruz County
160603	Fee-for-Service	1013141753	1013141753	1	1	ASAY, DANIEL B MD	6/13/2022	207L00000X	NA	Other	026	PHYSICIANS	176738	None	None	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
160613	Fee-for-Service	1225234974	1225234974	1	1	ANWAR, GUL I MD	10/14/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	109555	08	Family Practice	0	In state provider	None	1041 N CHINA LAKE BLVD	STE B	RIDGECREST	CA	93555	3183	15	06029	35.63953945	-117.669891	Kern County
160652	Fee-for-Service	1871855940	1871855940	1	1	ANDREWS, ANNE H NP	10/27/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
160688	Fee-for-Service	1043538085	1043538085	1	1	ANZALONE, SUSAN P MD	7/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130690	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
160689	Fee-for-Service	1720422736	1720422736	1	1	ATHER, NIMAH MD	6/5/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	134980	10	Gastroenterology (M.D. only)	0	In state provider	None	200 MED PLAZA	#365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
160699	Fee-for-Service	1942883798	1942883798	1	2	ALIGN MEDICAL GROUP INC	6/3/2024	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	18419 US HIGHWAY 18	STE 6	APPLE VALLEY	CA	92307	2333	36	06071	34.53946944	-117.2621779	San Bernardino County
160702	Fee-for-Service	1922284017	1922284017	1	1	AUNE, BETH OT	12/28/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	77564 COUNTRY CLUB DR.	SUITE 401B	PALM DESERT	CA	92211	6246	33	06065	33.75833451	-116.3114325	Riverside County
160722	Fee-for-Service	1487697736	1487697736	1	1	ABHYANKAR, STELLA S MD	2/11/2011	207R00000X	NA	Other	026	PHYSICIANS	114160	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
160728	Fee-for-Service	1801059860	1801059860	1	1	ATHANASIOU, NICHOLAS A MD	2/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	110558	36	Psychiatry	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
160733	Fee-for-Service	1144251497	1144251497	1	1	ANG, ROGER	6/6/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	62536	08	Family Practice	0	In state provider	None	411 4TH ST	None	WHEATLAND	CA	95692	9467	58	06115	39.01085205	-121.4234151	Yuba County
160742	Fee-for-Service	1619451184	1619451184	1	1	ALGOS INC., A MEDICAL CORPOR	12/13/2018	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	1125 E 17TH ST	UNIT N-452	SANTA ANA	CA	92701	2201	30	06059	33.76004145	-117.854838	Orange County
160754	Fee-for-Service	1225433493	1225433493	1	1	ALHARBI, OMAR MD	4/24/2024	282N00000X	NA	Hospitals	026	PHYSICIANS	148217	10	Gastroenterology (M.D. only)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
160762	Fee-for-Service	1699192930	1699192930	1	1	AZUL, JAMESON MD	10/28/2019	207R00000X	NA	Other	026	PHYSICIANS	149442	67	Endocrinology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
160770	Fee-for-Service	1982009007	1982009007	1	1	ABANOBI, NKEIRUKA I NP	3/9/2022	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4760 SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09811852	-118.293408	Los Angeles County
160836	Fee-for-Service	1962405456	1962405456	1	1	AGER, PHYLLIS J MD	8/26/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	21590	30	Radiology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
160887	Fee-for-Service	1881679967	1881679967	1	1	AVILA, ROBERT A	6/28/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	15446 S WESTERN AVENUE	None	GARDENA	CA	90249	4319	19	06037	33.89042107	-118.3091303	Los Angeles County
160888	Fee-for-Service	1255387338	1255387338	1	1	AFKARIAN, MARYAM MD	1/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146013	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
160905	Fee-for-Service	1467526707	1467526707	1	1	ATG REHAB SPECIALISTS INC.	1/24/2000	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ATG REHAB	446 WESTRIDGE DR	None	WATSONVILLE	CA	95076	4159	44	06087	36.91145639	-121.7834839	Santa Cruz County
160970	Fee-for-Service	1528415957	1528415957	1	1	AIC HEALTH CARE INC	6/26/2018	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	27489 PORTSMOUTH AVE	None	HAYWARD	CA	94545	4014	01	06001	37.6263479	-122.1037188	Alameda County
160985	Fee-for-Service	1528352481	1528352481	1	1	ANDERSON, DANIELLE NICOLE MD	4/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146469	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2601 W ALAMEDA AVE	STE 212	BURBANK	CA	91505	4814	19	06037	34.15783817	-118.3293969	Los Angeles County
160996	Fee-for-Service	1316088479	1316088479	1	1	ARROYO VISTA FAMILY	11/21/2001	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	4815 VALLEY BLVD	STE C	LOS ANGELES	CA	90032	3300	19	06037	34.06646275	-118.1795291	Los Angeles County
161010	Fee-for-Service	1699716100	1699716100	1	1	AGRON, MICHAEL S MD INC	11/30/1989	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
161011	Fee-for-Service	1639155880	1639155880	1	1	ASHLEY, JEFF L MD INC	4/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	30335	07	Dermatology	0	In state provider	None	2625 W ALAMEDA AVE	STE 517	BURBANK	CA	91505	4817	19	06037	34.1577056	-118.329779	Los Angeles County
161030	Fee-for-Service	1619451184	1619451184	1	1	ALGOS INC., A MEDICAL CORPOR	12/13/2018	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	1125 E 17TH ST	UNIT N-452	SANTA ANA	CA	92701	2201	30	06059	33.76004145	-117.854838	Orange County
161034	Fee-for-Service	1700048147	1700048147	1	1	AHMAD HASSAN ALI, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 S COULTER ST	None	AMARILLO	TX	79106	1770	00	None	35.200053	-101.921862	Potter County
161069	Fee-for-Service	1982857520	1982857520	1	1	ARAGUAS, ROSARIO DPM	9/8/2010	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	4231 HWY 86	STE 5	BRAWLEY	CA	92227	9648	13	06025	32.95825939	-115.551562	Imperial County
161084	Fee-for-Service	1194106526	1194106526	1	1	ALAN, NIMA MD	7/11/2023	207T00000X	NA	General Surgery	026	PHYSICIANS	185726	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
161086	Fee-for-Service	1285392621	1285392621	1	1	AURAN, DEBORAH	9/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
161098	Fee-for-Service	1275575466	1275575466	1	1	ATTIA, LAWRENCE A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	350 W 58TH ST	None	NEW YORK	NY	10019	1859	00	None	40.768137	-73.984455	New York County
161117	Fee-for-Service	1376968933	1376968933	1	1	AYALA, YOVANI S LCSW	1/5/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
161129	Fee-for-Service	1639167158	1639167158	1	1	ARAIN, MOHAMMAD A MD	12/26/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	38905	41	Internal Medicine	0	In state provider	None	1505 SHEPARD DR	STE 104	SANTA MARIA	CA	93454	7016	42	06083	34.93433773	-120.4213014	Santa Barbara County
161140	Fee-for-Service	1487087136	1487087136	1	1	ANESTHESIA MEDICAL GROUP OF	11/13/2013	207LP2900X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	IMPERIAL VALLEY INC	207 W LEGION	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
161153	Fee-for-Service	1083671010	1083671010	1	1	AFTAB, AMIR MD	9/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1707 W CHARLESTON BLVD	STE 230	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
161169	Fee-for-Service	1144235698	1144235698	1	1	APFELDORF, WILLIAM MD	10/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
161175	Fee-for-Service	1255387338	1255387338	1	1	AFKARIAN, MARYAM MD	1/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146013	45	Nephrology (Renal-Kidney)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
161208	Fee-for-Service	1598062176	1598062176	1	1	ANOTHER CHOICE ANOTHER	1/30/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	CHANCE	8401 GERBER ROAD	ROOM 1	SACRAMENTO	CA	95828	3711	34	06067	38.482884	-121.393197	Sacramento County
161245	Fee-for-Service	1619119278	1619119278	1	1	AKE, CHRISTOPHER D DO	9/24/2020	207ZP0102X	NA	Other	026	PHYSICIANS	11579	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
161261	Fee-for-Service	1043546625	1043546625	1	1	ALLEN, EMILE A MD	7/14/2021	163WG0000X	NA	Other	026	PHYSICIANS	63769	None	None	0	In state provider	None	6955 FOOTHILL BLVD	67A	OAKLAND	CA	94605	2455	01	06001	37.76924146	-122.1732586	Alameda County
161273	Fee-for-Service	1750895496	1750895496	1	1	AMORE HOSPICE INC	9/15/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2648 INTERNATIONAL BLVD	301	OAKLAND	CA	94601	1506	01	06001	37.78093454	-122.231728	Alameda County
161276	Fee-for-Service	1629512595	1629512595	1	1	AHI VEIN AND VASCULAR	8/9/2017	2085R0204X	NA	Other	026	PHYSICIANS	141267	30	Radiology	0	In state provider	SPECIALISTS INC, A PROFE	2125 S EL CAMINO REAL	SUITE 210	OCEANSIDE	CA	92054	6260	37	06073	33.18895278	-117.3283467	San Diego County
161286	Fee-for-Service	1316088479	1316088479	1	1	ARROYO VISTA FAMILY	12/1/2001	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	4815 VALLEY BLVD	STE C	LOS ANGELES	CA	90032	3300	19	06037	34.06646275	-118.1795291	Los Angeles County
161310	Fee-for-Service	1033539903	1033539903	1	1	AMIT S KAINTH	4/5/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3355 RIVERBEND DR	STE 300	SPRINGFIELD	OR	97477	8800	00	None	44.08239413	-123.0281717	Lane County
161327	Fee-for-Service	1831258540	1831258540	1	1	ARAKAKI, CATHERINE T OD	12/26/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9333 E ROSECRANS AVE	None	BELLFLOWER	CA	90706	2141	19	06037	33.90413858	-118.1346616	Los Angeles County
161345	Fee-for-Service	1982135208	1982135208	1	1	ALAVERDYAN, ARTUR MD	6/28/2021	207R00000X	NA	Other	026	PHYSICIANS	166071	None	None	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
161403	Fee-for-Service	1215350780	1215350780	1	1	AZMAT, AFSHEEN MD	8/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133072	41	Internal Medicine	0	In state provider	None	ONE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
161407	Fee-for-Service	1366774655	1366774655	1	1	ARORA, SAMEER MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114448	41	Internal Medicine	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
161423	Fee-for-Service	1134410376	1134410376	1	1	ALI, HIRRA MD	8/1/2022	2086X0206X	NA	General Surgery	026	PHYSICIANS	144216	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
161427	Fee-for-Service	1487087136	1487087136	1	1	ANESTHESIA MEDICAL GROUP OF	6/30/2017	207LP2900X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	IMPERIAL VALLEY INC	207 W LEGION	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
161473	Fee-for-Service	1871927673	1871927673	1	1	ALEMAN-NESEL, JACQUELINE LC	2/23/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SW	16800 DEVONSHIRE ST	212	GRANADA HILLS	CA	91344	7403	19	06037	34.25745651	-118.4982159	Los Angeles County
161476	Fee-for-Service	1902995962	1902995962	2	1	ANTIOCH MEDICAL & HOSPITAL S	12/2/2014	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	SUPPLY INC	601 W 2ND ST	None	ANTIOCH	CA	94509	1255	07	06013	38.01687633	-121.8139759	Contra Costa County
161480	Fee-for-Service	1538111661	1538111661	1	1	AULUCK HARINDER J.S. MD	5/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	42771	36	Psychiatry	0	In state provider	None	1440 MILITARY W	STE 201C	BENICIA	CA	94510	2449	48	06095	38.06790605	-122.1823312	Solano County
161483	Fee-for-Service	1215207469	1215207469	1	1	ANNU G. SHARMA, M.D. INC.	2/17/2012	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	43676	40	Pediatrics	0	In state provider	None	15785 LAGUNA CANYON	STE 215	IRVINE	CA	92618	3165	30	06059	33.66542536	-117.7615537	Orange County
161523	Fee-for-Service	1154793586	1154793586	1	1	ABRAMSON, TIFFANY M R MD	4/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138494	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1500 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
161528	Fee-for-Service	1801891809	1801891809	1	1	ASANTE THREE RIVERS	6/2/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	COMMUNITY HOSPITAL LLC	500 RAMSEY AVE	None	GRANTS PASS	OR	97527	5554	00	None	42.4198785	-123.3432318	Josephine County
161533	Fee-for-Service	1619119278	1619119278	1	1	AKE, CHRISTOPHER D DO	9/24/2020	207ZP0102X	NA	Other	026	PHYSICIANS	11579	22	Pathology (M.D. only)	0	In state provider	None	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
161562	Fee-for-Service	1750895496	1750895496	1	1	AMORE HOSPICE INC	9/15/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2648 INTERNATIONAL BLVD	301	OAKLAND	CA	94601	1506	01	06001	37.78093454	-122.231728	Alameda County
161573	Fee-for-Service	1316088479	1316088479	1	1	ARROYO VISTA FAMILY	12/1/2001	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	4815 VALLEY BLVD	STE C	LOS ANGELES	CA	90032	3300	19	06037	34.06646275	-118.1795291	Los Angeles County
161681	Fee-for-Service	1023021680	1023021680	1	1	ARNOLD, STEPHEN B MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	30250	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
161683	Fee-for-Service	1023797321	1023797321	1	1	AMPARANO, DOMINICK NP	1/5/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
161731	Fee-for-Service	1891795712	1891795712	1	1	AUKER, TODD A MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	57565	18	Ophthalmology	0	In state provider	None	2324 SANTA RITA RD	STE 7	PLEASANTON	CA	94566	4150	01	06001	37.68217511	-121.8757097	Alameda County
161816	Fee-for-Service	1801891809	1801891809	1	1	ASANTE THREE RIVERS	6/2/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	1	Border provider	COMMUNITY HOSPITAL LLC	500 RAMSEY AVE	None	GRANTS PASS	OR	97527	5554	00	None	42.4198785	-123.3432318	Josephine County
161914	Fee-for-Service	1740427657	1740427657	1	4	ALTAMED HEALTH SERVICES CORP	5/9/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2130 SOUTH RAITT STREET	None	SANTA ANA	CA	92704	5001	30	06059	33.717699	-117.896118	Orange County
161971	Fee-for-Service	1467485730	1467485730	1	1	AJAKWE, REGINALD C MD	9/12/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93702	05	Anesthesiology	0	In state provider	None	2701 W ALAMEDA AVE	STE 203	BURBANK	CA	91505	4406	19	06037	34.15751343	-118.3303715	Los Angeles County
161994	Fee-for-Service	1275795916	1275795916	1	1	ADHANOM, TEAMRAT A MD	9/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116667	41	Internal Medicine	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
161996	Fee-for-Service	1033387170	1033387170	1	1	ALIREZA, JAFARI MD INC	7/29/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49135	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	15141 E WHITTIER BLVD	STE 240	WHITTIER	CA	90603	2135	19	06037	33.94810044	-118.0039419	Los Angeles County
161997	Fee-for-Service	1467672907	1467672907	1	1	ALI, HARIS MD	8/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92960	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	STE 3150	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
162016	Fee-for-Service	1245702711	1245702711	1	1	AUSMUS, DONNA J DC	10/24/2022	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	20290 S EUCLID ST	104	ANAHEIM	CA	92802	3141	30	06059	33.79347	-117.941202	Orange County
162027	Fee-for-Service	1801821053	1801821053	1	1	ANDERSON, DEBORAH L CNM	12/6/2005	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1001 POTRERO AVE	RM 6D14	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
162030	Fee-for-Service	1124644752	1124644752	1	1	AHMAD, ABDEL KARIM MD	11/6/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191385	None	None	0	In state provider	None	4955 VAN NUYS BLVD	SUITE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
162080	Fee-for-Service	1285218024	1285218024	1	1	ABDELMALEK, MARIAN M MD	1/2/2025	207R00000X	NA	Other	026	PHYSICIANS	20418	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
162097	Fee-for-Service	1366258246	1366258246	1	1	ACKMAN, CATHERINE NP	4/11/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
162117	Fee-for-Service	1356351670	1356351670	1	1	ARA-YUBA CITY DIALYSIS	11/20/2001	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	LLC	2115 E ONSTOTT RD	None	YUBA CITY	CA	95991	1556	51	06101	39.16145541	-121.6346977	Sutter County
162127	Fee-for-Service	1164593323	1164593323	1	1	ADVANCED LUNG CENTER	3/22/1996	207RP1001X	NA	Pulmonology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP, INC	401 S LA BREA BLVD	SUITE 205	INGLEWOOD	CA	90301	2321	19	06037	33.95921962	-118.3533372	Los Angeles County
162128	Fee-for-Service	1932330073	1932330073	1	1	ANAND, AVNINDER S	4/15/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	939 ELLIS ST	None	SAN FRANCISCO	CA	94109	7714	38	06075	37.78368811	-122.4218578	San Francisco County
162129	Fee-for-Service	1497792204	1497792204	1	1	ASHLEY, EUAN A MD	6/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93502	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
162134	Fee-for-Service	1538109285	1538109285	1	1	ARMEN PHARMACY INC	7/29/1992	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ARMEN PHARMACY	1025 E BROADWAY	None	GLENDALE	CA	91205	1205	19	06037	34.14628746	-118.2421845	Los Angeles County
162155	Fee-for-Service	1285862011	1285862011	1	1	AREECKAL, SUSAN V MD	4/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147586	08	Family Practice	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
162161	Fee-for-Service	1295367399	1295367399	1	1	ABNOUS, NAYIRI A OD	10/11/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2619 E COLORADO BLVD	SUITE 150	PASADENA	CA	91107	3747	19	06037	34.14616014	-118.0964013	Los Angeles County
162179	Fee-for-Service	1285704106	1285704106	1	1	ATWILL, PEGGY J LMFT	12/13/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1110 CALIFORNIA BLVD	STE E	SAN LUIS OBISPO	CA	93401	2971	40	06079	35.2851605	-120.6536824	San Luis Obispo County
162181	Fee-for-Service	1487717278	1487717278	1	1	ASKEW, JAIME R LMFT	11/28/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
162201	Fee-for-Service	1740427657	1740427657	1	4	ALTAMED HEALTH SERVICES CORP	5/9/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2130 SOUTH RAITT STREET	None	SANTA ANA	CA	92704	5001	30	06059	33.717699	-117.896118	Orange County
162202	Fee-for-Service	1548339252	1548339252	1	1	ASCANIO, ROSANA LMFT	10/3/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1304 SOLANO AVE	None	ALBANY	CA	94706	1826	01	06001	37.89061138	-122.292565	Alameda County
162228	Fee-for-Service	1043211857	1043211857	1	1	ALWAYS HOME SERVICES	6/18/1992	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	7777 GREENBACK LANE	SUITE 208	CITRUS HEIGHTS	CA	95610	5800	34	06067	38.678868	-121.2777135	Sacramento County
162230	Fee-for-Service	1811561939	1811561939	1	1	ADAMS, MONET J RCP	6/4/2021	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
162269	Fee-for-Service	1518034412	1518034412	1	1	ATLURI,REVATI X MD	10/1/1998	207R00000X	NA	Other	026	PHYSICIANS	64873	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
162303	Fee-for-Service	1477877173	1477877173	1	1	ANAST, NICHOLAS W MD	7/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117621	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
162320	Fee-for-Service	1174535090	1174535090	1	1	ABBOTT, MAXWELL B. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 E BOULDER ST	None	COLORADO SPGS	CO	80909	5533	00	None	38.8388119	-104.7995065	El Paso County
162376	Fee-for-Service	1336829852	1336829852	1	1	ALPINE VIEW LODGE LLC	9/26/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	973 ARNOLD WAY	None	ALPINE	CA	91901	1106	37	06073	32.83552364	-116.7944519	San Diego County
162396	Fee-for-Service	1124405584	1124405584	1	1	APOLLO PHYSICIANS MEDICAL	3/27/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	GROUP	8191 TIMBERLAKE WAY	SUITE 200	SACRAMENTO	CA	95823	5418	34	06067	38.460222	-121.4131365	Sacramento County
162410	Fee-for-Service	1669733853	1669733853	1	1	ALBIN, LACEY LMFT	7/19/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
162429	Fee-for-Service	1811210941	1811210941	1	1	ADVANCED CARE EMERGENCY	11/4/2010	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	1	Border provider	SERVICES PLC	2735 SILVER CREEK RD	None	BULLHEAD CITY	AZ	86442	7924	00	None	35.110926	-114.5552445	Mohave County
162433	Fee-for-Service	1306296900	1306296900	1	1	AWAD, SHADI MD	12/1/2020	207R00000X	NA	Other	026	PHYSICIANS	169982	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
162468	Fee-for-Service	1407836935	1407836935	1	1	ATHALE, SANJEEV D MD	1/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114198	None	None	0	In state provider	None	1025 N DOUTY STREET	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
162479	Fee-for-Service	1154854826	1154854826	1	1	AHMED, SARAH R	4/23/2021	207R00000X	NA	Other	026	PHYSICIANS	161674	None	None	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
162533	Fee-for-Service	1669123626	1669123626	1	2	ADVANCED RADIOLOGY AND INTER	8/16/2022	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	VENTIONAL ASSOCIATES	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
162544	Fee-for-Service	1740773787	1740773787	1	1	AMEZCUA, MIGUEL DO	12/18/2022	207L00000X	NA	Other	026	PHYSICIANS	17655	None	None	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
162547	Fee-for-Service	1366185811	1366185811	1	1	ALWAYS CARE MEDICAL SUPPLY I	12/15/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	NC	863 SAN PABLO AVE	A	ALBANY	CA	94706	1683	01	06001	37.89048454	-122.2989907	Alameda County
162551	Fee-for-Service	1093825267	1093825267	1	1	APRIA HEALTHCARE LLC	8/12/2004	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	38444 SKY CANYON DR	STE 110	MURRIETA	CA	92563	2669	33	06065	33.56094815	-117.1357729	Riverside County
162561	Fee-for-Service	1255669495	1255669495	1	1	AMIRGHOLAMI, MAHIN MD INC	5/11/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	102266	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	23101 SHERMAN PLACE	SUITE 302	WEST HILLS	CA	91307	2047	19	06037	34.20099112	-118.6297991	Los Angeles County
162605	Fee-for-Service	1366590275	1366590275	1	1	ALEXANDER, LAWRENCE R MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71482	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
162606	Fee-for-Service	1265966113	1265966113	1	1	AHN, SUSIE MD	12/9/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	173255	None	None	0	In state provider	None	3624 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4006	07	06013	38.00418494	-121.8432075	Contra Costa County
162622	Fee-for-Service	1700985629	1700985629	1	1	ALULA, MAHLET MD	8/5/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79649	41	Internal Medicine	0	In state provider	None	2020 GENESEE AVE	None	SAN DIEGO	CA	92123	4219	37	06073	32.7921973	-117.1571251	San Diego County
162623	Fee-for-Service	1902079452	1902079452	1	1	ABLE PHYSICAL THERAPY CORP	9/16/2008	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1902 ROYALTY DRIVE	SUITE 170	POMONA	CA	91767	3030	19	06037	34.07791925	-117.746146	Los Angeles County
162637	Fee-for-Service	1992901383	1992901383	1	2	ATKINSON, CHERI V LCSW	2/21/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16702 CORAL CAY LN	None	HUNTINGTON BEACH	CA	92649	2907	30	06059	33.71943871	-118.0646512	Orange County
162658	Fee-for-Service	1265997936	1265997936	1	1	ANGIOLI, SHANDA PSYD	10/22/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2810 E DEL MAR BLVD	None	PASADENA	CA	91107	4320	19	06037	34.14212984	-118.092328	Los Angeles County
162685	Fee-for-Service	1124405584	1124405584	1	1	APOLLO PHYSICIANS MEDICAL	3/27/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	GROUP	8191 TIMBERLAKE WAY	SUITE 200	SACRAMENTO	CA	95823	5418	34	06067	38.460222	-121.4131365	Sacramento County
162716	Fee-for-Service	1558455956	1558455956	3	2	ADVANTAGE HEALTH CARE SERVIC	12/13/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8237 ROCHESTER AVE	#140	RANCHO CUCAMONGA	CA	91730	0717	36	06071	34.103952	-117.5435325	San Bernardino County
162767	Fee-for-Service	1154519072	1154519072	1	1	ADAMS, ELOA MD	5/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	91239	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
162782	Fee-for-Service	1366520272	1366520272	1	1	ARK, BELINDA C MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80820	68	Hematology	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
162783	Fee-for-Service	1952618324	1952618324	1	1	AGRAIT-BERTRAN, EDGARDO A MD	4/3/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	145606	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
162800	Fee-for-Service	1952076630	1952076630	1	1	ANTHONY MARTIN MILLS MD, A M	8/29/2024	207R00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	ICAL GROUP	8601 S BROADWAY	None	LOS ANGELES	CA	90003	3319	19	06037	33.9598857	-118.2783041	Los Angeles County
162801	Fee-for-Service	1033190970	1033190970	1	1	AQUINO, MELINDA L MD	10/1/2009	2086S0129X	NA	General Surgery	026	PHYSICIANS	94731	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2250 HAYES STREET	612	SAN FRANCISCO	CA	94117	1078	38	06075	37.77302042	-122.45342	San Francisco County
162822	Fee-for-Service	1679732671	1679732671	1	1	AMERSON, ERIN H MD	7/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105532	07	Dermatology	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
162842	Fee-for-Service	1891805610	1891805610	2	1	ALVAREZ, CARLOS A MD	11/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	42986	41	Internal Medicine	0	In state provider	None	5401 WHITE LANE	None	BAKERSFIELD	CA	93309	6279	15	06029	35.31803715	-119.0627831	Kern County
162844	Fee-for-Service	1932396421	1932396421	1	1	ASSOCIATED EYE SPECIALISTS	7/26/2016	207W00000X	NA	Ophthalmology	026	PHYSICIANS	59821	None	None	0	In state provider	MEDICAL GROUP INC	5333 HOLLISTER AVENUE	STE 123	SANTA BARBARA	CA	93111	3315	42	06083	34.43491982	-119.8105484	Santa Barbara County
162861	Fee-for-Service	1538179312	1538179312	1	1	APPLETON, CHRISTOPHER D DO	3/13/2020	207ZP0102X	NA	Other	026	PHYSICIANS	16721	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
162877	Fee-for-Service	1417579285	1417579285	1	1	ALTA HOSPICE OF CALIFORNIA	2/27/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3333 GLENDALE BLVD	STE 4	LOS ANGELES	CA	90039	1840	19	06037	34.11926281	-118.259677	Los Angeles County
162903	Fee-for-Service	1972552206	1972552206	1	1	APTE, NIKHIL M MD	5/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85281	41	Internal Medicine	0	In state provider	None	5575 W LAS POSITAS BLVD	STE 130	PLEASANTON	CA	94588	5800	01	06001	37.69214859	-121.8796532	Alameda County
162905	Fee-for-Service	1649280074	1649280074	1	1	ANASTASI, JAMES L MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	33376	41	Internal Medicine	0	In state provider	None	1301 20TH ST	STE 550	SANTA MONICA	CA	90404	2080	19	06037	34.02976782	-118.4812493	Los Angeles County
162911	Fee-for-Service	1902079452	1902079452	1	1	ABLE PHYSICAL THERAPY CORP	6/23/2014	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1902 ROYALTY DRIVE	SUITE 170	POMONA	CA	91767	3030	19	06037	34.07791925	-117.746146	Los Angeles County
162933	Fee-for-Service	1619545472	1619545472	1	1	ANGELS TOUCH CARE HOME LLC	4/5/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1653 SWALLOW WAY	None	HERCULES	CA	94547	1651	07	06013	38.00472941	-122.2665066	Contra Costa County
162941	Fee-for-Service	1316904287	1316904287	1	1	ALLINA HEALTH SYSTEM	8/30/2001	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MERCY HOSPITAL	4050 COON RAPIDS BLVD NW	None	COON RAPIDS	MN	55433	2522	00	None	45.18395809	-93.36860464	Anoka County
162957	Fee-for-Service	1487849048	1487849048	1	1	ANJOLA, LAURA J NP	5/16/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	923 DANA DRIVE	None	REDDING	CA	96003	4051	45	06089	40.58575147	-122.354559	Shasta County
162974	Fee-for-Service	1124405584	1124405584	1	1	APOLLO PHYSICIANS MEDICAL	3/27/2017	193200000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	GROUP	8191 TIMBERLAKE WAY	SUITE 200	SACRAMENTO	CA	95823	5418	34	06067	38.460222	-121.4131365	Sacramento County
162977	Fee-for-Service	1316207814	1316207814	1	1	ARIAS, KARINA LCSW	5/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
162987	Fee-for-Service	1629249859	1629249859	1	1	AGENA, TARA R MD	2/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97352	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
162993	Fee-for-Service	1962580050	1962580050	1	1	ASGARI, MARYAM M MD	3/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82504	07	Dermatology	0	In state provider	None	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
162996	Fee-for-Service	1881795250	1881795250	1	1	AKHAVAN, FARAHNAZ LAC	6/24/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1733 SOUTH ESCONDIDO BLV	None	ESCONDIDO	CA	92025	6519	37	06073	33.10401451	-117.0726812	San Diego County
163021	Fee-for-Service	1639379506	1639379506	1	1	AURANICKY, JANELE M PHD	3/17/2011	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
163022	Fee-for-Service	1093463697	1093463697	1	1	ALL HEALTH VENTURES INC	5/3/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	3863 W RAMSEY ST	None	BANNING	CA	92220	3513	33	06065	33.9267007	-116.919329	Riverside County
163027	Fee-for-Service	1568577724	1568577724	1	1	ARMSTRONG COUNTY MEMORIAL	8/13/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 NOLTE DR	None	KITTANNING	PA	16201	7111	00	None	40.81126087	-79.56256844	Armstrong County
163028	Fee-for-Service	1215059795	1215059795	1	1	AUBURN UNION SCHOOL DIST	7/11/1999	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	255 EPPERLE LN	None	AUBURN	CA	95603	3745	31	06061	38.90625292	-121.0728878	Placer County
163056	Fee-for-Service	1063571768	1063571768	1	1	ALLISON, JANE M	12/6/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
163065	Fee-for-Service	1467701110	1467701110	1	1	AMBROSIA, JOYCE	8/1/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3425 W VICTORY BLVD	None	BURBANK	CA	91505	1545	19	06037	34.18475147	-118.34856	Los Angeles County
163072	Fee-for-Service	1366520272	1366520272	1	1	ARK, BELINDA C MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80820	41	Internal Medicine	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
163077	Fee-for-Service	1609008481	1609008481	1	1	AHMADI, MAZYAR E MD	7/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101569	30	Radiology	0	In state provider	None	3941 J ST	None	SACRAMENTO	CA	95819	3624	34	06067	38.570652	-121.4535465	Sacramento County
163084	Fee-for-Service	1952076630	1952076630	1	1	ANTHONY MARTIN MILLS MD, A M	12/31/2024	207R00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ICAL GROUP	8601 S BROADWAY	None	LOS ANGELES	CA	90003	3319	19	06037	33.9598857	-118.2783041	Los Angeles County
163113	Fee-for-Service	1710529425	1710529425	1	1	AGDIGOS, JANICE D LMFT	7/2/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	155 HOSPITALITY LN	245	SAN BERNARDINO	CA	92408	3305	36	06071	34.06580948	-117.2856915	San Bernardino County
163127	Fee-for-Service	1225563976	1225563976	1	1	ABOVE AND BEYOND CARE	4/1/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PROVIDERS INC	7365 CARNELIAN ST	SUITE 116A	RANCHO CUCAMONGA	CA	91730	1156	36	06071	34.12038413	-117.6160525	San Bernardino County
163129	Fee-for-Service	1033275524	1033275524	1	1	ARRHYTHMIA SPECIALISTS	6/9/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	INC	112 LA CASA VIA	STE 360	WALNUT CREEK	CA	94598	3017	07	06013	37.91229899	-122.0423696	Contra Costa County
163151	Fee-for-Service	1215708656	1215708656	1	1	ACEVEDO, CARLOS CRNA	3/23/2025	163WC1600X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
163164	Fee-for-Service	1417579285	1417579285	1	1	ALTA HOSPICE OF CALIFORNIA	2/27/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3333 GLENDALE BLVD	STE 4	LOS ANGELES	CA	90039	1840	19	06037	34.11926281	-118.259677	Los Angeles County
163173	Fee-for-Service	1508625294	1508625294	1	1	AREVALO, FELICIA	3/19/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	54	06107	0	0	None
163179	Fee-for-Service	1962597807	1962597807	1	4	ADVANCED CALIFORNIA MEDICAL	9/10/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55154	41	Internal Medicine	0	In state provider	None	9834 GENESSE AVE	SUITE 425	LA JOLLA	CA	92037	1264	37	06073	32.884074	-117.225855	San Diego County
163193	Fee-for-Service	1649280074	1649280074	1	1	ANASTASI, JAMES L MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	33376	01	General Practice	0	In state provider	None	1301 20TH ST	STE 550	SANTA MONICA	CA	90404	2080	19	06037	34.02976782	-118.4812493	Los Angeles County
163226	Fee-for-Service	1962588921	1962588921	1	1	ALAMI-RAD, MAHVASH PHD	12/2/2005	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	16496 BERNARDO CENTER DR	SUITE 307	SAN DIEGO	CA	92128	2524	37	06073	33.01375281	-117.0777466	San Diego County
163230	Fee-for-Service	1316904287	1316904287	1	1	ALLINA HEALTH SYSTEM	8/30/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MERCY HOSPITAL	4050 COON RAPIDS BLVD NW	None	COON RAPIDS	MN	55433	2522	00	None	45.18395809	-93.36860464	Anoka County
163272	Fee-for-Service	1376814640	1376814640	1	1	ANNE MARIE DENIS	4/18/2022	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	506 LENOX AVE	None	NEW YORK	NY	10037	1802	00	None	40.814352	-73.94031	New York County
163321	Fee-for-Service	1487946661	1487946661	1	1	AIVAZ, OHARA MD	11/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	145230	07	Dermatology	0	In state provider	None	99 N LA CIENEGA BLVD	None	BEVERLY HILLS	CA	90211	2222	19	06037	34.06736471	-118.3763201	Los Angeles County
163356	Fee-for-Service	1568413961	1568413961	1	1	AHLERING, JOHN R MD	1/1/1982	207L00000X	NA	Other	026	PHYSICIANS	37463	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
163357	Fee-for-Service	1225448053	1225448053	1	1	ALMODOVAR, JORGE MD	10/1/2020	208600000X	NA	General Surgery	026	PHYSICIANS	144030	02	General Surgery	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3220	33	06065	33.763572	-116.4056895	Riverside County
163374	Fee-for-Service	1952076630	1952076630	1	1	ANTHONY MARTIN MILLS MD, A M	10/23/2023	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ICAL GROUP	8601 S BROADWAY	None	LOS ANGELES	CA	90003	3319	19	06037	33.9598857	-118.2783041	Los Angeles County
163418	Fee-for-Service	1538721568	1538721568	1	2	ASSIST TRANSIT, LLC	12/9/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	8949 RESEDA	201	NORTHRIDGE	CA	91324	3916	19	06037	34.233255	-118.536109	Los Angeles County
163425	Fee-for-Service	1821478231	1821478231	1	1	ARANAS, JAI-AR R NP	8/20/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
163469	Fee-for-Service	1962597807	1962597807	1	4	ADVANCED CALIFORNIA MEDICAL	9/10/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	55154	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9834 GENESSE AVE	SUITE 425	LA JOLLA	CA	92037	1264	37	06073	32.884074	-117.225855	San Diego County
163473	Fee-for-Service	1417906835	1417906835	1	1	ALAM, MUHAMMAD M MD	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144556	41	Internal Medicine	0	In state provider	None	729 N MEDICAL CTR DR W	SUITE 221	CLOVIS	CA	93611	6879	10	06019	36.84152435	-119.6624818	Fresno County
163475	Fee-for-Service	1275748493	1275748493	1	1	AHAD, ROOMAN F MD	7/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	13	Neurology (M.D. only)	1	Border provider	None	3175 ST ROSE PARKWAY	SUITE 200	HENDERSON	NV	89052	3506	00	None	35.99940075	-115.12488	Clark County
163502	Fee-for-Service	1013959220	1013959220	1	1	AKERMAN, ANDREW MD	5/12/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	144778	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
163559	Fee-for-Service	1356707533	1356707533	1	1	AVANTGARDE SENIOR LIVING	10/1/2016	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5645 LINDLEY AVE	None	TARZANA	CA	91356	2557	19	06037	34.173666	-118.5273095	Los Angeles County
163603	Fee-for-Service	1659522191	1659522191	1	1	AMARNATH, ASHRITH R MD	2/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125371	02	General Surgery	0	In state provider	None	555 CAPITOL MALL	SUITE 260	SACRAMENTO	CA	95814	4503	34	06067	38.579166	-121.500621	Sacramento County
163642	Fee-for-Service	1992901383	1992901383	1	1	ATKINSON, CHERI V LCSW	5/30/1998	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	16702 CORAL CAY LN	None	HUNTINGTON BEACH	CA	92649	2907	30	06059	33.71943871	-118.0646512	Orange County
163663	Fee-for-Service	1952076630	1952076630	1	1	ANTHONY MARTIN MILLS MD, A M	5/15/2024	207R00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ICAL GROUP	8601 S BROADWAY	None	LOS ANGELES	CA	90003	3319	19	06037	33.9598857	-118.2783041	Los Angeles County
163677	Fee-for-Service	1396336772	1396336772	1	1	AS TRANSPORTATION SERVICES L	12/13/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LC	1731 W GLENOAKS BLVD	202	GLENDALE	CA	91201	1599	19	06037	34.17201073	-118.2907193	Los Angeles County
163678	Fee-for-Service	1851403521	1851403521	1	1	AFFILIATES IN DERMATOLOG	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GRP INC	460 34TH ST	None	OAKLAND	CA	94609	2820	01	06001	37.8220873	-122.2645378	Alameda County
163714	Fee-for-Service	1336780774	1336780774	1	1	A.F.F.R.E.E.C.A.	4/13/2025	2278H0200X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	879 W. 190TH ST	#430	GARDENA	CA	90248	4220	19	06037	33.85927671	-118.2896516	Los Angeles County
163744	Fee-for-Service	1902331630	1902331630	1	1	AHN, JEFFREY Y MD	8/29/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	159137	68	Hematology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
163745	Fee-for-Service	1326009994	1326009994	1	1	ASHMAN, RANDY E CRNA	6/15/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
163760	Fee-for-Service	1417906835	1417906835	1	1	ALAM, MUHAMMAD M MD	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144556	68	Hematology	0	In state provider	None	729 N MEDICAL CTR DR W	SUITE 221	CLOVIS	CA	93611	6879	10	06019	36.84152435	-119.6624818	Fresno County
163795	Fee-for-Service	1689172223	1689172223	1	1	ADVANTA CARE HOME HEALTH	9/9/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	3475 INVESTMENT BLVD	STE 5	HAYWARD	CA	94545	3804	01	06001	37.62549675	-122.1192632	Alameda County
163815	Fee-for-Service	1447203757	1447203757	1	1	ANDREW DANIEL	3/23/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 TOWSON AVE	None	FORT SMITH	AR	72901	4921	00	None	35.374455	-94.42107	Sebastian County
163819	Fee-for-Service	1629209382	1629209382	1	1	ALMENDRAL, DANTE MD	2/8/2015	193400000X	NA	Other	026	PHYSICIANS	80668	18	Ophthalmology	0	In state provider	A MEDICAL CORPORATION	2425 NORTH BROADWAY	None	LOS ANGELES	CA	90031	2218	19	06037	34.0736584	-118.2160723	Los Angeles County
163829	Fee-for-Service	1124647334	1124647334	1	1	ARSENAULT, JOHN J MD	7/24/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	185377	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
163838	Fee-for-Service	1629283197	1629283197	1	1	ALTAMED HEALTH SERVICES	9/13/2005	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	4650 SUNSET BLVD	1ST FLOOR,PAGE BLDG	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
163842	Fee-for-Service	1740490937	1740490937	1	1	APLA HEALTH & WELLNESS	11/1/2013	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1127 WILSHIRE BLVD	SUITE 1504	LOS ANGELES	CA	90017	4006	19	06037	34.05270508	-118.2641005	Los Angeles County
163931	Fee-for-Service	1992901383	1992901383	1	1	ATKINSON, CHERI V LCSW	12/16/2002	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	16702 CORAL CAY LN	None	HUNTINGTON BEACH	CA	92649	2907	30	06059	33.71943871	-118.0646512	Orange County
163933	Fee-for-Service	1003134545	1003134545	1	1	ASIAN HEALTH SERVICES	11/1/2011	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	250 E 18TH ST	2ND FLOOR	OAKLAND	CA	94606	1729	01	06001	37.79999844	-122.2527149	Alameda County
163983	Fee-for-Service	1497753909	1497753909	1	1	ASSUDANI, ANIL MD	7/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75568	36	Psychiatry	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
164003	Fee-for-Service	1225084221	1225084221	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7201 BOULDER AVE	None	HIGHLAND	CA	92346	3313	36	06071	34.123842	-117.1953945	San Bernardino County
164029	Fee-for-Service	1720667835	1720667835	1	1	AMERICAN EAGLE HOME HEALTH C	5/3/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	490 S ROSEMEAD BLVD	SUITE 4	PASADENA	CA	91107	4958	19	06037	34.13808	-118.073204	Los Angeles County
164046	Fee-for-Service	1417906835	1417906835	1	1	ALAM, MUHAMMAD M MD	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144556	78	Neoplastic Diseases/Oncology	0	In state provider	None	729 N MEDICAL CTR DR W	SUITE 221	CLOVIS	CA	93611	6879	10	06019	36.84152435	-119.6624818	Fresno County
164048	Fee-for-Service	1609371822	1609371822	1	1	ALBEAR, SINAN MD	7/1/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	186632	None	None	0	In state provider	None	100 E CALIFORNIA BLVD	None	PASADENA	CA	91105	3205	19	06037	34.1357725	-118.148301	Los Angeles County
164080	Fee-for-Service	1477875532	1477875532	1	1	ASHBURN, AMY A RN PNP	6/7/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
164128	Fee-for-Service	1629283197	1629283197	1	1	ALTAMED HEALTH SERVICES	9/13/2005	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	4650 SUNSET BLVD	1ST FLOOR,PAGE BLDG	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
164130	Fee-for-Service	1740490937	1740490937	1	1	APLA HEALTH & WELLNESS	11/1/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1127 WILSHIRE BLVD	SUITE 1504	LOS ANGELES	CA	90017	4006	19	06037	34.05270508	-118.2641005	Los Angeles County
164143	Fee-for-Service	1255015905	1255015905	1	1	AAA COMPREHENSIVE HEALTHCARE	4/30/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2740 S BRISTOL STREET	SUITE 222	SANTA ANA	CA	92704	6233	30	06059	33.70999696	-117.8854626	Orange County
164190	Fee-for-Service	1053522342	1053522342	1	1	ASHOUIAN, NASRIN MD	10/10/2017	207RN0300X	NA	Nephrology	026	PHYSICIANS	137294	45	Nephrology (Renal-Kidney)	0	In state provider	None	3011 CERES AVE	STE 100	CHICO	CA	95973	5637	04	06007	39.77592447	-121.8384651	Butte County
164211	Fee-for-Service	1871519447	1871519447	1	1	ABLIN, IDALIA C NP	9/18/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2110 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3703	15	06029	35.37344851	-119.0261655	Kern County
164219	Fee-for-Service	1003134545	1003134545	1	1	ASIAN HEALTH SERVICES	6/1/2010	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	250 E 18TH ST	2ND FLOOR	OAKLAND	CA	94606	1729	01	06001	37.79999844	-122.2527149	Alameda County
164258	Fee-for-Service	1801132170	1801132170	1	1	ABDARBASHI, PAYUM MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124031	41	Internal Medicine	0	In state provider	None	17909 W SOLEDAD CANYON	None	CANYON COUNTRY	CA	91387	3210	19	06037	34.41652621	-118.4458684	Los Angeles County
164259	Fee-for-Service	1154630044	1154630044	1	1	ACADIA PAIN MANAGEMENT GROUP	3/5/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	INC	4704 HOEN AVE	None	SANTA ROSA	CA	95405	7824	49	06097	38.441187	-122.664645	Sonoma County
164270	Fee-for-Service	1588619407	1588619407	1	1	AKRAWI, WILLIAM P MD	9/30/1996	207L00000X	NA	Other	026	PHYSICIANS	75113	01	General Practice	0	In state provider	None	1040 W TOWN AND COUNTRY	None	ORANGE	CA	92868	4716	30	06059	33.77652153	-117.862461	Orange County
164294	Fee-for-Service	1033678859	1033678859	1	1	ANDERSON, LAUREN E MD	9/12/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181858	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
164302	Fee-for-Service	1649835778	1649835778	1	1	ADVENTIST HEALTH PHYSICIANS	7/26/2019	225100000X	NA	Physical Therapist	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	101 RALEY BLVD	STE 102	CHICO	CA	95928	8352	04	06007	39.7160085	-121.7917665	Butte County
164304	Fee-for-Service	1205839735	1205839735	1	1	ANUNCIACION, ROY P MD	1/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	74550	40	Pediatrics	0	In state provider	None	1920 TIENDA DR	STE 102	LODI	CA	95242	3931	39	06077	38.11678155	-121.2957005	San Joaquin County
164306	Fee-for-Service	1265941165	1265941165	1	1	ACCENT ON WELLNESS PSYCHOLOG	5/9/2022	103TA0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	Y ASSOCIATES, INC.	2790 SKYPARK DRIVE	215	TORRANCE	CA	90505	5388	19	06037	33.80456075	-118.3357569	Los Angeles County
164335	Fee-for-Service	1033613229	1033613229	1	1	ANDERSON, LINDSEY E DO	8/16/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18016	None	None	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
164338	Fee-for-Service	1174873756	1174873756	1	1	ANGELS HOME HEALTH LLC	9/17/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	29970 TECHNOLOGY DR	208	MURRIETA	CA	92563	2649	33	06065	33.5604702	-117.1370275	Riverside County
164352	Fee-for-Service	1528386786	1528386786	1	1	ANTELOPE HILLS MANOR ICF/DDN	2/24/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	8533 TULLIA PLACE	None	ANTELOPE	CA	95843	5986	34	06067	38.724426	-121.345911	Sacramento County
164372	Fee-for-Service	1295760221	1295760221	1	1	APPLEBAUM, STEVEN H MD	9/1/1995	207RH0003X	NA	Oncology	026	PHYSICIANS	72790	None	None	0	In state provider	None	10 CONGRESS ST	STE 502	PASADENA	CA	91105	3023	19	06037	34.13396893	-118.1528162	Los Angeles County
164384	Fee-for-Service	1396247599	1396247599	1	1	ARRIVILLAGA RAUDA, VANNESA	12/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	2068 ORANGE TREE LANE	216	REDLANDS	CA	92374	0109	36	06071	34.0679639	-117.2250148	San Bernardino County
164408	Fee-for-Service	1568869303	1568869303	1	1	ANGEL CONGREGATE LIVING, INC	7/27/2018	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	38536 DESERT VIEW DR	None	PALMDALE	CA	93551	4301	19	06037	34.58284798	-118.1496474	Los Angeles County
164418	Fee-for-Service	1649648767	1649648767	1	2	ASPIRE COUNSELING SERVICES -	4/24/2017	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	12402 INDUSTRIAL BLVD	B-6	VICTORVILLE	CA	92395	5871	36	06071	34.47628904	-117.2829923	San Bernardino County
164432	Fee-for-Service	1255015905	1255015905	1	1	AAA COMPREHENSIVE HEALTHCARE	4/30/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2740 S BRISTOL STREET	SUITE 222	SANTA ANA	CA	92704	6233	30	06059	33.70999696	-117.8854626	Orange County
164459	Fee-for-Service	1548434046	1548434046	1	1	AYYAD, ALAEDDIN M MD	8/5/2018	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	107740	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2780 EUREKA WAY	None	REDDING	CA	96001	0223	45	06089	40.58585835	-122.4124086	Shasta County
164476	Fee-for-Service	1649913591	1649913591	1	1	ABEYSEKERA, MARIA E MD	2/7/2025	390200000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1221 E SPRUCE AVE	None	FRESNO	CA	93720	3374	10	06019	36.84197867	-119.761714	Fresno County
164483	Fee-for-Service	1649492448	1649492448	1	1	ABRISHAMY, SHAHRAM MD	8/16/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85245	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
164496	Fee-for-Service	1740427657	1740427657	1	11	ALTAMED HEALTH SERVICES CORP	3/21/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	333 WEST WALNUT STREET	None	SANTA ANA	CA	92701	5662	30	06059	33.7444413	-117.8701314	Orange County
164510	Fee-for-Service	1003134545	1003134545	1	1	ASIAN HEALTH SERVICES	2/23/2011	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	250 E 18TH ST	2ND FLOOR	OAKLAND	CA	94606	1729	01	06001	37.79999844	-122.2527149	Alameda County
164520	Fee-for-Service	1801976535	1801976535	1	1	ADRIAN, CHRISTOPHER D MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	85834	68	Hematology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
164550	Fee-for-Service	1932223781	1932223781	1	2	AIDS SERVICES FOUNDATION	9/1/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	OF ORANGE COUNTY	17982 SKY PARK CIRCLE	SUITE J	IRVINE	CA	92614	6482	30	06059	33.68933118	-117.8596634	Orange County
164560	Fee-for-Service	1437658291	1437658291	1	1	ARF-TBI, INC	10/10/2019	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	17281 MEADOWVIEW DRIVE	None	YORBA LINDA	CA	92886	3215	30	06059	33.89277888	-117.8321373	Orange County
164568	Fee-for-Service	1134225980	1134225980	1	1	ABRIGNANI, LAURA M NP	10/2/2024	363LW0102X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
164572	Fee-for-Service	1568449304	1568449304	1	2	ANDERSON VALLEY HEALTH	3/31/1988	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	13500 AIRORT RD	None	BOONVILLE	CA	95415	0338	23	06045	39.01236566	-123.3794356	Mendocino County
164595	Fee-for-Service	1265941165	1265941165	1	1	ACCENT ON WELLNESS PSYCHOLOG	5/9/2022	103TA0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	Y ASSOCIATES, INC.	2790 SKYPARK DRIVE	215	TORRANCE	CA	90505	5388	19	06037	33.80456075	-118.3357569	Los Angeles County
164600	Fee-for-Service	1710944889	1710944889	1	1	AUERBACH, ANDREW D MD	10/1/1998	207R00000X	NA	Other	026	PHYSICIANS	84782	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	# A405	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
164601	Fee-for-Service	1033504063	1033504063	1	1	ADVANCED ORTHOPAEDICS &	8/5/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SPORTS MEDICINE INC	450 SUTTER ST	SUITE 400	SAN FRANCISCO	CA	94108	3906	38	06075	37.78934929	-122.4077786	San Francisco County
164628	Fee-for-Service	1275825184	1275825184	1	1	ALONSO, FERNANDO E MD	12/18/2018	208600000X	NA	General Surgery	026	PHYSICIANS	156722	02	General Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
164629	Fee-for-Service	1902427438	1902427438	1	1	ATTENTIVE COGNITIVE AND MENT	10/30/2020	251S00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	AL HEALTH SERVICES PSYCH	111 DEERWOOD ROAD	SUITE 200	SAN RAMON	CA	94583	4409	07	06013	37.77475997	-121.9892508	Contra Costa County
164630	Fee-for-Service	1154421956	1154421956	1	1	AGUIAR, PAUL J CRNA	9/20/2007	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3511	19	06037	33.89242734	-118.2947128	Los Angeles County
164634	Fee-for-Service	1558795021	1558795021	1	1	ARGUS NEUROLOGY CORPORATION	8/5/2014	193400000X	NA	Other	026	PHYSICIANS	80357	13	Neurology (M.D. only)	0	In state provider	None	2070 CLINTON AVE	None	ALAMEDA	CA	94501	4399	01	06001	37.76333626	-122.253868	Alameda County
164638	Fee-for-Service	1457414872	1457414872	1	1	ASTROTH, KAY M CRNA	6/2/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
164640	Fee-for-Service	1780710145	1780710145	1	1	AGARWALA, AAKASH V MD	12/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109608	05	Anesthesiology	0	In state provider	None	1600 WEST AVE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
164686	Fee-for-Service	1972983427	1972983427	1	1	ALGHARBI, SOLAIMAN MD	2/24/2021	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
164731	Fee-for-Service	1982993069	1982993069	1	1	ATIGAPRAMOJ, NISA S MD	5/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108312	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC:5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
164743	Fee-for-Service	1316988587	1316988587	1	1	ANDERSON, WAYNE R MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	42641	08	Family Practice	0	In state provider	None	1225 15TH ST	None	SANTA MONICA	CA	90404	1101	19	06037	34.02683888	-118.4870127	Los Angeles County
164747	Fee-for-Service	1477200939	1477200939	1	1	AMY'S COMFORT CARE INC	5/26/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	9609 GHIRARDELLI DR	None	BAKERSFIELD	CA	93311	9684	15	06029	35.30917552	-119.1093975	Kern County
164771	Fee-for-Service	1740298074	1740298074	1	1	ANDERSON, BRIAN C. MD	1/1/1994	207RR0500X	NA	Other	026	PHYSICIANS	30998	41	Internal Medicine	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
164781	Fee-for-Service	1740427657	1740427657	1	11	ALTAMED HEALTH SERVICES CORP	3/21/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	333 WEST WALNUT STREET	None	SANTA ANA	CA	92701	5662	30	06059	33.7444413	-117.8701314	Orange County
164798	Fee-for-Service	1003134545	1003134545	1	1	ASIAN HEALTH SERVICES	6/1/2010	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	250 E 18TH ST	2ND FLOOR	OAKLAND	CA	94606	1729	01	06001	37.79999844	-122.2527149	Alameda County
164799	Fee-for-Service	1790082832	1790082832	1	1	ADVENTIST HEALTH PHYSCIANS	3/30/2011	208D00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	2701 CHESTER AVE	None	BAKERSFIELD	CA	93301	2016	15	06029	35.384166	-119.0188765	Kern County
164807	Fee-for-Service	1801976535	1801976535	1	1	ADRIAN, CHRISTOPHER D MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	85834	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
164836	Fee-for-Service	1932223781	1932223781	1	2	AIDS SERVICES FOUNDATION	9/1/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	OF ORANGE COUNTY	17982 SKY PARK CIRCLE	SUITE J	IRVINE	CA	92614	6482	30	06059	33.68933118	-117.8596634	Orange County
164870	Fee-for-Service	1801085964	1801085964	1	1	AZADEH, BEHNAZ LAC	1/6/2022	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	22672 LAMBERT ST	613	LAKE FOREST	CA	92630	1613	30	06059	33.63324401	-117.7136718	Orange County
164878	Fee-for-Service	1205016250	1205016250	1	1	ANDREW SCOTT LITTLE MD	5/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2910 N 3RD AVE	None	PHOENIX	AZ	85013	4434	00	None	33.4805218	-112.0782792	Maricopa County
164892	Fee-for-Service	1376871566	1376871566	1	1	AGABABIAN MEDICAL CLINIC INC	1/19/2010	207R00000X	NA	Other	026	PHYSICIANS	93668	None	None	0	In state provider	None	6608 SAN FERNANDO ROAD	None	GLENDALE	CA	91201	1703	19	06037	34.16905984	-118.2924974	Los Angeles County
164912	Fee-for-Service	1134185432	1134185432	1	1	ABED T MARY V MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	355 GRAND STREET	None	JERSEY CITY	NJ	07306	0000	00	None	40.71668982	-74.05033042	Hudson County
164915	Fee-for-Service	1497743686	1497743686	1	1	ANNETTE J SCHLUETER MD	5/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
164917	Fee-for-Service	1417263450	1417263450	1	1	ABDULLAH, OBAI MD	10/14/2019	207R00000X	NA	Other	026	PHYSICIANS	126425	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
164943	Fee-for-Service	1376729699	1376729699	1	1	AVANGARD SOUZ BUSINESS	7/3/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	LONG LIFE MEDICAL HEALTH	23120 LYONS AVE	SUITE 8	SANTA CLARITA	CA	91321	2668	19	06037	34.37990415	-118.5371422	Los Angeles County
164996	Fee-for-Service	1871171769	1871171769	1	1	ATLANTIC HOME HEALTH CARE	5/5/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	490 S ROSEMEAD BLVD	SUITE 6	PASADENA	CA	91107	4956	19	06037	34.13808	-118.073204	Los Angeles County
165014	Fee-for-Service	1932453032	1932453032	1	2	ACTON AGUE DULCE UNIFIED	10/1/2022	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	SCHOOL DISTRICT	32248 CROWN VALLEY RD	None	ACTON	CA	93510	2620	19	06037	34.47262052	-118.1972129	Los Angeles County
165017	Fee-for-Service	1598031429	1598031429	1	1	ATHALE, JANHAVI MD	2/10/2023	207RC0200X	NA	Other	026	PHYSICIANS	169183	None	None	0	In state provider	None	1221 E SPRUCE AVE	None	FRESNO	CA	93720	3374	10	06019	36.84197867	-119.761714	Fresno County
165022	Fee-for-Service	1629762471	1629762471	1	1	ANINION, MERIAM NP	1/29/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
165026	Fee-for-Service	1972575298	1972575298	1	1	ABUHAMAD, GHASSAN MD	8/10/2022	2086S0129X	NA	General Surgery	026	PHYSICIANS	179282	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
165034	Fee-for-Service	1629604699	1629604699	1	1	ANDERSON, ZACHARY D DO	7/12/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20099	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
165045	Fee-for-Service	1497068282	1497068282	1	1	AHDOOT, DAFNA D MD	6/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111521	None	None	0	In state provider	None	1543 E PALMDALE BLVD	SUITE F	PALMDALE	CA	93550	2000	19	06037	34.57966352	-118.101582	Los Angeles County
165069	Fee-for-Service	1144413501	1144413501	1	1	APPELLE, NICOLE A MD	4/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98620	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
165073	Fee-for-Service	1629397674	1629397674	1	1	AGRAWAL, HARSH MD	1/21/2019	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	118644	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
165089	Fee-for-Service	1497998553	1497998553	1	1	A-BIZ INC	4/9/2019	No Taxonomy Provided	NA	None	093	CARE COORDINATOR AGENCIES (CCA)	-	-	NOT APPLICABLE	0	In state provider	None	11631 VICTORY BLVD	SUITE 100	NORTH HOLLYWOOD	CA	91606	3572	19	06037	34.18671045	-118.385712	Los Angeles County
165094	Fee-for-Service	1801976535	1801976535	1	1	ADRIAN, CHRISTOPHER D MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	85834	78	Neoplastic Diseases/Oncology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94122	2722	38	06075	37.76332993	-122.4582988	San Francisco County
165119	Fee-for-Service	1669522470	1669522470	1	1	AHMAD, NAJEH M MD	7/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89721	08	Family Practice	0	In state provider	None	2450 SR MARY COLUMBA DR	None	RED BLUFF	CA	96080	0000	52	06103	40.14921426	-122.2216794	Tehama County
165130	Fee-for-Service	1477523249	1477523249	1	1	AGARWAL, SANJAY K MD	10/8/2008	207RS0012X	NA	Other	026	PHYSICIANS	104257	41	Internal Medicine	0	In state provider	None	350 30TH STREET	STE 411	OAKLAND	CA	94609	3425	01	06001	37.81892183	-122.2640154	Alameda County
165173	Fee-for-Service	1447563622	1447563622	1	1	ACIERTO, DAVID JOHN S DO	2/24/2021	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
165185	Fee-for-Service	1023210432	1023210432	1	1	AHDOOT, DAVID MD	11/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	55892	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	191 S BUENA VISTA ST	STE 340	BURBANK	CA	91505	4562	19	06037	34.15872557	-118.3283863	Los Angeles County
165193	Fee-for-Service	1881433662	1881433662	1	1	ALI, AYMON N MD	9/23/2024	390200000X	NA	Other	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
165200	Fee-for-Service	1114014586	1114014586	1	1	AHMED, PARVEZ MD	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	78852	40	Pediatrics	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
165201	Fee-for-Service	1760802144	1760802144	1	1	ARENAS, ALEJANDRO MD	9/15/2019	207L00000X	NA	Other	026	PHYSICIANS	164170	05	Anesthesiology	0	In state provider	None	1600 WEST AVENUE J	None	LANCASTER	CA	93534	4289	19	06037	34.68938848	-118.158354	Los Angeles County
165227	Fee-for-Service	1518054097	1518054097	1	1	AMSDEN, CHRISTOPHER F MD	4/26/2020	208VP0000X	NA	Other	026	PHYSICIANS	57040	25	Physical Medicine and Rehabilitation	0	In state provider	None	3751 E SHIELDS AVE	None	FRESNO	CA	93726	0000	10	06019	36.7796958	-119.7618088	Fresno County
165234	Fee-for-Service	1528468030	1528468030	1	1	ACOLATSE, SEDINA LMFT	4/11/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
165253	Fee-for-Service	1275632887	1275632887	1	1	AGARWAL, DIMPLE MD	5/28/2015	207R00000X	NA	Other	026	PHYSICIANS	66261	66	Emergency Medicine (Urgent Care)	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
165313	Fee-for-Service	1144216383	1144216383	1	1	AQUINO, ERICSON B MD	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90769	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
165357	Fee-for-Service	1811167257	1811167257	2	1	ARONSON & ROSENTHAL MD INC	4/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3440 LOMITA BLVD	STE 120	TORRANCE	CA	90505	4801	19	06037	33.81328127	-118.3452927	Los Angeles County
165360	Fee-for-Service	1942216304	1942216304	1	1	ARAGON, MYRIAM Y LMFT	9/24/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1809 W. REDLANDS BLVD	None	REDLANDS	CA	92373	8054	36	06071	34.06288379	-117.2156673	San Bernardino County
165364	Fee-for-Service	1629399126	1629399126	1	1	AUSTIN, STEPHANIE A MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121282	84	Surgery-Head and Neck	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
165367	Fee-for-Service	1952310310	1952310310	2	1	APRIA HEALTHCARE LLC	6/24/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2510 DEAN LESHER DR	STE D	CONCORD	CA	94520	1368	07	06013	38.02149622	-122.0308614	Contra Costa County
165371	Fee-for-Service	1699834101	1699834101	1	1	ASAHARA, KYM K N	6/18/2012	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 W PROVIDENCE AVE	None	ORANGE	CA	92868	3892	30	06059	33.78142951	-117.866583	Orange County
165372	Fee-for-Service	1770889297	1770889297	1	1	ADVANCED ENDOSCOPY	8/6/2012	193400000X	NA	Other	026	PHYSICIANS	46472	10	Gastroenterology (M.D. only)	0	In state provider	CONSULTANTS	6699 ALVARADO RD	STE 2301	SAN DIEGO	CA	92120	5241	37	06073	32.77665383	-117.0540279	San Diego County
165376	Fee-for-Service	1497998553	1497998553	1	1	A-BIZ INC	1/10/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11631 VICTORY BLVD	SUITE 100	NORTH HOLLYWOOD	CA	91606	3572	19	06037	34.18671045	-118.385712	Los Angeles County
165391	Fee-for-Service	1558357285	1558357285	1	1	AHMAD, TAUQIR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SAGUARO MEDICAL ASSOC	5901 W INDIAN SCHOOL RD,	#1	PHOENIX	AZ	85033	0000	00	None	33.494724	-112.186827	Maricopa County
165399	Fee-for-Service	1043713803	1043713803	1	1	ACCESS MEDICAL, INC.	7/23/2019	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	890 COWAN RD	STE F	BURLINGAME	CA	94010	1208	41	06081	37.60090515	-122.3761527	San Mateo County
165406	Fee-for-Service	1164260741	1164260741	1	1	ARIA VASCULAR A PROFESSIONAL	4/3/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1611 W MARCH LN	None	STOCKTON	CA	95207	6401	39	06077	37.98803343	-121.3263859	San Joaquin County
165428	Fee-for-Service	1346617594	1346617594	1	1	AKHIMIEN, PATIENCE R	6/14/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	789 E COOLEY DRIVE	None	COLTON	CA	92324	4007	36	06071	34.05795035	-117.3040272	San Bernardino County
165439	Fee-for-Service	1104856806	1104856806	1	2	AMERICAN ORTHOTICS &	5/1/2017	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	PROSTHETICS LLC	3714 TIBBETTS ST	STE 104	RIVERSIDE	CA	92506	2664	33	06065	33.9472185	-117.397305	Riverside County
165480	Fee-for-Service	1992748420	1992748420	2	1	AHDOOT, MORRIS M MD	2/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	67668	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	15775 LAGUNA CANYON RD	STE 200	IRVINE	CA	92618	3191	30	06059	33.6663745	-117.760682	Orange County
165503	Fee-for-Service	1871023515	1871023515	1	1	ABI P&O INC	12/26/2018	261QA0900X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	6190 FAIRMOUNT AVENUE	STE A	SAN DIEGO	CA	92120	3428	37	06073	32.78728736	-117.1014929	San Diego County
165510	Fee-for-Service	1336454065	1336454065	1	1	ALVARADO, TERESA LMFT	11/6/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3610 CENTRAL AVE STE 400	None	RIVERSIDE	CA	92506	5907	33	06065	33.95352247	-117.3917745	Riverside County
165514	Fee-for-Service	1114003605	1114003605	1	1	A&I HUATUCO INC	9/1/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	1530 BESSIE AVE	STE 102	TRACY	CA	95376	3080	39	06077	37.74570848	-121.4330255	San Joaquin County
165525	Fee-for-Service	1730485517	1730485517	1	1	ARKUN, ALP MD	9/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114603	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
165529	Fee-for-Service	1568235604	1568235604	1	1	AHCS MISSION, LLC	12/13/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4631 TELLER AVE	STE 110	NEWPORT BEACH	CA	92660	8105	30	06059	33.66641504	-117.857408	Orange County
165535	Fee-for-Service	1538176847	1538176847	1	1	ASHRAF, MUFEED A MD	11/1/2021	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
165539	Fee-for-Service	1275632887	1275632887	1	1	AGARWAL, DIMPLE MD	5/28/2015	207R00000X	NA	Other	026	PHYSICIANS	66261	41	Internal Medicine	0	In state provider	None	47111 MONROE ST	None	INDIO	CA	92201	6739	33	06065	33.70620698	-116.2339008	Riverside County
165599	Fee-for-Service	1215390166	1215390166	1	1	ARJA, SOWMYA MD	3/29/2024	207RA0201X	NA	Other	026	PHYSICIANS	167950	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
165622	Fee-for-Service	1831322536	1831322536	1	2	ALFAY, WISAM Z MD	8/25/2022	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	161468	None	None	0	In state provider	None	27450 YNEZ ROAD	109	TEMECULA	CA	92591	4649	33	06065	33.50684549	-117.1502048	Riverside County
165624	Fee-for-Service	1366445868	1366445868	1	1	ADAMSON, DARYL A. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9205 SW BARNES RD	None	PORTLAND	OR	97225	6603	00	None	45.51093	-122.771907	Washington County
165631	Fee-for-Service	1942443080	1942443080	1	1	AHMED, SHAWN I MD	7/1/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	143418	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
165638	Fee-for-Service	1831188689	1831188689	1	1	ARIEF, JULAIHA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	18731 N REEMS RD	BLDG F680	SURPRISE	AZ	85374	8644	00	None	33.653673	-112.374477	Maricopa County
165652	Fee-for-Service	1629399126	1629399126	1	1	AUSTIN, STEPHANIE A MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121282	04	Otology, Laryngology, Rhinology	0	In state provider	None	3 MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
165672	Fee-for-Service	1962691451	1962691451	1	1	AU, REBECCA LCSW	3/6/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2850 TELEGRAPH AVE	110	BERKELEY	CA	94705	1159	01	06001	37.85808554	-122.2594469	Alameda County
165683	Fee-for-Service	1457971772	1457971772	1	1	AKAZAWA, JENNIFER A MD	12/8/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	186675	None	None	0	In state provider	None	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	41	06081	37.51438187	-122.2607682	San Mateo County
165694	Fee-for-Service	1164260741	1164260741	1	1	ARIA VASCULAR A PROFESSIONAL	4/3/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1611 W MARCH LN	None	STOCKTON	CA	95207	6401	39	06077	37.98803343	-121.3263859	San Joaquin County
165704	Fee-for-Service	1396032751	1396032751	1	1	AGGARWAL, SAURABH MD	10/17/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	172183	None	None	0	In state provider	None	1901 TOWN AND COUNTRY DR	SUITE 104	NORCO	CA	92860	3611	33	06065	33.92721419	-117.561448	Riverside County
165715	Fee-for-Service	1356796163	1356796163	1	1	AGNIHOTHRI, RITESH MD	9/20/2022	207N00000X	NA	Dermatology	026	PHYSICIANS	169533	None	None	0	In state provider	None	910 MAPLE ST	None	REDWOOD CITY	CA	94063	2034	41	06081	37.48867968	-122.2222351	San Mateo County
165729	Fee-for-Service	1386184208	1386184208	1	1	AMELI, GIEVE H LMFT	5/1/2020	101YP2500X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
165757	Fee-for-Service	1659657856	1659657856	1	1	ALFA SURGERY CENTER LLC	10/23/2012	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	256 LANDIS AVE	SUITE 100	CHULA VISTA	CA	91910	2650	37	06073	32.64258295	-117.0815646	San Diego County
165779	Fee-for-Service	1154812055	1154812055	1	1	ANGUIANO, MARIA LMFT	2/26/2024	1041C0700X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
165803	Fee-for-Service	1114003605	1114003605	1	1	A&I HUATUCO INC	9/1/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1530 BESSIE AVE	STE 102	TRACY	CA	95376	3080	39	06077	37.74570848	-121.4330255	San Joaquin County
165830	Fee-for-Service	1649498015	1649498015	1	1	ANDERSON, ANDREA D MD	1/17/2012	208600000X	NA	General Surgery	026	PHYSICIANS	90631	02	General Surgery	0	In state provider	None	4190 GREEN RIVER RD	STE 201	CORONA	CA	92880	1507	33	06065	33.87951921	-117.6465879	Riverside County
165846	Fee-for-Service	1497013064	1497013064	1	1	ABLABUTYAN, LILIT MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142038	18	Ophthalmology	0	In state provider	None	1310 S CENTRAL AVE	None	GLENDALE	CA	91204	2506	19	06037	34.12963979	-118.2577867	Los Angeles County
165888	Fee-for-Service	1619176757	1619176757	1	1	ABAJIAN, MICHELLE D MD	9/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92905	40	Pediatrics	0	In state provider	None	501 N ORANGE AVE	STE 200	GLENDALE	CA	91203	1911	19	06037	34.15323119	-118.2565389	Los Angeles County
165901	Fee-for-Service	1649648767	1649648767	1	1	ASPIRE COUNSELING SERVICES -	4/24/2017	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	A MEDICAL CORPORATION	12402 INDUSTRIAL BLVD	B-6	VICTORVILLE	CA	92395	5871	36	06071	34.47628904	-117.2829923	San Bernardino County
165904	Fee-for-Service	1730448366	1730448366	1	1	ANDERSON, ASHLEY H DO	8/6/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16535	08	Family Practice	0	In state provider	None	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	57	06113	38.66314048	-121.794696	Yolo County
165907	Fee-for-Service	1760879340	1760879340	1	1	AKKAD, APURVA A MD	7/17/2023	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	144098	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
165912	Fee-for-Service	1659303873	1659303873	1	1	ANGSTREICH, GREG R MD	8/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54662	68	Hematology	0	In state provider	None	17500 RED HILL AVE	SUITE 250	IRVINE	CA	92614	7600	30	06059	33.69482227	-117.8539174	Orange County
165950	Fee-for-Service	1508350414	1508350414	1	1	ARNOLD, AMARILYS LCSW	2/28/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
165973	Fee-for-Service	1326292715	1326292715	2	1	ALL SMILES HOME HEALTH CARE	11/5/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	14545 VICTORY BLVD	SUITE 602	VAN NUYS	CA	91411	1680	19	06037	34.18668846	-118.450152	Los Angeles County
165980	Fee-for-Service	1164260741	1164260741	1	1	ARIA VASCULAR A PROFESSIONAL	4/3/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	1611 W MARCH LN	None	STOCKTON	CA	95207	6401	39	06077	37.98803343	-121.3263859	San Joaquin County
165998	Fee-for-Service	1396376935	1396376935	1	1	ANGEL TRANS LLC	9/10/2020	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2740 FULTON AVE	214	SACRAMENTO	CA	95821	5186	34	06067	38.615157	-121.4009055	Sacramento County
166078	Fee-for-Service	1710964242	1710964242	2	1	AZUOGU, ONYEMEZE MD	12/10/2019	2080P0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
166160	Fee-for-Service	1659965077	1659965077	1	1	AVRORA HOSPICE CARE	9/21/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10700 VENTURA BLVD	2A	STUDIO CITY	CA	91604	4629	19	06037	34.13812154	-118.3644157	Los Angeles County
166199	Fee-for-Service	1659303873	1659303873	1	1	ANGSTREICH, GREG R MD	8/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54662	78	Neoplastic Diseases/Oncology	0	In state provider	None	17500 RED HILL AVE	SUITE 250	IRVINE	CA	92614	7600	30	06059	33.69482227	-117.8539174	Orange County
166235	Fee-for-Service	1033809876	1033809876	1	1	ALBERT, IAN LMFT	11/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
166236	Fee-for-Service	1669630596	1669630596	1	1	ASSAL, MARIAN F S MD	10/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115630	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
166256	Fee-for-Service	1972065563	1972065563	1	1	APOLINARIO, MICHAEL A MD	9/14/2022	208M00000X	NA	Other	026	PHYSICIANS	181348	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
166266	Fee-for-Service	1336430446	1336430446	1	1	AKIYAMA, ELIZABETH S MD	9/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	71283	22	Pathology (M.D. only)	0	In state provider	None	2615 EYE STREET	None	BAKERSFIELD	CA	93301	2006	15	06029	35.38291587	-119.0199632	Kern County
166284	Fee-for-Service	1578979787	1578979787	1	1	AGRAWAL, PULAK MD	9/15/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	149538	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
166301	Fee-for-Service	1982099024	1982099024	1	1	AKHAVAN, BOBAK J MD	8/16/2021	207R00000X	NA	Other	026	PHYSICIANS	163091	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
166315	Fee-for-Service	1245473131	1245473131	1	1	ALMULLAHASSANI, AMEER MD	4/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136384	01	General Practice	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
166361	Fee-for-Service	1063039832	1063039832	1	1	ARANA, FRANCESCA A MD	10/31/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
166463	Fee-for-Service	1669560249	1669560249	1	1	AGGARWAL, MEENAKSHI MD	9/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72230	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
166467	Fee-for-Service	1558674523	1558674523	1	1	AHL, SCOTT G DO	8/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12063	41	Internal Medicine	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	7303	56	06111	34.27623479	-119.2520218	Ventura County
166472	Fee-for-Service	1467867440	1467867440	1	1	ANTHONY, CHRISTY MD	11/5/2019	207L00000X	NA	Other	026	PHYSICIANS	150111	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
166479	Fee-for-Service	1831377688	1831377688	1	1	AGYEMAN, AKUA A MD	10/5/2021	208M00000X	NA	Other	026	PHYSICIANS	84608	None	None	0	In state provider	None	1375 UNIVERSITY AVE	None	HEALDSBURG	CA	95448	3382	49	06097	38.6272407	-122.8638253	Sonoma County
166492	Fee-for-Service	1841272697	1841272697	1	1	AHDOOT, JOSEPH MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55697	66	Emergency Medicine (Urgent Care)	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
166496	Fee-for-Service	1760818207	1760818207	1	1	ALVA, BRITANY A LMFT	9/24/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19330 JESSE LN	STE 280	RIVERSIDE	CA	92508	5091	33	06065	33.90484164	-117.3254297	Riverside County
166506	Fee-for-Service	1447492335	1447492335	1	1	ABELSON, DANIEL J MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	105661	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
166509	Fee-for-Service	1740427657	1740427657	1	12	ALTAMED HEALTH SERVICES CORP	3/21/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1450 SOUTH CENTER STREET	None	SANTA ANA	CA	92704	3660	30	06059	33.72791168	-117.8981816	Orange County
166549	Fee-for-Service	1144758780	1144758780	1	1	ALVO HOLDING, INC.	2/27/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5055 NOVGOROD STREET	None	LOS ANGELES	CA	90032	1648	19	06037	34.09064636	-118.1732843	Los Angeles County
166567	Fee-for-Service	1134107675	1134107675	1	1	APRIA HEALTHCARE LLC	9/1/1999	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	10090 WILLOW CREEK RD	None	SAN DIEGO	CA	92131	1623	37	06073	32.90145637	-117.1095024	San Diego County
166603	Fee-for-Service	1245473131	1245473131	1	1	ALMULLAHASSANI, AMEER MD	4/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136384	13	Neurology (M.D. only)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
166647	Fee-for-Service	1548880685	1548880685	1	1	AVERY CARE HOSPICE INC	6/25/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11030 ARROW ROUTE	UNIT 209	RANCHO CUCAMONGA	CA	91730	4837	36	06071	34.0991145	-117.563265	San Bernardino County
166658	Fee-for-Service	1053725317	1053725317	1	2	AKHAVAN, PARVIZ DO A MEDICAL	10/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	7552	10	Gastroenterology (M.D. only)	0	In state provider	None	723 E MANCHESTER AVE	None	LOS ANGELES	CA	90001	3632	19	06037	33.96015588	-118.2621099	Los Angeles County
166662	Fee-for-Service	1912365891	1912365891	1	2	ARYA MEDICAL GROUP CORP	2/20/2018	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	520 W I ST	None	LOS BANOS	CA	93635	4211	20	06039	37.06346603	-120.8593647	Merced County
166666	Fee-for-Service	1730257932	1730257932	2	1	ALLERGY & ASTHMA ADULT & PED	8/8/2018	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	A	130 STONY POINT RD	SUITE E	SANTA ROSA	CA	95401	4120	49	06097	38.44143	-122.7452805	Sonoma County
166676	Fee-for-Service	1437237906	1437237906	1	2	AUBURN EYE CARE ASSOCIATES	9/7/2016	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	601 AUBURN FOLSOM RD	STE A	AUBURN	CA	95603	5623	31	06061	38.87967476	-121.0799313	Placer County
166682	Fee-for-Service	1114005352	1114005352	1	1	ALPINE ORTHOPEDIC MED GP	12/26/2019	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2488 N CALIFORNIA ST	None	STOCKTON	CA	95204	3494	39	06077	37.97587328	-121.2911856	San Joaquin County
166692	Fee-for-Service	1891146908	1891146908	1	2	ALEMOH, KEMI LCSW	9/1/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	12761 SCHABARUM AVE	None	BALDWIN PARK	CA	91706	6807	19	06037	34.08060971	-117.9958001	Los Angeles County
166699	Fee-for-Service	1760778898	1760778898	1	1	AVILA ACOSTA, ADRIANA J MD	2/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128146	None	None	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4404	50	06099	37.66508443	-120.9962589	Stanislaus County
166714	Fee-for-Service	1285053462	1285053462	1	1	ALEXANDER ENURAH	5/3/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5200 DTC PKWY	STE 400	GREENWOOD VLG	CO	80111	2719	00	None	39.621636	-104.8992545	Arapahoe County
166720	Fee-for-Service	1053803882	1053803882	1	1	AHN, JONATHON MD	7/1/2023	207L00000X	NA	Other	026	PHYSICIANS	164226	None	None	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
166724	Fee-for-Service	1417065228	1417065228	1	1	AGGARWAL, SONA L MD	4/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85835	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
166739	Fee-for-Service	1124018031	1124018031	1	7	ADVENTIST HEALTH CLEARLAKE	2/19/2016	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	15322 LAKE SHORE DR	SUITE 204	CLEARLAKE	CA	95422	9815	17	06033	38.95045805	-122.6255271	Lake County
166743	Fee-for-Service	1609938331	1609938331	2	1	ATHENA PHARMACY INC	7/26/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14332 RAMONA BLVD	None	BALDWIN PARK	CA	91706	3241	19	06037	34.08602796	-117.9615089	Los Angeles County
166750	Fee-for-Service	1669560249	1669560249	1	1	AGGARWAL, MEENAKSHI MD	9/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	72230	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
166753	Fee-for-Service	1558504381	1558504381	1	1	ATKINSON, ERIN E MD	2/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116372	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	#365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
166773	Fee-for-Service	1841272697	1841272697	1	1	AHDOOT, JOSEPH MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55697	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
166790	Fee-for-Service	1619031317	1619031317	1	1	ANEJA, ALKA MD	12/5/2014	2084P0800X	NA	Psychiatry	026	PHYSICIANS	112029	36	Psychiatry	0	In state provider	None	39001 SUNDALE DR	None	FREMONT	CA	94538	2005	01	06001	37.5461169	-121.979068	Alameda County
166791	Fee-for-Service	1831225762	1831225762	1	1	ALTERNATIVE CHOICES INC	8/17/1991	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	22840 VAN BUREN ST	None	GRAND TERRACE	CA	92313	5747	36	06071	34.02664452	-117.305793	San Bernardino County
166792	Fee-for-Service	1861561300	1861561300	1	1	AKHAVAN, RAMIN D MD	9/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	83287	30	Radiology	0	In state provider	None	10767 RIVERSIDE DR	None	NORTH HOLLYWOOD	CA	91602	2324	19	06037	34.15228949	-118.365732	Los Angeles County
166797	Fee-for-Service	1740427657	1740427657	1	12	ALTAMED HEALTH SERVICES CORP	3/21/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1450 SOUTH CENTER STREET	None	SANTA ANA	CA	92704	3660	30	06059	33.72791168	-117.8981816	Orange County
166821	Fee-for-Service	1497399117	1497399117	1	1	AINA-SHITTU, ZAINAB O MD	2/13/2023	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
166830	Fee-for-Service	1396905725	1396905725	1	1	ADAMS, ROBERT H DO	2/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12318	08	Family Practice	0	In state provider	None	9089 BASELINE ROAD	SUITE 100	RANCHO CUCAMONGA	CA	91730	1295	36	06071	34.12151248	-117.6074505	San Bernardino County
166832	Fee-for-Service	1144535576	1144535576	1	1	AFOLAKE O AWOYALE, M.D	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1170 CLEVELAND AVE	SUITE 1004	EAST POINT	GA	30344	3615	00	None	33.68127228	-84.42742435	Fulton County
166836	Fee-for-Service	1043501760	1043501760	1	4	AHN, SANG HOON MD INC	4/25/2014	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6301 BEACH BLVD	STE 204	BUENA PARK	CA	90621	4030	30	06059	33.86880928	-117.9983013	Orange County
166845	Fee-for-Service	1770860314	1770860314	1	1	AMENITY HEALTH SERVICES INC	5/23/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	12722 RIVERSIDE DRIVE	SUITE 209	VALLEY VILLAGE	CA	91607	3356	19	06037	34.15758454	-118.410318	Los Angeles County
166853	Fee-for-Service	1730743345	1730743345	1	1	AUSTIN, JITLADA L CNP	2/3/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3100 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	01	06001	37.70453535	-121.8586496	Alameda County
166856	Fee-for-Service	1366445298	1366445298	1	1	ASH, RICHARD D MD	8/26/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	38028	40	Pediatrics	0	In state provider	None	5720 STONERIDGE MALL RD	STE 240	PLEASANTON	CA	94588	2828	01	06001	37.69247085	-121.9301884	Alameda County
166873	Fee-for-Service	1992261887	1992261887	1	1	APUZZO, SERGIO MD	4/26/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	FRESNO AND R ST	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
166914	Fee-for-Service	1598128522	1598128522	1	1	ASGHAR, AEEN M MD	7/2/2021	208800000X	NA	Other	026	PHYSICIANS	171503	None	None	0	In state provider	None	1510 SAN PABLO ST	None	LOS ANGELES	CA	90033	5320	19	06037	34.06287152	-118.2029433	Los Angeles County
166938	Fee-for-Service	1548880685	1548880685	1	1	AVERY CARE HOSPICE INC	6/25/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11030 ARROW ROUTE	UNIT 209	RANCHO CUCAMONGA	CA	91730	4837	36	06071	34.0991145	-117.563265	San Bernardino County
166962	Fee-for-Service	1437237906	1437237906	1	2	AUBURN EYE CARE ASSOCIATES	9/7/2016	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	601 AUBURN FOLSOM RD	STE A	AUBURN	CA	95603	5623	31	06061	38.87967476	-121.0799313	Placer County
166970	Fee-for-Service	1114005352	1114005352	1	1	ALPINE ORTHOPEDIC MED GP	1/1/1979	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	2488 N CALIFORNIA ST	None	STOCKTON	CA	95204	3494	39	06077	37.97587328	-121.2911856	San Joaquin County
166991	Fee-for-Service	1225124993	1225124993	2	1	ALLEN-FLORER FAMILY HOMES	9/20/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	6074 N 9TH STREET	None	FRESNO	CA	93710	5816	10	06019	36.82439008	-119.7581724	Fresno County
167024	Fee-for-Service	1568987493	1568987493	1	1	AKOPIAN, ANI OD	10/2/2017	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	477 E COLORADO BLVD	None	PASADENA	CA	91101	2024	19	06037	34.14587948	-118.140561	Los Angeles County
167037	Fee-for-Service	1710413299	1710413299	1	1	ABLES, LAUREN DO	5/26/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	16873	08	Family Practice	0	In state provider	None	1450 TREAT BLVD	STE 160	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
167044	Fee-for-Service	1932532488	1932532488	1	1	ALY, DILYANA G PT	3/26/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	29798 HAUN	201	MENIFEE	CA	92586	6541	33	06065	33.68787713	-117.1748638	Riverside County
167057	Fee-for-Service	1669864302	1669864302	1	1	ADELSTEIN, T PHD	1/28/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYCHOLOGIST PC	150 MORNING SUN AVE	None	MILL VALLEY	CA	94941	3507	21	06041	37.8875095	-122.5284474	Marin County
167073	Fee-for-Service	1215165477	1215165477	1	1	AL-SUBU, AWNI M MD	11/1/2020	2080P0203X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	600 HIGHLAND AVE	None	MADISON	WI	53792	0001	00	None	43.07868393	-89.4316606	Dane County
167124	Fee-for-Service	1629164496	1629164496	1	1	ALLENBY, HEATHER LMFT	10/18/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7170 N FINANCIAL DR.	STE 110	FRESNO	CA	93720	2939	10	06019	36.84000952	-119.7711439	Fresno County
167131	Fee-for-Service	1730350042	1730350042	2	1	ADF INVESTMENTS INC.	2/3/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	20920 EARL ST	None	TORRANCE	CA	90503	4393	19	06037	33.839901	-118.358042	Los Angeles County
167149	Fee-for-Service	1225125297	1225125297	1	2	AMBROSE, ANTHONY L MD	9/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	33172	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8040 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	6010	19	06037	34.21736595	-118.4487378	Los Angeles County
167162	Fee-for-Service	1659035145	1659035145	1	1	ALISHA MANNING LICENSED CLIN	8/19/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NICAL SOCIAL WORKER CORP	1849 SAWTELLE BLVD	610	LOS ANGELES	CA	90025	7013	19	06037	34.04266851	-118.4451527	Los Angeles County
167180	Fee-for-Service	1467567511	1467567511	1	2	ANDERSON, PERRY SHARZER	9/24/2018	261QR0200X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1025 S ANAHEIM BLVD	None	ANAHEIM	CA	92805	5806	30	06059	33.81994338	-117.9087416	Orange County
167204	Fee-for-Service	1417205683	1417205683	1	2	ARREGUIN, MELISA NP	1/3/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	325 S WILLIS ST	None	VISALIA	CA	93291	6105	54	06107	36.327717	-119.2981005	Tulare County
167210	Fee-for-Service	1710559687	1710559687	1	1	ARNOLD, ASHLEY L LCSW	1/14/2025	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
167216	Fee-for-Service	1033612858	1033612858	1	1	ASIF, ZEESHAN S MD	3/18/2022	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
167233	Fee-for-Service	1528467099	1528467099	1	1	ALLY, MINA S MD	5/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144146	07	Dermatology	0	In state provider	None	276 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.2402111	-121.8021684	Santa Clara County
167238	Fee-for-Service	1851704100	1851704100	1	1	ATWAL, DANISH	6/4/2021	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
167241	Fee-for-Service	1740427657	1740427657	1	6	ALTAMED HEALTH SERVICES CORP	3/21/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1080 NORTH CALIFORNIA	None	ORANGE	CA	92867	5810	30	06059	33.805575	-117.8410565	Orange County
167257	Fee-for-Service	1376722736	1376722736	1	1	ALI, ALTAF L MD	9/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42679	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5365 WALNUT AVE	STE L	CHINO	CA	91708	0511	36	06071	34.02626051	-117.6883155	San Bernardino County
167269	Fee-for-Service	1538218300	1538218300	1	1	ADEYEMO, MOGBONJUBOLA MD	8/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	85970	41	Internal Medicine	0	In state provider	None	361 N SAN JACINTO ST	SUITE A B C	HEMET	CA	92543	3118	33	06065	33.752259	-116.958686	Riverside County
167299	Fee-for-Service	1093969750	1093969750	1	1	ABOEED, AYHAM MD	8/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137420	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
167354	Fee-for-Service	1649739772	1649739772	1	1	AGUDELO, ADRIAN MD	11/11/2022	207P00000X	NA	Other	026	PHYSICIANS	177461	None	None	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
167417	Fee-for-Service	1184689663	1184689663	1	1	ALI, MIR B MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72359	02	General Surgery	0	In state provider	None	11160 WARNER AVE	STE 421	FOUNTAIN VALLEY	CA	92708	4056	30	06059	33.71630854	-117.934317	Orange County
167427	Fee-for-Service	1790980829	1790980829	1	1	AWALT, ROBERT M PHD	9/3/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3420 KENYON ST	None	SAN DIEGO	CA	92110	5001	37	06073	32.74894593	-117.2139252	San Diego County
167429	Fee-for-Service	1548449572	1548449572	1	1	AGBO, OKWII CNP	5/15/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1508 E. FLORENCE AVENUE	None	LOS ANGELES	CA	90001	2536	19	06037	33.9746867	-118.2473559	Los Angeles County
167430	Fee-for-Service	1285693879	1285693879	2	1	ABBASIAN, MOHAMMAD MD	1/6/2023	207L00000X	NA	Other	026	PHYSICIANS	85125	None	None	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
167520	Fee-for-Service	1669979381	1669979381	1	1	ALPHA PHARMACEUTICAL INC	8/28/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1870 TICE VALLEY BLVD	None	WALNUT CREEK	CA	94595	2224	07	06013	37.87974111	-122.0752716	Contra Costa County
167529	Fee-for-Service	1740427657	1740427657	1	6	ALTAMED HEALTH SERVICES CORP	3/21/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1080 NORTH CALIFORNIA	None	ORANGE	CA	92867	5810	30	06059	33.805575	-117.8410565	Orange County
167552	Fee-for-Service	1013217389	1013217389	1	1	ANAHEIM MEDICAL GROUP INC	8/4/2020	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	C	2571 W LA PALMA AVE	None	ANAHEIM	CA	92801	2622	30	06059	33.84687747	-117.975258	Orange County
167575	Fee-for-Service	1972832681	1972832681	1	1	AVETYAN, ADRINE LMFT	8/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3655 ALAMO ST	STE 202	SIMI VALLEY	CA	93063	2187	56	06111	34.28646704	-118.7257456	Ventura County
167586	Fee-for-Service	1093969750	1093969750	1	1	ABOEED, AYHAM MD	8/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137420	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
167597	Fee-for-Service	1346583770	1346583770	1	1	ALI, AAMNA MD	2/13/2024	208600000X	NA	General Surgery	026	PHYSICIANS	136751	None	None	0	In state provider	None	807 ILLINOIS AVENUE	None	LOS BANOS	CA	93635	3512	24	06047	37.064394	-120.857788	Merced County
167707	Fee-for-Service	1699846626	1699846626	1	1	ANIDI, IFEOMA E MD	12/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52763	40	Pediatrics	0	In state provider	None	1168 SAN GABRIEL BLVD	STE EANDF	ROSEMEAD	CA	91770	4236	19	06037	34.04272643	-118.086007	Los Angeles County
167751	Fee-for-Service	1508098419	1508098419	1	1	ABO KHAMIS, MOHAMMED MD	6/15/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	160122	41	Internal Medicine	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
167778	Fee-for-Service	1588160451	1588160451	1	1	APPLEY, MAYA A MD	10/3/2023	207RA0401X	NA	Other	026	PHYSICIANS	166244	None	None	0	In state provider	None	200 MEDICAL PLAZA	SUITE 420	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
167799	Fee-for-Service	1821367236	1821367236	1	1	ADAMS, STUART OD PC	9/1/2012	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	110 N SPRING ST	None	BLYTHE	CA	92225	1633	33	06065	33.61069481	-114.5981348	Riverside County
167827	Fee-for-Service	1568400885	1568400885	1	1	AYOUB, ELIAS I MD APC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	39256	04	Otology, Laryngology, Rhinology	0	In state provider	None	11480 BROOKSHIRE AVE	STE 303	DOWNEY	CA	90241	5024	19	06037	33.93622932	-118.1311752	Los Angeles County
167844	Fee-for-Service	1609855873	1609855873	1	1	AMIE HAUGO M.D.	8/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1720 UNIVERSITY DR S	None	FARGO	ND	58103	4940	00	None	46.853136	-96.797421	Cass County
167845	Fee-for-Service	1033427067	1033427067	1	1	ALDRIDGE, MICHAEL E MD	1/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113903	41	Internal Medicine	0	In state provider	None	21840 S NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
167895	Fee-for-Service	1386054989	1386054989	1	1	ACCENTCARE HOME HEALTH OF	5/26/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	2344 S 2ND STREET	SUITE B	EL CENTRO	CA	92243	5606	13	06025	32.77196997	-115.5460437	Imperial County
167918	Fee-for-Service	1124343199	1124343199	1	1	ANDERSON, ALEXIS D	2/26/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
167919	Fee-for-Service	1326051806	1326051806	1	2	ALLEN, GWEN M MD INC	3/21/2022	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1141 W REDONDO BEACH BLV	SUITE 402	GARDENA	CA	90247	3582	19	06037	33.89247036	-118.2941482	Los Angeles County
167929	Fee-for-Service	1851324206	1851324206	1	1	ALHAMBRA FAMILY MEDICAL	12/3/2004	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CENTER INC AMPC	1336 W VALLEY BLVD	#A	ALHAMBRA	CA	91803	2480	19	06037	34.07762246	-118.1379895	Los Angeles County
167932	Fee-for-Service	1225734650	1225734650	1	1	ASIAN & PACIFIC ISLANDER	4/11/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1460 PINE STREET	None	SAN FRANCISCO	CA	94109	4720	38	06075	37.78974473	-122.4198356	San Francisco County
167940	Fee-for-Service	1154308062	1154308062	1	1	ARDITI, MOSE MD	6/11/1998	174400000X	NA	Other	026	PHYSICIANS	49151	77	Infectious Disease	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
167948	Fee-for-Service	1780950543	1780950543	1	1	ALAN F DAKAK MD INC	5/24/2012	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	96755	40	Pediatrics	0	In state provider	None	3941 SAN DIMAS ST	101	BAKERSFIELD	CA	93301	5711	15	06029	35.39552345	-119.0082184	Kern County
167979	Fee-for-Service	1477504801	1477504801	1	1	ADAMSON, JOHN W MD	8/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	20742	68	Hematology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
167985	Fee-for-Service	1275648610	1275648610	1	1	ANTELYES, ROY MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37727	None	None	0	In state provider	None	100 CONGRESS ST	None	PASADENA	CA	91105	0000	19	06037	34.13395172	-118.1534955	Los Angeles County
168035	Fee-for-Service	1245307057	1245307057	1	1	ANDERSON, PAMELA E MD	8/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	51789	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
168037	Fee-for-Service	1851737050	1851737050	1	1	ARNDT, JUSTIN M MD	7/1/2017	207P00000X	NA	Other	026	PHYSICIANS	134476	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
168038	Fee-for-Service	1801417043	1801417043	1	1	ARNOLD, ERIC M MD	6/23/2023	390200000X	NA	Other	026	PHYSICIANS	183110	None	None	0	In state provider	None	43112 N 15TH ST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
168040	Fee-for-Service	1508098419	1508098419	1	1	ABO KHAMIS, MOHAMMED MD	6/15/2020	207RP1001X	NA	Pulmonology	026	PHYSICIANS	160122	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
168069	Fee-for-Service	1467971747	1467971747	1	1	ALL FOR HEALTH, HEALTH FOR	5/1/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	ALL, INC	710 S CENTRAL AVE	SUITE 350	GLENDALE	CA	91204	4647	19	06037	34.13746423	-118.2578296	Los Angeles County
168104	Fee-for-Service	1891724316	1891724316	1	1	ABDELSHEHID, JOHN MD	3/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81545	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3865 JACKSON ST	None	RIVERSIDE	CA	92503	3919	33	06065	33.92617009	-117.4404151	Riverside County
168132	Fee-for-Service	1982084539	1982084539	1	1	ALONSO, JUAN LCSW	8/6/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	45926 OASIS ST	None	INDIO	CA	92201	4559	33	06065	33.715512	-116.2207015	Riverside County
168133	Fee-for-Service	1992717854	1992717854	1	1	ABERIN, ALEX MD	9/6/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	80481	None	None	0	In state provider	None	3200 BELL RD	None	AUBURN	CA	95603	9244	31	06061	38.94193574	-121.103139	Placer County
168135	Fee-for-Service	1629283197	1629283197	1	2	ALTAMED HEALTH SERVICES	9/6/2013	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2100 W 3RD STREET	SUITE 200	LOS ANGELES	CA	90057	1993	19	06037	34.06308947	-118.2733326	Los Angeles County
168161	Fee-for-Service	1669436960	1669436960	1	1	ABRAHAM, MARIA R MD	5/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148336	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
168166	Fee-for-Service	1881221000	1881221000	1	1	AULAKH, SABREEN K MD	6/7/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	186189	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
168174	Fee-for-Service	1669800702	1669800702	1	1	ANGELS HOSPICE SERVICES INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	126 S JACKSON ST	SUITE 304	GLENDALE	CA	91205	4921	19	06037	34.14533965	-118.2500741	Los Angeles County
168180	Fee-for-Service	1386054989	1386054989	1	1	ACCENTCARE HOME HEALTH OF	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	2344 S 2ND STREET	SUITE B	EL CENTRO	CA	92243	5606	13	06025	32.77196997	-115.5460437	Imperial County
168204	Fee-for-Service	1659989184	1659989184	1	1	AZURDIA CASTRO, NATALIE LCS	4/25/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
168206	Fee-for-Service	1326051806	1326051806	1	2	ALLEN, GWEN M MD INC	9/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	61790	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1141 W REDONDO BEACH BLV	SUITE 402	GARDENA	CA	90247	3582	19	06037	33.89247036	-118.2941482	Los Angeles County
168214	Fee-for-Service	1851324206	1851324206	1	1	ALHAMBRA FAMILY MEDICAL	12/3/2004	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CENTER INC AMPC	1336 W VALLEY BLVD	#A	ALHAMBRA	CA	91803	2480	19	06037	34.07762246	-118.1379895	Los Angeles County
168215	Fee-for-Service	1225734650	1225734650	1	1	ASIAN & PACIFIC ISLANDER	4/11/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1460 PINE STREET	None	SAN FRANCISCO	CA	94109	4720	38	06075	37.78974473	-122.4198356	San Francisco County
168236	Fee-for-Service	1174728240	1174728240	1	1	ALFOLDY, DIANE B	6/14/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4510 VIEWRIDGE AVENUE	None	SAN DIEGO	CA	92123	1637	37	06073	32.82283469	-117.1248707	San Diego County
168238	Fee-for-Service	1386678605	1386678605	2	1	AMERICAN MEDICAL RESPONSE	6/1/2017	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	WEST	240 E HWY 246	STE 300	BUELTON	CA	93427	9648	42	06083	34.61076396	-120.1866322	Santa Barbara County
168264	Fee-for-Service	1477504801	1477504801	1	1	ADAMSON, JOHN W MD	8/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	20742	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
168266	Fee-for-Service	1669539672	1669539672	1	1	ARCADIA FOOT CLINIC, INC	8/31/1991	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	25 N SANTA ANITA AVE	STE J	ARCADIA	CA	91006	3166	19	06037	34.14103063	-118.0315845	Los Angeles County
168292	Fee-for-Service	1184203838	1184203838	1	1	ATKINSON, BROOKE R DO	7/1/2024	207P00000X	NA	Other	026	PHYSICIANS	20451	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6601 WHITE FEATHER RD	None	JOSHUA TREE	CA	92252	6607	36	06071	34.13189479	-116.2767026	San Bernardino County
168298	Fee-for-Service	1619321098	1619321098	1	1	AL SHAWWAF, AHMED MD	3/10/2023	208M00000X	NA	Other	026	PHYSICIANS	172928	None	None	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
168313	Fee-for-Service	1114991825	1114991825	1	1	AGNEW, ROBYN M CNM	3/27/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1530 S OLIVE ST	None	LOS ANGELES	CA	90015	3023	19	06037	34.03542552	-118.2652073	Los Angeles County
168319	Fee-for-Service	1649732629	1649732629	1	1	ABDUL-MASSIH, CESAR MD	10/25/2023	207RS0010X	NA	Other	026	PHYSICIANS	178307	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
168323	Fee-for-Service	1245307057	1245307057	1	1	ANDERSON, PAMELA E MD	8/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	51789	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
168343	Fee-for-Service	1851528343	1851528343	1	1	ANDREWS, JASON R MD	2/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128987	77	Infectious Disease	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
168345	Fee-for-Service	1205909637	1205909637	1	1	ALLEGAKOEN,CLARENCE P MD	3/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	53837	41	Internal Medicine	0	In state provider	None	2500 GRANT ROAD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
168347	Fee-for-Service	1548819550	1548819550	1	1	AEGIS TREATMENT CENTERS, LLC	2/24/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1111 W INYOKERN RD	B	RIDGECREST	CA	93555	2370	15	06029	35.65168148	-117.692992	Kern County
168353	Fee-for-Service	1467971747	1467971747	1	1	ALL FOR HEALTH, HEALTH FOR	5/1/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ALL, INC	710 S CENTRAL AVE	SUITE 350	GLENDALE	CA	91204	4647	19	06037	34.13746423	-118.2578296	Los Angeles County
168366	Fee-for-Service	1548208978	1548208978	1	1	ANIS, JOHN O MD	7/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77310	None	None	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
168367	Fee-for-Service	1588246755	1588246755	1	1	ARGUETA, VILMA A LMFT	12/31/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2223 SANTA CLARA AVE	STE B5	ALAMEDA	CA	94501	4469	01	06001	37.76685808	-122.2452973	Alameda County
168404	Fee-for-Service	1356451785	1356451785	1	1	ABUDAYYEH, ISLAM MD	5/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84032	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
168412	Fee-for-Service	1881847424	1881847424	1	1	ADVANCE URGENT MED GROUP INC	10/7/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1401 W 1ST STREET	STE 101	SANTA ANA	CA	92703	3757	30	06059	33.74548648	-117.8871165	Orange County
168418	Fee-for-Service	1629283197	1629283197	1	2	ALTAMED HEALTH SERVICES	9/6/2013	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	2100 W 3RD STREET	SUITE 200	LOS ANGELES	CA	90057	1993	19	06037	34.06308947	-118.2733326	Los Angeles County
168419	Fee-for-Service	1558775908	1558775908	1	1	ARANETA, NICOLE MARIE ROSE S	12/30/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	160531	01	General Practice	0	In state provider	MD	1450 TREAT BLVD	STE 320	WALNUT CREEK	CA	94597	2168	07	06013	37.92643968	-122.0521822	Contra Costa County
168452	Fee-for-Service	1497719447	1497719447	1	2	ALLERGY, ASTHMA & RESPIRATOR	3/24/2021	207K00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	Y CARE MEDICAL CENTER	2220 CLARK AVE	UNIT A	LONG BEACH	CA	90815	2521	19	06037	33.79772674	-118.1338339	Los Angeles County
168461	Fee-for-Service	1669800702	1669800702	1	1	ANGELS HOSPICE SERVICES INC	2/1/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	126 S JACKSON ST	SUITE 304	GLENDALE	CA	91205	4921	19	06037	34.14533965	-118.2500741	Los Angeles County
168482	Fee-for-Service	1629633391	1629633391	1	1	ARNOCO, GLENN P NP	11/8/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
168491	Fee-for-Service	1598294126	1598294126	1	1	ABREU DIAZ, MONICA C MD	8/1/2023	207R00000X	NA	Other	026	PHYSICIANS	186278	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
168555	Fee-for-Service	1629657440	1629657440	1	1	ANNISSA GEM CARE	3/8/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	825 LILAC DRIVE	None	PLACENTIA	CA	92870	4728	30	06059	33.87762782	-117.8571644	Orange County
168596	Fee-for-Service	1205062395	1205062395	1	1	ANDREWS-STEELE, RAHILA T MD	5/23/2019	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	144294	39	Preventive (M.D. only)	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
168608	Fee-for-Service	1508086885	1508086885	1	1	ARORA, ROHIT MD	10/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	136531	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2000 MOWRY AVENUE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
168609	Fee-for-Service	1063806743	1063806743	1	1	AGUILERA, ANGEL J MD	6/14/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	144702	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
168630	Fee-for-Service	1851528343	1851528343	1	1	ANDREWS, JASON R MD	2/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128987	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
168634	Fee-for-Service	1548819550	1548819550	1	1	AEGIS TREATMENT CENTERS, LLC	2/24/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1111 W INYOKERN RD	B	RIDGECREST	CA	93555	2370	15	06029	35.65168148	-117.692992	Kern County
168664	Fee-for-Service	1528271186	1528271186	1	1	AMERICARE ADHC INC	10/28/2002	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	10610 CORTE ACUARIO	None	SAN DIEGO	CA	92130	8702	37	06073	32.91217026	-117.2239558	San Diego County
168671	Fee-for-Service	1649580929	1649580929	1	1	AMBERCITY HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3590 CENTRAL AVE	STE 207	RIVERSIDE	CA	92506	2708	33	06065	33.95352593	-117.3909386	Riverside County
168685	Fee-for-Service	1366190316	1366190316	1	1	ANO TWO FACILITY	4/27/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	FOR THE ELDERLY INC	7905 STANSBURY AVE	None	PANORAMA CITY	CA	91402	5216	19	06037	34.2143455	-118.4399947	Los Angeles County
168701	Fee-for-Service	1881847424	1881847424	1	1	ADVANCE URGENT MED GROUP INC	10/7/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1401 W 1ST STREET	STE 101	SANTA ANA	CA	92703	3757	30	06059	33.74548648	-117.8871165	Orange County
168797	Fee-for-Service	1083608533	1083608533	1	1	ADAMS, CHARLES A MD	8/1/1974	No Taxonomy Provided	NA	None	026	PHYSICIANS	28056	36	Psychiatry	0	In state provider	None	285 N EL CAMINO REAL	#219	ENCINITAS	CA	92024	5383	37	06073	33.05317488	-117.2611779	San Diego County
168842	Fee-for-Service	1891109468	1891109468	1	1	ABUSLEME, ISAAC E MD	3/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125024	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
168902	Fee-for-Service	1477083244	1477083244	1	1	ANDERSEN-NOEL, CARMELA K LMF	5/23/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1609 E. PALMDALE BLVD.	SUITE C & D	PALMDALE	CA	93550	4881	19	06037	34.57967548	-118.1008305	Los Angeles County
168904	Fee-for-Service	1265819478	1265819478	1	1	ASSADI, RAMI-JAMES MD	1/17/2024	2084N0400X	NA	Neurology	026	PHYSICIANS	192015	None	None	0	In state provider	None	152 PIONEER LANE	A-H	BISHOP	CA	93514	2563	14	06027	37.36269	-118.407312	Inyo County
168922	Fee-for-Service	1740567619	1740567619	1	1	ARCH HEALTH PARTNERS	1/17/2012	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	120 CRAVEN RD	STE 205	SAN MARCOS	CA	92078	4235	37	06073	33.12748853	-117.1662795	San Diego County
168935	Fee-for-Service	1831266857	1831266857	1	1	AZCUETA, CRESCANTINO P M	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78176	40	Pediatrics	0	In state provider	ATTN MGA OFFICE	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
168955	Fee-for-Service	1649580929	1649580929	1	1	AMBERCITY HOSPICE INC	6/7/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3590 CENTRAL AVE	STE 207	RIVERSIDE	CA	92506	2708	33	06065	33.95352593	-117.3909386	Riverside County
168957	Fee-for-Service	1598149536	1598149536	1	1	AJAM OUGHLI, HANADI MD	6/4/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	159226	36	Psychiatry	0	In state provider	None	760 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
169002	Fee-for-Service	1881629707	1881629707	1	1	ALMEIDA, RICHARD D MD	12/13/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87929	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
169042	Fee-for-Service	1932582699	1932582699	1	3	AKSHAY MEHTA MD INC	1/17/2020	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
169049	Fee-for-Service	1841457652	1841457652	1	1	AHN, ERIC S MD	9/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151227	18	Ophthalmology	0	In state provider	None	420 E 3RD ST	#603	LOS ANGELES	CA	90013	1644	19	06037	34.04702011	-118.241912	Los Angeles County
169052	Fee-for-Service	1851497937	1851497937	1	1	AZAI, YOSHIMI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1959 NE PACIFIC STREET	MS 359110 C/O UWP	SEATTLE	WA	98195	9110	00	None	47.65080692	-122.3081828	King County
169073	Fee-for-Service	1629536909	1629536909	1	1	ADAMS, TRACY E LCSW	11/1/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD STE 1	None	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
169088	Fee-for-Service	1689271389	1689271389	1	1	ANGEL FULLERTON MEDICAL GROU	1/12/2022	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	P	1125 W ORANGETHORPE AVEN	None	FULLERTON	CA	92833	4735	30	06059	33.85936305	-117.9444934	Orange County
169097	Fee-for-Service	1457531543	1457531543	1	1	AZAD, SARAH P MD	6/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	93504	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
169150	Fee-for-Service	1144241571	1144241571	1	1	ANDERSONS, PETER V MD	12/28/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	97669	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
169169	Fee-for-Service	1578260725	1578260725	1	1	AWTS, LLC	2/1/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	678 THIRD STREET	None	WOODLAND	CA	95695	4034	57	06113	38.67218698	-121.7707131	Yolo County
169172	Fee-for-Service	1912365891	1912365891	1	1	ARYA MEDICAL GROUP CORP	7/28/2017	207RC0200X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
169202	Fee-for-Service	1851772693	1851772693	1	1	ASSAD, DENISE LCSW	6/27/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	672 W 11TH ST	STE 102	TRACY	CA	95376	3869	39	06077	37.73965649	-121.4360235	San Joaquin County
169236	Fee-for-Service	1144640855	1144640855	1	1	AKARY, EIHAB MD	12/2/2022	208800000X	NA	Other	026	PHYSICIANS	178024	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
169275	Fee-for-Service	1598180655	1598180655	1	1	ADVENTIST HEALTH PHYSICIANS	2/20/2020	261QM2500X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	415 HOSPITAL DR	A	UKIAH	CA	95482	4545	23	06045	39.15408161	-123.2020675	Mendocino County
169305	Fee-for-Service	1710133889	1710133889	1	1	AIMAQ, RAHIM MD	7/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113236	02	General Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
169329	Fee-for-Service	1629007588	1629007588	1	1	ABID, FARIDA MD	1/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
169335	Fee-for-Service	1578060380	1578060380	1	1	ADAMS, SHAYNA S MD	8/1/2021	207P00000X	NA	Other	026	PHYSICIANS	173824	None	None	0	In state provider	None	520 WEST I ST	None	LOS BANOS	CA	95616	6201	24	06047	37.06346603	-120.8593647	Merced County
169414	Fee-for-Service	1841368461	1841368461	1	1	AZIZI, FRAIDON F MD	11/17/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	82340	None	None	0	In state provider	None	2773 HARRIS ST	STE A & D	EUREKA	CA	95503	4866	12	06023	40.78052829	-124.1363953	Humboldt County
169437	Fee-for-Service	1376607150	1376607150	1	2	ANDERSON, JOHN	2/8/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	98145	30	Radiology	0	In state provider	None	1380 LEAD HILL RD	SUITE 100	ROSEVILLE	CA	95661	2997	31	06061	38.74953449	-121.2601832	Placer County
169447	Fee-for-Service	1568228807	1568228807	1	1	AMANDEEP KAUR JOHAL, M.D., I	4/4/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	AND WALK-IN CLINIC	2693 FLORIN RD	None	SACRAMENTO	CA	95822	4524	34	06067	38.496177	-121.4781075	Sacramento County
169452	Fee-for-Service	1033301882	1033301882	1	1	ARZUMANYAN, HASMIK MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111294	67	Endocrinology	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
169468	Fee-for-Service	1982604476	1982604476	1	1	ASLAMY,WAZHMA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	340 E PALM LANE	STE A 175	PHOENIX	AZ	85004	4603	00	None	33.469812	-112.0681485	Maricopa County
169490	Fee-for-Service	1538457122	1538457122	1	1	ASHA E ATWELL D.O.	1/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 N BEAVER ST	None	FLAGSTAFF	AZ	86001	3118	00	None	35.208594	-111.645099	Coconino County
169533	Fee-for-Service	1104404128	1104404128	1	1	ACCIANI, ALYSE L DPM	9/16/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
169581	Fee-for-Service	1487306437	1487306437	1	1	ABT, STEVAN P CRNA	11/9/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
169599	Fee-for-Service	1326275363	1326275363	1	1	AWAD, RAMY A MD	1/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	90487	02	General Surgery	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
169625	Fee-for-Service	1740427657	1740427657	1	26	ALTAMED HEALTH SERVICES CORP	8/14/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	12871 ESTOCK DRIVE	None	GARDEN GROVE	CA	92840	4205	30	06059	33.78539113	-117.9100867	Orange County
169629	Fee-for-Service	1235517608	1235517608	1	1	ADAMS-BERRY KATHY L MD	8/10/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	82301	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6444 COYLE AVE	STE 3	CARMICHAEL	CA	95608	0300	34	06067	38.667807	-121.3129395	Sacramento County
169698	Fee-for-Service	1467468306	1467468306	1	1	ANDERSON, PATRICIA MD	8/29/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	48621	None	None	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
169708	Fee-for-Service	1306859772	1306859772	1	1	ARTZ, ANDREW S MD	9/12/2019	207RH0000X	NA	Hematology	026	PHYSICIANS	165285	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
169709	Fee-for-Service	1710633359	1710633359	1	1	AYERS, HANNAH LMFT	7/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
169725	Fee-for-Service	1003497678	1003497678	1	1	AHMADI, MARYAM MD	6/11/2024	390200000X	NA	Other	026	PHYSICIANS	None	22	Pathology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
169727	Fee-for-Service	1952920183	1952920183	1	1	ALBAKRI, ABDEL HAFEZ R MD	8/1/2023	208M00000X	NA	Other	026	PHYSICIANS	180099	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
169736	Fee-for-Service	1558701540	1558701540	1	1	ALSAMMAN, MOHD AMER MD	6/16/2023	207R00000X	NA	Other	026	PHYSICIANS	184601	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
169746	Fee-for-Service	1245240290	1245240290	1	1	ANDERSON,JAMES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 SOUTH MAIN	None	FORTWORTH	TX	76104	4917	00	None	32.72717074	-97.32642896	Tarrant County
169771	Fee-for-Service	1205497500	1205497500	1	1	AKUA BEHAVIORAL HEALTH, INC	2/15/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	8086 ORANGE AVE	None	FAIR OAKS	CA	95628	5941	34	06067	38.64735	-121.2650595	Sacramento County
169794	Fee-for-Service	1710932157	1710932157	2	1	ADVENTIST HEALTH MENDOCINO	8/19/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	COAST	700 RIVER DRIVE	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
169807	Fee-for-Service	1326037847	1326037847	1	1	ALTA CARE CENTER, LLC	8/15/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	13075 BLACKBIRD ST	None	GARDEN GROVE	CA	92843	2902	30	06059	33.77353611	-117.9130729	Orange County
169817	Fee-for-Service	1043501760	1043501760	1	3	AHN, SANG HOON MD INC	6/25/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	500 S VIRGIL AVE	SUITE 101	LOS ANGELES	CA	90020	1404	19	06037	34.064964	-118.2870335	Los Angeles County
169824	Fee-for-Service	1285635573	1285635573	1	1	ARRASTIA, MARIA C R MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
169829	Fee-for-Service	1659554194	1659554194	1	1	ANDERSON, STEPHEN A MD	1/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81689	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
169867	Fee-for-Service	1508943440	1508943440	1	1	ALLOO, ROBERT G MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	32780	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
169870	Fee-for-Service	1366560757	1366560757	1	1	ANDREWS, SILVIA B LMFT	2/22/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	965 E YOSEMITE AVE	12	MANTECA	CA	95336	5943	39	06077	37.79749432	-121.2033865	San Joaquin County
169896	Fee-for-Service	1033599139	1033599139	1	1	ADJUNTA, LAURA CCC-SLP	3/24/2021	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	16800 ASTON	STE 175	IRVINE	CA	92606	4820	30	06059	33.70035445	-117.8435881	Orange County
169898	Fee-for-Service	1851869705	1851869705	1	2	APPLE MEDICAL CLINIC INC	5/18/2022	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1433 MERCED AVE	112	WEST COVINA	CA	91790	3402	19	06037	34.06252177	-117.9477117	Los Angeles County
169912	Fee-for-Service	1740427657	1740427657	1	26	ALTAMED HEALTH SERVICES CORP	8/14/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	12871 ESTOCK DRIVE	None	GARDEN GROVE	CA	92840	4205	30	06059	33.78539113	-117.9100867	Orange County
169940	Fee-for-Service	1376671362	1376671362	2	1	ABILITY PATHWAYS	6/19/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED	9310 ELBEN AVE	None	SUN VALLEY	CA	91352	3403	19	06037	34.23809036	-118.3355719	Los Angeles County
169942	Fee-for-Service	1215997259	1215997259	1	1	ALVAREZ, ELIAZAR MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	67483	01	General Practice	0	In state provider	None	1851 N RIVERSIDE AVE	None	RIALTO	CA	92376	8069	36	06071	34.133238	-117.3704145	San Bernardino County
169947	Fee-for-Service	1497175434	1497175434	1	1	ANDRIA E TATEM	1/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
169981	Fee-for-Service	1063496164	1063496164	1	1	AKPOFURE, BLESSING MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	75078	05	Anesthesiology	0	In state provider	None	2701 S BRISTOL STREET	None	SANTA ANA	CA	92704	6201	30	06059	33.71114199	-117.8853958	Orange County
170048	Fee-for-Service	1497883821	1497883821	1	1	ARLT, CAROLE	12/27/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	50687	-	NOT APPLICABLE	0	In state provider	None	265 SOUTH ANITA DRIVE	SUITES 202, 301, 302	ORANGE	CA	92868	3355	30	06059	33.78499409	-117.8811837	Orange County
170061	Fee-for-Service	1528062106	1528062106	1	1	ALDANA, RICHARD MD	8/24/2004	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43152	08	Family Practice	0	In state provider	None	5330 E SUNCREST RD	None	ANAHEIM	CA	92807	3727	30	06059	33.84956649	-117.7991865	Orange County
170097	Fee-for-Service	1851417281	1851417281	1	1	ALPERN, LOUSINE MD	4/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	97357	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
170103	Fee-for-Service	1093088338	1093088338	1	1	AMERIKS, KIYOMI E DO	11/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12231	36	Psychiatry	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
170105	Fee-for-Service	1235353137	1235353137	1	2	ADVANCED INSTRUMENTS INC.	3/23/2023	237600000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2150 APPIAN WAY	104	PINOLE	CA	94564	0001	07	06013	37.9958468	-122.3021554	Contra Costa County
170150	Fee-for-Service	1952472862	1952472862	1	1	AKASHI, KATHY R MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	57845	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
170163	Fee-for-Service	1831267202	1831267202	1	1	AGUIAR, BRENDA M OT	11/27/2022	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
170171	Fee-for-Service	1811058415	1811058415	1	1	AIZARANI-HALLAK, ANTOINE	4/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87305	24	Plastic Surgery	0	In state provider	ANTOINE HALLAK MD INC	16766 BERNARDO CENTER DR	STE 109	SAN DIEGO	CA	92128	2501	37	06073	33.01756519	-117.0759175	San Diego County
170172	Fee-for-Service	1417571126	1417571126	1	1	APEX HEALTH CARE SERVICES	8/30/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	17034 BELLFLOWER BLVD	None	BELLFLOWER	CA	90706	5950	19	06037	33.8792907	-118.125183	Los Angeles County
170178	Fee-for-Service	1639551989	1639551989	1	2	AMERICAN CAPITAL INVESTMENTS	8/5/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	RANSPORTATION	14547 TITUS STREET	216	PANORAMA CITY	CA	91402	7301	19	06037	34.21973977	-118.4503255	Los Angeles County
170203	Fee-for-Service	1689647778	1689647778	1	1	AGHI, MANISH K MD	4/4/2008	207T00000X	NA	General Surgery	026	PHYSICIANS	101651	14	Neurological Surgery	0	In state provider	None	533 PARNASSUS AVE	# U126	SAN FRANCISCO	CA	94122	2722	38	06075	37.76304484	-122.4592904	San Francisco County
170208	Fee-for-Service	1306507991	1306507991	1	1	ANOOSH HOME CARE	10/1/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3415 S SEPULVEDA BLVD	STE 1174	LOS ANGELES	CA	90034	6060	19	06037	34.02086527	-118.4235306	Los Angeles County
170209	Fee-for-Service	1215331426	1215331426	1	1	AGUILAR, CHARLES P MD	6/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	141314	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
170213	Fee-for-Service	1124293063	1124293063	1	1	ATWOOD, AMY K MD	11/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117758	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	395 HICKEY BLVD	None	DALY CITY	CA	94015	2770	41	06081	37.66312028	-122.4631592	San Mateo County
170255	Fee-for-Service	1104120385	1104120385	1	2	ALL CARE PHYSICAL THERAPY PC	12/2/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8929 AERO DR	STE E	SAN DIEGO	CA	92123	2231	37	06073	32.80975402	-117.1359375	San Diego County
170256	Fee-for-Service	1922323104	1922323104	1	1	AXTELL, SUSAN M PHD	6/7/2010	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
170269	Fee-for-Service	1770110751	1770110751	1	1	ABEL, PERI LMFT	4/20/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21241 VENTURA	STE 290	WOODLAND HILLS	CA	91364	2108	19	06037	34.16736368	-118.5947825	Los Angeles County
170282	Fee-for-Service	1891795449	1891795449	1	1	ALI, RAED M MD	12/21/2007	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	61744	20	Orthopedic Surgery	0	In state provider	None	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	30	06059	33.89343304	-117.9279349	Orange County
170283	Fee-for-Service	1144407123	1144407123	1	1	ANDREW,DAVID DO	4/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1015 NW 22ND AVE	None	PORTLAND	OR	97210	3025	00	None	45.53024175	-122.6966202	Multnomah County
170296	Fee-for-Service	1174527774	1174527774	1	1	AUSTIN, FERNANDO H MD	9/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	30459	10	Gastroenterology (M.D. only)	0	In state provider	None	9930 TALBERT AVE	None	FOUNTAIN VALLEY	CA	92708	5153	30	06059	33.70166152	-117.955521	Orange County
170311	Fee-for-Service	1992806210	1992806210	1	1	ALVIRA, CRISTINA M MD	7/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	72940	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
170332	Fee-for-Service	1114914876	1114914876	1	1	ALLRED, CHRISTOPHER T OD	4/1/2000	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1342 E CHAPMAN AVE	None	FULLERTON	CA	92831	3954	30	06059	33.87409201	-117.9039639	Orange County
170344	Fee-for-Service	1053912436	1053912436	1	1	ADONAI HOME HEALTH CARE INC	2/7/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	121 W LEXINGTON DR	STE L300E	GLENDALE	CA	91203	2203	19	06037	34.1517575	-118.2560706	Los Angeles County
170351	Fee-for-Service	1528062106	1528062106	1	1	ALDANA, RICHARD MD	8/24/2004	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	43152	01	General Practice	0	In state provider	None	5330 E SUNCREST RD	None	ANAHEIM	CA	92807	3727	30	06059	33.84956649	-117.7991865	Orange County
170361	Fee-for-Service	1093277956	1093277956	1	1	ANSARI, SHAJIA RAHMAN MD	4/26/2023	207ZP0102X	NA	Other	026	PHYSICIANS	184859	None	None	0	In state provider	None	10833 LECONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
170392	Fee-for-Service	1598165227	1598165227	1	1	AMARAL, LIZ R LMFT	5/25/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
170399	Fee-for-Service	1033588777	1033588777	1	1	ASSOCIATE HOME HEALTH CARE	11/18/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	183 W NORTH STREET	SUITE 1	MANTECA	CA	95336	4710	39	06077	37.80105523	-121.2175827	San Joaquin County
170405	Fee-for-Service	1477817542	1477817542	1	1	ABDELNOUR, LAMA M MD	6/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135151	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
170422	Fee-for-Service	1841452281	1841452281	1	1	APONTE, MARGARITA M MD	10/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132458	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
170427	Fee-for-Service	1669645776	1669645776	1	1	ALVIRA, PROVIDENCE M	9/21/2010	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6367 ALVARADO CT	101	SAN DIEGO	CA	92120	4914	37	06073	32.77665968	-117.0614306	San Diego County
170444	Fee-for-Service	1043236946	1043236946	1	1	ALLMEYER, RITA M	7/26/2017	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1255 LIBERTY ST	None	REDDING	CA	96001	0814	45	06089	40.58769807	-122.3879041	Shasta County
170445	Fee-for-Service	1952472862	1952472862	1	1	AKASHI, KATHY R MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	57845	10	Gastroenterology (M.D. only)	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
170459	Fee-for-Service	1417571126	1417571126	1	1	APEX HEALTH CARE SERVICES	8/30/2022	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	17034 BELLFLOWER BLVD	None	BELLFLOWER	CA	90706	5950	19	06037	33.8792907	-118.125183	Los Angeles County
170461	Fee-for-Service	1700975042	1700975042	1	1	AMBARDEKAR, AMRUT V MD	4/9/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
170511	Fee-for-Service	1437122397	1437122397	1	1	AMIT DHINGRA,MD	4/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13634 N 93RD AVE	STE 100	PEORIA	AZ	85381	4915	00	None	33.608088	-112.260546	Maricopa County
170513	Fee-for-Service	1154423499	1154423499	1	1	ANDREW AYERS MARTIN	10/3/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1970 HOSPITAL DR	None	CLARKSDALE	MS	38614	7202	00	None	34.19710722	-90.55191441	Coahoma County
170522	Fee-for-Service	1043223746	1043223746	1	1	ARMANDI, BARRY MD	6/14/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	160684	30	Radiology	0	In state provider	None	10101 RIVERSIDE DR	None	TOLUCA LAKE	CA	91602	2517	19	06037	34.15223753	-118.3508865	Los Angeles County
170544	Fee-for-Service	1104120385	1104120385	1	2	ALL CARE PHYSICAL THERAPY PC	11/20/2023	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8929 AERO DR	STE E	SAN DIEGO	CA	92123	2231	37	06073	32.80975402	-117.1359375	San Diego County
170612	Fee-for-Service	1417007238	1417007238	1	1	AUSTIN, KRISTINA H MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	54383	18	Ophthalmology	0	In state provider	None	6880 PALM AVE	None	SEBASTOPOL	CA	95472	4270	49	06097	38.39599965	-122.8192479	Sonoma County
170652	Fee-for-Service	1639259328	1639259328	1	1	AFTERGOOD, DAVID E MD	11/30/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	37724	67	Endocrinology	0	In state provider	None	8737 BEVERLY BLVD	STE 301	LOS ANGELES	CA	90048	1839	19	06037	34.07687959	-118.381876	Los Angeles County
170654	Fee-for-Service	1376907535	1376907535	1	2	ADVANCED CENTER FOR SPORTS &	5/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	13043	None	None	0	In state provider	None	665 CAMINO DE LOS MARES	STE 305	SAN CLEMENTE	CA	92673	2841	30	06059	33.45730192	-117.6483252	Orange County
170675	Fee-for-Service	1336120666	1336120666	1	1	ANGELES, MICHAEL A MD	11/27/2023	207R00000X	NA	Other	026	PHYSICIANS	188458	None	None	0	In state provider	None	1900 DRESDEN	None	LINCOLN	CA	95648	8803	31	06061	38.85524393	-121.2946284	Placer County
170681	Fee-for-Service	1598875833	1598875833	1	1	AMINOFF, MICHAEL J MD	9/30/1990	2084N0400X	NA	Neurology	026	PHYSICIANS	31714	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	APT 887	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
170688	Fee-for-Service	1477817542	1477817542	1	1	ABDELNOUR, LAMA M MD	6/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	135151	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
170695	Fee-for-Service	1639815186	1639815186	1	1	APEX COMMUNITY HEALTH CENTER	2/14/2024	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	18040 SHERMAN WAY	STE 204	RESEDA	CA	91335	4656	19	06037	34.20103048	-118.526787	Los Angeles County
170703	Fee-for-Service	1285835793	1285835793	1	1	ABDELNABY, MARYAM A MD INC	3/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	80495	41	Internal Medicine	0	In state provider	None	301 VICTORIA STREET	None	COSTA MESA	CA	92627	1995	30	06059	33.65258952	-117.9121545	Orange County
170706	Fee-for-Service	1912962879	1912962879	2	1	AIRCARE HOME RESPIRATORY LLC	3/29/2016	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	13311 GARDEN GROVE BLVD	STE D	GARDEN GROVE	CA	92843	2202	30	06059	33.77637908	-117.9007412	Orange County
170707	Fee-for-Service	1306080585	1306080585	1	1	ARCE, DOMINIQUE Y MD	6/16/2022	207L00000X	NA	Other	026	PHYSICIANS	175796	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
170726	Fee-for-Service	1255423190	1255423190	1	1	ARON, RITA LMFT	6/5/2022	103T00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3201 WILSHIRE BLVD	209	SANTA MONICA	CA	90403	4746	19	06037	34.04063728	-118.4717816	Los Angeles County
170743	Fee-for-Service	1255677134	1255677134	1	1	AHMED, ZAVIER S MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135146	41	Internal Medicine	0	In state provider	None	11180 WARNER AVENUE	SUITE 463	FOUNTAIN VALLEY	CA	92708	7505	30	06059	33.71632048	-117.9334575	Orange County
170784	Fee-for-Service	1538300512	1538300512	1	1	ARRIETA, MELISSA M LMFT	10/2/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1451 S RIMPAU AVE	SUITE 216	CORONA	CA	92879	7522	33	06065	33.86546916	-117.5455079	Riverside County
170785	Fee-for-Service	1740644657	1740644657	1	1	ALI, MOHAMMED F MD	3/21/2019	390200000X	NA	Other	026	PHYSICIANS	152531	41	Internal Medicine	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
170812	Fee-for-Service	1639361421	1639361421	1	1	ARTEAGA, JAMES R MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74114	02	General Surgery	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
170829	Fee-for-Service	1760463251	1760463251	1	1	ALBIRINI, ABDULMAWLA MD	11/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54980	41	Internal Medicine	0	In state provider	None	2710 DOLBEER STREET	None	EUREKA	CA	95501	4736	12	06023	40.78449066	-124.1414748	Humboldt County
170831	Fee-for-Service	1104120385	1104120385	1	2	ALL CARE PHYSICAL THERAPY PC	8/4/2022	225100000X	NA	Physical Therapist	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8929 AERO DR	STE E	SAN DIEGO	CA	92123	2231	37	06073	32.80975402	-117.1359375	San Diego County
170848	Fee-for-Service	1487856704	1487856704	1	1	AHMED, KAMRAN MD	1/26/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109865	30	Radiology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
170874	Fee-for-Service	1245329721	1245329721	1	1	ACHARA, IROEGBU BOBBY	9/15/2008	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	WEST SIDE MED SUPPLIES	44300 N DIVISION AVE	SUITE B	LANCASTER	CA	93535	3512	19	06037	34.688142	-118.1303345	Los Angeles County
170892	Fee-for-Service	1669070702	1669070702	1	1	ANGELS VISIT HOSPICE	12/10/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	21006 DEVONSHIRE ST	STE 203	CHATSWORTH	CA	91311	2384	19	06037	34.25722549	-118.5913485	Los Angeles County
170902	Fee-for-Service	1215375753	1215375753	1	1	AVERY, OBOESI V OD	1/25/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
170910	Fee-for-Service	1669403390	1669403390	1	2	AXIS COMMUNITY HEALTH, INC.	11/1/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	4361 RAILROAD AVENUE	None	PLEASANTON	CA	94566	6611	01	06001	37.66138479	-121.8737265	Alameda County
170927	Fee-for-Service	1447253380	1447253380	1	1	ABEL, MICHAEL E MD	3/1/1984	208C00000X	NA	General Surgery	026	PHYSICIANS	38707	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
170957	Fee-for-Service	1184681710	1184681710	1	1	ALLEN, SCOTT A MD	7/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	89017	08	Family Practice	0	In state provider	None	555 TACHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
170981	Fee-for-Service	1740390111	1740390111	1	1	AZIZ, HUMA MD	8/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71045	41	Internal Medicine	0	In state provider	None	625 LINCOLN AVE	None	SAN JOSE	CA	95126	3705	43	06085	37.31809479	-121.9082315	Santa Clara County
171003	Fee-for-Service	1558727776	1558727776	1	1	ANGELCARE HOME HEALTH	2/8/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES LLC	1525 MCCARTHY BLVD	STE 1128	MILPITAS	CA	95035	7451	43	06085	37.4068329	-121.9195423	Santa Clara County
171024	Fee-for-Service	1538357215	1538357215	1	1	ADVANCED KIDNEY MEDICAL	1/29/2009	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP	3933 COFFEE RD	STE B	BAKERSFIELD	CA	93308	5024	15	06029	35.395335	-119.092336	Kern County
171025	Fee-for-Service	1669525051	1669525051	1	1	ALONSO, RAMIRO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 E NOLANA AVE	STE 9	MCALLEN	TX	78504	6113	00	None	26.2370052	-98.204497	Hidalgo County
171032	Fee-for-Service	1255677134	1255677134	1	1	AHMED, ZAVIER S MD	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	135146	45	Nephrology (Renal-Kidney)	0	In state provider	None	11180 WARNER AVENUE	SUITE 463	FOUNTAIN VALLEY	CA	92708	7505	30	06059	33.71632048	-117.9334575	Orange County
171084	Fee-for-Service	1457439283	1457439283	1	1	ACQUAVIVA, ANTHONY M MD	6/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90994	34	Urology and Urological Surgery	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
171086	Fee-for-Service	1922626845	1922626845	1	1	ALEJO, JOSE LMFT	1/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6777 N WILLOW AVE	None	FRESNO	CA	93710	5900	10	06019	36.83465436	-119.7311422	Fresno County
171094	Fee-for-Service	1003314006	1003314006	1	1	ADVENTIST HEALTH PHYSICIANS	4/28/2020	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1215 PLUMAS ST	STE 800	YUBA CITY	CA	95991	4084	51	06101	39.14709336	-121.6175316	Sutter County
171112	Fee-for-Service	1669039533	1669039533	1	1	ARAM HARIJAN MD PC	12/19/2022	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	151 CLAYDELLE AVE	None	EL CAJON	CA	92020	4505	37	06073	32.794155	-116.958763	San Diego County
171113	Fee-for-Service	1194879528	1194879528	1	1	ARIA, LESLIE A	10/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1660 E ROSEVILLE PKWY	BLDG C	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
171120	Fee-for-Service	1073877262	1073877262	1	1	AWOMOLO, AGBOOLA MD	7/2/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	179562	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
171141	Fee-for-Service	1497862254	1497862254	1	1	AL-HARIRI, AMR MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	54396	41	Internal Medicine	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
171159	Fee-for-Service	1619982592	1619982592	1	1	ALLMAN, GEORGE W MD	11/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	50102	33	Thoracic Surgery	0	In state provider	None	1500 SOUTHGATE AVE	STE 209	DALY CITY	CA	94015	2231	41	06081	37.67558248	-122.4750825	San Mateo County
171160	Fee-for-Service	1902893357	1902893357	1	1	ARCHIBALD, JOHN D OD	3/10/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	28125 BRADLEY ROAD	SUITE 180	SUN CITY	CA	92586	2279	33	06065	33.71309746	-117.1898349	Riverside County
171181	Fee-for-Service	1669070702	1669070702	1	1	ANGELS VISIT HOSPICE	12/10/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	21006 DEVONSHIRE ST	STE 203	CHATSWORTH	CA	91311	2384	19	06037	34.25722549	-118.5913485	Los Angeles County
171184	Fee-for-Service	1043612351	1043612351	1	1	ATANASIO, JOSEPH F III PSYD	6/6/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
171186	Fee-for-Service	1386176519	1386176519	1	1	ANGKADJAJA, JULIA Y MD	10/11/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	157712	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
171193	Fee-for-Service	1295824423	1295824423	1	1	ALIZADEH, ARASH A MD	9/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	92354	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
171195	Fee-for-Service	1255839254	1255839254	1	1	ADVENTIST HEALTH PHYSICIANS	8/20/2019	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	481 PLUMAS BLVD	STE 104	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
171201	Fee-for-Service	1669403390	1669403390	1	2	AXIS COMMUNITY HEALTH, INC.	11/1/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	4361 RAILROAD AVENUE	None	PLEASANTON	CA	94566	6611	01	06001	37.66138479	-121.8737265	Alameda County
171204	Fee-for-Service	1609481027	1609481027	1	1	ARTEMIS HEALTHCARE	8/9/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	220 S KENWOOD ST	SUITE 101	GLENDALE	CA	91205	5122	19	06037	34.14355865	-118.2513018	Los Angeles County
171227	Fee-for-Service	1780609933	1780609933	1	1	AGARWAL, MADHU MD	3/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	73978	18	Ophthalmology	0	In state provider	None	4440 BROCKTON AVE	STE 330	RIVERSIDE	CA	92501	4026	33	06065	33.97764104	-117.3838896	Riverside County
171229	Fee-for-Service	1770693541	1770693541	1	1	ALWATTAR, MOHAMMAD S MD	12/19/1994	207P00000X	NA	Other	026	PHYSICIANS	49352	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1510 W VERDUGO AVE	None	BURBANK	CA	91506	2472	19	06037	34.16830503	-118.3218088	Los Angeles County
171269	Fee-for-Service	1073110607	1073110607	1	1	ALBION MEDICAL PARTNERS OF C	9/19/2023	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	NERS WEST, P.C	10000 LAKEWOOD BLVD	None	DOWNEY	CA	90240	4020	19	06037	33.94833058	-118.1166411	Los Angeles County
171306	Fee-for-Service	1790104842	1790104842	1	1	ALEXEEVA, MADELEINE A DO MD	7/1/2018	207P00000X	NA	Other	026	PHYSICIANS	16422	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6263	54	06107	36.327888	-119.294919	Tulare County
171316	Fee-for-Service	1558737486	1558737486	1	1	ADVENTIST HEALTH CLEARLAKE	2/1/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL, INC	18990 COYOTE VALLEY RD	SUITE 8, 9, & 10	HIDDEN VALLEY	CA	95467	8339	17	06033	38.79462138	-122.5574782	Lake County
171321	Fee-for-Service	1962436774	1962436774	1	1	ADAMS, HUGH R MD	1/1/1982	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	31891	25	Physical Medicine and Rehabilitation	0	In state provider	None	2865 ATLANTIC AVE	STE 20	LONG BEACH	CA	90806	1740	19	06037	33.809418	-118.185058	Los Angeles County
171338	Fee-for-Service	1932188521	1932188521	1	1	AHMED, SYED SAJEEL MD	4/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	87434	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1331 W AVENUE J	STE 101	LANCASTER	CA	93534	2942	19	06037	34.68946152	-118.155699	Los Angeles County
171349	Fee-for-Service	1417554049	1417554049	1	1	ALIOTO, ANDREA PSYD	6/4/2021	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1263 E ARQUES AVENUE	None	SUNNYVALE	CA	94085	4701	43	06085	37.38060846	-121.9896672	Santa Clara County
171368	Fee-for-Service	1255352704	1255352704	1	1	AZER, SHERIF A MD	12/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	34806	05	Anesthesiology	0	In state provider	None	11234 ANDERSON ST	None	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
171369	Fee-for-Service	1578633749	1578633749	1	1	ALLEN, KAMALA PHD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	None	None	0	In state provider	None	591 CAMINO DE LA REINA	STE 918	SAN DIEGO	CA	92108	3111	37	06073	32.76632791	-117.1616245	San Diego County
171370	Fee-for-Service	1396935250	1396935250	1	1	ANCHETA, JANICE C MD	12/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94525	30	Radiology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
171397	Fee-for-Service	1558414516	1558414516	1	1	ALLEN, JEREMIAH G MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130357	02	General Surgery	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
171428	Fee-for-Service	1477294817	1477294817	1	1	ADVANCED HOME DIALYSIS, INC	6/12/2023	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	19231 VICTORY BLVD	SUITE 103	RESEDA	CA	91335	6314	19	06037	34.18659852	-118.552221	Los Angeles County
171430	Fee-for-Service	1154102259	1154102259	1	1	ANGAL, NEETI	10/13/2023	225100000X	NA	Physical Therapist	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2262 N. 1ST ST	None	SAN JOSE	CA	95131	2022	43	06085	37.37772646	-121.921374	Santa Clara County
171436	Fee-for-Service	1750475661	1750475661	1	1	AMARO, RAFAEL A MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	34264	41	Internal Medicine	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
171438	Fee-for-Service	1851836084	1851836084	1	2	ANKUR GUPTA MD INC	9/19/2018	2086S0129X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	3751 KATELLA AVENUE	None	LOS ALAMITOS	CA	90720	3113	30	06059	33.80318353	-118.0666665	Orange County
171446	Fee-for-Service	1629277611	1629277611	1	1	AMINI, NELIE F NP	4/17/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
171447	Fee-for-Service	1306162490	1306162490	1	1	ARTHRITIS CARE AND RESEARCH	6/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	85072	83	Rheumatology	0	In state provider	CENTER	15644 POMERADO RD	STE 102	POWAY	CA	92064	2419	37	06073	32.99717879	-117.0579379	San Diego County
171472	Fee-for-Service	1740427657	1740427657	1	3	ALTAMED HEALTH SERVICES CORP	3/11/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2609 WEST 5TH STREET	None	SANTA ANA	CA	92703	1818	30	06059	33.74873178	-117.9029547	Orange County
171492	Fee-for-Service	1609481027	1609481027	1	1	ARTEMIS HEALTHCARE	8/9/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	220 S KENWOOD ST	SUITE 101	GLENDALE	CA	91205	5122	19	06037	34.14355865	-118.2513018	Los Angeles County
171516	Fee-for-Service	1770693541	1770693541	1	1	ALWATTAR, MOHAMMAD S MD	12/19/1994	207P00000X	NA	Other	026	PHYSICIANS	49352	40	Pediatrics	0	In state provider	None	1510 W VERDUGO AVE	None	BURBANK	CA	91506	2472	19	06037	34.16830503	-118.3218088	Los Angeles County
171529	Fee-for-Service	1669673463	1669673463	1	2	ALAMEDA HEALTH SYSTEM	6/12/2008	No Taxonomy Provided	NA	None	060	COUNTY HOSPITAL INPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
171601	Fee-for-Service	1437129715	1437129715	1	1	ACHARYA, MANISH MD	12/10/2021	207P00000X	NA	Other	026	PHYSICIANS	172553	None	None	0	In state provider	None	1205 E NORTH ST	None	MANTECA	CA	95336	4900	39	06077	37.80110374	-121.1974853	San Joaquin County
171607	Fee-for-Service	1558737486	1558737486	1	1	ADVENTIST HEALTH CLEARLAKE	2/1/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL, INC	18990 COYOTE VALLEY RD	SUITE 8, 9, & 10	HIDDEN VALLEY	CA	95467	8339	17	06033	38.79462138	-122.5574782	Lake County
171628	Fee-for-Service	1932287711	1932287711	1	1	ALEKS, NORMAN M MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69024	05	Anesthesiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
171629	Fee-for-Service	1932188521	1932188521	1	1	AHMED, SYED SAJEEL MD	4/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	87434	41	Internal Medicine	0	In state provider	None	1331 W AVENUE J	STE 101	LANCASTER	CA	93534	2942	19	06037	34.68946152	-118.155699	Los Angeles County
171654	Fee-for-Service	1740669563	1740669563	1	1	ADDALA, ANANTA DO	6/15/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	13994	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
171661	Fee-for-Service	1689672909	1689672909	1	1	AUSTIN, JULIANA L MD	8/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	85298	40	Pediatrics	0	In state provider	None	2650 ELM AVENUE	STE 210	LONG BEACH	CA	90806	1600	19	06037	33.805521	-118.1882945	Los Angeles County
171663	Fee-for-Service	1053358523	1053358523	2	1	ADELGAIS, KATHLEEN M MD	10/4/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
171671	Fee-for-Service	1396791307	1396791307	1	1	ACCENTCARE HOME HEALTH	4/30/1998	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA, INC	2300 CONTRA COSTA BLVD	STE 125	PLEASANT HILL	CA	94523	3958	07	06013	37.94465627	-122.0602767	Contra Costa County
171672	Fee-for-Service	1184279770	1184279770	1	1	ASRANI, ANJALI NP	11/12/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
171680	Fee-for-Service	1083667976	1083667976	1	1	ARROW RESPIRATORY CARE	10/13/2004	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1175 E ARROW HWY	STE H	UPLAND	CA	91786	5525	36	06071	34.09981647	-117.636003	San Bernardino County
171692	Fee-for-Service	1982861712	1982861712	1	1	ALICE MCCAULEY	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SACRED HEART MEDICAL	101 W 8TH AVE	None	SPOKANE	WA	99204	0000	00	None	47.647989	-117.4112415	Spokane County
171706	Fee-for-Service	1821529058	1821529058	1	1	AWAD, MUNADEL A MD	11/30/2021	208M00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
171711	Fee-for-Service	1336638394	1336638394	1	1	APELO, CHARITY AMBER J MD	7/22/2021	207P00000X	NA	Other	026	PHYSICIANS	165521	None	None	0	In state provider	None	5451 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02626886	-117.6858645	San Bernardino County
171737	Fee-for-Service	1487149456	1487149456	1	1	ALTASHI, AHMED A PT	1/4/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3215 CALIFORNIA STREET	4	STOCKTON	CA	95204	3433	39	06077	37.98127088	-121.2934355	San Joaquin County
171745	Fee-for-Service	1184965592	1184965592	1	1	ASBORNO, NATALIE M NP	3/23/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
171752	Fee-for-Service	1326433350	1326433350	1	1	ALMODOVAR, KYLE M	9/1/2018	208M00000X	NA	Other	026	PHYSICIANS	15120	41	Internal Medicine	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
171761	Fee-for-Service	1740427657	1740427657	1	3	ALTAMED HEALTH SERVICES CORP	3/11/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2609 WEST 5TH STREET	None	SANTA ANA	CA	92703	1818	30	06059	33.74873178	-117.9029547	Orange County
171824	Fee-for-Service	1720213101	1720213101	1	1	ABBOTT, JOEL E DO	7/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	11538	31	Roentgenology, Radiology (M.D. only)	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
171869	Fee-for-Service	1679660674	1679660674	1	1	AMERICAN MEDICAL RESPONSE OF	1/25/2016	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	SOUTHERN CA	1055 WEST AVE J	None	LANCASTER	CA	93534	5418	19	06037	34.68946453	-118.1500695	Los Angeles County
171897	Fee-for-Service	1285078790	1285078790	1	1	ASIODU, UCHE P LCSW	7/31/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
171924	Fee-for-Service	1144203282	1144203282	1	1	AKBAR, A N MD	5/18/2023	207L00000X	NA	Other	026	PHYSICIANS	61007	None	None	0	In state provider	None	1000 FIVEPOINT	None	IRVINE	CA	92618	2377	30	06059	33.65251244	-117.7317885	Orange County
171950	Fee-for-Service	1689672909	1689672909	1	1	AUSTIN, JULIANA L MD	8/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	85298	67	Endocrinology	0	In state provider	None	2650 ELM AVENUE	STE 210	LONG BEACH	CA	90806	1600	19	06037	33.805521	-118.1882945	Los Angeles County
171965	Fee-for-Service	1528243821	1528243821	1	1	ARSENAULT, DARIN PSYD	6/8/2021	103TH0004X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
171970	Fee-for-Service	1235595356	1235595356	1	1	ALVARADO, RUDOLPH MD PC	12/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79387	41	Internal Medicine	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3300	10	06019	36.83626596	-119.7674879	Fresno County
172111	Fee-for-Service	1811194020	1811194020	1	1	AVITIA, SOFIA MD	12/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97394	04	Otology, Laryngology, Rhinology	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
172114	Fee-for-Service	1154633709	1154633709	1	1	ALANI, ANAS A MD	8/30/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	125237	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
172149	Fee-for-Service	1215224704	1215224704	1	1	AGNES VALERIE KWO MD	3/23/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 TOWSON AVE	None	FORT SMITH	AR	72901	4921	00	None	35.374455	-94.42107	Sebastian County
172153	Fee-for-Service	1518328053	1518328053	1	1	ANDRUSKI, KASEY D LMFT	3/18/2017	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17130 SEQUOIA ST	STE 103	HESPERIA	CA	92345	1827	36	06071	34.46911749	-117.289755	San Bernardino County
172163	Fee-for-Service	1417040619	1417040619	2	1	AMADOR EMERGENCY PHYSICIANS	8/5/2011	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	MEDICAL GROUP INC	200 MISSION BLVD	None	JACKSON	CA	95642	2564	03	06005	38.35007723	-120.7659932	Amador County
172166	Fee-for-Service	1578313623	1578313623	1	1	ACCULABS LLC	4/7/2025	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	4411 N CEDAR AVE	STE 102	FRESNO	CA	93726	2538	10	06019	36.79798989	-119.7543649	Fresno County
172172	Fee-for-Service	1932520079	1932520079	1	1	ABBASI, MEHVISH NP	9/6/2022	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
172192	Fee-for-Service	1578655908	1578655908	1	1	AGGARWAL, SANGEETA K MD	3/4/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78359	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
172233	Fee-for-Service	1295132314	1295132314	1	1	AGHAPY MEDICAL GROUP INC	1/29/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	349 W COMPTON BLVD	None	COMPTON	CA	90220	3110	19	06037	33.89598014	-118.2276822	Los Angeles County
172234	Fee-for-Service	1518935790	1518935790	1	1	ADAMS-RENTERIA, JODY L NP	7/10/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
172255	Fee-for-Service	1740621671	1740621671	1	1	ALI, SYED S MD	9/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139922	41	Internal Medicine	0	In state provider	None	525 WEST ACACIA STREET	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
172296	Fee-for-Service	1851303234	1851303234	1	1	ANDERSON, MAXINE M MD	12/18/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	68783	02	General Surgery	0	In state provider	None	3630 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2609	19	06037	33.93112671	-118.2035532	Los Angeles County
172305	Fee-for-Service	1649287574	1649287574	1	1	ALLEN, SUZANNE D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1003 WILLOW CREEK RD	None	PRESCOTT	AZ	86301	1641	00	None	34.558992	-112.481901	Yavapai County
172315	Fee-for-Service	1215964242	1215964242	1	1	ANDONIAN, ROBERT W MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36500	34	Urology and Urological Surgery	0	In state provider	None	123 DI SALVO AVE	STE D	SAN JOSE	CA	95128	1717	43	06085	37.32628785	-121.9371289	Santa Clara County
172323	Fee-for-Service	1861562068	1861562068	1	1	AMERICAN HEALTH SERVICES LLC	11/6/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	21505 NORWALK BLVD	None	HAWAIIAN GARDENS	CA	90716	1121	19	06037	33.834015	-118.0720655	Los Angeles County
172336	Fee-for-Service	1144252396	1144252396	1	1	ACEVES-CASILLAS PEDRO MD	10/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95197	41	Internal Medicine	0	In state provider	None	3304 RENNER DR	None	FORTUNA	CA	95540	3120	12	06023	40.58239308	-124.1360417	Humboldt County
172344	Fee-for-Service	1154369577	1154369577	1	1	ARSLAN, WAQAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 E ROOSEVELT ST	None	PHOENIX	AZ	85008	4973	00	None	33.457203	-112.0262625	Maricopa County
172352	Fee-for-Service	1376252551	1376252551	1	1	AMPARO, JOANA MINA P CRNA	1/17/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
172397	Fee-for-Service	1023045697	1023045697	1	1	ADAMS, AUDREY L MD	6/11/1998	207L00000X	NA	Other	026	PHYSICIANS	47649	05	Anesthesiology	0	In state provider	None	16795 LARK AVE	STE 230	LOS GATOS	CA	95032	7650	43	06085	37.25302151	-121.966891	Santa Clara County
172419	Fee-for-Service	1043923402	1043923402	1	1	ANCHETA, APRIL VIOLET NP	1/22/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
172423	Fee-for-Service	1457437964	1457437964	1	1	ABENE, ANTHONY J MD	7/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	76825	20	Orthopedic Surgery	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
172429	Fee-for-Service	1518016443	1518016443	1	2	ARMSTRONG, RALPH H MD	7/29/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	22532	-	NOT APPLICABLE	0	In state provider	None	625 E MAIN STREET	None	SANTA PAULA	CA	93060	2608	56	06111	34.35196586	-119.0663619	Ventura County
172433	Fee-for-Service	1003331000	1003331000	1	1	ABHINAV, KUMAR MD	8/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
172435	Fee-for-Service	1649091026	1649091026	1	1	AYNNA YEE SAE MD INC	12/16/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1280 SUMMERFIELD ROAD	None	SANTA ROSA	CA	95405	7313	49	06097	38.445534	-122.6642715	Sonoma County
172473	Fee-for-Service	1992852677	1992852677	1	1	ABY, JANELLE L MD	12/31/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	80353	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
172485	Fee-for-Service	1477510287	1477510287	1	1	AMADO, MERCEDES C MD	7/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	59685	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
172512	Fee-for-Service	1356549125	1356549125	1	1	ANGELOV, PETER A DO	7/1/2017	207P00000X	NA	Other	026	PHYSICIANS	15339	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
172522	Fee-for-Service	1295132314	1295132314	1	1	AGHAPY MEDICAL GROUP INC	1/29/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	349 W COMPTON BLVD	None	COMPTON	CA	90220	3110	19	06037	33.89598014	-118.2276822	Los Angeles County
172539	Fee-for-Service	1598294803	1598294803	1	1	ALDO GAMARRA MD INC	3/28/2018	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	1658 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.6893627	-118.1605523	Los Angeles County
172601	Fee-for-Service	1861848582	1861848582	1	1	ALI, SARAH MD	5/30/2022	207RE0101X	NA	Endocrinology	026	PHYSICIANS	150624	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
172617	Fee-for-Service	1013027366	1013027366	1	1	APRIA HEALTHCARE LLC	9/21/1998	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	7514 MURRAY DR	None	STOCKTON	CA	95210	5311	39	06077	38.01778731	-121.3020835	San Joaquin County
172642	Fee-for-Service	1497037733	1497037733	1	1	AMARO, AMBER A CRNA	12/30/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
172646	Fee-for-Service	1922164961	1922164961	1	1	ABDELSAYED, ADEL N MD	3/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89894	01	General Practice	0	In state provider	None	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	19	06037	34.0309884	-118.2642142	Los Angeles County
172648	Fee-for-Service	1154593929	1154593929	1	1	AZADI-RAD, AYAT MD	11/5/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	95715	40	Pediatrics	0	In state provider	None	7232 VAN NUYS BLVD	STE 201	VAN NUYS	CA	91405	2231	19	06037	34.202241	-118.4487235	Los Angeles County
172661	Fee-for-Service	1508314808	1508314808	1	1	ABRAHAM, JONATHAN DPM	5/18/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2272 BACON ST	None	SAN FRANCISCO	CA	94520	0000	38	06075	37.98200856	-122.0347914	Contra Costa County
172672	Fee-for-Service	1568110047	1568110047	1	1	APINYAVAT, SONYA OD	12/4/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
172715	Fee-for-Service	1255399473	1255399473	1	1	ALLERGY CONSULTANTS	3/1/1995	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	43	Pediatric Allergy	0	In state provider	MEDICAL GROUP, INC.	1521 BESSIE AVE	None	TRACY	CA	95376	3004	39	06077	37.74540705	-121.4331189	San Joaquin County
172732	Fee-for-Service	1790003143	1790003143	1	1	ALEXANDRA GRINO, MD	8/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	462 1ST AVE	None	NEW YORK	NY	10016	9196	00	None	40.739544	-73.9763325	New York County
172739	Fee-for-Service	1427310713	1427310713	1	1	ATTARIAN, SHIRIN MD	9/18/2023	207RH0003X	NA	Oncology	026	PHYSICIANS	190504	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
172764	Fee-for-Service	1144276643	1144276643	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	260 W FOOTHILL PKWY	None	CORONA	CA	92882	8540	33	06065	33.8448074	-117.5736088	Riverside County
172772	Fee-for-Service	1477510287	1477510287	1	1	AMADO, MERCEDES C MD	7/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	59685	03	Allergy	0	In state provider	None	3020 CHILDREN'S WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
172786	Fee-for-Service	1023530151	1023530151	1	1	APPEL, CHRISTOPHER OD	2/5/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	1	Border provider	None	628 N 1ST ST	SUITE C	LAKEVIEW	OR	97630	1506	00	None	42.19019123	-120.3467593	Lake County
172804	Fee-for-Service	1134463532	1134463532	1	1	AGUILA, ILIANA A MD	5/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127370	01	General Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
172809	Fee-for-Service	1972066686	1972066686	1	1	ANSARI, ANDREA MD	10/14/2024	207LC0200X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
172810	Fee-for-Service	1295132314	1295132314	1	1	AGHAPY MEDICAL GROUP INC	1/29/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	349 W COMPTON BLVD	None	COMPTON	CA	90220	3110	19	06037	33.89598014	-118.2276822	Los Angeles County
172817	Fee-for-Service	1235562224	1235562224	1	1	AVENAL COMMUNITY HEALTH CTR	10/15/2015	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1000 SKYLINE BLVD	None	AVENAL	CA	93204	1850	16	06031	36.00790722	-120.1216067	Kings County
172829	Fee-for-Service	1780675181	1780675181	1	1	AASI, SUMAIRA Z MD	9/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54709	07	Dermatology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
172865	Fee-for-Service	1508263476	1508263476	1	1	ANOZIE, ULOMA NP	3/18/2025	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
172879	Fee-for-Service	1700160405	1700160405	1	1	AMREEN HOMES INC	5/5/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	13873 OAKWOOD GLEN PLACE	None	VALLEY CENTER	CA	92082	1567	37	06073	33.24334854	-117.030321	San Diego County
172882	Fee-for-Service	1346757085	1346757085	1	1	ALVA CHAVEZ, GERARDO	10/14/2023	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	45926 OASIS ST	None	INDIO	CA	92201	4559	33	06065	33.715512	-116.2207015	Riverside County
172894	Fee-for-Service	1922001809	1922001809	1	1	ALTA LOS ANGELES	7/6/1995	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HOSPITALS INC	4081 E OLYMPIC BLVD	None	LOS ANGELES	CA	90023	3330	19	06037	34.01891346	-118.186614	Los Angeles County
172909	Fee-for-Service	1356621858	1356621858	1	1	ABUMAHFOUZ, OMAR A MD	9/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153288	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
172914	Fee-for-Service	1710037296	1710037296	1	1	ABBASSI, CAROLINA CRNA	6/2/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
172924	Fee-for-Service	1710665864	1710665864	1	1	ANDREW KELADA, MD	1/17/2025	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	RE	680 SUNRISE AVE	None	ROSEVILLE	CA	95661	4110	31	06061	38.7360182	-121.2720418	Placer County
172926	Fee-for-Service	1265745343	1265745343	1	1	ANA MERCEDES-GERMOSEN	3/16/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3269 N STOCKTON HILL RD	None	KINGMAN	AZ	86409	3619	00	None	35.220006	-114.0380145	Mohave County
172930	Fee-for-Service	1558990945	1558990945	1	1	ALFREDO LEE CHANG MD INC	3/16/2021	207RC0200X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	500 N GARFIELD AVE	SUITE 204	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
172965	Fee-for-Service	1912999533	1912999533	1	1	AHN, EUGENE S	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71690	None	None	0	In state provider	None	1240 WESTLAKE BLVD	STE 103	WESTLAKE VILLAGE	CA	91361	1975	56	06111	34.14966879	-118.8378084	Ventura County
172972	Fee-for-Service	1063589984	1063589984	1	1	AGBING, MARIA L MD	2/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67108	36	Psychiatry	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
172986	Fee-for-Service	1659724821	1659724821	1	1	ALPHA AIR CENTER LLC	2/8/2018	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	5509 DENNIS WEAVER DR	None	WEBB CITY	MO	64870	7207	00	None	37.14686812	-94.50177159	Jasper County
172987	Fee-for-Service	1497911630	1497911630	1	1	AMERICAN CAREQUEST INC	2/16/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	819 COWAN RD	SUITE #C-2	BURLINGAME	CA	94010	1220	41	06081	37.60215521	-122.3748143	San Mateo County
172996	Fee-for-Service	1447351747	1447351747	1	1	AHMED, AIJAZ MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	60520	None	None	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
173017	Fee-for-Service	1952941841	1952941841	1	1	ARM 4 ARM FOUNDATION	7/23/2020	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	7400 VAN NUYS BLVD	SUITE 111	VAN NUYS	CA	91405	1972	19	06037	34.205454	-118.448724	Los Angeles County
173020	Fee-for-Service	1316198112	1316198112	1	1	ARORA, SHAGUN D MD	4/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116668	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
173040	Fee-for-Service	1316902208	1316902208	1	1	AKDHC LLC	8/1/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	1	Border provider	HYPERTENSION CENTER LLC	1225 HANCOCK RD	STE 203	BULLHEAD CITY	AZ	86442	5962	00	None	35.108307	-114.6055365	Mohave County
173043	Fee-for-Service	1821099227	1821099227	1	1	AXMINSTER MEDICAL GROUP	12/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INC	4314 W SLAUSON AVE	None	LOS ANGELES	CA	90043	2854	19	06037	33.98885257	-118.3509655	Los Angeles County
173085	Fee-for-Service	1093746752	1093746752	1	4	ADVANCE OCCUPATIONAL & HAND	1/4/2016	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	HAND THERAPY CENTER	401 NORTH BROOKHURST	SUITE 100	ANAHEIM	CA	92801	5614	30	06059	33.83687311	-117.9590457	Orange County
173100	Fee-for-Service	1093727901	1093727901	1	1	APPIAN IMAGING, LLC	4/1/1999	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NORTH BAY MRI CENTER	2149 APPIAN WAY	None	PINOLE	CA	94564	2514	07	06013	37.99738125	-122.3013414	Contra Costa County
173106	Fee-for-Service	1235562224	1235562224	1	1	AVENAL COMMUNITY HEALTH CTR	3/19/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1000 SKYLINE BLVD	None	AVENAL	CA	93204	1850	16	06031	36.00790722	-120.1216067	Kings County
173137	Fee-for-Service	1275194714	1275194714	1	1	ADHIKARI, JUHISHREE MD	8/19/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	179635	None	None	0	In state provider	None	16465 SIERRA LAKES PKWY	SUITE 275	FONTANA	CA	92336	1242	36	06071	34.13805177	-117.4457839	San Bernardino County
173167	Fee-for-Service	1598962961	1598962961	1	1	AHMED, CAROL A DO	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7217	08	Family Practice	0	In state provider	ATTN MGA OFFICE	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
173185	Fee-for-Service	1922001809	1922001809	1	1	ALTA LOS ANGELES	10/19/1983	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITALS INC	4081 E OLYMPIC BLVD	None	LOS ANGELES	CA	90023	3330	19	06037	34.01891346	-118.186614	Los Angeles County
173206	Fee-for-Service	1396415949	1396415949	1	1	ADVENTIST HEALTH PHYSICIANS	2/15/2023	208800000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1560 E CHEVY CHASE DR	325	GLENDALE	CA	91206	4140	19	06037	34.15290734	-118.2302295	Los Angeles County
173214	Fee-for-Service	1710665864	1710665864	1	1	ANDREW KELADA, MD	1/17/2025	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	RE	680 SUNRISE AVE	None	ROSEVILLE	CA	95661	4110	31	06061	38.7360182	-121.2720418	Placer County
173276	Fee-for-Service	1497911630	1497911630	1	1	AMERICAN CAREQUEST INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	819 COWAN RD	SUITE #C-2	BURLINGAME	CA	94010	1220	41	06081	37.60215521	-122.3748143	San Mateo County
173315	Fee-for-Service	1689009128	1689009128	1	1	ARIA HOSPICE LLC	6/26/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	229 S 8TH STREET	STE A	EL CENTRO	CA	92243	2902	13	06025	32.79101931	-115.5613857	Imperial County
173328	Fee-for-Service	1760521074	1760521074	1	1	ALEXANDER, MARYA MD	12/26/2007	2084P0800X	NA	Psychiatry	026	PHYSICIANS	73146	36	Psychiatry	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
173330	Fee-for-Service	1720629488	1720629488	1	1	ALL CARE HOSPICE CARE	12/24/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	150 E OLIVE AVE	STE 215	BURBANK	CA	91436	1985	19	06037	34.18064474	-118.3089507	Los Angeles County
173339	Fee-for-Service	1306140801	1306140801	1	2	ANNETTE TAMRAZ PHYSICAL THER	3/3/2021	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1000 N CENTRAL AVE.	SUITE 110	GLENDALE	CA	91202	2957	19	06037	34.15992057	-118.2572221	Los Angeles County
173357	Fee-for-Service	1457413841	1457413841	1	1	AMURAO, JOSEPHINE A CRNA	3/16/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
173363	Fee-for-Service	1184656670	1184656670	1	1	AIELLO, ROSALIA	12/5/2013	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3460 E LA PALMA AVENUE	None	ANAHEIM	CA	92806	2020	30	06059	33.85429451	-117.8446551	Orange County
173368	Fee-for-Service	1093746752	1093746752	1	4	ADVANCE OCCUPATIONAL & HAND	1/4/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	HAND THERAPY CENTER	401 NORTH BROOKHURST	SUITE 100	ANAHEIM	CA	92801	5614	30	06059	33.83687311	-117.9590457	Orange County
173386	Fee-for-Service	1467500025	1467500025	2	1	AMITINA, NOEMI MD	1/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	67927	22	Pathology (M.D. only)	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
173394	Fee-for-Service	1235562224	1235562224	1	1	AVENAL COMMUNITY HEALTH CTR	3/19/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1000 SKYLINE BLVD	None	AVENAL	CA	93204	1850	16	06031	36.00790722	-120.1216067	Kings County
173404	Fee-for-Service	1487700068	1487700068	1	1	ALBUJA CRUZ, MARIA B MD	9/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	02	General Surgery	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
173422	Fee-for-Service	1134329964	1134329964	1	1	AMINLARI, AMY C MD	7/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95329	None	None	0	In state provider	None	520 W I ST	None	LOS BANOS	CA	93635	3419	24	06047	37.06346603	-120.8593647	Merced County
173430	Fee-for-Service	1598341455	1598341455	1	1	ADONIS HOSPICE, INC	5/3/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	18401 BURBANK BLVD	STE 224	TARZANA	CA	91356	6911	19	06037	34.17187827	-118.5339035	Los Angeles County
173431	Fee-for-Service	1912471772	1912471772	1	1	AMARI, LEE M RCP	2/19/2019	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
173442	Fee-for-Service	1568074441	1568074441	1	1	ANGELS ON EARTH HEALTHCARE	9/25/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	1386 E WALNUT ST	STE 201	PASADENA	CA	91106	1510	19	06037	34.1494887	-118.1216815	Los Angeles County
173470	Fee-for-Service	1922001809	1922001809	1	1	ALTA LOS ANGELES	10/19/1983	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITALS INC	4081 E OLYMPIC BLVD	None	LOS ANGELES	CA	90023	3330	19	06037	34.01891346	-118.186614	Los Angeles County
173476	Fee-for-Service	1083699185	1083699185	1	1	ADAMCZYK, AMY CPO	1/10/2006	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	590 FOREST AVE	None	PALO ALTO	CA	94301	2611	43	06085	37.44777101	-122.155623	Santa Clara County
173523	Fee-for-Service	1396829362	1396829362	1	1	ADELMAN, SCOTT H MD	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	73841	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
173524	Fee-for-Service	1750587101	1750587101	1	1	ATOUI, RIM I MD	7/29/2010	207RP1001X	NA	Pulmonology	026	PHYSICIANS	100098	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
173541	Fee-for-Service	1619263233	1619263233	1	1	ALBERELLI, TONYA T MD	1/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132085	18	Ophthalmology	0	In state provider	None	1237 B ST	None	HAYWARD	CA	94541	2915	01	06001	37.67566503	-122.0786821	Alameda County
173542	Fee-for-Service	1912297433	1912297433	1	1	ASHBROOK, LIZA H MD	7/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	124588	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
173552	Fee-for-Service	1902462633	1902462633	1	1	AMAGWULA, CHIMEZIE B MD	8/15/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
173562	Fee-for-Service	1326694860	1326694860	1	1	ANDRADE HONESTO, ANA R LCSW	3/31/2020	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
173576	Fee-for-Service	1871988147	1871988147	1	1	ANGRA, KUNAL MD	7/7/2020	390200000X	NA	Other	026	PHYSICIANS	161745	07	Dermatology	0	In state provider	None	838 NORDAHL RD	250	SAN MARCOS	CA	92069	1005	37	06073	33.13569751	-117.1191477	San Diego County
173594	Fee-for-Service	1891280509	1891280509	1	1	AQUIPEL, SHALLYMAR AU	12/13/2024	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	905 MAPLE ST	None	REDWOOD CITY	CA	94063	0000	41	06081	37.48767797	-122.223049	San Mateo County
173595	Fee-for-Service	1548249485	1548249485	1	1	ADAM, RODNEY D. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
173600	Fee-for-Service	1457930331	1457930331	1	2	APOLLO PHARMACEUTICAL SERVIC	9/15/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ES	16104 HART ST	None	VAN NUYS	CA	91406	3903	19	06037	34.19749625	-118.4843828	Los Angeles County
173602	Fee-for-Service	1225090400	1225090400	1	1	ALLEY, CONNIE J CRNA	7/26/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	18111 BROOKHURST STREET	None	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
173603	Fee-for-Service	1689009128	1689009128	1	1	ARIA HOSPICE LLC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	229 S 8TH STREET	STE A	EL CENTRO	CA	92243	2902	13	06025	32.79101931	-115.5613857	Imperial County
173610	Fee-for-Service	1740229277	1740229277	1	1	ALWAY, TIFFANY H DPM	7/26/2012	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1626 MYRTLE AVE	STE A	EUREKA	CA	95501	1457	12	06023	40.7946092	-124.1362277	Humboldt County
173616	Fee-for-Service	1720629488	1720629488	1	1	ALL CARE HOSPICE CARE	12/24/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	150 E OLIVE AVE	STE 215	BURBANK	CA	91436	1985	19	06037	34.18064474	-118.3089507	Los Angeles County
173618	Fee-for-Service	1366224560	1366224560	1	1	ANDERSON, LAUREN PT	12/29/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
173624	Fee-for-Service	1306140801	1306140801	1	2	ANNETTE TAMRAZ PHYSICAL THER	3/3/2021	261QP2000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1000 N CENTRAL AVE.	SUITE 110	GLENDALE	CA	91202	2957	19	06037	34.15992057	-118.2572221	Los Angeles County
173682	Fee-for-Service	1235562224	1235562224	1	1	AVENAL COMMUNITY HEALTH CTR	1/25/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	1000 SKYLINE BLVD	None	AVENAL	CA	93204	1850	16	06031	36.00790722	-120.1216067	Kings County
173685	Fee-for-Service	1548423437	1548423437	1	1	AKHZARI, AMIR MD	7/15/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	110425	41	Internal Medicine	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
173702	Fee-for-Service	1992347090	1992347090	1	1	ANDRIDGE, KIMBERLI PSYD	2/23/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	599 HIGUERA ST	F5	SAN LUIS OBISPO	CA	93401	3851	40	06079	35.27800642	-120.6658808	San Luis Obispo County
173714	Fee-for-Service	1922015395	1922015395	1	1	ASSEFF, DAVID MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	54132	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
173718	Fee-for-Service	1598341455	1598341455	1	1	ADONIS HOSPICE, INC	5/3/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	18401 BURBANK BLVD	STE 224	TARZANA	CA	91356	6911	19	06037	34.17187827	-118.5339035	Los Angeles County
173723	Fee-for-Service	1871784553	1871784553	1	1	ADATYA, ELISSA K MD	7/25/2018	207R00000X	NA	Other	026	PHYSICIANS	155561	01	General Practice	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28200485	-118.4030797	Los Angeles County
173744	Fee-for-Service	1760419824	1760419824	1	1	ANKNEY, WILLIAM A MD	11/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	88642	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1000 NUT TREE RD	None	VACAVILLE	CA	95687	4100	48	06095	38.35581953	-121.9530257	Solano County
173806	Fee-for-Service	1912263260	1912263260	1	1	ALZUBAIDI, HAYDER MD	5/12/2021	207R00000X	NA	Other	026	PHYSICIANS	169402	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
173813	Fee-for-Service	1750587101	1750587101	1	1	ATOUI, RIM I MD	7/29/2010	207RP1001X	NA	Pulmonology	026	PHYSICIANS	100098	41	Internal Medicine	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
173814	Fee-for-Service	1023712940	1023712940	1	1	AFFIRM & EMBRACE PSYCHOTHERA	10/20/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PY INC	345 ROEDER CT	None	SAN JOSE	CA	95111	4057	43	06085	37.26716028	-121.8093137	Santa Clara County
173818	Fee-for-Service	1710401369	1710401369	1	1	ALLEY, LAUREN E	3/6/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	740 S PLACENTIA AVE	STE 100	PLACENTIA	CA	92870	6832	30	06059	33.86285731	-117.8822066	Orange County
173853	Fee-for-Service	1407984149	1407984149	1	1	ASIAN PACIFIC HEALTHCARE	7/1/2001	261QC1500X	NA	Other	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	VENTURE	1530 HILLHURST AVE	STE 200	LOS ANGELES	CA	90027	5516	19	06037	34.098921	-118.287374	Los Angeles County
173865	Fee-for-Service	1982764858	1982764858	1	1	AVENDANO, PAULINA J MD	2/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77201	40	Pediatrics	0	In state provider	None	1300 AVENIDA VISTA HERMO	SUITE 200	SAN CLEMENTE	CA	92673	6338	30	06059	33.45766933	-117.5920941	Orange County
173873	Fee-for-Service	1003216268	1003216268	1	1	AIKEN, LAUREN A LMFT	8/22/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
173883	Fee-for-Service	1891070686	1891070686	1	1	ANUGOM, FELISTA CNP	8/4/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	16660 PARAMOUNT BLVD	SUITE 208	PARAMOUNT	CA	90723	5458	19	06037	33.882723	-118.1599535	Los Angeles County
173897	Fee-for-Service	1376122416	1376122416	1	1	ABIRI, PARINAZ MD	7/31/2024	207R00000X	NA	Other	026	PHYSICIANS	181198	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
173965	Fee-for-Service	1811995293	1811995293	1	1	AITKEN COLLEEN A MD	12/1/2003	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	68298	08	Family Practice	0	In state provider	None	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
174034	Fee-for-Service	1811288822	1811288822	1	1	ALIJI, NARMIN MD	7/11/2019	2084P0804X	NA	Psychiatry	026	PHYSICIANS	129727	36	Psychiatry	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
174041	Fee-for-Service	1841555109	1841555109	1	1	ALEXANDER, SERENE M DO	9/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14603	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
174076	Fee-for-Service	1962413229	1962413229	1	1	ARTACHO, ISABELO S MD	6/5/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	46129	40	Pediatrics	0	In state provider	None	6323 N FRESNO ST	STE 104	FRESNO	CA	93710	5282	10	06019	36.82867612	-119.7814182	Fresno County
174087	Fee-for-Service	1770978488	1770978488	1	1	ANDREEV-DRAKHLIN, ALEXANDER	11/17/2021	207R00000X	NA	Other	026	PHYSICIANS	173276	None	None	0	In state provider	Y MD	995 POTRERO AVE	RM WD84	SAN FRANCISCO	CA	94110	2859	38	06075	37.75729541	-122.4066641	San Francisco County
174158	Fee-for-Service	1770591869	1770591869	1	1	ARAFILES, WENDY A MD	3/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	2	Out of state provider	None	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	None	33.478749	-112.0426515	Maricopa County
174204	Fee-for-Service	1588292270	1588292270	1	1	AH HOSPICE INC	1/13/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14540 VICTORY BLVD	STE 217	VAN NUYS	CA	91411	4602	19	06037	34.1866315	-118.4501385	Los Angeles County
174227	Fee-for-Service	1861683559	1861683559	1	1	ADATYA, SIRTAZ N MD	10/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150453	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
174292	Fee-for-Service	1972968493	1972968493	1	1	AXIS HOME HEALTH CARE INC	6/18/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6360 VAN NUYS BLVD	STE 106B	VAN NUYS	CA	91401	2638	19	06037	34.186023	-118.448701	Los Angeles County
174308	Fee-for-Service	1285253799	1285253799	1	1	ALAZZEH, MOHANAD I MD	7/1/2024	207P00000X	NA	Other	026	PHYSICIANS	179559	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
174345	Fee-for-Service	1710243886	1710243886	1	1	ALEXANDRA DITULLIO MD	12/16/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
174390	Fee-for-Service	1720071954	1720071954	1	1	ALDERSON CONV HOSPITAL	3/1/1966	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	124 WALNUT ST	None	WOODLAND	CA	95695	3137	57	06113	38.68160056	-121.7781391	Yolo County
174402	Fee-for-Service	1093195208	1093195208	1	1	ABDI, RIDWA MD	9/29/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	160621	08	Family Practice	0	In state provider	None	18600 SOUTH FIGUEROA ST	None	GARDENA	CA	90248	4505	19	06037	33.861339	-118.281473	Los Angeles County
174418	Fee-for-Service	1326730920	1326730920	1	1	ABK SWEET HOMECARE INC	9/19/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	10171 NORTHAMPTON AVENUE	None	WESTMINSTER	CA	92683	7558	30	06059	33.73380488	-117.9517513	Orange County
174442	Fee-for-Service	1548740814	1548740814	1	1	AREEPRACHAPIROM, JOSIE P RCP	10/5/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
174455	Fee-for-Service	1265112239	1265112239	1	1	ALTAMIRANO, OLIVIA PHD	8/11/2023	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
174465	Fee-for-Service	1982618849	1982618849	1	1	A DE LA PENA MD AMG INC	1/31/1990	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	None	7100 VAN NUYS BLVD	# 120	VAN NUYS	CA	91405	3063	19	06037	34.19957761	-118.4487663	Los Angeles County
174469	Fee-for-Service	1598895401	1598895401	1	1	AUCELLA, VANESSA J LCSW	11/3/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	460 E CARSON PLAZA DR	215	CARSON	CA	90746	3206	19	06037	33.84594175	-118.2663997	Los Angeles County
174482	Fee-for-Service	1043710890	1043710890	1	1	ALVARADO, SHEELA LMFT	11/3/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	210 ESTATES DRIVE	STE 200	ROSEVILLE	CA	95678	2600	31	06061	38.74765852	-121.273857	Placer County
174495	Fee-for-Service	1588292270	1588292270	1	1	AH HOSPICE INC	1/13/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14540 VICTORY BLVD	STE 217	VAN NUYS	CA	91411	4602	19	06037	34.1866315	-118.4501385	Los Angeles County
174514	Fee-for-Service	1861683559	1861683559	1	1	ADATYA, SIRTAZ N MD	10/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150453	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
174541	Fee-for-Service	1710447131	1710447131	1	1	ANGELO, JENA L OT	2/8/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1529 SEABRIGHT AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.97862009	-122.0098896	Santa Cruz County
174549	Fee-for-Service	1104175389	1104175389	1	1	ALFARO, LETICIA B LCSW	5/23/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	45926 OASIS ST	None	INDIO	CA	92201	4559	33	06065	33.715512	-116.2207015	Riverside County
174566	Fee-for-Service	1952482333	1952482333	1	1	AZMOON, SHAHDAD MD	11/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91785	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
174573	Fee-for-Service	1861698656	1861698656	1	1	ANDERSON, NATHAN S MD	7/15/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	162440	None	None	0	In state provider	None	500 DOYLE PARK DR	SUITE 103	SANTA ROSA	CA	95405	4558	49	06097	38.44332	-122.6985255	Sonoma County
174579	Fee-for-Service	1295173805	1295173805	1	1	AYOUB, JOHN CRNA	12/5/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
174600	Fee-for-Service	1396276168	1396276168	1	1	ANDERSON, REDMOND-CRAIG MD	6/16/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	159211	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
174629	Fee-for-Service	1033192372	1033192372	1	1	ACHERMAN, RUBEN J MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	35	Pediatric Cardiology (M.D. only)	1	Border provider	None	3006 S MARYLAND PKWY	STE 690	LAS VEGAS	NV	89109	2297	00	None	36.135288	-115.1368705	Clark County
174634	Fee-for-Service	1477936490	1477936490	1	1	AMBERS, ERICA L NP	5/16/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	1500 E 2ND STREET	STE 400	RENO	NV	89502	1198	00	None	39.52743427	-119.7932613	Washoe County
174635	Fee-for-Service	1700597879	1700597879	1	1	ANGELA M RODRIGUEZ INC	6/26/2024	208200000X	NA	General Surgery	022	PHYSICIANS GROUP	-	84	Surgery-Head and Neck	0	In state provider	None	2100 WEBSTER ST	416	SAN FRANCISCO	CA	94115	2379	38	06075	37.7904826	-122.4324477	San Francisco County
174699	Fee-for-Service	1386252112	1386252112	1	1	AHMC SETON MEDICAL CENTER	1/27/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	1900 SULLIVAN	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
174713	Fee-for-Service	1710071774	1710071774	1	1	ARONCHICK, CRAIG A MD	3/29/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	160559	None	None	0	In state provider	None	111 RALEY BLVD	SUITE 100	CHICO	CA	95928	8351	04	06007	39.71601447	-121.790817	Butte County
174724	Fee-for-Service	1659456218	1659456218	1	1	ASHRAF, HADIA MD INC	5/14/2012	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	62197	08	Family Practice	0	In state provider	None	1117 E DEVONSHIRE AVE	None	HEMET	CA	92543	3083	33	06065	33.75116909	-116.9601666	Riverside County
174725	Fee-for-Service	1942730072	1942730072	1	1	ANDERSON, RACHEL N MD	4/28/2022	207L00000X	NA	Other	026	PHYSICIANS	157471	None	None	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
174747	Fee-for-Service	1760590590	1760590590	1	1	APRIA HEALTHCARE LLC	12/19/2000	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	38888 EL DESIERTO RD	None	PALM DESERT	CA	92211	1164	33	06065	33.76610441	-116.3071358	Riverside County
174752	Fee-for-Service	1982618849	1982618849	1	1	A DE LA PENA MD AMG INC	10/30/1991	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7100 VAN NUYS BLVD	# 120	VAN NUYS	CA	91405	3063	19	06037	34.19957761	-118.4487663	Los Angeles County
174764	Fee-for-Service	1437982477	1437982477	1	1	ALSHAMMARI, ABDULLAH MD	3/18/2025	207XS0117X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
174858	Fee-for-Service	1962851808	1962851808	1	1	ADVANCED COMMUNITY MEDICAL	2/28/2017	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	CARE CORP	323 N PRAIRIE AVENUE	SUITE 417	INGLEWOOD	CA	90301	4506	19	06037	33.966333	-118.3439975	Los Angeles County
174867	Fee-for-Service	1760847610	1760847610	1	1	ALLEN, PAUL LMFT	9/16/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	337 N VINEYARD AVE	STE 400	ONTARIO	CA	91764	4436	36	06071	34.066728	-117.611622	San Bernardino County
174868	Fee-for-Service	1811054067	1811054067	1	1	ARAO, MICHAEL OD	11/26/2012	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3772 HOWE STREET	None	OAKLAND	CA	94611	5311	01	06001	37.8243542	-122.2566075	Alameda County
174887	Fee-for-Service	1063007979	1063007979	1	1	AURA HOSPICE LLC	3/24/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5065 DEER VALLEY RD	STE 110	ANTIOCH	CA	94531	8311	07	06013	37.96431645	-121.7808782	Contra Costa County
174894	Fee-for-Service	1952993271	1952993271	1	1	ALMAZAN, DILLON J PT	2/4/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	23430 HAWTHORNE BLVD	STE 105	TORRANCE	CA	90505	4777	19	06037	33.81316465	-118.3510077	Los Angeles County
174925	Fee-for-Service	1588703979	1588703979	1	1	ASHBROOK, CHARLES D MD	11/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	99188	36	Psychiatry	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
174927	Fee-for-Service	1356457790	1356457790	1	1	ABDO, GABY J DO	2/8/2015	207K00000X	NA	Other	026	PHYSICIANS	7216	08	Family Practice	0	In state provider	None	410 ARDEN AVE	STE 100	GLENDALE	CA	91203	4003	19	06037	34.15842441	-118.2618749	Los Angeles County
174931	Fee-for-Service	1376115881	1376115881	1	1	ABUKRAA, INAS MD	7/3/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
174937	Fee-for-Service	1528220647	1528220647	1	1	ANDERSON, ERICA L LMFT	10/30/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	MFT	15437 ANACAPA RD	#22	VICTORVILLE	CA	92392	2458	36	06071	34.50557513	-117.3250277	San Bernardino County
174973	Fee-for-Service	1417275033	1417275033	1	1	ADETUYI, OLUSEGUN A MD	2/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122119	None	None	0	In state provider	None	199 E WEBSTER ST	None	COLUSA	CA	95932	2954	06	06011	39.20737704	-122.0004043	Colusa County
174975	Fee-for-Service	1780342642	1780342642	1	1	ABED, MARAM N	12/17/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
175006	Fee-for-Service	1205213170	1205213170	1	1	AUBIN-POULIOT, ANNICK P MD	9/3/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	145844	04	Otology, Laryngology, Rhinology	0	In state provider	None	1701 4TH ST	STE 120	SANTA ROSA	CA	95404	3661	49	06097	38.448801	-122.699439	Sonoma County
175030	Fee-for-Service	1821476987	1821476987	1	1	AARYAN INC	5/15/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8207 ARLINGTON AVE	None	RIVERSIDE	CA	92503	0429	33	06065	33.94648651	-117.461133	Riverside County
175042	Fee-for-Service	1194234351	1194234351	1	1	ALPINE MANAGEMENT	7/12/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	ENTERPRISES INC	9245 LAGUNA SPRINGS DR	STE 200	ELK GROVE	CA	95758	7991	34	06067	38.422494	-121.3965495	Sacramento County
175073	Fee-for-Service	1780950543	1780950543	1	2	ALAN F DAKAK MD INC	3/5/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	1220 HEMLOCK WAY	105 B	SANTA ANA	CA	92707	3650	30	06059	33.70975375	-117.8842792	Orange County
175079	Fee-for-Service	1093898454	1093898454	1	1	ASHMEAD ALI, MD	9/8/1997	208D00000X	NA	Adult Primary Care	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CAL CITY CLINIC	9300 N LOOP BLVD	None	CALIFORNIA CITY	CA	93505	2269	15	06029	35.13321511	-117.9623345	Kern County
175091	Fee-for-Service	1285971820	1285971820	1	2	ARCH HEALTH PARTNERS	12/9/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	488 E VALLEY PKWY	STE 215	ESCONDIDO	CA	92025	3351	37	06073	33.12523814	-117.0769715	San Diego County
175097	Fee-for-Service	1396364147	1396364147	1	1	AVILA-GARIBAY, FERNANDO J MD	9/12/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	182447	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
175105	Fee-for-Service	1043697451	1043697451	1	1	ARAI, AUDREY MD	7/19/2019	390200000X	NA	Other	026	PHYSICIANS	146135	08	Family Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
175149	Fee-for-Service	1962851808	1962851808	1	1	ADVANCED COMMUNITY MEDICAL	2/28/2017	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	CARE CORP	323 N PRAIRIE AVENUE	SUITE 417	INGLEWOOD	CA	90301	4506	19	06037	33.966333	-118.3439975	Los Angeles County
175153	Fee-for-Service	1548279672	1548279672	1	1	ARYANA, ARASH MD	6/23/2008	207R00000X	NA	Other	026	PHYSICIANS	102881	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3941 J ST	STE 260	SACRAMENTO	CA	95819	3633	34	06067	38.570652	-121.4535465	Sacramento County
175156	Fee-for-Service	1538724687	1538724687	1	1	AL-AYOUBI, SAMIR R MD	12/16/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	8580	30	06059	33.56008604	-117.6657795	Orange County
175173	Fee-for-Service	1063007979	1063007979	1	1	AURA HOSPICE LLC	3/24/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5065 DEER VALLEY RD	STE 110	ANTIOCH	CA	94531	8311	07	06013	37.96431645	-121.7808782	Contra Costa County
175178	Fee-for-Service	1811204555	1811204555	1	1	AMPLA HEALTH	2/8/2012	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	236 H WEST EAST AVE	None	CHICO	CA	95926	7239	04	06007	39.75480717	-121.864654	Butte County
175224	Fee-for-Service	1770737579	1770737579	1	1	ARONOFF-SPENCER, ELIAH S MD	1/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	104748	77	Infectious Disease	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
175225	Fee-for-Service	1497824098	1497824098	1	1	ALLEN, FRANCIS D LCSW	6/13/1999	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	805 W LA VETA AVE	STE 209	ORANGE	CA	92868	3929	30	06059	33.78064152	-117.8606475	Orange County
175229	Fee-for-Service	1962742304	1962742304	1	1	ALFASSI, RINA R	4/7/2014	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
175257	Fee-for-Service	1205270956	1205270956	1	1	ANDERSEN, STUART MD	1/17/2022	207R00000X	NA	Other	026	PHYSICIANS	162976	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
175273	Fee-for-Service	1588607220	1588607220	1	1	AMIR, REHAN MD	10/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
175366	Fee-for-Service	1093898454	1093898454	1	1	ASHMEAD ALI, MD	9/8/1997	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CAL CITY CLINIC	9300 N LOOP BLVD	None	CALIFORNIA CITY	CA	93505	2269	15	06029	35.13321511	-117.9623345	Kern County
175375	Fee-for-Service	1770599276	1770599276	1	1	AOYAMA, CHISA MD	11/20/2020	207ZP0102X	NA	Other	026	PHYSICIANS	51435	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
175385	Fee-for-Service	1952322984	1952322984	1	1	ANYADIKE, CYRIL O MD	6/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	78604	41	Internal Medicine	0	In state provider	None	8110 AIRPORT BLVD	None	LOS ANGELES	CA	90045	3119	19	06037	33.96526302	-118.3852705	Los Angeles County
175390	Fee-for-Service	1912066630	1912066630	1	1	ARAZI, TRACY L AUD	4/4/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
175420	Fee-for-Service	1902216872	1902216872	1	1	ABCEDE, GAIL F L P MD	8/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145109	41	Internal Medicine	0	In state provider	None	24411 HEALTH CENTER DR	STE 680	LAGUNA HILLS	CA	92653	3692	30	06059	33.6087201	-117.7076948	Orange County
175435	Fee-for-Service	1962851808	1962851808	1	1	ADVANCED COMMUNITY MEDICAL	2/28/2017	261QP2300X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CARE CORP	323 N PRAIRIE AVENUE	SUITE 417	INGLEWOOD	CA	90301	4506	19	06037	33.966333	-118.3439975	Los Angeles County
175458	Fee-for-Service	1568016558	1568016558	1	1	ALAKA, MARIAM MD	8/16/2022	207P00000X	NA	Other	026	PHYSICIANS	179540	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
175469	Fee-for-Service	1902427438	1902427438	1	2	ATTENTIVE COGNITIVE AND MENT	4/8/2021	251S00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	AL HEALTH SERVICES PSYCH	111 DEERWOOD RD	STE 200	SAN RAMON	CA	94583	4445	07	06013	37.77475997	-121.9892508	Contra Costa County
175472	Fee-for-Service	1609124544	1609124544	1	1	ARIZONA PHYSICIAN SERVICES	11/19/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	LLC	5330 S HWY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
175514	Fee-for-Service	1740778653	1740778653	1	1	ALAYARI, AMETHYST A MD	9/1/2024	2080P0204X	NA	Other	026	PHYSICIANS	165368	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
175578	Fee-for-Service	1922175777	1922175777	1	1	ABURTO-ERAZO, JULIA E NP	11/1/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1336 BRIDGEGATE DR	None	DIAMOND BAR	CA	91765	3955	19	06037	33.99743665	-117.8357377	Los Angeles County
175589	Fee-for-Service	1215463625	1215463625	1	1	ARVISAIS-ANHALT, SIMONE MD	9/29/2023	207ZP0105X	NA	Other	026	PHYSICIANS	171539	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
175592	Fee-for-Service	1891394128	1891394128	1	1	ALTO PHARMACY, LLC	6/29/2021	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4240 KEARNY MESA ROAD	107	SAN DIEGO	CA	92111	3769	37	06073	32.81857281	-117.1491983	San Diego County
175603	Fee-for-Service	1588805956	1588805956	1	1	A AND F CARE SERVICES INC	6/8/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3617 PACIFIC BLVD	None	SAN MATEO	CA	94403	3519	41	06081	37.53536376	-122.2948133	San Mateo County
175647	Fee-for-Service	1215640560	1215640560	1	1	ABDIRAHMAN, NAIMA NP	6/12/2023	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
175675	Fee-for-Service	1952322984	1952322984	1	1	ANYADIKE, CYRIL O MD	6/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	78604	10	Gastroenterology (M.D. only)	0	In state provider	None	8110 AIRPORT BLVD	None	LOS ANGELES	CA	90045	3119	19	06037	33.96526302	-118.3852705	Los Angeles County
175725	Fee-for-Service	1770182024	1770182024	1	1	AVA HOSPICE CORP	10/15/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	333 N SANTA ANITA AVE	STE 13	ARCADIA	CA	91006	2823	19	06037	34.14447	-118.031608	Los Angeles County
175737	Fee-for-Service	1124274915	1124274915	1	1	AYALIN, TYLER E MD	1/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116574	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
175752	Fee-for-Service	1790706430	1790706430	1	1	ANDERSON, JOHN C MD	11/2/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	143100	None	None	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
175756	Fee-for-Service	1720377146	1720377146	1	1	ARAS, MANDAR A MD	1/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130155	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
175796	Fee-for-Service	1104177807	1104177807	1	1	AVERY, PRISCILLA M LMFT	5/18/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
175800	Fee-for-Service	1740778653	1740778653	1	1	ALAYARI, AMETHYST A MD	9/1/2024	2080P0204X	NA	Other	026	PHYSICIANS	165368	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
175820	Fee-for-Service	1851534853	1851534853	1	1	ATCHIKOVA, ELENA Y MD	3/4/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105610	None	None	0	In state provider	None	39000 BOB HOPE DRIVE	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
175845	Fee-for-Service	1619239670	1619239670	1	1	ATTREYA, AKASH K DO	3/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14972	01	General Practice	0	In state provider	None	2175 ROSELINE AVENUE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
175847	Fee-for-Service	1932693538	1932693538	1	1	ASFOUR, DAVID J DO	12/20/2022	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
175858	Fee-for-Service	1114459773	1114459773	1	1	ASHBURN, SHANNON LMFT	5/25/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8421 AUBURN BLVD	SUITE 110	CITRUS HEIGHTS	CA	95610	0359	34	06067	38.719026	-121.291335	Sacramento County
175863	Fee-for-Service	1467815944	1467815944	1	1	ALMARIO, JOSE ANTONIO N MD	8/19/2024	163WG0100X	NA	Other	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	2929 HEALTH CENTER DR	None	SAN DIEGO	CA	92123	2762	37	06073	32.79692047	-117.1567137	San Diego County
175884	Fee-for-Service	1144273095	1144273095	1	1	ARORA, RAMESH MEDICAL	7/1/1987	193400000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	CORP	14411 HAMLIN ST	None	VAN NUYS	CA	91401	1467	19	06037	34.18869553	-118.447074	Los Angeles County
175896	Fee-for-Service	1316957806	1316957806	1	1	ARNOLD, JEFFREY L MD	6/18/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	68735	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
175901	Fee-for-Service	1548574759	1548574759	1	1	AKINLOSOTU, DEJI J CRNA	5/26/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
175916	Fee-for-Service	1295785566	1295785566	1	1	AGUIRRE, JOSE A MD	10/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1600 MEDICAL PARKWAY	None	CARSON CITY	NV	89703	4625	00	None	39.202263	-119.7841095	Consolidated Municipality of Carson City
175927	Fee-for-Service	1356572648	1356572648	1	1	ANGOLA, NICHOLE M LCSW	4/7/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
176003	Fee-for-Service	1841884863	1841884863	1	1	A AND E LOVING SENIOR HOME	12/9/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	INC	14931 OAKSPRING DR	None	FONTANA	CA	92336	5537	36	06071	34.12901336	-117.4791086	San Bernardino County
176013	Fee-for-Service	1770182024	1770182024	1	1	AVA HOSPICE CORP	10/15/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	333 N SANTA ANITA AVE	STE 13	ARCADIA	CA	91006	2823	19	06037	34.14447	-118.031608	Los Angeles County
176107	Fee-for-Service	1114048857	1114048857	1	1	AVALON FAMILY MED GRP	8/22/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1626 N AVALON BLVD	None	WILMINGTON	CA	90744	1431	19	06037	33.79626132	-118.2636969	Los Angeles County
176117	Fee-for-Service	1093893679	1093893679	1	1	AYYALA, SREEDEVI J MD	1/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	90855	01	General Practice	0	In state provider	None	1220 ROSSMOOR PKWY	None	WALNUT CREEK	CA	94595	2501	07	06013	37.87825259	-122.0703705	Contra Costa County
176155	Fee-for-Service	1679865950	1679865950	1	1	AVALLONE, THOMAS J MD	5/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147199	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA	1-340	LOS ANGELES	CA	90095	7001	19	06037	34.06482757	-118.4443441	Los Angeles County
176173	Fee-for-Service	1144273095	1144273095	1	1	ARORA, RAMESH MEDICAL	7/1/1987	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CORP	14411 HAMLIN ST	None	VAN NUYS	CA	91401	1467	19	06037	34.18869553	-118.447074	Los Angeles County
176182	Fee-for-Service	1326014036	1326014036	1	1	AZIZ, SUELMAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	34616 11TH PLACE SOUTH	STE #4	FEDERAL WAY	WA	98003	8705	00	None	47.291373	-122.319543	King County
176209	Fee-for-Service	1285669671	1285669671	1	1	ABE, MICHIO MD	3/19/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91884	41	Internal Medicine	0	In state provider	None	1437 S ATLANTIC BLVD	None	LOS ANGELES	CA	90022	5015	19	06037	34.01175497	-118.159261	Los Angeles County
176221	Fee-for-Service	1851340194	1851340194	1	1	AMIRI, FARIBA MD	2/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	52862	None	None	0	In state provider	None	8765 AERO DR	STE 130	SAN DIEGO	CA	92123	1767	37	06073	32.80965252	-117.139383	San Diego County
176263	Fee-for-Service	1396318390	1396318390	1	1	ALLAHDADI MD INC	10/7/2021	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	42	06083	34.42887662	-119.7237878	Santa Barbara County
176278	Fee-for-Service	1760835169	1760835169	1	1	AHMAD, MUHAMMAD MD	10/14/2022	207R00000X	NA	Other	026	PHYSICIANS	180286	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
176324	Fee-for-Service	1437190915	1437190915	1	1	ARTZ, SHANA MD	8/30/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	164972	30	Radiology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
176327	Fee-for-Service	1497800569	1497800569	1	1	ASHNIN, MICHAEL MD	11/5/2024	207L00000X	NA	Other	026	PHYSICIANS	55508	05	Anesthesiology	0	In state provider	None	1515 E OCEAN AVE.	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
176355	Fee-for-Service	1386940203	1386940203	1	1	AGAHI, GOLNAZ LCSW	6/12/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
176402	Fee-for-Service	1780292219	1780292219	1	1	ANG HOSPICE INC	10/8/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	95 3RD ST	STE 254	SAN FRANCISCO	CA	94103	3103	38	06075	37.78653271	-122.402286	San Francisco County
176438	Fee-for-Service	1295813087	1295813087	1	1	ANCEL, MARILYN A	3/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	46815	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
176442	Fee-for-Service	1902882806	1902882806	1	1	ANDREW CORTEZ	1/17/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6622 N 91ST AVE	STE 200	GLENDALE	AZ	85305	2569	00	None	33.532551	-112.2557625	Maricopa County
176478	Fee-for-Service	1720069438	1720069438	1	1	ALASTRA, ANTHONY J MD	2/20/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	156134	14	Neurological Surgery	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
176487	Fee-for-Service	1811617442	1811617442	1	1	AKUA BEHAVIORAL HEALTH, INC	2/17/2025	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1784 SAN DIEGO AVE	None	SAN DIEGO	CA	92110	1906	37	06073	32.74381765	-117.1837576	San Diego County
176506	Fee-for-Service	1194037945	1194037945	1	1	ALAZZEH, AHMAD MD	7/13/2020	207LC0200X	NA	Other	026	PHYSICIANS	166481	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
176524	Fee-for-Service	1841655099	1841655099	1	1	ALGOS INC., A MEDICAL CORPOR	10/16/2018	208VP0000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	802 MAGNOLIA AVE	SUITE 206	CORONA	CA	92879	3104	33	06065	33.8596449	-117.5529774	Riverside County
176545	Fee-for-Service	1821521527	1821521527	1	1	AGYEMAN, KWAME B MD	7/21/2021	207R00000X	NA	Other	026	PHYSICIANS	158219	None	None	0	In state provider	None	599 INLAND CENTER DR	STE 105	SAN BERNARDINO	CA	92408	1819	36	06071	34.0904396	-117.2957326	San Bernardino County
176637	Fee-for-Service	1619475613	1619475613	1	1	ADVENTIST HEALTH PHYSICIANS	8/20/2019	207Y00000X	NA	ENT/Otolaryngology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	370 DEL NORTE AVE	STE 203	YUBA CITY	CA	95991	4142	51	06101	39.14466521	-121.6166961	Sutter County
176640	Fee-for-Service	1649209768	1649209768	1	1	ABOUJAOUDE, ELIAS N MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69837	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
176657	Fee-for-Service	1306884754	1306884754	1	1	ABDEL-SAMED, GIHAN S MD	10/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135047	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91773	3219	19	06037	34.20289797	-118.6294006	Los Angeles County
176658	Fee-for-Service	1568449304	1568449304	1	1	ANDERSON VALLEY HEALTH	3/15/2006	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER, INC	13500 AIRPORT RD	None	BOONVILLE	CA	95415	0338	23	06045	39.01236566	-123.3794356	Mendocino County
176688	Fee-for-Service	1780292219	1780292219	1	1	ANG HOSPICE INC	10/8/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	95 3RD ST	STE 254	SAN FRANCISCO	CA	94103	3103	38	06075	37.78653271	-122.402286	San Francisco County
176715	Fee-for-Service	1902079452	1902079452	1	5	ABLE PHYSICAL THERAPY CORP	5/25/2018	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1535 DEERPARK DR	None	FULLERTON	CA	92831	2286	30	06059	33.88668862	-117.8789387	Orange County
176717	Fee-for-Service	1427228956	1427228956	2	1	ALBOINY, SAFWAN MD	6/4/2018	2084N0400X	NA	Neurology	026	PHYSICIANS	113426	13	Neurology (M.D. only)	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
176746	Fee-for-Service	1962486720	1962486720	1	1	AIZENBERG, DEBBIE MD	6/11/2008	174400000X	NA	Other	026	PHYSICIANS	89647	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
176764	Fee-for-Service	1457345001	1457345001	1	1	AG LA MESA, LLC	10/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5696 LAKE MURRAY BLVD	None	LA MESA	CA	91942	1929	37	06073	32.78336448	-117.0287263	San Diego County
176784	Fee-for-Service	1568601789	1568601789	1	1	ANIMAS DIALYSIS LLC	1/1/2009	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1721 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	4004	19	06037	34.0124819	-118.1200543	Los Angeles County
176794	Fee-for-Service	1912367046	1912367046	1	1	AGARWAL, SHRUTI DO	7/26/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	18403	None	None	0	In state provider	None	3000 LAS POSITAS	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
176798	Fee-for-Service	1447351747	1447351747	1	2	AHMED, AIJAZ MD	5/4/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	60520	None	None	0	In state provider	None	1551 BISHOP ST	STE 230	SAN LUIS OBISPO	CA	93401	4635	40	06079	35.27475609	-120.6454494	San Luis Obispo County
176800	Fee-for-Service	1780974303	1780974303	1	1	ALEXANDER, HARSHA K MD	8/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129110	41	Internal Medicine	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
176854	Fee-for-Service	1851450944	1851450944	1	1	AYN PHARMACY CORP	3/22/1996	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY	9730 WILSHIRE BLVD	SUITE 103 & 114	BEVERLY HILLS	CA	90212	2022	19	06037	34.06705051	-118.4074425	Los Angeles County
176860	Fee-for-Service	1699289181	1699289181	1	1	ANDREW NANGALAMA MD, PHD, PC	11/3/2021	193200000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	915 HIGHLAND POINTE DR	STE 250	ROSEVILLE	CA	95678	5419	31	06061	38.78338654	-121.2837779	Placer County
176862	Fee-for-Service	1861755415	1861755415	1	1	AMESUR, LINNEA S DO	12/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12977	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
176870	Fee-for-Service	1598905978	1598905978	1	1	ANANTH, LALITHA MD FACP INC	5/14/2009	193400000X	NA	Other	026	PHYSICIANS	40291	83	Rheumatology	0	In state provider	None	11100 WARNER AVE	STE 304	FOUNTAIN VALLEY	CA	92708	7512	30	06059	33.716291	-117.9355051	Orange County
176941	Fee-for-Service	1295035343	1295035343	1	1	ARAIZA, MARCELLA LMFT	9/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2158 JEAN AVE	None	SOUTH LAKE TAHOE	CA	96150	3412	09	06017	38.91508934	-119.9978421	El Dorado County
176947	Fee-for-Service	1568449304	1568449304	1	1	ANDERSON VALLEY HEALTH	3/15/2006	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER, INC	13500 AIRPORT RD	None	BOONVILLE	CA	95415	0338	23	06045	39.01236566	-123.3794356	Mendocino County
176968	Fee-for-Service	1912411596	1912411596	1	1	ARAFA, JOSEPH CCC-SLP	12/29/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	PY	8616 LA TIJERA BOULEVARD	STE 319	LOS ANGELES	CA	90045	3954	19	06037	33.95943215	-118.3918599	Los Angeles County
176984	Fee-for-Service	1376540732	1376540732	1	1	ASHER, SHELLIE L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ALBANY MEDICAL CENTERE	47 NEW SCOTLAND AVE	None	ALBANY	NY	12208	0000	00	None	42.65281106	-73.77466567	Albany County
177004	Fee-for-Service	1902079452	1902079452	1	5	ABLE PHYSICAL THERAPY CORP	5/25/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1535 DEERPARK DR	None	FULLERTON	CA	92831	2286	30	06059	33.88668862	-117.8789387	Orange County
177018	Fee-for-Service	1457800930	1457800930	1	1	ABSOLUTE NON EMERGENCY	7/19/2018	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	MEDICAL TRANPOSRT	801 BOULDER AVENUE	None	LATHROP	CA	95330	9207	39	06077	37.83538404	-121.2788799	San Joaquin County
177029	Fee-for-Service	1124329131	1124329131	1	1	ALLIANCE FOR WELLNESS, INC.	2/7/2025	208D00000X	NA	Adult Primary Care	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	16260 VENTURA BLVD	630	ENCINO	CA	91436	2255	19	06037	34.15687678	-118.4876342	Los Angeles County
177076	Fee-for-Service	1295393775	1295393775	1	1	AGARWAL, RISHABH MD	6/7/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
177082	Fee-for-Service	1255419727	1255419727	1	1	ALONA SUCHIN	4/18/2022	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 PELHAM PKWY S	None	BRONX	NY	10461	1138	00	None	40.857111	-73.847448	Bronx County
177084	Fee-for-Service	1144833229	1144833229	1	1	ALL YOU NEED HOME HEALTH	11/10/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	220 N GLENOAKS BLVD	SUITE B	BURBANK	CA	91502	1213	19	06037	34.1842049	-118.3075494	Los Angeles County
177095	Fee-for-Service	1720588288	1720588288	1	1	ABSOLUTE COMFORT HOME	9/17/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HEALTHCARE INC	5924 E LOS ANGELES AVE	STE J	SIMI VALLEY	CA	93063	7034	56	06111	34.27171481	-118.6755673	Ventura County
177111	Fee-for-Service	1881128510	1881128510	1	1	AHMAD, MONA M MD	3/10/2023	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	179531	None	None	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
177122	Fee-for-Service	1225229024	1225229024	2	1	AALAMI, OLIVER O MD	6/24/2022	2086S0129X	NA	General Surgery	026	PHYSICIANS	71647	None	None	0	In state provider	None	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
177140	Fee-for-Service	1720575988	1720575988	1	1	ALTAMIRANO, MARYIN J MD	10/18/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166892	None	None	0	In state provider	None	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
177152	Fee-for-Service	1245420181	1245420181	1	1	AGARWAL,VIKAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 LOTHROP STREET	STE 3950 PRESLAY S TOWER	PITTSBURGH	PA	15213	0000	00	None	40.44188737	-79.96079711	Allegheny County
177155	Fee-for-Service	1023178019	1023178019	1	1	ANDELMAN, ROSS B MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	72412	36	Psychiatry	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
177156	Fee-for-Service	1053449900	1053449900	1	1	AMANECER COMMUNITY COUNSELIN	1/28/2021	261QM0801X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	G SERVICE, A NON-PROFIT	1200 WILSHIRE BLVD	SUITE 200, 210, 300	LOS ANGELES	CA	90017	1931	19	06037	34.05307427	-118.2651099	Los Angeles County
177175	Fee-for-Service	1801934005	1801934005	1	2	ADDICTION RESEARCH AND TREAT	10/11/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	11682 ATLANTIC AVE	None	LYNWOOD	CA	90262	3007	19	06037	33.91730723	-118.1889829	Los Angeles County
177187	Fee-for-Service	1790888196	1790888196	1	1	AUSTIN, PATRICIA L MD	9/10/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	29698	18	Ophthalmology	0	In state provider	None	1270 ARROYO WAY	None	WALNUT CREEK	CA	94596	4216	07	06013	37.90508953	-122.060565	Contra Costa County
177211	Fee-for-Service	1902323793	1902323793	1	1	ACHARYA, MINATI D OD	8/28/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
177214	Fee-for-Service	1881867554	1881867554	1	1	AMERICARE GROUP INC	4/10/2009	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	ADMINISTRATOR	220 WEST MANCHESTER BLV	None	INGLEWOOD	CA	90301	4615	19	06037	33.96161649	-118.358378	Los Angeles County
177243	Fee-for-Service	1063535037	1063535037	1	1	AFUALO, RHEA L	3/22/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVENUE	RMC MOB2	RIVERSIDE	CA	92505	3047	33	06065	33.904782	-117.469323	Riverside County
177246	Fee-for-Service	1639173545	1639173545	1	1	ASTA, LISA M	7/25/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	83245	40	Pediatrics	0	In state provider	None	3100 TELEGRAPH AVE	FL 2	OAKLAND	CA	94609	3210	01	06001	37.82037533	-122.2667839	Alameda County
177260	Fee-for-Service	1306839915	1306839915	1	1	ALLY, ZAHORA N MD	6/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	84383	78	Neoplastic Diseases/Oncology	0	In state provider	None	4721 DALLAS RANCH	None	ANTIOCH	CA	94531	8811	07	06013	37.97016362	-121.7967323	Contra Costa County
177288	Fee-for-Service	1811664089	1811664089	1	1	ACOSTA, MICHELLE W PT	10/6/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
177316	Fee-for-Service	1124329131	1124329131	1	1	ALLIANCE FOR WELLNESS, INC.	4/21/2023	208D00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	16260 VENTURA BLVD	630	ENCINO	CA	91436	2255	19	06037	34.15687678	-118.4876342	Los Angeles County
177323	Fee-for-Service	1720167794	1720167794	1	1	ATIZ, MICHELE A OD	2/16/2005	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ALL FOR EYES OPTOMETRY	1035 S GAREY AVE	None	POMONA	CA	91766	3330	19	06037	34.05021677	-117.7499586	Los Angeles County
177326	Fee-for-Service	1902552565	1902552565	1	1	ARANDIA, RUEL D NP	6/15/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1517 KNICKERBOCKER	None	STOCKTON	CA	95210	3119	39	06077	38.02415455	-121.2934722	San Joaquin County
177335	Fee-for-Service	1609064435	1609064435	1	1	ADV WOMEN'S HEALTHCARE	7/5/2007	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	AMC	79-200 CORPORATE CTR DR	STE 201	LA QUINTA	CA	92253	7245	33	06065	33.71039647	-116.2841051	Riverside County
177349	Fee-for-Service	1386092880	1386092880	1	1	ABOUHAMZEH, ELHAM PSYD	3/9/2019	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2102 BUSINESS CENTER DR	135	IRVINE	CA	92612	1001	30	06059	33.68027087	-117.855546	Orange County
177358	Fee-for-Service	1811066905	1811066905	1	2	ALVARADO ORTHOPEDIC MEDI	2/9/2009	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP INC	8860 CENTER DRIVE	None	LA MESA	CA	91942	7001	37	06073	32.78189749	-117.0075062	San Diego County
177369	Fee-for-Service	1477632651	1477632651	1	1	ANWAR, MUHAMMAD MD	9/11/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42620	33	Thoracic Surgery	0	In state provider	None	924 EMILY WAY	None	MADERA	CA	93637	5647	20	06039	36.94437816	-120.0505356	Madera County
177396	Fee-for-Service	1821492836	1821492836	1	1	ADVANCED HEALTHCARE FOR WOME	1/23/2015	363LF0000X	NA	Nurse Practitioner	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	WOMEN AND CHILDREN A	600 NORTH MOUNTAIN AVE	SUITE A104	UPLAND	CA	91786	4359	36	06071	34.10094187	-117.6700806	San Bernardino County
177402	Fee-for-Service	1285730929	1285730929	1	1	AYALA, LUIS A	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	60697	40	Pediatrics	0	In state provider	None	1250 N IRWIN ST	None	HANFORD	CA	93230	2956	16	06031	36.33781332	-119.6476969	Kings County
177403	Fee-for-Service	1134909450	1134909450	1	1	ASANTE-ANSONG, FIDELIA NP	10/16/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
177411	Fee-for-Service	1265722375	1265722375	1	1	ANTON, EMILY M MD	9/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134956	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
177439	Fee-for-Service	1669803003	1669803003	1	1	ADVENTIST HEALTH PHYSICIANS	11/25/2014	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	2256 DOCKERY AVENUE	STE B	SELMA	CA	93662	3873	10	06019	36.566298	-119.6018135	Fresno County
177483	Fee-for-Service	1972752848	1972752848	1	1	ALDRICH, JON M MD	12/16/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	90628	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVENUE	BOX 00648	SAN FRANCISCO	CA	94122	0648	38	06075	37.76332993	-122.4582988	San Francisco County
177493	Fee-for-Service	1497138002	1497138002	1	1	ALWAHAB, AREEJ K MD	10/27/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	166758	None	None	0	In state provider	None	2150 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4811	36	06071	34.134705	-117.2787865	San Bernardino County
177495	Fee-for-Service	1568802361	1568802361	1	1	ANDERTON, AMY C MD	6/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	147995	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
177504	Fee-for-Service	1063094464	1063094464	1	1	ATTERBURY, KIP PT	11/4/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HGHWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
177521	Fee-for-Service	1932378437	1932378437	1	1	ALI, ZIAD A M MD	9/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102552	01	General Practice	0	In state provider	None	2455 JEFFERSON BLVD	STE 100	WEST SACRAMENTO	CA	95691	5313	57	06113	38.55304251	-121.5367185	Yolo County
177572	Fee-for-Service	1851469894	1851469894	1	1	ALTBAUM, STEPHEN J LMFT	5/8/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
177586	Fee-for-Service	1811317811	1811317811	1	1	AMERICAN RIVER HOME CARE	7/3/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1451 RIVER PARK DR	SUITE 244	SACRAMENTO	CA	95815	4521	34	06067	38.598651	-121.439673	Sacramento County
177603	Fee-for-Service	1124329131	1124329131	1	1	ALLIANCE FOR WELLNESS, INC.	4/21/2023	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	16260 VENTURA BLVD	630	ENCINO	CA	91436	2255	19	06037	34.15687678	-118.4876342	Los Angeles County
177648	Fee-for-Service	1811066905	1811066905	1	2	ALVARADO ORTHOPEDIC MEDI	11/10/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	MEDICAL GROUP INC	8860 CENTER DRIVE	None	LA MESA	CA	91942	7001	37	06073	32.78189749	-117.0075062	San Diego County
177649	Fee-for-Service	1457352262	1457352262	1	1	ASNANI, MONICA G MD	3/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71831	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
177651	Fee-for-Service	1588161194	1588161194	1	1	ALAUNUS HOME HEALTH, INC.	7/19/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	110 S ROSEMEAD BLVD	SUITE R4	PASADENA	CA	91107	3960	19	06037	34.144533	-118.073274	Los Angeles County
177658	Fee-for-Service	1477632651	1477632651	1	1	ANWAR, MUHAMMAD MD	9/11/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	42620	02	General Surgery	0	In state provider	None	924 EMILY WAY	None	MADERA	CA	93637	5647	20	06039	36.94437816	-120.0505356	Madera County
177686	Fee-for-Service	1154327112	1154327112	1	1	AKIN, SADRI M MD	7/31/1988	261QR0200X	NA	Mammography/MRI Provider	026	PHYSICIANS	41024	30	Radiology	0	In state provider	None	1902 ROYALTY DR	STE 180	POMONA	CA	91767	3012	19	06037	34.07791925	-117.746146	Los Angeles County
177697	Fee-for-Service	1689699415	1689699415	1	1	AMPLA HEALTH	9/1/1995	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	278 MAIN STREET	None	HAMILTON CITY	CA	95951	0000	11	06021	39.74142945	-122.0117975	Glenn County
177698	Fee-for-Service	1720518129	1720518129	1	1	AITALI, ADEL DPM	2/19/2021	213ES0103X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	635 ANDERSON RD STE 19	None	DAVIS	CA	95616	3505	57	06113	38.54876426	-121.7587542	Yolo County
177706	Fee-for-Service	1720138779	1720138779	1	1	ALISON TOTHY MD	5/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5841 S MARYLAND AVE	None	CHICAGO	IL	60637	1443	00	None	41.788431	-87.60489252	Cook County
177777	Fee-for-Service	1457382483	1457382483	1	1	AMISUB OF SOUTH CAROLINA	12/27/2000	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	INC	222 S HERLONG AVE	None	ROCK HILL	SC	29732	1158	00	None	34.95531222	-81.05223344	York County
177814	Fee-for-Service	1932378437	1932378437	1	1	ALI, ZIAD A M MD	9/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102552	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2455 JEFFERSON BLVD	STE 100	WEST SACRAMENTO	CA	95691	5313	57	06113	38.55304251	-121.5367185	Yolo County
177837	Fee-for-Service	1013546373	1013546373	1	1	ABEDINI, ASHKAN MD	9/12/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184847	None	None	0	In state provider	None	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	37	06073	32.781195	-117.0070695	San Diego County
177847	Fee-for-Service	1669403390	1669403390	1	1	AXIS COMMUNITY HEALTH, INC.	9/1/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	4361 RAILROAD AVE	None	PLEASANTON	CA	94566	6611	01	06001	37.66138479	-121.8737265	Alameda County
177854	Fee-for-Service	1982983391	1982983391	1	1	ARYAL, MADAN MD	2/1/2021	207R00000X	NA	Other	026	PHYSICIANS	167530	None	None	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
177919	Fee-for-Service	1073148110	1073148110	1	1	ALI, AASER MD	10/28/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
177962	Fee-for-Service	1740427657	1740427657	1	13	ALTAMED HEALTH SERVICES CORP	4/16/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2240 SOUTH MAIN STREET	None	SANTA ANA	CA	92707	3264	30	06059	33.716601	-117.870201	Orange County
177975	Fee-for-Service	1154327112	1154327112	1	1	AKIN, SADRI M MD	7/31/1988	261QR0200X	NA	Mammography/MRI Provider	026	PHYSICIANS	41024	01	General Practice	0	In state provider	None	1902 ROYALTY DR	STE 180	POMONA	CA	91767	3012	19	06037	34.07791925	-117.746146	Los Angeles County
177983	Fee-for-Service	1689699415	1689699415	1	1	AMPLA HEALTH	9/1/1997	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	278 MAIN STREET	None	HAMILTON CITY	CA	95951	0000	11	06021	39.74142945	-122.0117975	Glenn County
177992	Fee-for-Service	1174901508	1174901508	1	1	ABBOUD, CHRISTINE DO	1/31/2022	207L00000X	NA	Other	026	PHYSICIANS	18451	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
178006	Fee-for-Service	1386772796	1386772796	2	1	ABILITY PATHWAYS INC	7/23/2007	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	FORBES DIVISION	2472 FORBES AVE	None	CLAREMONT	CA	91711	1717	19	06037	34.12836975	-117.7158321	Los Angeles County
178011	Fee-for-Service	1932987542	1932987542	1	1	ALBRIGHT, DEREK NP	3/16/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
178038	Fee-for-Service	1821409822	1821409822	1	1	AGRAWAL, NUPUR MD	7/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156567	40	Pediatrics	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
178044	Fee-for-Service	1699052605	1699052605	1	1	AKKINENI, KEERTHI MD	2/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149978	26	Psychiatry (child)	0	In state provider	None	111 SMITH RANCH RD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
178057	Fee-for-Service	1609210590	1609210590	1	1	ALLERGY ASTHMA & SINUS	3/14/2014	207KA0200X	NA	Other	026	PHYSICIANS	72098	03	Allergy	0	In state provider	CENTERS OF SILICON	20400 LAKE CHABOT RD	SUITE 304	CASTRO VALLEY	CA	94546	5316	01	06001	37.69628351	-122.0866765	Alameda County
178066	Fee-for-Service	1457382483	1457382483	1	1	AMISUB OF SOUTH CAROLINA	8/4/2006	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	INC	222 S HERLONG AVE	None	ROCK HILL	SC	29732	1158	00	None	34.95531222	-81.05223344	York County
178086	Fee-for-Service	1689612871	1689612871	1	1	ALDERDICE, MARK A	11/1/2000	207P00000X	NA	Other	026	PHYSICIANS	62209	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1330 NATIVIDAD RD	None	SALINAS	CA	93906	3101	27	06053	36.696996	-121.633173	Monterey County
178146	Fee-for-Service	1659098879	1659098879	1	1	AHUJA, SHERRY V.	12/8/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	3996 WILDROSE WAY	None	SACRAMENTO	CA	95826	4441	34	06067	38.54277	-121.364982	Sacramento County
178242	Fee-for-Service	1932631793	1932631793	1	1	AHMED, RASHA DO	5/8/2020	390200000X	NA	Other	026	PHYSICIANS	17041	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
178250	Fee-for-Service	1740427657	1740427657	1	13	ALTAMED HEALTH SERVICES CORP	4/16/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2240 SOUTH MAIN STREET	None	SANTA ANA	CA	92707	3264	30	06059	33.716601	-117.870201	Orange County
178260	Fee-for-Service	1396908042	1396908042	1	1	ADELANI, MUYIBAT A MD	7/30/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123763	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
178268	Fee-for-Service	1417039926	1417039926	1	1	ALGOS INC, A MEDICAL CORPOR	7/19/2024	103TB0200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ATION	830 S CITRUS AVE	SUITE 201	AZUSA	CA	91702	5942	19	06037	34.108074	-117.8902345	Los Angeles County
178272	Fee-for-Service	1689699415	1689699415	1	1	AMPLA HEALTH	9/1/1995	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	278 MAIN STREET	None	HAMILTON CITY	CA	95951	0000	11	06021	39.74142945	-122.0117975	Glenn County
178275	Fee-for-Service	1134389125	1134389125	1	1	ADENUGA, OLUFEMI M MD	10/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	126280	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
178280	Fee-for-Service	1356876833	1356876833	1	1	AZIZIANS, SARET CNP	12/28/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10455 S DE ANZA BLVD	None	CUPERTINO	CA	95014	3011	43	06085	37.316601	-122.032407	Santa Clara County
178312	Fee-for-Service	1144752783	1144752783	1	1	ABDI, FARAH A MD	9/1/2022	207R00000X	NA	Other	026	PHYSICIANS	162161	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
178316	Fee-for-Service	1134784655	1134784655	1	1	AYOUBY, SHUJA DO	3/20/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20328	None	None	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
178329	Fee-for-Service	1821409822	1821409822	1	1	AGRAWAL, NUPUR MD	7/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156567	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
178332	Fee-for-Service	1699052605	1699052605	1	1	AKKINENI, KEERTHI MD	2/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149978	36	Psychiatry	0	In state provider	None	111 SMITH RANCH RD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
178352	Fee-for-Service	1114288867	1114288867	1	1	AVELAR, TAURINO N MD	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126407	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
178373	Fee-for-Service	1689612871	1689612871	1	1	ALDERDICE, MARK A	11/1/2000	207P00000X	NA	Other	026	PHYSICIANS	62209	08	Family Practice	0	In state provider	None	1330 NATIVIDAD RD	None	SALINAS	CA	93906	3101	27	06053	36.696996	-121.633173	Monterey County
178422	Fee-for-Service	1902150675	1902150675	1	1	ALMADEN, VIRGILIO C MD A	1/1/2013	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	39833	01	General Practice	0	In state provider	A MEDICAL CORPORATION	751 WEST LEGION ROAD	STE 205	BRAWLEY	CA	92227	7755	13	06025	32.95996012	-115.5538196	Imperial County
178435	Fee-for-Service	1114215944	1114215944	1	2	ALOIS ZAUNER, M.D. INC.	5/20/2014	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	None	2220 LYNN RD	STE 303	THOUSAND OAKS	CA	91360	8007	56	06111	34.20863046	-118.8852156	Ventura County
178443	Fee-for-Service	1588893846	1588893846	1	1	ARGUETA, GRACIELA I LCSW	2/28/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
178467	Fee-for-Service	1336448059	1336448059	1	1	ABBOTT, ANGELA LMFT	8/10/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
178477	Fee-for-Service	1922490960	1922490960	1	2	AGHABY COMPREHENSIVE	4/5/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2542 E FLORENCE AVE	SUITE B AND C	WALNUT PARK	CA	90255	4780	19	06037	33.97430191	-118.2264151	Los Angeles County
178493	Fee-for-Service	1023069788	1023069788	1	1	ASTON-SAGER, AMANDA L MD	10/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	82505	22	Pathology (M.D. only)	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
178529	Fee-for-Service	1649433525	1649433525	1	1	ALEGRIA, JAMILET C MD	7/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103952	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
178554	Fee-for-Service	1417039926	1417039926	1	1	ALGOS INC, A MEDICAL CORPOR	4/11/2018	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ATION	830 S CITRUS AVE	SUITE 201	AZUSA	CA	91702	5942	19	06037	34.108074	-117.8902345	Los Angeles County
178562	Fee-for-Service	1689699415	1689699415	1	1	AMPLA HEALTH	3/25/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	278 MAIN STREET	None	HAMILTON CITY	CA	95951	0000	11	06021	39.74142945	-122.0117975	Glenn County
178593	Fee-for-Service	1124267505	1124267505	1	1	ANDERSON, DONNA L	5/4/2010	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1930 WILSHIRE BLVD	STE 904	LOS ANGELES	CA	90057	3619	19	06037	34.05720458	-118.2744084	Los Angeles County
178649	Fee-for-Service	1952510059	1952510059	1	1	ALBACHA,HJAZI IZAT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 HOLMES AVE	None	PHILIDELPHIA	PA	19152	2007	00	None	40.05806112	-75.04222609	Philadelphia
178673	Fee-for-Service	1265525216	1265525216	1	1	ACEVES, JOSE A MD	3/21/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	48529	08	Family Practice	0	In state provider	None	14609 WHITTIER BLVD	None	WHITTIER	CA	90605	1723	19	06037	33.95222875	-118.0132682	Los Angeles County
178678	Fee-for-Service	1528164803	1528164803	1	1	ALEX J. AUSEON D.O.	3/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1740 W TAYLOR ST	None	CHICAGO	IL	60612	7232	00	None	41.8692353	-87.67061005	Cook County
178706	Fee-for-Service	1356640502	1356640502	1	1	AST, ALLISON M MD	10/25/2022	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	181963	None	None	0	In state provider	None	15400 LOS GATOS BLVD	None	LOS GATOS	CA	95032	2502	43	06085	37.24572659	-121.957997	Santa Clara County
178717	Fee-for-Service	1437102845	1437102845	1	1	ARIFF, ASAN M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10503 W THUNDERBIRD BLVD	STE 104	SUN CITY	AZ	85351	3047	00	None	33.604578	-112.285998	Maricopa County
178721	Fee-for-Service	1114215944	1114215944	1	2	ALOIS ZAUNER, M.D. INC.	5/20/2014	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	2220 LYNN RD	STE 303	THOUSAND OAKS	CA	91360	8007	56	06111	34.20863046	-118.8852156	Ventura County
178727	Fee-for-Service	1548790041	1548790041	1	1	AL-BANAA, KADHIM I	9/20/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	170000	68	Hematology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
178743	Fee-for-Service	1750439576	1750439576	1	1	AUSTIN, JOHN H MD	8/1/1998	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	61792	01	General Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
178748	Fee-for-Service	1740733237	1740733237	1	1	AQUIPEL, STACY A C PSY	9/19/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
178757	Fee-for-Service	1013028034	1013028034	2	1	APRIA HEALTHCARE LLC	9/15/2020	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	12520 BUSINESS CENTER	SUITE E	VICTORVILLE	CA	92395	4723	36	06071	34.47661296	-117.2869599	San Bernardino County
178760	Fee-for-Service	1225322522	1225322522	1	1	ABRAHAM, JUSTIN V MD	9/19/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	175759	None	None	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
178763	Fee-for-Service	1922490960	1922490960	1	2	AGHABY COMPREHENSIVE	4/5/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	2542 E FLORENCE AVE	SUITE B AND C	WALNUT PARK	CA	90255	4780	19	06037	33.97430191	-118.2264151	Los Angeles County
178771	Fee-for-Service	1740427657	1740427657	1	20	ALTAMED HEALTH SERVICES CORP	5/16/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	13641 CLINTON STREET	None	GARDEN GROVE	CA	92843	4110	30	06059	33.76449	-117.9116385	Orange County
178816	Fee-for-Service	1649433525	1649433525	1	1	ALEGRIA, JAMILET C MD	7/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	103952	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
178835	Fee-for-Service	1427721216	1427721216	1	1	AOKI, STEPHANIE K PHD	12/10/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
178881	Fee-for-Service	1245254580	1245254580	1	1	ASUNCION, IMMANUEL A MD	8/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	89792	08	Family Practice	0	In state provider	None	500 SAN PABLO AVE	STE 300	ALBANY	CA	94706	1127	01	06001	37.89781848	-122.3014067	Alameda County
178886	Fee-for-Service	1609942713	1609942713	1	1	ALVES, STEPHEN J	2/26/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
178894	Fee-for-Service	1013952019	1013952019	1	1	ARIZONA CVS STORES LLC	10/26/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	1	Border provider	None	1555 S AVENUE B	None	YUMA	AZ	85364	4584	00	None	32.699268	-114.6494925	Yuma County
178895	Fee-for-Service	1346433059	1346433059	1	1	ANSARI, ATHAR M MD INC	5/22/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	50706	41	Internal Medicine	0	In state provider	None	790 W ORANGE AVE	STE B	EL CENTRO	CA	92243	3274	13	06025	32.7888123	-115.5609792	Imperial County
178916	Fee-for-Service	1891993622	1891993622	1	1	ANTILLON, MONICA M LCSW	5/19/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
178917	Fee-for-Service	1528135373	1528135373	1	1	AUMAN, LORI A NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2814	19	06037	33.918975	-118.1291985	Los Angeles County
178969	Fee-for-Service	1134803216	1134803216	1	1	ALI, FAHEEMAH S BIRTH DOULA	10/8/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	01	06001	0	0	None
178980	Fee-for-Service	1932582699	1932582699	1	8	AKSHAY MEHTA MD INC	1/17/2020	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	13100 STUDEBAKER RD	None	NORWALK	CA	90650	2531	19	06037	33.912594	-118.099152	Los Angeles County
178991	Fee-for-Service	1265790752	1265790752	1	1	ANTONIO, EDSEL DO	8/7/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	21927	09	Gynecology (D.O. only)	0	In state provider	None	1401 GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
179011	Fee-for-Service	1376583617	1376583617	1	1	ACCENTCARE HOME HEALTH OF CA	4/30/1998	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5050 MURPHY CANYON ROAD	SUITE 200	SAN DIEGO	CA	92123	4441	37	06073	32.83051691	-117.1202755	San Diego County
179019	Fee-for-Service	1346423829	1346423829	1	1	AHMED, RAHEEL MD	11/1/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	-	14	Neurological Surgery	2	Out of state provider	None	600 HIGHLAND AVE	None	MADISON	WI	53792	0001	00	None	43.07868393	-89.4316606	Dane County
179044	Fee-for-Service	1588635890	1588635890	1	1	ADDO, EMMANUEL J MD	2/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	83783	None	None	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
179059	Fee-for-Service	1740427657	1740427657	1	20	ALTAMED HEALTH SERVICES CORP	5/16/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	13641 CLINTON STREET	None	GARDEN GROVE	CA	92843	4110	30	06059	33.76449	-117.9116385	Orange County
179133	Fee-for-Service	1316570443	1316570443	1	1	ALLEN, MARSHA-GAYE C AU	2/2/2021	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
179182	Fee-for-Service	1346433059	1346433059	1	1	ANSARI, ATHAR M MD INC	5/22/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	50706	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	790 W ORANGE AVE	STE B	EL CENTRO	CA	92243	3274	13	06025	32.7888123	-115.5609792	Imperial County
179206	Fee-for-Service	1124620992	1124620992	1	1	ATASHIGOLESTAN, MONA AU	12/16/2020	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	5250 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91601	3186	19	06037	34.1665161	-118.3755868	Los Angeles County
179221	Fee-for-Service	1205074085	1205074085	1	1	AGARWAL, RINKI G MD	6/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107307	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
179255	Fee-for-Service	1649282302	1649282302	1	1	AHN, ANTHONY KW MD	12/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86508	None	None	0	In state provider	None	8635 W 3RD ST	None	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
179274	Fee-for-Service	1457472664	1457472664	1	1	APEX HEALTHCARE MEDICAL CENT	9/8/2020	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	28400 MCCALL BLVD.	B10	MENIFEE	CA	92585	9658	33	06065	33.71805454	-117.1672547	Riverside County
179281	Fee-for-Service	1063096113	1063096113	1	1	ANTYPAS, CARLA R DO	1/2/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22397	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
179282	Fee-for-Service	1265790752	1265790752	1	1	ANTONIO, EDSEL DO	8/7/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	21927	15	Obstetrics (D.O. only)	0	In state provider	None	1401 GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
179287	Fee-for-Service	1992297717	1992297717	1	1	ALDAOUD, SAAD G MD	11/11/2021	208M00000X	NA	Other	026	PHYSICIANS	173927	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
179296	Fee-for-Service	1285813576	1285813576	1	1	ADAMYAN, AKOP	2/27/2007	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	14355 VICTORY BLVD	STE B	VAN NUYS	CA	91401	6528	19	06037	34.1867283	-118.4462699	Los Angeles County
179333	Fee-for-Service	1285686220	1285686220	1	1	AZER, BERNARD MAHER DO	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7817	45	Nephrology (Renal-Kidney)	0	In state provider	None	3810 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3302	30	06059	33.80299148	-118.0666755	Orange County
179337	Fee-for-Service	1043679913	1043679913	1	1	AVILA, ANDREA I NP	3/4/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1035 PLACER STREET	None	REDDING	CA	96001	1125	45	06089	40.58349378	-122.3853903	Shasta County
179348	Fee-for-Service	1982982070	1982982070	1	1	AMERY CONSULTING INC.	9/18/2018	261QS1200X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	72855 FRED WARING DR	SUITE C19	PALM DESERT	CA	92260	9372	33	06065	33.72858055	-116.3943135	Riverside County
179350	Fee-for-Service	1093737959	1093737959	1	1	ARUL, NANDINI MD	12/31/2008	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	105945	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.17453515	-117.35558	San Diego County
179355	Fee-for-Service	1376723601	1376723601	1	1	ANANDA, RAJESWARI MD INC	1/1/1978	No Taxonomy Provided	NA	None	026	PHYSICIANS	31897	13	Neurology (M.D. only)	0	In state provider	None	2876 SYCAMORE DR	STE 305	SIMI VALLEY	CA	93065	1550	56	06111	34.28795345	-118.7438659	Ventura County
179356	Fee-for-Service	1366705006	1366705006	1	1	ALVARADO, FLORY LMFT	8/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
179424	Fee-for-Service	1457563074	1457563074	1	1	ADDICTION TREATMENT SVS	6/30/2003	363A00000X	NA	Physician Assistant	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1496 N BEALE RD	None	MARYSVILLE	CA	95901	6205	58	06115	39.12743446	-121.5621716	Yuba County
179486	Fee-for-Service	1558825067	1558825067	1	1	ASD6 LLC	2/16/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	4033 6TH AVENUE	None	SAN DIEGO	CA	92103	2202	37	06073	32.75038594	-117.1587725	San Diego County
179501	Fee-for-Service	1700819927	1700819927	1	1	ANNABI, HANI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	615 E SCHUSTER AVE	STE 7	EL PASO	TX	79902	4360	00	None	31.77164741	-106.4937967	El Paso County
179574	Fee-for-Service	1831136738	1831136738	1	1	ALZAGATITI, BASSAM I MD	7/11/2022	174400000X	NA	Other	026	PHYSICIANS	56366	None	None	0	In state provider	None	4770 HERNDON	105	FRESNO	CA	93722	8401	10	06019	36.83717984	-119.8778388	Fresno County
179615	Fee-for-Service	1801496476	1801496476	1	1	ARL CARE AND PROGRAM	9/15/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	PROVIDERS INC	3937 CASANOVA DR	None	SAN MATEO	CA	94403	3614	41	06081	37.53670146	-122.2837884	San Mateo County
179619	Fee-for-Service	1285686220	1285686220	1	1	AZER, BERNARD MAHER DO	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7817	41	Internal Medicine	0	In state provider	None	3810 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3302	30	06059	33.80299148	-118.0666755	Orange County
179650	Fee-for-Service	1316234511	1316234511	1	1	AKOTIA, POOJA M DO	6/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12452	01	General Practice	0	In state provider	None	15725 E WHITTIER BLVD.	None	WHITTIER	CA	90603	3102	19	06037	33.94435533	-117.9931159	Los Angeles County
179653	Fee-for-Service	1265897003	1265897003	1	1	AYE, JENNIFER DO	1/10/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	21699	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
179712	Fee-for-Service	1093893679	1093893679	1	2	AYYALA, SREEDEVI J MD	11/24/2020	207R00000X	NA	Other	086	MEDICAL DIRECTORS	90855	-	NOT APPLICABLE	0	In state provider	None	37437 GLENMOOR DRIVE	None	FREMONT	CA	94536	5731	01	06001	37.55051453	-122.0125168	Alameda County
179736	Fee-for-Service	1639633142	1639633142	1	1	ARKA HOME HEALTH CARE INC	5/14/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1714 W MAGNOLIA BLVD	SUITE 201	BURBANK	CA	91506	1840	19	06037	34.17454367	-118.3271207	Los Angeles County
179744	Fee-for-Service	1972099521	1972099521	1	1	ALDOLAIM, SADEG T NP	3/7/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
179747	Fee-for-Service	1962407429	1962407429	1	1	ADJOVU, SETH K MD	9/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
179791	Fee-for-Service	1780033084	1780033084	1	1	ADVENTIST HEALTH PHYSICIANS	11/23/2016	193200000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	999 S FAIRMONT AVENUE	SUITE 100	LODI	CA	95240	5140	39	06077	38.1206163	-121.2858323	San Joaquin County
179796	Fee-for-Service	1144895954	1144895954	1	1	ARGANDA, MARK ANTON	10/30/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
179828	Fee-for-Service	1497967756	1497967756	1	1	ARD, SCOTT W MD	4/16/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	185366	None	None	0	In state provider	None	11180 WARNER AVE	STE 269	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
179865	Fee-for-Service	1346279460	1346279460	1	1	ABDUL-RAZAK, BASIMA MD	4/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53991	None	None	0	In state provider	None	9300 VALLEY CHILD PLACE	None	MADERA	CA	93636	8761	20	06039	0	0	None
179868	Fee-for-Service	1326282385	1326282385	1	1	AMEZCUA, HERMINIA MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126117	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	43112 15TH ST WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
179870	Fee-for-Service	1053600734	1053600734	1	1	AKILESWARAN, CHITRA P MD	9/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124651	None	None	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
179882	Fee-for-Service	1093249963	1093249963	1	1	ASHKAR, MOHAMED MD	2/5/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	192290	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
179899	Fee-for-Service	1316156367	1316156367	1	1	AMIRSHAHI, BIJAN LMFT	4/16/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4000 BARRANCA PARKWAY	STE 250	IRVINE	CA	92604	1713	30	06059	33.68357129	-117.8077084	Orange County
179903	Fee-for-Service	1124189212	1124189212	1	1	ARDMORE MED GROUP INC	4/10/1992	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	ARDMORE MED GROUP INC	3518 W 8TH ST	None	LOS ANGELES	CA	90005	2902	19	06037	34.05765742	-118.3072468	Los Angeles County
179959	Fee-for-Service	1447597471	1447597471	1	1	ALGOS INC A MEDICAL CORPORAT	8/1/2018	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	10565 CIVIC CENTER DR	WEST BLDG., SUITE 165	RANCHO CUCAMONGA	CA	91730	3853	36	06071	34.10278226	-117.5747989	San Bernardino County
180021	Fee-for-Service	1336243559	1336243559	1	1	ANNIE JEFFREY MEMORIAL	2/14/2017	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	COUNTY HEALTH CENTER	531 BEEBE ST	None	OSCEOLA	NE	68651	0428	00	None	41.17014275	-97.54902179	Polk County
180064	Fee-for-Service	1053775585	1053775585	1	1	AMAR, CHETAN MD	9/9/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	167587	36	Psychiatry	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
180091	Fee-for-Service	1336409291	1336409291	1	1	AYVAZIAN, ARBI DO	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12896	None	None	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
180099	Fee-for-Service	1720641814	1720641814	1	1	AVENAL COMMUNITY HEALTH CENT	12/26/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CY	209 C ST	None	LEMOORE	CA	93245	2930	16	06031	36.30089987	-119.7833254	Kings County
180108	Fee-for-Service	1962597807	1962597807	1	2	ADVANCED CALIFORNIA MEDICAL	1/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	55154	None	None	0	In state provider	CENTER INC	4074 FAIRMONT AVE	None	SAN DIEGO	CA	92105	1608	37	06073	32.75098505	-117.1009103	San Diego County
180112	Fee-for-Service	1639629595	1639629595	1	1	ALGOS INC., A MEDICAL CORPOR	12/18/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	830 S CITRUS AVE	SUITE 203	AZUSA	CA	91702	5942	19	06037	34.108074	-117.8902345	Los Angeles County
180145	Fee-for-Service	1447414495	1447414495	1	1	ALFANDARI, RONNY DPM	3/1/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2080 CENTURY PARK E	SUITE 1508	LOS ANGELES	CA	90067	2001	19	06037	34.05887194	-118.4122914	Los Angeles County
180156	Fee-for-Service	1306011879	1306011879	1	1	ANDERSON, DUA M MD	4/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	114909	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
180190	Fee-for-Service	1013938208	1013938208	1	1	ABDOU, ZAHID JEAN MD	3/31/1993	207R00000X	NA	Other	026	PHYSICIANS	74824	41	Internal Medicine	0	In state provider	None	414 N BOYLE AVE	None	LOS ANGELES	CA	90033	2410	19	06037	34.05043205	-118.2180396	Los Angeles County
180198	Fee-for-Service	1205360484	1205360484	1	1	ALIZADEH, REZA MD	6/28/2022	207W00000X	NA	Ophthalmology	026	PHYSICIANS	178828	None	None	0	In state provider	None	36 W YOKUTS AVE	STE 1	STOCKTON	CA	95207	5713	39	06077	37.99833959	-121.3074229	San Joaquin County
180203	Fee-for-Service	1669550349	1669550349	1	1	ANDERSON, KEVIN R MD	10/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	60685	34	Urology and Urological Surgery	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
180229	Fee-for-Service	1639661200	1639661200	1	1	ALI, SABAH CCC-SLP	3/31/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3555 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60574038	-122.0836254	Alameda County
180230	Fee-for-Service	1245429356	1245429356	1	1	ACHONDO, NAOMI OT	5/15/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1655 E 6TH ST	A-204	CORONA	CA	92879	1732	33	06065	33.87383273	-117.5305398	Riverside County
180233	Fee-for-Service	1336154707	1336154707	1	1	AZER, PAUL C MD	6/30/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	34941	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	8737 BEVERLY BLVD	STE 301	LOS ANGELES	CA	90048	1839	19	06037	34.07687959	-118.381876	Los Angeles County
180246	Fee-for-Service	1447597471	1447597471	1	1	ALGOS INC A MEDICAL CORPORAT	8/1/2018	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	None	10565 CIVIC CENTER DR	WEST BLDG., SUITE 165	RANCHO CUCAMONGA	CA	91730	3853	36	06071	34.10278226	-117.5747989	San Bernardino County
180260	Fee-for-Service	1639583818	1639583818	1	1	ALLRED, CRAIG D MD	2/6/2018	207P00000X	NA	Other	026	PHYSICIANS	138252	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
180270	Fee-for-Service	1972606374	1972606374	1	1	ALAMAR, ALI G MD	3/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	69613	41	Internal Medicine	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
180291	Fee-for-Service	1740579408	1740579408	1	1	AMOG, FREDERICK D MD	1/17/2020	208600000X	NA	General Surgery	026	PHYSICIANS	160924	02	General Surgery	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
180309	Fee-for-Service	1336243559	1336243559	1	1	ANNIE JEFFREY MEMORIAL	2/14/2017	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	COUNTY HEALTH CENTER	531 BEEBE ST	None	OSCEOLA	NE	68651	0428	00	None	41.17014275	-97.54902179	Polk County
180324	Fee-for-Service	1154377653	1154377653	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	40101 MONTEREY AVE	None	RANCHO MIRAGE	CA	92270	3261	33	06065	33.75635374	-116.3913147	Riverside County
180332	Fee-for-Service	1477594745	1477594745	1	1	ALAM, GEORGE A MD	4/30/1993	207P00000X	NA	Other	026	PHYSICIANS	74532	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
180348	Fee-for-Service	1629098314	1629098314	1	1	ARNOLD, ANTHONY C MD	6/30/1985	207W00000X	NA	Ophthalmology	026	PHYSICIANS	32595	18	Ophthalmology	0	In state provider	None	200 STEIN PLAZA RM 1-340	None	LOS ANGELES	CA	90024	0000	19	06037	34.06482757	-118.4443441	Los Angeles County
180375	Fee-for-Service	1043345051	1043345051	1	1	ADVANCED EYE ASSOCIATES	10/17/2006	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	A PROF CORP	200 JOSE FIGUERES AVE	STE 350	SAN JOSE	CA	95116	1555	43	06085	37.36122014	-121.8505998	Santa Clara County
180387	Fee-for-Service	1881139210	1881139210	1	1	ABOVE CARE HOME HEALTH INC	12/28/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	201 N BRAND BLVD	STE 200	GLENDALE	CA	91203	2609	19	06037	34.14829897	-118.255124	Los Angeles County
180405	Fee-for-Service	1376573717	1376573717	1	1	AMOTT, THOMAS R MD	4/30/1991	174400000X	NA	Other	026	PHYSICIANS	23129	41	Internal Medicine	0	In state provider	None	COUNTY ROAD 99	None	DAVIS	CA	95616	0000	57	06113	38.57575978	-121.7859718	Yolo County
180468	Fee-for-Service	1134513211	1134513211	1	1	AL-TAMEEMI, AHMED MD	2/25/2022	207R00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
180473	Fee-for-Service	1073856423	1073856423	1	1	AKSHAY MURALIDHAR	8/19/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3330 N 2ND ST	STE 300	PHOENIX	AZ	85012	2369	00	None	33.486606	-112.071654	Maricopa County
180495	Fee-for-Service	1508381799	1508381799	1	1	ANTIN SACHS, INC.	8/15/2023	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	4420 RAINIER AVE	STE 202	SAN DIEGO	CA	92120	3329	37	06073	32.78984169	-117.0989475	San Diego County
180499	Fee-for-Service	1316424013	1316424013	1	1	ARROYO, JUAN LCSW	5/14/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
180505	Fee-for-Service	1285104026	1285104026	1	1	ANANTH, MINA MD	2/12/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	163145	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
180520	Fee-for-Service	1336154707	1336154707	1	1	AZER, PAUL C MD	6/30/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	34941	67	Endocrinology	0	In state provider	None	8737 BEVERLY BLVD	STE 301	LOS ANGELES	CA	90048	1839	19	06037	34.07687959	-118.381876	Los Angeles County
180536	Fee-for-Service	1447597471	1447597471	1	1	ALGOS INC A MEDICAL CORPORAT	8/1/2018	103TB0200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	10565 CIVIC CENTER DR	WEST BLDG., SUITE 165	RANCHO CUCAMONGA	CA	91730	3853	36	06071	34.10278226	-117.5747989	San Bernardino County
180558	Fee-for-Service	1306842083	1306842083	1	1	ALI, JUAN O MD	3/8/2023	207L00000X	NA	Other	026	PHYSICIANS	85744	None	None	0	In state provider	None	525 NORTH GARFIELD AVE	None	MONTEREY PARK	CA	91754	1202	19	06037	34.06794352	-118.1229278	Los Angeles County
180577	Fee-for-Service	1255393419	1255393419	2	1	ASHLAND EMERGENCY ASSOCIATES	3/1/1999	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	280 MAPLE	None	ASHLAND	OR	97520	1552	00	None	42.20644248	-122.724936	Jackson County
180597	Fee-for-Service	1801135660	1801135660	1	1	ARTAVIA-TURCKEL, IVANNA V LM	9/10/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
180632	Fee-for-Service	1912107970	1912107970	1	1	AWASTHI, SMITA MD	8/4/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	113306	None	None	0	In state provider	None	3301 C STREET	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
180636	Fee-for-Service	1164651212	1164651212	1	1	ABDULLAH, KASHIF N MD	5/27/2015	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	125901	01	General Practice	0	In state provider	None	175 NORTH JACKSON AVENUE	SUITE 101	SAN JOSE	CA	95116	1909	43	06085	37.36217918	-121.8472051	Santa Clara County
180640	Fee-for-Service	1750563128	1750563128	1	1	ABDALLA, SHERIF MD	9/12/2022	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	101952	None	None	0	In state provider	None	6767 N FRESNO ST	STE 206	FRESNO	CA	93710	3739	10	06019	36.83686637	-119.7813437	Fresno County
180642	Fee-for-Service	1174147037	1174147037	1	1	AWONIYI, UGBODU E NP	11/20/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
180677	Fee-for-Service	1033699848	1033699848	1	1	AN, LOUIS P LMFT	5/3/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
180682	Fee-for-Service	1376573717	1376573717	1	1	AMOTT, THOMAS R MD	4/30/1991	174400000X	NA	Other	026	PHYSICIANS	23129	01	General Practice	0	In state provider	None	COUNTY ROAD 99	None	DAVIS	CA	95616	0000	57	06113	38.57575978	-121.7859718	Yolo County
180712	Fee-for-Service	1053354233	1053354233	1	1	ANESTHESIA SVC MED GRP	1/1/1966	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
180729	Fee-for-Service	1407812209	1407812209	1	1	ANDAYA, BRIGIDA E MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	77308	05	Anesthesiology	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
180735	Fee-for-Service	1598384422	1598384422	1	1	ANGELS OF HOPE MED TRANS	1/20/2022	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	12087 LOPEZ CANYON RD	107	SYLMAR	CA	91342	6063	19	06037	34.292754	-118.40463	Los Angeles County
180745	Fee-for-Service	1629064860	1629064860	1	1	ACS PHARMACY, INC	8/1/2005	183500000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	SUNNY BAY PHARMACY #3	450 E HUNTINGTON DR	None	ARCADIA	CA	91006	3748	19	06037	34.14015053	-118.0208745	Los Angeles County
180749	Fee-for-Service	1972749075	1972749075	1	1	ANGELS HOSPICE LLC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	19830 LAKE CHABOT RD	UNIT B	CASTRO VALLEY	CA	94546	4063	01	06001	37.70011045	-122.0877799	Alameda County
180774	Fee-for-Service	1881005833	1881005833	1	1	AKBARI, YASMIN S MD	5/4/2021	2085P0229X	NA	Other	026	PHYSICIANS	171536	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
180776	Fee-for-Service	1700284841	1700284841	1	1	AYE, YIN YIN MD	10/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132558	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
180788	Fee-for-Service	1255378303	1255378303	1	1	ALEXANDER, MAGDI MD	10/1/1999	208600000X	NA	General Surgery	026	PHYSICIANS	79508	None	None	0	In state provider	None	50 BELLEFONTAINE STREET	SUITE 409	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
180795	Fee-for-Service	1144872870	1144872870	1	1	APP OF NEVADA ED PLLC	10/15/2019	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	1299 BERTHA HOWE	None	MESQUITE	NV	89027	7500	00	None	36.80863769	-114.1155175	Clark County
180800	Fee-for-Service	1083167357	1083167357	2	1	ASHLEY MCCALLISTER	7/16/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1717 ARLINGTON AVE	None	CALDWELL	ID	83605	4802	00	None	43.654374	-116.694738	Canyon County
180807	Fee-for-Service	1659768406	1659768406	1	1	ARROWHEAD HEALTHCARE CENTER	10/29/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	4343 N SIERRA WAY	None	SAN BERNARDINO	CA	92407	3822	36	06071	34.167978	-117.2849835	San Bernardino County
180821	Fee-for-Service	1447597471	1447597471	1	1	ALGOS INC A MEDICAL CORPORAT	8/1/2018	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	10565 CIVIC CENTER DR	WEST BLDG., SUITE 165	RANCHO CUCAMONGA	CA	91730	3853	36	06071	34.10278226	-117.5747989	San Bernardino County
180833	Fee-for-Service	1437441672	1437441672	1	1	AVVARI, SUNIL K MD	4/9/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	9000 MING AVE	STE L-1B	BAKERSFIELD	CA	93311	1318	15	06029	35.33989328	-119.1034715	Kern County
180835	Fee-for-Service	1134296072	1134296072	1	1	AMBE, RAJEEV K MD	8/23/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	77951	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
180862	Fee-for-Service	1437503117	1437503117	1	1	ABRAHAM, MARY-ANN MD	11/19/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	2230 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1419	34	06067	38.555631	-121.459203	Sacramento County
180872	Fee-for-Service	1114104858	1114104858	1	1	ALTAMED COMM HEALTH CLN	4/28/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	EL MONTE	10418 VALLEY BLVD	STE B	EL MONTE	CA	91731	2402	19	06037	34.07647884	-118.0458956	Los Angeles County
180883	Fee-for-Service	1700069549	1700069549	1	5	ACUTE CARE SURGERY MEDICAL G	11/19/2020	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	ROUP INC.	807 ILLINOIS AVENUE	None	LOS BANOS	CA	93635	3512	24	06047	37.064394	-120.857788	Merced County
180912	Fee-for-Service	1629311543	1629311543	1	1	ADVENTIST HEALTH PHYSICIANS	6/17/2013	207RH0003X	NA	Oncology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1687 ERRINGER RD	STE 104	SIMI VALLEY	CA	93065	6508	56	06111	34.268886	-118.761426	Ventura County
181039	Fee-for-Service	1972749075	1972749075	1	1	ANGELS HOSPICE LLC	9/28/2009	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	19830 LAKE CHABOT RD	UNIT B	CASTRO VALLEY	CA	94546	4063	01	06001	37.70011045	-122.0877799	Alameda County
181057	Fee-for-Service	1356376057	1356376057	1	1	AMERICAN MEDICAL REPONSE	11/8/1995	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	WEST	4451 CATEPILLAR RD	STE 1	REDDING	CA	96003	1421	45	06089	40.62653577	-122.3844366	Shasta County
181089	Fee-for-Service	1093070674	1093070674	1	1	ANTONINO, AMANDA	8/29/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4502 EAST AVE S	None	PALMDALE	CA	93552	4480	19	06037	34.55800153	-118.0488825	Los Angeles County
181126	Fee-for-Service	1164674503	1164674503	1	1	ANDERSON, LYNETTE B	11/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10259	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
181131	Fee-for-Service	1598261158	1598261158	1	1	ANSTETT, ERICA L MD	11/29/2022	207L00000X	NA	Other	026	PHYSICIANS	180781	None	None	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
181161	Fee-for-Service	1609860709	1609860709	1	1	ADAMS, SCOTT E DPM	10/23/2007	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	310 S HALCYON RD	STE 101	ARROYO GRANDE	CA	93420	3863	40	06079	35.11464177	-120.5916364	San Luis Obispo County
181171	Fee-for-Service	1700069549	1700069549	1	5	ACUTE CARE SURGERY MEDICAL G	11/19/2020	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	89	Surgery-Traumatic	0	In state provider	ROUP INC.	807 ILLINOIS AVENUE	None	LOS BANOS	CA	93635	3512	24	06047	37.064394	-120.857788	Merced County
181203	Fee-for-Service	1396812434	1396812434	1	1	ALLEN, DARLENA LCSW	9/5/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5051 CANYON CREST DR	SUITE 204	RIVERSIDE	CA	92507	0000	33	06065	33.9589602	-117.3311519	Riverside County
181236	Fee-for-Service	1588719017	1588719017	1	1	ARMSTRONG, MARJAN LMFT	3/12/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
181264	Fee-for-Service	1629498241	1629498241	1	1	APPLE, MICHELLE MD	9/20/2018	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	137656	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
181271	Fee-for-Service	1568052728	1568052728	1	1	ARIA HEALTH HOME CARE INC	12/30/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	17941 VENTURA BLVD	STE 206	ENCINO	CA	91316	4826	19	06037	34.16426107	-118.5238125	Los Angeles County
181313	Fee-for-Service	1689014615	1689014615	1	1	A RELATIONSHIP CENTER FOR	8/19/2013	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	CHANGE	40 4TH ST	None	PETALUMA	CA	94952	3040	49	06097	38.23231118	-122.6386253	Sonoma County
181320	Fee-for-Service	1386763944	1386763944	1	1	ANDREW CASSAR MD	11/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	333 N DOBSON RD	STE 11	CHANDLER	AZ	85224	4412	00	None	33.308613	-111.8758005	Maricopa County
181325	Fee-for-Service	1942463682	1942463682	1	1	AUGUSTE, KURTIS I MD	7/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	82763	14	Neurological Surgery	0	In state provider	None	744 52ND ST	#5203	OAKLAND	CA	94609	1809	01	06001	37.83734299	-122.2677613	Alameda County
181340	Fee-for-Service	1700861333	1700861333	1	1	AMJADI, HAMID R DO	10/7/2024	207R00000X	NA	Other	026	PHYSICIANS	22935	41	Internal Medicine	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
181367	Fee-for-Service	1346803731	1346803731	1	1	AZUMA, LAUREN MD	9/7/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	179775	None	None	0	In state provider	None	2675 PLEASANT HILL	None	PLEASANT HILL	CA	94523	2033	07	06013	37.95521179	-122.0898401	Contra Costa County
181379	Fee-for-Service	1023609609	1023609609	1	1	AUXILIUM HOME HEALTH INC	12/12/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2525 E COLORADO BLVD	STE 106	PASADENA	CA	91107	3771	19	06037	34.1461235	-118.097982	Los Angeles County
181380	Fee-for-Service	1790848505	1790848505	1	1	ABAD, ALEXANDER G	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO STREET	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
181491	Fee-for-Service	1417440272	1417440272	1	1	AVO, NAM T	6/18/2018	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	23685 MOULTON PKWY	SUITE B-1	LAGUNA HILLS	CA	92653	1938	30	06059	33.61903968	-117.7316499	Orange County
181492	Fee-for-Service	1710165998	1710165998	1	1	AU, HUY DUONG MD	8/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	97524	41	Internal Medicine	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
181496	Fee-for-Service	1700069549	1700069549	1	4	ACUTE CARE SURGERY MEDICAL G	3/20/2020	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	89	Surgery-Traumatic	0	In state provider	ROUP, INC.	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
181510	Fee-for-Service	1427305242	1427305242	1	1	ALEMI, WAIS MD	5/3/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	175515	08	Family Practice	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
181512	Fee-for-Service	1982679239	1982679239	1	1	ALVAREZ, CARLOS	6/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	66787	02	General Surgery	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
181556	Fee-for-Service	1861714263	1861714263	1	1	ALAVI, ALIREZA R DO	3/17/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10778	None	None	0	In state provider	None	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1019	38	06075	37.7738933	-122.4544685	San Francisco County
181560	Fee-for-Service	1568052728	1568052728	1	1	ARIA HEALTH HOME CARE INC	12/30/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	17941 VENTURA BLVD	STE 206	ENCINO	CA	91316	4826	19	06037	34.16426107	-118.5238125	Los Angeles County
181586	Fee-for-Service	1023200409	1023200409	1	1	ARCERITO, MASSIMO MD	4/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111450	02	General Surgery	0	In state provider	None	3660 PARK SIERRA DR	STE 105	RIVERSIDE	CA	92505	3071	33	06065	33.90330693	-117.4707039	Riverside County
181590	Fee-for-Service	1982883252	1982883252	1	1	AHMED, ZULFIQAR MD APC	6/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	53666	01	General Practice	0	In state provider	None	1030 S GLENDALE AVE	STE 406	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
181596	Fee-for-Service	1073045589	1073045589	1	1	ACTION FAMILY COUNSELING	8/6/2018	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	SCV INC	22722 SOLEDAD CANYON RD	None	SANTA CLARITA	CA	91350	2629	19	06037	34.42111809	-118.5328023	Los Angeles County
181606	Fee-for-Service	1093772204	1093772204	1	1	AGATA-VENGER PARTNERSHIP	9/15/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	14	Neurological Surgery	1	Border provider	None	3061 S MARYLAND PKWY	STE 200	LAS VEGAS	NV	89109	6227	00	None	36.134172	-115.1369265	Clark County
181641	Fee-for-Service	1922167667	1922167667	1	1	AMBEGAONKAR, ADITYA P MD	1/14/2009	207R00000X	NA	Other	026	PHYSICIANS	81483	41	Internal Medicine	0	In state provider	None	12291 E WASHINGTON BLVD	#100	WHITTIER	CA	90027	6062	19	06037	33.96734104	-118.0508773	Los Angeles County
181643	Fee-for-Service	1013901974	1013901974	1	1	AHLUWALIA, CHANDNISH K MD	4/1/2000	193400000X	NA	Other	026	PHYSICIANS	44903	22	Pathology (M.D. only)	0	In state provider	INC	1812 VERDUGO BLVD	None	GLENDALE	CA	91208	1407	19	06037	34.20560177	-118.216054	Los Angeles County
181686	Fee-for-Service	1497790125	1497790125	1	1	AKAMINE, JAMES S MD	4/30/1995	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	57673	30	Radiology	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
181695	Fee-for-Service	1508175431	1508175431	2	1	ADVENTIST HEALTH MEDICAL	11/1/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER TEHACHAPI	2041 BELSHAW STREET	None	MOJAVE	CA	93501	1601	15	06029	35.0563195	-118.1681479	Kern County
181706	Fee-for-Service	1821492836	1821492836	1	2	ADVANCED HEALTHCARE FOR WOME	6/27/2024	363LF0000X	NA	Nurse Practitioner	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	N	225 E AIRPORT DR	140	SAN BERNARDINO	CA	92408	3464	36	06071	34.06725001	-117.2831777	San Bernardino County
181710	Fee-for-Service	1477177210	1477177210	1	1	ANAND NARAYAN MD INC	12/21/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	317 W EL MONTE WAY	None	DINUBA	CA	93618	1631	54	06107	36.54595565	-119.397867	Tulare County
181723	Fee-for-Service	1518498716	1518498716	1	1	ALMADIDY, ZAYED A MD	2/1/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	1131 WILSHIRE BLVD	100	SANTA MONICA	CA	90401	2072	19	06037	34.02509887	-118.4909994	Los Angeles County
181750	Fee-for-Service	1023113172	1023113172	1	1	ARROWHEAD RADIOLOGY MEDICAL	7/1/1983	2085N0904X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
181769	Fee-for-Service	1205848892	1205848892	1	1	ARORA, RASHI MD	2/12/2024	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
181785	Fee-for-Service	1700069549	1700069549	1	4	ACUTE CARE SURGERY MEDICAL G	3/20/2020	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	ROUP, INC.	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
181809	Fee-for-Service	1447246293	1447246293	1	1	ABOELATA, NOHA M MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	71602	01	General Practice	0	In state provider	None	9925 INTERNATIONAL BLVD	STE 5	OAKLAND	CA	94603	2558	01	06001	37.74332565	-122.1698542	Alameda County
181845	Fee-for-Service	1407063027	1407063027	1	1	ASADA, BEY-YING C	7/6/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVENUE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
181849	Fee-for-Service	1265483523	1265483523	1	1	AGARWAL, ANUPAM	4/29/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	132737	41	Internal Medicine	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
181878	Fee-for-Service	1982883252	1982883252	1	1	AHMED, ZULFIQAR MD APC	6/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	53666	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1030 S GLENDALE AVE	STE 406	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
181879	Fee-for-Service	1821231648	1821231648	1	1	ANDZEL, GAJA MD	7/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113941	67	Endocrinology	0	In state provider	None	33758 YUCAIPA BLVD	None	YUCAIPA	CA	92399	2243	36	06071	34.03407872	-117.0672458	San Bernardino County
181889	Fee-for-Service	1396851903	1396851903	1	1	ANTHONY, VINCENT L MD	4/15/2008	207RN0300X	NA	Nephrology	026	PHYSICIANS	96566	45	Nephrology (Renal-Kidney)	0	In state provider	None	248 N LOCUST ST	None	INGLEWOOD	CA	90301	1258	19	06037	33.96630273	-118.3504074	Los Angeles County
181964	Fee-for-Service	1134144041	1134144041	1	1	AYMAR, SUMMER C DO	8/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9778	08	Family Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
181969	Fee-for-Service	1871550590	1871550590	1	3	ALLERGY & ASTHMA MEDICAL GRO	1/3/2024	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	UP OF THE BAY AREA, INC	160 GLEN COVE MARINA RD	103	VALLEJO	CA	94591	7290	48	06095	38.07062486	-122.2124251	Solano County
181983	Fee-for-Service	1508175431	1508175431	2	1	ADVENTIST HEALTH MEDICAL	11/1/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER TEHACHAPI	2041 BELSHAW STREET	None	MOJAVE	CA	93501	1601	15	06029	35.0563195	-118.1681479	Kern County
181998	Fee-for-Service	1477177210	1477177210	1	1	ANAND NARAYAN MD INC	12/21/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	317 W EL MONTE WAY	None	DINUBA	CA	93618	1631	54	06107	36.54595565	-119.397867	Tulare County
182014	Fee-for-Service	1720496110	1720496110	1	1	AR HOSPICE CARE INC	7/23/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14547 TITUS ST	STE 214	PANORAMA CITY	CA	91402	4936	19	06037	34.21973977	-118.4503255	Los Angeles County
182031	Fee-for-Service	1619997061	1619997061	1	1	AKINBI, MODESOLA	12/10/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	FLAGSHIP MEDICAL SUPPLY	13414 1/2 S AVALON BL	None	LOS ANGELES	CA	90061	2231	19	06037	33.910002	-118.2652835	Los Angeles County
182048	Fee-for-Service	1215044292	1215044292	1	1	AMANDA LOQUIAS,NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
182049	Fee-for-Service	1013901586	1013901586	1	1	AYANZEN, RON H MD	7/1/2000	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	101 CIVIC CENTER LN	None	LK HAVASU CTY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
182083	Fee-for-Service	1437336435	1437336435	1	2	AZZAM, SAMIR MD INC	4/28/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	51621	08	Family Practice	0	In state provider	None	1310 W STEWART DR	STE 210	ORANGE	CA	92868	3837	30	06059	33.78236048	-117.8664975	Orange County
182096	Fee-for-Service	1982631289	1982631289	1	1	ANAPOELL, WILLIAM S MD	12/14/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81706	41	Internal Medicine	0	In state provider	None	501 WASHINGTON ST	STE 600	SAN DIEGO	CA	92103	2239	37	06073	32.74986289	-117.1599343	San Diego County
182104	Fee-for-Service	1497173694	1497173694	1	2	AIKOYE, SALISU A MD	3/30/2023	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	154761	-	NOT APPLICABLE	0	In state provider	None	12440 FIRESTONE BLVD STE	None	NORWALK	CA	90650	4397	19	06037	33.90523023	-118.0681168	Los Angeles County
182109	Fee-for-Service	1780062323	1780062323	1	1	AL HORANY, BASSEL MD	5/15/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	155781	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
182112	Fee-for-Service	1003419102	1003419102	1	1	ARC COMFORT HOSPICE CARE INC	8/13/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1201 S VICTORY BLVD	SUITE 102	BURBANK	CA	91502	2552	19	06037	34.16527115	-118.3059384	Los Angeles County
182142	Fee-for-Service	1538177845	1538177845	1	1	ALEXANDER, MARY E MD	1/1/1998	207R00000X	NA	Other	026	PHYSICIANS	66922	41	Internal Medicine	0	In state provider	None	525 3RD AVE	None	CHULA VISTA	CA	91910	5616	37	06073	32.63367609	-117.0769202	San Diego County
182214	Fee-for-Service	1639790561	1639790561	1	1	ADVANCE HOSPICE AND	10/15/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	14545 FRIAR ST	STE 266	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
182216	Fee-for-Service	1275635492	1275635492	1	1	AL-KHOURY, LAMA M MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76252	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
182272	Fee-for-Service	1508175431	1508175431	2	1	ADVENTIST HEALTH MEDICAL	11/1/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CENTER TEHACHAPI	2041 BELSHAW STREET	None	MOJAVE	CA	93501	1601	15	06029	35.0563195	-118.1681479	Kern County
182288	Fee-for-Service	1477177210	1477177210	1	1	ANAND NARAYAN MD INC	1/10/2022	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	317 W EL MONTE WAY	None	DINUBA	CA	93618	1631	54	06107	36.54595565	-119.397867	Tulare County
182302	Fee-for-Service	1720496110	1720496110	1	1	AR HOSPICE CARE INC	7/23/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14547 TITUS ST	STE 214	PANORAMA CITY	CA	91402	4936	19	06037	34.21973977	-118.4503255	Los Angeles County
182352	Fee-for-Service	1669525911	1669525911	1	1	AMIN, FARZANA MD	3/31/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	95033	36	Psychiatry	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
182357	Fee-for-Service	1134380751	1134380751	1	1	ALEXIS, MOLARA N A MD	3/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146779	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0000	39	06077	37.97026329	-121.2890849	San Joaquin County
182373	Fee-for-Service	1366655532	1366655532	1	1	AHUJA, ANITA MD	3/7/2011	174400000X	NA	Other	026	PHYSICIANS	92045	40	Pediatrics	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
182387	Fee-for-Service	1376501080	1376501080	1	1	AZIZAD, MASOUD M MD INC	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74207	41	Internal Medicine	0	In state provider	None	18433 ROSCOE BLVD	STE 208	NORTHRIDGE	CA	91325	4108	19	06037	34.22076747	-118.534725	Los Angeles County
182400	Fee-for-Service	1003419102	1003419102	1	1	ARC COMFORT HOSPICE CARE INC	8/13/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1201 S VICTORY BLVD	SUITE 102	BURBANK	CA	91502	2552	19	06037	34.16527115	-118.3059384	Los Angeles County
182437	Fee-for-Service	1659997112	1659997112	1	1	ARBELA DIALYSIS LLC	11/13/2020	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	900 HUNTINGTON DR	STE B	SAN MARINO	CA	91108	1825	19	06037	34.11194205	-118.1264561	Los Angeles County
182448	Fee-for-Service	1073076899	1073076899	1	1	ABENES, MARIA PSYD	2/23/2024	103TC1900X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
182475	Fee-for-Service	1073924171	1073924171	1	1	AVILA, MARCELA LMFT	2/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
182477	Fee-for-Service	1114536612	1114536612	1	1	ATLAS HOSPICE CARE, INC	7/26/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	180 PROMENADE CIRCLE	STE 300	SACRAMENTO	CA	95834	2952	34	06067	38.636649	-121.49838	Sacramento County
182499	Fee-for-Service	1639790561	1639790561	1	1	ADVANCE HOSPICE AND	10/15/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	14545 FRIAR ST	STE 266	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
182504	Fee-for-Service	1275635492	1275635492	1	1	AL-KHOURY, LAMA M MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76252	13	Neurology (M.D. only)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
182513	Fee-for-Service	1144339748	1144339748	1	1	APRIA HEALTHCARE LLC	10/2/1997	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	480 CARLTON CT	None	S SAN FRANCISCO	CA	94080	2012	41	06081	37.65748007	-122.3933243	San Mateo County
182524	Fee-for-Service	1780608638	1780608638	1	1	ALI-KHAN, MIR MD	11/2/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	48827	36	Psychiatry	0	In state provider	None	5353 G STREET	None	CHINO	CA	91710	5249	36	06071	34.00987149	-117.6880905	San Bernardino County
182538	Fee-for-Service	1487139101	1487139101	1	1	AGUILAR, JOSELYNN	6/14/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1030 NEVADA ST.	SUITE 103	REDLANDS	CA	92374	2957	36	06071	34.064172	-117.217431	San Bernardino County
182568	Fee-for-Service	1407309933	1407309933	1	1	AKELLA, RAMYA MD	12/8/2022	207R00000X	NA	Other	026	PHYSICIANS	181655	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
182592	Fee-for-Service	1164599056	1164599056	1	1	ARNELL, RICHARD E MD	10/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	63498	02	General Surgery	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
182615	Fee-for-Service	1669787495	1669787495	1	1	ARROYO PHYSICAL THERAPY	12/13/2018	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12241 INDUSTRIAL BLVD	210	VICTORVILLE	CA	92395	7794	36	06071	34.473357	-117.282883	San Bernardino County
182622	Fee-for-Service	1295973782	1295973782	1	1	ARUN, APARNA MD	12/18/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	151257	40	Pediatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
182630	Fee-for-Service	1518399732	1518399732	1	1	ALLEY, ANNA CRNA	4/4/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1717 E DATE PLACE	None	SAN BERNARDINO	CA	92404	4428	36	06071	34.14094893	-117.2500411	San Bernardino County
182648	Fee-for-Service	1437801081	1437801081	1	1	ACACIA GUEST HOME LLC	2/10/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1847 ACACIA HILL ROAD	None	DIAMOND BAR	CA	91765	2942	19	06037	33.98879373	-117.8234472	Los Angeles County
182658	Fee-for-Service	1639275670	1639275670	1	1	ACADEMIC HOSPITALISTS	9/10/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	MEDICAL GROUP INC	50 BELLEFONTAINE STREET	STE 307	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
182660	Fee-for-Service	1932137452	1932137452	1	1	ANAVIAN, ROBERT R DPM	12/31/1989	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	23456 HAWTHORNE BLVD	STE 270	TORRANCE	CA	90505	4779	19	06037	33.812631	-118.3510145	Los Angeles County
182666	Fee-for-Service	1932582699	1932582699	1	4	AKSHAY MEHTA MD INC	1/17/2020	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	3630 E IMPERIAL HWY	300	LYNNWOOD	CA	90262	2646	19	06037	33.93112671	-118.2035532	Los Angeles County
182685	Fee-for-Service	1386901593	1386901593	1	2	AL KHATIB, SHADI MD	3/1/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	117754	40	Pediatrics	0	In state provider	None	200 SOUTH WELLS ROAD	SUITE 100	VENTURA	CA	93004	1378	56	06111	34.29321532	-119.1597424	Ventura County
182698	Fee-for-Service	1396147419	1396147419	1	2	AAA FAMILY MEDICAL GROUP	3/2/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	11949 HESPERIA RD	None	HESPERIA	CA	92345	2181	36	06071	34.46821643	-117.2924699	San Bernardino County
182716	Fee-for-Service	1336106293	1336106293	1	1	ANGELA MCCOY MD	8/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 S ACADEMY RD	None	GUTHRIE	OK	73044	8727	00	None	35.87692745	-97.46042533	Logan County
182719	Fee-for-Service	1164257887	1164257887	1	1	A GRACEFUL JOURNEY DOULA SER	9/9/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	48	06095	0	0	None
182731	Fee-for-Service	1487691192	1487691192	1	1	ANDERSON, FRANK L MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	54882	10	Gastroenterology (M.D. only)	0	In state provider	None	3536 MENDOCINO AVE	STE 300	SANTA ROSA	CA	95403	3634	49	06097	38.473326	-122.725935	Sonoma County
182739	Fee-for-Service	1003869090	1003869090	1	1	ACUTE CARE MEDICAL COASTAL	6/30/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2701 S BRISTOL ST	None	SANTA ANA	CA	92704	6201	30	06059	33.71114199	-117.8853958	Orange County
182747	Fee-for-Service	1972538791	1972538791	1	1	ANDERSEN, BRUCE A PT	6/1/1999	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	866 PLUMAS ST	None	YUBA CITY	CA	95991	4022	51	06101	39.14154171	-121.6177237	Sutter County
182760	Fee-for-Service	1396788469	1396788469	1	1	ANDERSON, BRIAN L MD	2/4/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70747	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
182765	Fee-for-Service	1114536612	1114536612	1	1	ATLAS HOSPICE CARE, INC	7/26/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	180 PROMENADE CIRCLE	STE 300	SACRAMENTO	CA	95834	2952	34	06067	38.636649	-121.49838	Sacramento County
182788	Fee-for-Service	1932582699	1932582699	1	2	AKSHAY MEHTA MD INC	1/17/2020	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	3330 LOMITA BLVD	None	TORRANCE	CA	90505	5002	19	06037	33.81253631	-118.3435557	Los Angeles County
182810	Fee-for-Service	1285971820	1285971820	1	3	ARCH HEALTH PARTNERS	12/9/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	488 E VALLEY PKWY	STE 211	ESCONDIDO	CA	92025	3351	37	06073	33.12523814	-117.0769715	San Diego County
182814	Fee-for-Service	1578718243	1578718243	1	1	AUWINGER, BRAD H DO	8/18/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10620	08	Family Practice	0	In state provider	None	5765 GREENBACK LN	None	SACRAMENTO	CA	95841	2013	34	06067	38.681622	-121.327848	Sacramento County
182815	Fee-for-Service	1093880684	1093880684	1	1	ASHCRAFT, HAROLD T OD	9/1/2000	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	A PROFESSIONAL CORP	8735 LA TIJERA BLVD	None	LOS ANGELES	CA	90045	4852	19	06037	33.95755931	-118.3941302	Los Angeles County
182838	Fee-for-Service	1699874149	1699874149	1	1	AXELROD, LISA LMFT	4/25/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	73567 FRED WARING DR	None	PALM DESERT	CA	92260	2573	33	06065	33.72875053	-116.3812905	Riverside County
182855	Fee-for-Service	1538253190	1538253190	1	1	ARORA, AJIT S MD	1/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	45775	41	Internal Medicine	0	In state provider	None	7407 N CEDAR AVE	STE 101	FRESNO	CA	93720	3839	10	06019	36.84303529	-119.7568435	Fresno County
182859	Fee-for-Service	1225368665	1225368665	1	1	AMORE-BROCCOLI, ANTONIA T	9/4/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	720 CAPITOLA AVE	STE D	CAPITOLA	CA	95010	2784	44	06087	36.9803434	-121.9527431	Santa Cruz County
182873	Fee-for-Service	1164716635	1164716635	1	1	ABRENCILLO, RODEO A MD	7/13/2019	207RC0200X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	6410 FANNIN STREET	SUITE 1500	HOUSTON	TX	77030	5306	00	None	29.71419639	-95.39755562	Harris County
182920	Fee-for-Service	1043942477	1043942477	1	1	AGUILAR, PHILLIP NP	11/30/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	18672 FLORIDA ST	#100	HUNTINGTON BEACH	CA	92648	1917	30	06059	33.691185	-117.9910425	Orange County
182953	Fee-for-Service	1376949230	1376949230	1	1	AUNG, CHAN M MD	1/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140828	41	Internal Medicine	0	In state provider	None	790 E BONITA AVE	2ND FLOOR	POMONA	CA	91767	1906	19	06037	34.09621447	-117.737406	Los Angeles County
182963	Fee-for-Service	1649648767	1649648767	1	3	ASPIRE COUNSELING SERVICES -	2/3/2025	261QR0405X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	VICTORVILLE, LLC	12571 HESPERIA RD	None	VICTORVILLE	CA	92395	5847	36	06071	34.479497	-117.2908745	San Bernardino County
182979	Fee-for-Service	1285750372	1285750372	1	1	ARAKEL, ARTOON MD PC	8/14/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	49849	41	Internal Medicine	0	In state provider	None	1030 S GLENDALE AVE	STE 407	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
183012	Fee-for-Service	1215519822	1215519822	1	1	ALKOTOB, UMRON R DO	7/1/2024	207P00000X	NA	Other	026	PHYSICIANS	20499	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1050 LINDEN AVENUE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
183020	Fee-for-Service	1487691192	1487691192	1	1	ANDERSON, FRANK L MD	7/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	54882	41	Internal Medicine	0	In state provider	None	3536 MENDOCINO AVE	STE 300	SANTA ROSA	CA	95403	3634	49	06097	38.473326	-122.725935	Sonoma County
183093	Fee-for-Service	1417005687	1417005687	1	1	AGNEW, KATHLEEN G LCSW	5/1/2001	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	12797 VIA FELINO	None	DEL MAR	CA	92014	3805	37	06073	32.93387426	-117.2498574	San Diego County
183104	Fee-for-Service	1518168301	1518168301	1	1	ALAMEDA CO MEDICAL CTR	6/12/2008	No Taxonomy Provided	NA	None	060	COUNTY HOSPITAL INPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1015	01	06001	37.7069698	-122.1191104	Alameda County
183113	Fee-for-Service	1386261816	1386261816	1	1	AVAKIAN, MELODY C MD	4/20/2023	207QA0000X	NA	Pediatric Primary Care	026	PHYSICIANS	20457	None	None	0	In state provider	None	15503 VENTURA BLVD	150, 170	ENCINO	CA	91436	3115	19	06037	34.15483303	-118.4722163	Los Angeles County
183165	Fee-for-Service	1881897569	1881897569	1	1	ABE, TERRI L MD	8/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97985	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
183214	Fee-for-Service	1700069549	1700069549	1	6	ACUTE CARE SURGERY MEDICAL G	7/1/2021	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	ROUP INC.	6555 COYLE	SUITE 220	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
183253	Fee-for-Service	1598707440	1598707440	1	1	ALSOFROM, DENNIS J MD	7/26/1988	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	61941	30	Radiology	0	In state provider	None	1213 COFFEE RD	STE B	MODESTO	CA	95355	4229	50	06099	37.660401	-120.975669	Stanislaus County
183290	Fee-for-Service	1164422671	1164422671	1	1	AOU, CHRISTOPHER DO	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	726000	08	Family Practice	0	In state provider	None	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	30	06059	33.89343304	-117.9279349	Orange County
183310	Fee-for-Service	1235332321	1235332321	1	1	ALI KHAN	2/24/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9601 BAPTIST HEALTH DR	None	LITTLE ROCK	AR	72205	6321	00	None	34.744437	-92.3813595	Pulaski County
183334	Fee-for-Service	1396924668	1396924668	1	1	ARAKELIAN, RONALD A MD	5/31/1980	193400000X	NA	Other	026	PHYSICIANS	41222	41	Internal Medicine	0	In state provider	None	920 DELBON AVE	None	TURLOCK	CA	95382	2019	50	06099	37.51045858	-120.8376324	Stanislaus County
183349	Fee-for-Service	1811988421	1811988421	1	1	ABENDROTH, ROY E MD	1/12/1995	2085R0001X	NA	Other	026	PHYSICIANS	60844	30	Radiology	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
183353	Fee-for-Service	1801933775	1801933775	1	1	ANCHETA, ELIZABETH J MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	88071	40	Pediatrics	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
183360	Fee-for-Service	1336619451	1336619451	1	1	ALEGADO, TRICIA ROSE F CNP	1/18/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	491 E ALESSANDRO BLVD	None	RIVERSIDE	CA	92508	6071	33	06065	33.91628714	-117.3230954	Riverside County
183401	Fee-for-Service	1477547024	1477547024	1	1	AG SAN GABRIEL LLC	10/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	112 E BROADWAY	None	SAN GABRIEL	CA	91776	1805	19	06037	34.09888186	-118.0988338	Los Angeles County
183410	Fee-for-Service	1326732538	1326732538	1	1	AVS HEALTHCARE INC	8/2/2023	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	18425 BURBANK BLVD	STE 102	TARZANA	CA	91356	2806	19	06037	34.17226853	-118.5348151	Los Angeles County
183430	Fee-for-Service	1821019811	1821019811	1	1	AMIT R TRIVEDI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	None	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
183443	Fee-for-Service	1437388238	1437388238	1	1	ASFC LLC	4/21/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1715 S CEDAR AVE	None	FRESNO	CA	93702	4331	10	06019	36.725625	-119.7546225	Fresno County
183475	Fee-for-Service	1992380034	1992380034	1	1	ADVENTIST HEALTH PHYSICIANS	3/15/2022	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	20797 SANTA LUCIA ST	None	TEHACHAPI	CA	93561	8676	15	06029	35.12127544	-118.4905309	Kern County
183502	Fee-for-Service	1235704107	1235704107	1	1	AMERICAN HOME HEALTH	10/19/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PROVIDERS, INC	16501 SHERMAN WAY	STE 100	VAN NUYS	CA	91406	3757	19	06037	34.20125005	-118.4927785	Los Angeles County
183504	Fee-for-Service	1700069549	1700069549	1	6	ACUTE CARE SURGERY MEDICAL G	7/1/2021	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	89	Surgery-Traumatic	0	In state provider	ROUP INC.	6555 COYLE	SUITE 220	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
183525	Fee-for-Service	1114661386	1114661386	1	1	APARICIO, GERMAN OD	4/10/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1689 ARDEN WAY	STE 1091	SACRAMENTO	CA	95815	4096	34	06067	38.601549	-121.4274825	Sacramento County
183556	Fee-for-Service	1184018509	1184018509	1	1	ALLEN, AMANDA DO	6/1/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	18185	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
183571	Fee-for-Service	1225096464	1225096464	1	1	AARON GREELEY DO	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9201 W THOMAS RD	None	PHOENIX	AZ	85037	3332	00	None	33.47892	-112.2579	Maricopa County
183613	Fee-for-Service	1093838500	1093838500	1	1	AUDOMA, KRISTAL A	8/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
183618	Fee-for-Service	1316507031	1316507031	1	1	ALL STAR HOSPICE INC	2/12/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	41690 IVY ST	SUITE C5	MURRIETA	CA	92562	9436	33	06065	33.55420141	-117.2070182	Riverside County
183626	Fee-for-Service	1225013550	1225013550	1	1	AVERILL, WILLIAM K MD	12/31/1990	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	55413	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	19601 MARINER AVE	None	TORRANCE	CA	90503	1647	19	06037	33.85295217	-118.3506987	Los Angeles County
183634	Fee-for-Service	1235346156	1235346156	1	1	ACKER, KIRSTEN PSYD	11/27/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	350 RHODE ISLAND ST	200	SAN FRANCISCO	CA	94103	5182	38	06075	37.76542836	-122.4026384	San Francisco County
183640	Fee-for-Service	1528127271	1528127271	1	1	ASHBACHER, LAURENCE V MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36605	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
183659	Fee-for-Service	1336630839	1336630839	2	1	AMPLA HEALTH	11/18/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4941 OLIVEHURST AVE	None	OLIVEHURST	CA	95961	4225	58	06115	39.09746115	-121.5514942	Yuba County
183662	Fee-for-Service	1114589843	1114589843	1	1	ARCADO, JESSICA LMFT	2/5/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
183686	Fee-for-Service	1760509749	1760509749	1	1	ARASTU, ANWAR H MD	9/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	44427	41	Internal Medicine	0	In state provider	None	12675 LA MIRADA BLVD	STE 400	LA MIRADA	CA	90638	2236	19	06037	33.91589551	-118.0119734	Los Angeles County
183742	Fee-for-Service	1477914232	1477914232	1	2	ARTHRITIS AND RHEUMATISM CEN	3/20/2024	193400000X	NA	Other	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	TER INC., A MEDICAL CORP	1079 EUCALYPTUS ST	STE. A	MANTECA	CA	95337	4317	39	06077	37.80126585	-121.2326114	San Joaquin County
183776	Fee-for-Service	1467690834	1467690834	1	1	ABILLAR, MA IRENE D MD	6/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103053	40	Pediatrics	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
183792	Fee-for-Service	1700069549	1700069549	1	6	ACUTE CARE SURGERY MEDICAL G	7/1/2021	207X00000X	NA	Orthopedic Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ROUP INC.	6555 COYLE	SUITE 220	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
183819	Fee-for-Service	1346775665	1346775665	1	1	ADVANTAGE MRI ROSEVILLE LP	8/17/2018	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2990 LAVA RIDGE COURT	STE 100	ROSEVILLE	CA	95661	3965	31	06061	38.74665026	-121.2447557	Placer County
183824	Fee-for-Service	1801207014	1801207014	1	1	AIYER, ROHIT S MD	9/15/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	176800	None	None	0	In state provider	None	140 E COMMONWEALTH AVE	SUITE 101	FULLERTON	CA	92832	1905	30	06059	33.87034048	-117.922437	Orange County
183849	Fee-for-Service	1326118704	1326118704	1	1	APACIBLE, MARIA A F NP	6/19/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
183853	Fee-for-Service	1215946553	1215946553	1	1	AHMADIAN, NAVID MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	77813	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1141 ROSE AVE	None	SELMA	CA	93662	3241	10	06019	36.56881144	-119.5985344	Fresno County
183859	Fee-for-Service	1760661383	1760661383	1	1	ALBADAWI, FERAS OD	5/19/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5201 CALIFORNIA AVE	STE 410	BAKERSFIELD	CA	93309	1673	15	06029	35.35945895	-119.0607332	Kern County
183860	Fee-for-Service	1770851776	1770851776	2	2	ADVANCED MFM IMAGING CENTER,	11/7/2023	207VM0101X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC.	1577 E. CHEVY CHASE DR.	SUITE 300	GLENDALE	CA	91206	4092	19	06037	34.15313959	-118.2299467	Los Angeles County
183870	Fee-for-Service	1689300139	1689300139	1	1	AGE WITH CARE HOME HEALTH	7/9/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	12501 CHANDLER BLVD	STE 101	VALLEY VILLAGE	CA	91607	1952	19	06037	34.16870346	-118.4056065	Los Angeles County
183906	Fee-for-Service	1316507031	1316507031	1	1	ALL STAR HOSPICE INC	2/12/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	41690 IVY ST	SUITE C5	MURRIETA	CA	92562	9436	33	06065	33.55420141	-117.2070182	Riverside County
183920	Fee-for-Service	1659015162	1659015162	1	1	ARIEL ESCOBEDO, LICENSED CLI	4/20/2023	251S00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NICAL SOCIAL WORKER INC.	10320 JACKSON AVENUE	None	SOUTH GATE	CA	90280	6904	19	06037	33.93773667	-118.1883008	Los Angeles County
183932	Fee-for-Service	1205274768	1205274768	1	1	ABIDALI, HUSSEIN DO	12/11/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	18140	None	None	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
183961	Fee-for-Service	1922001809	1922001809	1	2	ALTA LOS ANGELES	7/23/2015	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	9542 ARTESIA BLVD	None	BELLFLOWER	CA	90706	6511	19	06037	33.87472553	-118.1294775	Los Angeles County
183963	Fee-for-Service	1386646347	1386646347	1	1	ANDERSON JR, CHARLES E MD	5/21/2019	207LP2900X	NA	Other	026	PHYSICIANS	44919	05	Anesthesiology	0	In state provider	None	36915 COOK ST	SUITE 102	PALM DESERT	CA	92211	6067	33	06065	33.77987071	-116.3558569	Riverside County
184003	Fee-for-Service	1295129484	1295129484	1	1	ALVAREZ CASTELLARES, VANESSA	11/8/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	137742	None	None	0	In state provider	U MD	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
184009	Fee-for-Service	1952570566	1952570566	1	1	ASHFORD LEONARDO, MELINDA	6/25/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	216 E PINE ST	None	EXETER	CA	93221	1750	54	06107	36.2964192	-119.1405448	Tulare County
184119	Fee-for-Service	1831174226	1831174226	1	1	ALLEN,RICHARD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 E 3900 S	None	SALT LAKE CITY	UT	84124	0000	00	None	40.6870437	-111.8844377	Salt Lake County
184130	Fee-for-Service	1760792477	1760792477	1	1	AUSPICE HOME CARE	5/27/2011	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1754 E BULLARD AVENUE	#102	FRESNO	CA	93710	5865	10	06019	36.82319966	-119.755546	Fresno County
184141	Fee-for-Service	1720664576	1720664576	1	1	ABJC GRACIOUS LIVING, INC.	11/8/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	349 E. KENWOOD STREET	None	UPLAND	CA	91784	8227	36	06071	34.13526859	-117.6465796	San Bernardino County
184194	Fee-for-Service	1699809020	1699809020	1	2	A AND E HOME HEALTH SERVICES	2/8/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2377 W FOOTHILL BLVD	SUITE 14	UPLAND	CA	91786	3580	36	06071	34.10690963	-117.6975663	San Bernardino County
184205	Fee-for-Service	1467499616	1467499616	1	1	ANDERSON, MICHELLE ANNE	6/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	83504	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
184206	Fee-for-Service	1689752784	1689752784	1	1	ARULANANDAN, CHANDRAN MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	45221	01	General Practice	0	In state provider	None	3000 LAS POSITAS RD	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
184229	Fee-for-Service	1013133800	1013133800	1	1	ANDRE, CURTIS A OD INC	1/1/1997	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	711 E HAWKEYE AVE	STE 1	TURLOCK	CA	95380	7505	50	06099	37.50733048	-120.840624	Stanislaus County
184236	Fee-for-Service	1457432775	1457432775	1	1	AHADDIAN, SOHEIL MD	12/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	47732	36	Psychiatry	0	In state provider	None	9735 WILSHIRE BLVD	STE 304	BEVERLY HILLS	CA	90212	2105	19	06037	34.06711051	-118.4074605	Los Angeles County
184257	Fee-for-Service	1992941397	1992941397	1	1	AHDAB, SAM MD	2/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	126658	05	Anesthesiology	0	In state provider	None	17330 BEAR VALLEY ROAD	SUITE A106	VICTORVILLE	CA	92395	7741	36	06071	34.47105684	-117.2841999	San Bernardino County
184288	Fee-for-Service	1013228188	1013228188	1	1	APELIAN MEDICAL INC	12/16/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	106296	08	Family Practice	0	In state provider	None	14624 SHERMAN WAY	STE 603	VAN NUYS	CA	91405	2279	19	06037	34.20078354	-118.450843	Los Angeles County
184289	Fee-for-Service	1558757666	1558757666	1	1	AGAFONOVA, ELENA Y MD	6/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150661	41	Internal Medicine	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
184325	Fee-for-Service	1922114362	1922114362	1	1	ACINAS, MARY D MD	1/31/1991	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66785	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
184328	Fee-for-Service	1366486581	1366486581	1	1	AMERICAN EMPIRE HOME HEALTH	6/27/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE SERVICES INC	2934 E GARVEY AVE S	SUITE 214	WEST COVINA	CA	91791	2178	19	06037	34.07157499	-117.8836824	Los Angeles County
184329	Fee-for-Service	1952690877	1952690877	1	1	ARGER, NICHOLAS K MD	6/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131346	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
184399	Fee-for-Service	1699518977	1699518977	1	1	ANNE, SUE CNP	4/14/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1401 S BALDWIN AVE	None	ARCADIA	CA	91007	7922	19	06037	34.12357479	-118.0551359	Los Angeles County
184401	Fee-for-Service	1487683397	1487683397	1	1	ALADE, IBIJOKE A MD	11/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54731	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
184412	Fee-for-Service	1811093982	1811093982	1	1	ANDERSON, WILLIAM C MD	2/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	21954	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27871 MEDICAL CENTER RD	SUITE 200	MISSION VIEJO	CA	92691	6406	30	06059	33.558534	-117.6641255	Orange County
184449	Fee-for-Service	1114956232	1114956232	1	1	ANNA MARIA MYKLEBUST MD	1/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	11101 N SHERMAN RD	None	EDGERTON	WI	53534	9002	00	None	42.83463076	-89.04308317	Rock County
184467	Fee-for-Service	1437152378	1437152378	1	1	ANDERSON, JAMES M MD	11/19/2021	2085P0229X	NA	Other	026	PHYSICIANS	175197	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
184468	Fee-for-Service	1184669426	1184669426	1	1	AYOUB, TAWFIK L MD	10/1/1998	207L00000X	NA	Other	026	PHYSICIANS	56184	05	Anesthesiology	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
184480	Fee-for-Service	1902079452	1902079452	1	2	ABLE PHYSICAL THERAPY CORP	5/25/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9530 IMPERIAL HWY	SUITE N	DOWNEY	CA	90242	3041	19	06037	33.91695649	-118.124442	Los Angeles County
184481	Fee-for-Service	1114339017	1114339017	1	1	AUNG, YAMIN MD	10/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147564	41	Internal Medicine	0	In state provider	None	600 COFFEE ROAD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
184494	Fee-for-Service	1689752784	1689752784	1	1	ARULANANDAN, CHANDRAN MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	45221	41	Internal Medicine	0	In state provider	None	3000 LAS POSITAS RD	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
184510	Fee-for-Service	1033394408	1033394408	1	1	AHMED, RASIQ A MD	1/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101248	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVENUE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
184531	Fee-for-Service	1982350385	1982350385	1	1	AUSTIN, MAGDALENA M NP	12/5/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
184544	Fee-for-Service	1477631059	1477631059	1	1	ALYONO, MARY M MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	86282	05	Anesthesiology	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
184563	Fee-for-Service	1902486848	1902486848	1	1	ALL4HEALTH HOME CARE, INC	2/13/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	SUITE 210C	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
184592	Fee-for-Service	1356653927	1356653927	1	1	AMENT, JARED D MD	8/29/2018	207T00000X	NA	General Surgery	026	PHYSICIANS	122608	14	Neurological Surgery	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
184605	Fee-for-Service	1952642886	1952642886	1	1	ABC RECOVERY CENTER INC	1/15/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	82353 INDIO BLVD	None	INDIO	CA	92201	3351	33	06065	33.72671547	-116.2281125	Riverside County
184606	Fee-for-Service	1730399304	1730399304	1	1	ANTHONY MERRILL	2/21/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	20100 N 51ST AVE	STE F620	GLENDALE	AZ	85308	5125	00	None	33.666507	-112.1696865	Maricopa County
184621	Fee-for-Service	1295893691	1295893691	1	1	ALEXANDER, ZACHARY M MD	8/1/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	54456	None	None	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
184630	Fee-for-Service	1922027994	1922027994	1	1	AGRAWAL, UNDAYAN MD	4/1/2010	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	86020	30	Radiology	0	In state provider	None	2800 L ST	STE 610	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
184637	Fee-for-Service	1003022898	1003022898	1	1	AHMED, NUSRAT MD	4/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52705	01	General Practice	0	In state provider	None	612 E JANSS RD	None	THOUSAND OAKS	CA	91360	5113	56	06111	34.19957051	-118.8666284	Ventura County
184647	Fee-for-Service	1891096921	1891096921	1	1	ALHADI, SAMEIR A MD	8/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119103	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
184698	Fee-for-Service	1811093982	1811093982	1	1	ANDERSON, WILLIAM C MD	2/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	21954	01	General Practice	0	In state provider	None	27871 MEDICAL CENTER RD	SUITE 200	MISSION VIEJO	CA	92691	6406	30	06059	33.558534	-117.6641255	Orange County
184701	Fee-for-Service	1588826242	1588826242	1	1	ABOLLHASSANI, MANDANA MD	5/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115564	41	Internal Medicine	0	In state provider	None	1900 SULLIVAN AVENUE	STE 816	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
184710	Fee-for-Service	1437768819	1437768819	1	1	ALAMEDA EYE CENTER, PC	9/30/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	2418 CENTRAL AVE	None	ALAMEDA	CA	94501	4516	01	06001	37.76380141	-122.2419646	Alameda County
184716	Fee-for-Service	1649439670	1649439670	1	1	ABRAMOV, DMITRY MD	7/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145954	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	11234 ANDERSON STREET	SUITE 1617	LOMA LINDA	CA	92354	2804	36	06071	34.049547	-117.264078	San Bernardino County
184734	Fee-for-Service	1245258615	1245258615	1	1	A TO Z HEALTHCARE SUPPLY, IN	3/13/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	A TO Z HEALTHCARE SUPPLY	2457 E WASHINGTON BLVD	None	PASADENA	CA	91104	2041	19	06037	34.16915748	-118.0998225	Los Angeles County
184756	Fee-for-Service	1184669426	1184669426	1	1	AYOUB, TAWFIK L MD	10/1/1998	207L00000X	NA	Other	026	PHYSICIANS	56184	01	General Practice	0	In state provider	None	1200 N STATE ST	None	LOS ANGELES	CA	90033	1029	19	06037	34.05855992	-118.209755	Los Angeles County
184768	Fee-for-Service	1902079452	1902079452	1	2	ABLE PHYSICAL THERAPY CORP	5/25/2018	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9530 IMPERIAL HWY	SUITE N	DOWNEY	CA	90242	3041	19	06037	33.91695649	-118.124442	Los Angeles County
184793	Fee-for-Service	1942592266	1942592266	1	1	ANG, JENNIFER M MD	9/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141659	07	Dermatology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
184819	Fee-for-Service	1093906075	1093906075	1	1	AZEVEDO, CHRISTINA J MD	7/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137090	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO STREET	None	LOS ANGELES	CA	90033	5315	19	06037	34.06269295	-118.2030006	Los Angeles County
184842	Fee-for-Service	1093174260	1093174260	1	1	ASHOURI, ANOUSHEH INC	3/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	113709	None	None	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
184908	Fee-for-Service	1972580140	1972580140	1	1	AAFREEN, TAHMINA MD	7/31/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142911	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
184931	Fee-for-Service	1275156481	1275156481	1	1	ASSISTING HANDS HEALTH CARE	6/12/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	436 W COLORADO ST	STE 208	GLENDALE	CA	91204	3075	19	06037	34.14249549	-118.2624705	Los Angeles County
184946	Fee-for-Service	1821540162	1821540162	1	1	AMERICAN EXCEL HOME HEALTH	4/26/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	2755 COTTAGE WAY	STE 12	SACRAMENTO	CA	95825	1221	34	06067	38.604033	-121.3983225	Sacramento County
184954	Fee-for-Service	1477974962	1477974962	1	1	AUNG, THANDA MD	6/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137594	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
184956	Fee-for-Service	1740265487	1740265487	1	1	AHRONS, MARCY MD	8/31/1989	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45080	40	Pediatrics	0	In state provider	None	100 CONGRESS STREET	PEDIATRICS	PASADENA	CA	91105	0000	19	06037	34.13395172	-118.1534955	Los Angeles County
184957	Fee-for-Service	1720645575	1720645575	1	1	ADVANCED MEDICAL EQUIPMENT A	10/26/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ND SUPPLIES	41695 ELM ST.	STE 301-302	MURRIETA	CA	92562	1417	33	06065	33.53361113	-117.1825429	Riverside County
184961	Fee-for-Service	1073599254	1073599254	1	1	AMINOLOLAMA-SHAKERI, SHA	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80023	41	Internal Medicine	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
184983	Fee-for-Service	1811210941	1811210941	1	2	ADVANCED CARE EMERGENCY	3/1/2002	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	SERVICES PLLC	1409 EAST LAKE MEAD BLVD	None	N LAS VEGAS	NV	89030	7120	00	None	36.19579448	-115.1228925	Clark County
184995	Fee-for-Service	1205169752	1205169752	1	1	AL-MOOMEN, RUSHDY M MD	3/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120029	45	Nephrology (Renal-Kidney)	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
184996	Fee-for-Service	1891752176	1891752176	1	1	ANSON, JOHN MD	4/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	14	Neurological Surgery	1	Border provider	None	3006 S MARYLAND PKWY	STE 200	LAS VEGAS	NV	89109	2218	00	None	36.135288	-115.1368705	Clark County
185009	Fee-for-Service	1184774580	1184774580	1	1	ANDRADE, KRISTIN E MD	8/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89016	40	Pediatrics	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
185033	Fee-for-Service	1538528690	1538528690	1	1	ARAKOZIE, ROXANNA E DO	1/13/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	18438	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
185071	Fee-for-Service	1487806535	1487806535	1	1	ADVANCED SLEEP MEDICINE SRVS	2/14/2011	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	INC	23332 HAWTHORNE BLVD	SUITE 302	TORRANCE	CA	90505	3773	19	06037	33.813747	-118.3510045	Los Angeles County
185074	Fee-for-Service	1891837621	1891837621	1	1	ARROYO VISTA FAMILY	1/19/2006	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HEALTH CTR MOBILE II	6000 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4232	19	06037	34.11150069	-118.1888319	Los Angeles County
185101	Fee-for-Service	1043734924	1043734924	1	1	AMERICAN URGENT CARE CENTER	9/11/2019	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	18840 VENTURA BLVD	110	TARZANA	CA	91356	3301	19	06037	34.17204394	-118.5442921	Los Angeles County
185106	Fee-for-Service	1154012631	1154012631	1	1	ACHUGBU, CHARLES OKWUDIRI	7/22/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	16908 SADDLEBROOK LANE	None	MORENO VALLEY	CA	92551	2423	33	06065	33.87505022	-117.2218203	Riverside County
185109	Fee-for-Service	1427655810	1427655810	1	1	AN ELEGANT SUFFICIENCY, A PS	5/21/2024	103TC0700X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5250 CLAREMONT AVE STE 1	None	STOCKTON	CA	95207	5700	39	06077	37.99861886	-121.3102123	San Joaquin County
185111	Fee-for-Service	1609934942	1609934942	1	1	ARTINYAN, AVO MD	7/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77942	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
185171	Fee-for-Service	1619086592	1619086592	1	1	AHLES, SCOTT MD	5/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36799	36	Psychiatry	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
185235	Fee-for-Service	1609113869	1609113869	1	1	ANDERSON, BRADFORD A MD INC	5/24/2016	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	60265	84	Surgery-Head and Neck	0	In state provider	None	8701 CAMINO MEDIA	SUITE C	BAKERSFIELD	CA	93311	1336	15	06029	35.34284479	-119.1000639	Kern County
185244	Fee-for-Service	1477974962	1477974962	1	1	AUNG, THANDA MD	6/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137594	83	Rheumatology	0	In state provider	None	200 MED PLAZA	365,420,120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
185268	Fee-for-Service	1134515331	1134515331	1	1	ALIC, AZRA LCSW	12/13/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
185283	Fee-for-Service	1205169752	1205169752	1	1	AL-MOOMEN, RUSHDY M MD	3/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120029	41	Internal Medicine	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
185291	Fee-for-Service	1003807652	1003807652	1	1	AGANOVIC, LEJLA MD	1/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	101098	30	Radiology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
185337	Fee-for-Service	1700143955	1700143955	1	1	AMERICAN HOSPICE AND HOME	4/29/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HEALTH CARE SERVICES	7031 KOLL CENTER PKWY	SUITE 230	PLEASANTON	CA	94566	3134	01	06001	37.66217502	-121.9006402	Alameda County
185342	Fee-for-Service	1134657943	1134657943	1	1	AHMADI, ROOZBEH	3/14/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	166182	25	Physical Medicine and Rehabilitation	0	In state provider	None	1117 W TOKAY ST	SUITE A	LODI	CA	95240	3844	39	06077	38.12636853	-121.2867765	San Joaquin County
185358	Fee-for-Service	1033236963	1033236963	1	1	ALEXANDER, SCOTT A MD	4/16/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85400	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
185361	Fee-for-Service	1891837621	1891837621	1	1	ARROYO VISTA FAMILY	5/20/2004	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	HEALTH CTR MOBILE II	6000 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4232	19	06037	34.11150069	-118.1888319	Los Angeles County
185378	Fee-for-Service	1649476243	1649476243	1	1	ARMISEN, VALESKA E MD	2/7/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	72580	01	General Practice	0	In state provider	None	11670 ATWOOD ROAD	None	AUBURN	CA	95603	9522	31	06061	38.93485327	-121.0988193	Placer County
185385	Fee-for-Service	1972584415	1972584415	1	1	ALTER, HARRISON J MD	9/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80744	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
185388	Fee-for-Service	1558454264	1558454264	1	1	ASLMAND, PEDRAM DPM INC	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2840 LONG BEACH BLVD	STE 130	LONG BEACH	CA	90806	1516	19	06037	33.808743	-118.189341	Los Angeles County
185392	Fee-for-Service	1154012631	1154012631	1	1	ACHUGBU, CHARLES OKWUDIRI	7/22/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	16908 SADDLEBROOK LANE	None	MORENO VALLEY	CA	92551	2423	33	06065	33.87505022	-117.2218203	Riverside County
185398	Fee-for-Service	1427655810	1427655810	1	1	AN ELEGANT SUFFICIENCY, A PS	10/14/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	5250 CLAREMONT AVE STE 1	None	STOCKTON	CA	95207	5700	39	06077	37.99861886	-121.3102123	San Joaquin County
185414	Fee-for-Service	1598812596	1598812596	1	1	AGUILUZ, AMABLE D JR MD	10/30/2014	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	33886	66	Emergency Medicine (Urgent Care)	0	In state provider	None	21500 PIONEER BLVD	SUITE 209	HAWAIIAN GARDENS	CA	90716	2600	19	06037	33.8326507	-118.0817625	Los Angeles County
185452	Fee-for-Service	1871652479	1871652479	1	1	ABILA, SOLOMAN O MD	11/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87755	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
185463	Fee-for-Service	1215510797	1215510797	1	1	ALRASHEED, KHALID M MD	7/4/2022	2084N0008X	NA	Neurology	026	PHYSICIANS	170687	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
185473	Fee-for-Service	1215159199	1215159199	1	1	ANDREW MICHAEL BELLIZZI	9/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
185497	Fee-for-Service	1184949570	1184949570	1	1	AHN, DAVID T MD	3/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117662	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
185504	Fee-for-Service	1811179898	1811179898	1	1	ALLEN, TENNILLE A NP	8/5/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2075 SAN JOAQUIN HILLS R	None	NEWPORT BEACH	CA	92660	6505	30	06059	33.61676129	-117.869325	Orange County
185518	Fee-for-Service	1306379383	1306379383	1	1	ANGEL OF MERCY HOME HEALTH	10/25/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE	1110 SONORA AVE	SUITE 102	GLENDALE	CA	91201	3173	19	06037	34.1688301	-118.2852463	Los Angeles County
185522	Fee-for-Service	1609113869	1609113869	1	1	ANDERSON, BRADFORD A MD INC	5/24/2016	2081P2900X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	60265	25	Physical Medicine and Rehabilitation	0	In state provider	None	8701 CAMINO MEDIA	SUITE C	BAKERSFIELD	CA	93311	1336	15	06029	35.34284479	-119.1000639	Kern County
185535	Fee-for-Service	1548490261	1548490261	1	1	ARETAEUS TELEMEDICINE INC.	8/9/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
185551	Fee-for-Service	1073070025	1073070025	1	1	AVALOS, VIVIAN CCC-SLP	2/26/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2201 E 4TH ST	None	SANTA ANA	CA	92705	3804	30	06059	33.74828847	-117.8360595	Orange County
185565	Fee-for-Service	1124675558	1124675558	1	1	ACCESSCARE HOME HEALTH	3/27/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES LLC	21618 GOLDEN TRIANGLE RD	STE 202	SANTA CLARITA	CA	91350	2615	19	06037	34.41525469	-118.5138076	Los Angeles County
185618	Fee-for-Service	1477954238	1477954238	1	1	AU, DAVID J OD	10/5/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1843 1/2 S LA CIENEGA	None	LOS ANGELES	CA	90035	4603	19	06037	34.04410366	-118.3768223	Los Angeles County
185625	Fee-for-Service	1700143955	1700143955	1	1	AMERICAN HOSPICE AND HOME	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HEALTH CARE SERVICES	7031 KOLL CENTER PKWY	SUITE 230	PLEASANTON	CA	94566	3134	01	06001	37.66217502	-121.9006402	Alameda County
185639	Fee-for-Service	1396109849	1396109849	1	1	ARAGHI, CAMERON MD	7/14/2020	207P00000X	NA	Other	026	PHYSICIANS	151294	66	Emergency Medicine (Urgent Care)	0	In state provider	None	555 EAST HARDY STREET	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
185651	Fee-for-Service	1891837621	1891837621	1	1	ARROYO VISTA FAMILY	1/19/2006	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HEALTH CTR MOBILE II	6000 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4232	19	06037	34.11150069	-118.1888319	Los Angeles County
185652	Fee-for-Service	1437247335	1437247335	1	1	AFSHAR, PARVIN MD	7/21/2009	2084P0800X	NA	Psychiatry	026	PHYSICIANS	44980	36	Psychiatry	0	In state provider	None	14150 CULVER DR	STE 307	IRVINE	CA	92604	0323	30	06059	33.70834263	-117.7839373	Orange County
185686	Fee-for-Service	1013675719	1013675719	1	1	AVANTGARDE SENIOR LIVING OF	1/13/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	LA JOLLA	6211 LA JOLLA HERMOSA	None	LA JOLLA	CA	92037	6736	37	06073	32.82352977	-117.274892	San Diego County
185688	Fee-for-Service	1427655810	1427655810	1	1	AN ELEGANT SUFFICIENCY, A PS	5/21/2024	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5250 CLAREMONT AVE STE 1	None	STOCKTON	CA	95207	5700	39	06077	37.99861886	-121.3102123	San Joaquin County
185701	Fee-for-Service	1598812596	1598812596	1	1	AGUILUZ, AMABLE D JR MD	10/30/2014	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	33886	01	General Practice	0	In state provider	None	21500 PIONEER BLVD	SUITE 209	HAWAIIAN GARDENS	CA	90716	2600	19	06037	33.8326507	-118.0817625	Los Angeles County
185722	Fee-for-Service	1104120385	1104120385	1	1	ALL CARE PHYSICAL THERAPY PC	8/4/2022	225X00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	.C.	8550 BALBOA BLVD	SUITE 242	NORTHRIDGE	CA	91325	3593	19	06037	34.225713	-118.5026045	Los Angeles County
185723	Fee-for-Service	1073655866	1073655866	1	1	AKHANJEE, LUTFUL K MD	2/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	45563	66	Emergency Medicine (Urgent Care)	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
185725	Fee-for-Service	1558380337	1558380337	1	1	ABRAHAM, ANITA MD	10/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142479	67	Endocrinology	0	In state provider	None	9390 BIG HORN BLVD	None	ELK GROVE	CA	95758	7978	34	06067	38.420172	-121.4083485	Sacramento County
185737	Fee-for-Service	1063660165	1063660165	1	1	AROCHO, MIRELIS CCC-SLP	10/18/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3407 W SIXTH STREET	STE 716	LOS ANGELES	CA	90020	2764	19	06037	34.06363337	-118.295759	Los Angeles County
185747	Fee-for-Service	1366896284	1366896284	1	1	ANAYA, MAGGIE J LMFT	10/26/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1294 E FIRST AVE	120	CHICO	CA	95926	1572	04	06007	39.75048481	-121.8251162	Butte County
185760	Fee-for-Service	1093740227	1093740227	1	2	ALI, ZULFIQAR MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	38449	41	Internal Medicine	0	In state provider	None	1544 B ST	STE 3	HAYWARD	CA	94541	3041	01	06001	37.67895193	-122.0732246	Alameda County
185766	Fee-for-Service	1568515567	1568515567	1	1	ARCELLANA, RENE C MD	1/2/2020	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	152579	40	Pediatrics	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
185777	Fee-for-Service	1366603144	1366603144	1	1	ADACHI, KRISTINA N MD	1/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111932	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	12311 MDCC	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
185790	Fee-for-Service	1184949570	1184949570	1	1	AHN, DAVID T MD	3/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117662	67	Endocrinology	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
185826	Fee-for-Service	1861571077	1861571077	1	1	ADVANTAGE PHYSICAL	3/16/2009	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	THERAPY INC	6512 WESTSIDE RD	STE B	REDDING	CA	96001	4868	45	06089	40.52111546	-122.3824845	Shasta County
185840	Fee-for-Service	1497730162	1497730162	1	1	ANDREASSI, PAOLO MD	6/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108072	34	Urology and Urological Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
185848	Fee-for-Service	1164508180	1164508180	1	1	ARTESIA CHRISTIAN HOME INC	3/1/1966	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	11614 183RD ST	None	ARTESIA	CA	90701	5506	19	06037	33.86568402	-118.0859899	Los Angeles County
185883	Fee-for-Service	1851612782	1851612782	1	1	ALBERT MEIER	3/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	915 HIGHLAND BLVD	None	BOZEMAN	MT	59715	6902	00	None	45.669708	-111.020157	Gallatin County
185894	Fee-for-Service	1013922814	1013922814	1	1	ACQUAH, JOHN E E MD	2/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137386	41	Internal Medicine	0	In state provider	None	2615 CHESTER AVENUE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
185905	Fee-for-Service	1104248871	1104248871	1	1	AIRE MEDICAL GROUP INC	8/10/2018	207KA0200X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	None	191 S BUENA VISTA ST	STE 330	BURBANK	CA	91505	4554	19	06037	34.15872557	-118.3283863	Los Angeles County
185928	Fee-for-Service	1407959315	1407959315	1	1	ADAPA, VENKATARAMANA MD	12/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	85126	41	Internal Medicine	0	In state provider	None	652 W 11TH ST	None	TRACY	CA	95376	3869	39	06077	37.73965047	-121.435452	San Joaquin County
185936	Fee-for-Service	1134699333	1134699333	1	1	A LIVING CHANCE CLINICAL TRI	6/6/2019	163WG0000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	ALS, INC	9449 SAN FERNANDO ROAD	None	SUN VALLEY	CA	91352	1421	19	06037	34.24087386	-118.3954268	Los Angeles County
185974	Fee-for-Service	1427655810	1427655810	1	1	AN ELEGANT SUFFICIENCY, A PS	5/21/2024	103TC0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5250 CLAREMONT AVE STE 1	None	STOCKTON	CA	95207	5700	39	06077	37.99861886	-121.3102123	San Joaquin County
185988	Fee-for-Service	1821376336	1821376336	1	1	ALIAN, YASAMAN	1/13/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	15775 LAGUNA CYN RD	SUITE 110	IRVINE	CA	92618	3192	30	06059	33.6663745	-117.760682	Orange County
186012	Fee-for-Service	1104120385	1104120385	1	1	ALL CARE PHYSICAL THERAPY PC	10/2/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	.C.	8550 BALBOA BLVD	SUITE 242	NORTHRIDGE	CA	91325	3593	19	06037	34.225713	-118.5026045	Los Angeles County
186013	Fee-for-Service	1558380337	1558380337	1	1	ABRAHAM, ANITA MD	10/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	142479	01	General Practice	0	In state provider	None	9390 BIG HORN BLVD	None	ELK GROVE	CA	95758	7978	34	06067	38.420172	-121.4083485	Sacramento County
186015	Fee-for-Service	1073655866	1073655866	1	1	AKHANJEE, LUTFUL K MD	2/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	45563	01	General Practice	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
186026	Fee-for-Service	1609442037	1609442037	1	1	AKHTAR AZIZ, FARIQ MD	10/14/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
186049	Fee-for-Service	1093740227	1093740227	1	2	ALI, ZULFIQAR MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	38449	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1544 B ST	STE 3	HAYWARD	CA	94541	3041	01	06001	37.67895193	-122.0732246	Alameda County
186107	Fee-for-Service	1235322603	1235322603	1	1	AJITPAL, SETHI S MD	7/14/2009	207RS0012X	NA	Other	026	PHYSICIANS	101134	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
186114	Fee-for-Service	1962629006	1962629006	1	1	ANN M HOFF	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	TRINITY MEDICAL GROUP	1 BURDICK EXPY W	None	MINOT	ND	58701	0000	00	None	48.2325845	-101.2938165	Ward County
186119	Fee-for-Service	1962597807	1962597807	1	1	ADVANCED CALIFORNIA MEDICAL	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	55154	None	None	0	In state provider	ADVANCED CA MED CTR INC	10737 CAMINO RUIZ	STE 114	SAN DIEGO	CA	92126	2361	37	06073	32.91416051	-117.1437943	San Diego County
186120	Fee-for-Service	1982314613	1982314613	1	1	ADVANCE NURSING PRACTICE MED	9/6/2023	193400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	PA	809 SYLVAN AVE	400	MODESTO	CA	95350	1500	50	06099	37.68900616	-120.9836976	Stanislaus County
186128	Fee-for-Service	1033270293	1033270293	2	1	ABRAHAMIAN, AZNIV A MD	9/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	50782	01	General Practice	0	In state provider	None	12507 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	3135	19	06037	34.18670353	-118.405791	Los Angeles County
186141	Fee-for-Service	1053524488	1053524488	1	1	AMINA, SHAHRAM MD	11/19/2018	2084N0400X	NA	Neurology	026	PHYSICIANS	152681	13	Neurology (M.D. only)	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
186191	Fee-for-Service	1205314937	1205314937	1	1	ALABASTRO, STACY M NP	3/29/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
186197	Fee-for-Service	1063791853	1063791853	1	1	ANDREWS, MICHAEL C MD	1/8/2020	207RC0200X	NA	Other	026	PHYSICIANS	141041	05	Anesthesiology	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
186217	Fee-for-Service	1134568439	1134568439	1	2	AGUILAR, GENOVEVA MD	2/10/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	138877	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
186226	Fee-for-Service	1770661860	1770661860	1	1	ALEKNA, VITAS P MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	35737	18	Ophthalmology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
186235	Fee-for-Service	1730170903	1730170903	1	1	ALTHAUSEN, PETER L MD	7/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74396	20	Orthopedic Surgery	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
186249	Fee-for-Service	1881148690	1881148690	1	1	ADEDIRAN, GANIYA I LPCC	11/27/2022	106H00000X	NA	Mental Health Outpatient Services	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
186267	Fee-for-Service	1245467687	1245467687	1	1	AMERI, HOSSEIN MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125239	18	Ophthalmology	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5301	19	06037	34.06269295	-118.2030006	Los Angeles County
186280	Fee-for-Service	1861446833	1861446833	1	1	ALIKHANI, SHAHRIAR MD	7/1/1998	207L00000X	NA	Other	026	PHYSICIANS	75045	05	Anesthesiology	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
186301	Fee-for-Service	1104120385	1104120385	1	1	ALL CARE PHYSICAL THERAPY PC	11/20/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	.C.	8550 BALBOA BLVD	SUITE 242	NORTHRIDGE	CA	91325	3593	19	06037	34.225713	-118.5026045	Los Angeles County
186314	Fee-for-Service	1710483078	1710483078	1	1	ARNOLD, SHIMEKA D LMFT	10/15/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
186317	Fee-for-Service	1952687949	1952687949	1	1	AHLFELD, AMY J PSYD	8/27/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2530 J STREET	SUITE 310	SACRAMENTO	CA	95816	4849	34	06067	38.574333	-121.47228	Sacramento County
186321	Fee-for-Service	1467060160	1467060160	1	1	A HEALING LIGHT FAMILY COUNS	6/25/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	ELING INC.	73929 LARREA ST	STE. 1B	PALM DESERT	CA	92260	4305	33	06065	33.71878454	-116.375094	Riverside County
186329	Fee-for-Service	1154307791	1154307791	1	1	AUGUST, DAVID A MD	11/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87680	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
186348	Fee-for-Service	1033776075	1033776075	1	1	AREFIEVA, CHRISTA A MD	10/1/2023	207P00000X	NA	Other	026	PHYSICIANS	179084	None	None	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
186374	Fee-for-Service	1922615582	1922615582	1	1	A&G HOSPICE CARE LLC	12/14/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6621 VAN NUYS BLVD	SUITE 116	VAN NUYS	CA	91405	4672	19	06037	34.19138471	-118.4487668	Los Angeles County
186391	Fee-for-Service	1922187574	1922187574	1	1	AURIEMMA, JASON F MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	76677	01	General Practice	0	In state provider	None	2030 SUTTER PL	STE 2000	DAVIS	CA	95616	6201	57	06113	38.56292466	-121.7715423	Yolo County
186443	Fee-for-Service	1356450498	1356450498	1	1	AHN, ELIZA S MD	9/30/1992	207R00000X	NA	Other	026	PHYSICIANS	77767	01	General Practice	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
186465	Fee-for-Service	1003816893	1003816893	1	1	ADIGA, SUCHETHA MD	9/24/2020	207ZP0102X	NA	Other	026	PHYSICIANS	160356	22	Pathology (M.D. only)	0	In state provider	None	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
186553	Fee-for-Service	1881353233	1881353233	1	2	ALPHA CARE PHARMACY PC	3/22/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15010 W WHITESBRIDGE AVE	None	KERMAN	CA	93630	1030	10	06019	36.73495449	-120.060495	Fresno County
186565	Fee-for-Service	1871550590	1871550590	1	1	ALLERGY & ASTHMA MEDICAL GRO	9/12/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	GROUP OF THE BAY AREA, I	370 N WIGET LANE	STE 210	WALNUT CREEK	CA	94598	2452	07	06013	37.92948925	-122.0275099	Contra Costa County
186633	Fee-for-Service	1821610817	1821610817	1	1	ALL COMFORT HOSPICE CARE,	5/10/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	5924 E LOS ANGELES AVE	STE W	SIMI VALLEY	CA	93063	4344	56	06111	34.27171481	-118.6755673	Ventura County
186661	Fee-for-Service	1922615582	1922615582	1	1	A&G HOSPICE CARE LLC	12/14/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6621 VAN NUYS BLVD	SUITE 116	VAN NUYS	CA	91405	4672	19	06037	34.19138471	-118.4487668	Los Angeles County
186699	Fee-for-Service	1376866707	1376866707	1	1	AHMAD, ZEINELDIN DPM	1/22/2013	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	5720 STONERIDGE MALL RD	130	PLEASANTON	CA	94588	2828	01	06001	37.69247085	-121.9301884	Alameda County
186738	Fee-for-Service	1407906050	1407906050	1	1	ALL EYES OPTOMETRY INC	12/28/2010	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4972 W PICO BLVD	STE 106B	LOS ANGELES	CA	90019	4200	19	06037	34.04775908	-118.3454539	Los Angeles County
186753	Fee-for-Service	1003816893	1003816893	1	1	ADIGA, SUCHETHA MD	9/24/2020	207ZP0102X	NA	Other	026	PHYSICIANS	160356	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
186785	Fee-for-Service	1679519524	1679519524	1	1	AUERSWALD, COLETTE L MD	10/31/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	78295	40	Pediatrics	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
186866	Fee-for-Service	1023113172	1023113172	1	2	ARROWHEAD RADIOLOGY MEDICAL	10/9/2019	2085R0202X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	GROUP INC	28062 BAXTER RD.	None	MURRIETA	CA	92563	1401	33	06065	33.61350847	-117.1691225	Riverside County
186915	Fee-for-Service	1679613111	1679613111	2	1	AMENA PHARMACY CORP	1/2/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	14642 NEWPORT AVE	None	TUSTIN	CA	92780	6057	30	06059	33.73082212	-117.8293987	Orange County
186919	Fee-for-Service	1821610817	1821610817	1	1	ALL COMFORT HOSPICE CARE,	5/10/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	5924 E LOS ANGELES AVE	STE W	SIMI VALLEY	CA	93063	4344	56	06111	34.27171481	-118.6755673	Ventura County
186921	Fee-for-Service	1376596650	1376596650	1	2	AN ANESTHESIA AND PAIN MANAG	8/14/2024	207LP2900X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	EMENT MEDICAL CORPORAT	1208 E 5TH ST	SUITE 300	BENICIA	CA	94510	3502	48	06095	38.05032887	-122.1471983	Solano County
186940	Fee-for-Service	1275892762	1275892762	1	1	AHN, JOSEPH E MD	12/23/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	112600	02	General Surgery	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
186961	Fee-for-Service	1164536132	1164536132	2	1	ASB PHARMACIES INC	5/7/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1844 SAN MIGUEL DR	#105	WALNUT CREEK	CA	94596	8601	07	06013	37.89504879	-122.0529911	Contra Costa County
187000	Fee-for-Service	1225109358	1225109358	1	1	ATHOS, LAURENCE M MD	3/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	34546	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	19830 LAKE CHABOT RD	STE D	CASTRO VALLEY	CA	94546	4063	01	06001	37.70011045	-122.0877799	Alameda County
187029	Fee-for-Service	1508200932	1508200932	1	1	ALAPAT, ROSE V MD	10/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149951	25	Physical Medicine and Rehabilitation	0	In state provider	None	10050 N WOLFE RD	None	CUPERTINO	CA	95014	2519	43	06085	37.323639	-122.014123	Santa Clara County
187041	Fee-for-Service	1821137274	1821137274	1	1	ASIAN MEDICAL CLINIC OF	5/12/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	FREMONT INC	1895 MOWRY AVE	STE 101	FREMONT	CA	94538	1700	01	06001	37.55909066	-121.9799265	Alameda County
187087	Fee-for-Service	1154640597	1154640597	1	1	ARAUJO, SARAH A LMFT	9/11/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
187097	Fee-for-Service	1518317429	1518317429	1	1	ANGELA MARIE DUPUIS	1/8/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	43 NEW SCOTLAND AVE	None	ALBANY	NY	12208	3412	00	None	42.653133	-73.7752995	Albany County
187098	Fee-for-Service	1154344356	1154344356	1	2	AIDS HEALTHCARE FOUNDATION	4/29/2024	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	518A CASTRO ST	None	SAN FRANCISCO	CA	94114	2512	38	06075	37.76058991	-122.4350444	San Francisco County
187129	Fee-for-Service	1437237906	1437237906	1	3	AUBURN EYE CARE ASSOCIATES	9/7/2016	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	333 S AUBURN ST	STE 1	COLFAX	CA	95713	9776	31	06061	39.09583982	-120.9507248	Placer County
187131	Fee-for-Service	1225774169	1225774169	1	2	A2Z BOND TRANSPORTATION	8/1/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	10769 WOODSIDE AVE	STE 202	SANTEE	CA	92071	3175	37	06073	32.83983465	-116.9648209	San Diego County
187201	Fee-for-Service	1962473686	1962473686	1	1	AVALA, LAKSHMI K MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	79103	40	Pediatrics	0	In state provider	None	151 N SUNRISE AVE	STE 1203	ROSEVILLE	CA	95661	2932	31	06061	38.74746043	-121.2655348	Placer County
187208	Fee-for-Service	1215566427	1215566427	1	1	ASHRAFIAN, SOGOL MD	8/22/2024	364SW0102X	NA	Other	026	PHYSICIANS	184535	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1220 HEMLOCK WAY	200	SANTA ANA	CA	92707	3655	30	06059	33.70975375	-117.8842792	Orange County
187213	Fee-for-Service	1114144359	1114144359	1	1	AXIS COMMUNITY HEALTH	4/1/1998	261Q00000X	NA	Other	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	4361 RAILROAD AVE	None	PLEASANTON	CA	94566	6611	01	06001	37.66138479	-121.8737265	Alameda County
187224	Fee-for-Service	1801161856	1801161856	1	1	ABRAHAMIAN, ALICE MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117100	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
187225	Fee-for-Service	1043639503	1043639503	1	1	ASKIN, ELISABETH T MD	8/23/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	141891	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
187244	Fee-for-Service	1265851471	1265851471	1	1	ADIBI, KAMI MD INC	6/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	64723	01	General Practice	0	In state provider	None	9064 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	1813	19	06037	34.235073	-118.4502245	Los Angeles County
187288	Fee-for-Service	1225109358	1225109358	1	1	ATHOS, LAURENCE M MD	3/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	34546	41	Internal Medicine	0	In state provider	None	19830 LAKE CHABOT RD	STE D	CASTRO VALLEY	CA	94546	4063	01	06001	37.70011045	-122.0877799	Alameda County
187293	Fee-for-Service	1528298619	1528298619	1	1	ATTA, MASSUDA MD	3/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	102840	41	Internal Medicine	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
187328	Fee-for-Service	1821137274	1821137274	1	1	ASIAN MEDICAL CLINIC OF	5/12/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	FREMONT INC	1895 MOWRY AVE	STE 101	FREMONT	CA	94538	1700	01	06001	37.55909066	-121.9799265	Alameda County
187336	Fee-for-Service	1104027424	1104027424	1	1	ASLANIAN, MELINEH DPM	5/1/2000	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	SARMONT PODIATRY INC	125 E GLENOAKS BLVD	STE 101	GLENDALE	CA	91207	2129	19	06037	34.15893574	-118.2541314	Los Angeles County
187375	Fee-for-Service	1659510188	1659510188	1	1	ARCHER, NICOLAS K CRNA	5/7/2009	390200000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
187389	Fee-for-Service	1427396571	1427396571	1	1	ADAMS-MCCORMACK, MARGARET R	7/25/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	CNM	3779 PIEDMONT AVE	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
187413	Fee-for-Service	1437237906	1437237906	1	3	AUBURN EYE CARE ASSOCIATES	9/7/2016	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	333 S AUBURN ST	STE 1	COLFAX	CA	95713	9776	31	06061	39.09583982	-120.9507248	Placer County
187423	Fee-for-Service	1508354333	1508354333	1	1	ANGELS ARMS HOME HEALTH	12/8/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	7414 FOOTHILL BLVD	None	TUJUNGA	CA	91042	9450	19	06037	34.25156571	-118.293672	Los Angeles County
187473	Fee-for-Service	1225176977	1225176977	1	1	ALAMEDA ELDER SERVICES, LLC	12/7/2023	261QP2000X	NA	Physical Therapist	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1721 WEBSTER ST	None	ALAMEDA	CA	94501	2135	01	06001	37.77686505	-122.2766703	Alameda County
187474	Fee-for-Service	1386339208	1386339208	1	1	ALCOCER, LUIS LCSW	4/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13200 CROSSROADS PARKWAY	SUITE 335	CITY OF INDUSTRY	CA	91746	3409	19	06037	34.03038726	-118.0130115	Los Angeles County
187481	Fee-for-Service	1528130333	1528130333	1	1	ANDERSON, MARLA R MD	7/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86512	02	General Surgery	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
187508	Fee-for-Service	1679180673	1679180673	1	1	ANCHOR HEALTH LLC	2/14/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	505 SAN MARIN DRIVE	STE 100B	NOVATO	CA	94945	1309	21	06041	38.12144894	-122.5842153	Marin County
187515	Fee-for-Service	1174807408	1174807408	1	1	ASHLEY WILLIAMS COUNSELING	4/23/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	INC	10900 E 183RD ST	STE 105	CERRITOS	CA	90703	5375	19	06037	33.86553452	-118.101933	Los Angeles County
187524	Fee-for-Service	1417915653	1417915653	1	2	ACCREDO HEALTH GROUP INC	12/20/2019	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	3000 ERICSSON DR	SUITE 100	WARRENDALE	PA	15086	6501	00	None	40.6586921	-80.10305404	Allegheny County
187554	Fee-for-Service	1073706495	1073706495	1	1	ABDELKARIM, MURRAD J MD FACC	8/15/2008	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	97044	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
187647	Fee-for-Service	1881819670	1881819670	1	1	AKALIN, MURAT Z MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	82942	08	Family Practice	0	In state provider	None	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	0000	26	06051	37.64575895	-118.9638914	Mono County
187658	Fee-for-Service	1528092723	1528092723	1	1	AMEDE, FRANCIS J MD	9/30/2020	207RC0200X	NA	Other	026	PHYSICIANS	162184	41	Internal Medicine	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
187669	Fee-for-Service	1811281363	1811281363	1	1	ADAMS, LORI PT	4/9/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1252 BROADWAY	SUITE B	PLACERVILLE	CA	95667	5806	09	06017	38.73128098	-120.7852781	El Dorado County
187683	Fee-for-Service	1669698742	1669698742	1	1	AUDREY PHARMACY, INC	9/7/2007	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9741 BOLSA AVE	STE 116	WESTMINSTER	CA	92683	6601	30	06059	33.74502448	-117.9595626	Orange County
187765	Fee-for-Service	1841631355	1841631355	1	1	AVILA, MANUEL N LMFT	1/30/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41555 COOK ST	100	PALM DESERT	CA	92211	5184	33	06065	33.74651823	-116.3563827	Riverside County
187771	Fee-for-Service	1770218679	1770218679	1	1	ANCHONDO, ALINA CCC-SLP	9/24/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3687 MT DIABLO	SUITE 100	LAFAYETTE	CA	94549	3717	07	06013	37.8898926	-122.1304235	Contra Costa County
187795	Fee-for-Service	1124070883	1124070883	1	1	ANDREW D LEE M.D.	10/4/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
187797	Fee-for-Service	1679180673	1679180673	1	1	ANCHOR HEALTH LLC	2/14/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	505 SAN MARIN DRIVE	STE 100B	NOVATO	CA	94945	1309	21	06041	38.12144894	-122.5842153	Marin County
187801	Fee-for-Service	1174807408	1174807408	1	1	ASHLEY WILLIAMS COUNSELING	4/23/2018	104100000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	INC	10900 E 183RD ST	STE 105	CERRITOS	CA	90703	5375	19	06037	33.86553452	-118.101933	Los Angeles County
187831	Fee-for-Service	1104878776	1104878776	1	1	AUER, DAVID E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1212 RICHMOND AVE	STE 301	HOUSTON	TX	77006	5424	00	None	29.73457612	-95.39385899	Harris County
187834	Fee-for-Service	1770661456	1770661456	1	1	AZEVEDO, ROBERT A MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67079	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8170 LAGUNA BLVD	STE 303	ELK GROVE	CA	95758	7903	34	06067	38.421054	-121.405365	Sacramento County
187844	Fee-for-Service	1184099970	1184099970	1	1	ADEQUATE CARE HOSPICE INC	5/21/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5323 W HILLSDALE AVE	None	VISALIA	CA	93291	5143	54	06107	36.329292	-119.350422	Tulare County
187895	Fee-for-Service	1558954743	1558954743	1	1	ADVENTIST HEALTH PHYSICIANS	5/26/2021	207V00000X	NA	Obstetrics & Gynecology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	460 GREENFIELD AVE	1	HANFORD	CA	93230	3500	16	06031	36.3296463	-119.6581535	Kings County
187908	Fee-for-Service	1962048488	1962048488	1	1	AQUINO, MELLANY A NP	4/7/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
187912	Fee-for-Service	1043501760	1043501760	1	2	AHN, SANG HOON MD INC	6/25/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	500 S VIRGIL AVE	SUITE 502	LOS ANGELES	CA	90020	1404	19	06037	34.064964	-118.2870335	Los Angeles County
187920	Fee-for-Service	1649876541	1649876541	1	1	ATBA, LLC	1/1/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2586 BUTHMANN AVE	None	TRACY	CA	95376	2165	39	06077	37.755621	-121.4322635	San Joaquin County
187922	Fee-for-Service	1518207067	1518207067	1	1	AFFILIATED PATHOLOGISTS OF	7/29/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	THE CENTRAL COAST	1911 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4131	40	06079	35.27851417	-120.6501092	San Luis Obispo County
187939	Fee-for-Service	1881819670	1881819670	1	1	AKALIN, MURAT Z MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	82942	36	Psychiatry	0	In state provider	None	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	0000	26	06051	37.64575895	-118.9638914	Mono County
187941	Fee-for-Service	1528092723	1528092723	1	1	AMEDE, FRANCIS J MD	9/30/2020	207RC0200X	NA	Other	026	PHYSICIANS	162184	45	Nephrology (Renal-Kidney)	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
187969	Fee-for-Service	1801816814	1801816814	1	1	ANTON, ROBERT C MD	4/18/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	151740	30	Radiology	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
187973	Fee-for-Service	1578958047	1578958047	1	1	ASPEN MEDICAL GROUP INC	5/1/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	11441 HEACOCK ST	SUITE B-1	MORENO VALLEY	CA	92557	7907	33	06065	33.954858	-117.243978	Riverside County
188022	Fee-for-Service	1386136828	1386136828	1	1	AIKEN, ACHILLES V MD	12/29/2021	207R00000X	NA	Other	026	PHYSICIANS	165913	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
188029	Fee-for-Service	1649342395	1649342395	1	1	ASCH, MICHELE MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	84609	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
188074	Fee-for-Service	1568425312	1568425312	1	1	ALCOULOUMRE, ERIC M MD	6/30/1983	207P00000X	NA	Other	026	PHYSICIANS	44915	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3828 DELMAS TER	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
188119	Fee-for-Service	1427123496	1427123496	2	1	ANAND NARAYAN MD INC	1/1/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	468 VERMONT AVE	None	DINUBA	CA	93618	1631	54	06107	36.54884449	-119.3894276	Tulare County
188121	Fee-for-Service	1447367586	1447367586	1	1	ALEXOPOULOS, SOPHOCLIS P	10/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99848	02	General Surgery	0	In state provider	MD	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
188130	Fee-for-Service	1972732782	1972732782	1	1	ANDINO, MARIA E	8/19/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1252 BROADWAY	STE B	PLACERVILLE	CA	95667	5827	09	06017	38.73128098	-120.7852781	El Dorado County
188132	Fee-for-Service	1184099970	1184099970	1	1	ADEQUATE CARE HOSPICE INC	5/21/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5323 W HILLSDALE AVE	None	VISALIA	CA	93291	5143	54	06107	36.329292	-119.350422	Tulare County
188190	Fee-for-Service	1669092623	1669092623	1	1	AHMED, NAWAL DO	8/6/2024	208M00000X	NA	Other	026	PHYSICIANS	21286	41	Internal Medicine	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
188193	Fee-for-Service	1992097992	1992097992	1	1	AHMAD YUSUF	1/6/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2150 HOSPITAL DR	None	WINDOM	MN	56101	1287	00	None	43.87837285	-95.11212234	Cottonwood County
188204	Fee-for-Service	1093095739	1093095739	1	1	AHMAD AL-KHASHMAN	8/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
188247	Fee-for-Service	1851408942	1851408942	1	1	ARNETTE, ESTHER E MD	5/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	45872	05	Anesthesiology	0	In state provider	None	2776 PACIFIC AVE	None	LONG BEACH	CA	90806	2316	19	06037	33.80692698	-118.1936915	Los Angeles County
188255	Fee-for-Service	1417200783	1417200783	1	1	ANNE LUHAN MD INC	12/13/2024	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	26691 PLAZA	SUITE 140	MISSION VIEJO	CA	92691	8581	30	06059	33.56533763	-117.6645538	Orange County
188376	Fee-for-Service	1578573697	1578573697	1	1	ALMOND, QUINCY H MD	12/29/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91842	41	Internal Medicine	0	In state provider	None	1310 W STEWART DR	STE 410	ORANGE	CA	92868	3855	30	06059	33.78236048	-117.8664975	Orange County
188450	Fee-for-Service	1972658482	1972658482	1	1	ARES, JOHN R MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	5330 SOUTH HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9225	00	None	35.002656	-114.595893	Mohave County
188452	Fee-for-Service	1770900805	1770900805	1	1	AKHLAQ, NADIA MD	2/1/2018	207R00000X	NA	Other	026	PHYSICIANS	150506	41	Internal Medicine	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
188462	Fee-for-Service	1235903188	1235903188	1	1	ALKHANDAK, DANA AU	12/11/2023	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	802 MAGNOLIA AVE	STE 208	CORONA	CA	92879	3157	33	06065	33.8596449	-117.5529774	Riverside County
188472	Fee-for-Service	1891021531	1891021531	1	1	ABDIAN, PEDRAM S MD	3/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109793	08	Family Practice	0	In state provider	None	1107 S ALVARADO ST	None	LOS ANGELES	CA	90006	4161	19	06037	34.04997092	-118.2810099	Los Angeles County
188523	Fee-for-Service	1811585300	1811585300	1	1	ANDON, VICTOR	3/14/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2446 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	3041	19	06037	34.01449625	-118.1287912	Los Angeles County
188525	Fee-for-Service	1861140337	1861140337	1	1	ALVAREZ, FRANK PT	7/8/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	137 S LAS POSAS RD	STE 254	SAN MARCOS	CA	92078	2475	37	06073	33.14138594	-117.1924065	San Diego County
188530	Fee-for-Service	1891875951	1891875951	1	1	ABOLHODA, AMIR M MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	85458	None	None	0	In state provider	None	3801 KATELLA AVE	SUITE 207	LOS ALAMITOS	CA	90720	3382	30	06059	33.80318951	-118.066068	Orange County
188540	Fee-for-Service	1356872667	1356872667	1	1	AG INFECTIOUS DISEASES, A ME	11/20/2018	282N00000X	NA	Hospitals	026	PHYSICIANS	None	77	Infectious Disease	0	In state provider	DICAL CORPORATION	2121 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2303	19	06037	34.02980528	-118.4786605	Los Angeles County
188557	Fee-for-Service	1720203979	1720203979	1	1	ANG, EDITH L MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	99459	01	General Practice	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
188578	Fee-for-Service	1841364155	1841364155	1	1	ABBASSI, DEREK C MD	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	63678	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
188615	Fee-for-Service	1609801422	1609801422	1	1	AMIN, PRANAV A MD	5/1/1999	207W00000X	NA	Ophthalmology	026	PHYSICIANS	69158	18	Ophthalmology	0	In state provider	None	480 PLUMAS BLVD	None	YUBA CITY	CA	95991	5005	51	06101	39.13286634	-121.6142652	Sutter County
188639	Fee-for-Service	1669090767	1669090767	1	1	AGUILAR, SARAH ELIZABETH R N	10/28/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	P	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
188643	Fee-for-Service	1043336266	1043336266	1	2	AUER, KATHERN L DO	5/28/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	3269 STOCKTON HILL RD	None	KINGMAN	AZ	86409	3619	00	None	35.220006	-114.0380145	Mohave County
188646	Fee-for-Service	1740481043	1740481043	1	1	AGUILAR, LORENZO O JR MD	10/13/2009	174400000X	NA	Other	026	PHYSICIANS	97130	13	Neurology (M.D. only)	0	In state provider	None	803 COFFEE RD	STE 1	MODESTO	CA	95355	4227	50	06099	37.65474897	-120.9756157	Stanislaus County
188662	Fee-for-Service	1821441221	1821441221	1	3	ATHENA BRASFIELD OD A PROFES	12/24/2024	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 FARRELL DR	STE B130	PALM SPRINGS	CA	92262	7949	33	06065	33.81787498	-116.5180068	Riverside County
188682	Fee-for-Service	1154373587	1154373587	1	1	ASHLING, KERRI A MD	2/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	89218	01	General Practice	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
188690	Fee-for-Service	1992479901	1992479901	1	1	AC ELDERLY HOMES INC	9/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1322 W ROBERTS AVE	None	FRESNO	CA	93711	2440	10	06019	36.82011943	-119.8157064	Fresno County
188700	Fee-for-Service	1093863938	1093863938	1	1	ALBUQUERQUE, CHERYL A MD	8/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52603	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
188753	Fee-for-Service	1215323621	1215323621	1	1	AMADI, GRACE P MD	9/1/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	162520	08	Family Practice	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
188770	Fee-for-Service	1861692485	1861692485	1	1	ALDOSS, IBRAHIM T MD	7/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111706	78	Neoplastic Diseases/Oncology	0	In state provider	None	1441 EASTLAKE AVE	NOR 8302E	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
188802	Fee-for-Service	1720042864	1720042864	2	1	ABRAHAM, REGINALD G M MD	6/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	75917	33	Thoracic Surgery	0	In state provider	None	11100 WARNER AVENUE	SUITE 258	FOUNTAIN VALLEY	CA	92708	7512	30	06059	33.716291	-117.9355051	Orange County
188812	Fee-for-Service	1962769109	1962769109	1	1	ASSUMMA, LORRAINE CNP	12/6/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	33205 TEMECULA PKWY	None	TEMECULA	CA	92592	9142	33	06065	33.48600119	-117.0789409	Riverside County
188816	Fee-for-Service	1265791768	1265791768	1	1	ANDERSON, DAVID M DO	7/1/2019	207RC0200X	NA	Other	026	PHYSICIANS	16734	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1485 RIVER PARK DR	STE 200	SACRAMENTO	CA	95815	4501	34	06067	38.599614	-121.438728	Sacramento County
188841	Fee-for-Service	1912106824	1912106824	1	1	ANAYA, CESAR LMFT	10/16/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
188845	Fee-for-Service	1831147248	1831147248	1	1	ARCHIBALD, R BURKE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	THE WOMENS CLINIC	100 E IDAHO, STE 400	None	BOISE	ID	83702	0000	00	None	43.61191085	-116.1938523	Ada County
188876	Fee-for-Service	1598747057	1598747057	2	1	ABUSLEME, VERONICA MD	5/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	38422	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	14621 NORDHOFF ST	STE 2A	PANORAMA CITY	CA	91402	1835	19	06037	34.23544349	-118.451079	Los Angeles County
188878	Fee-for-Service	1598774903	1598774903	2	1	APRIA HEALTCARE LLC	8/23/2015	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	755 BEVINS STREET	None	LAKEPORT	CA	95433	8734	17	06033	39.0369194	-122.9246875	Lake County
188901	Fee-for-Service	1003072307	1003072307	1	1	AMY LYNN MAY NP	3/14/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2401 GILLHAM RD	None	KANSAS CITY	MO	64108	4619	00	None	39.08346695	-94.57884975	Jackson County
188911	Fee-for-Service	1962444836	1962444836	1	1	AVALOS, STEPHEN M MD	6/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	56424	02	General Surgery	0	In state provider	None	FRESNO & R STREETS	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
188912	Fee-for-Service	1740594415	1740594415	1	1	ABDOU, RAFIK MD	9/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122692	41	Internal Medicine	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
188915	Fee-for-Service	1497381537	1497381537	1	1	ANDREW, NICHOLAS T MD	7/1/2023	207P00000X	NA	Other	026	PHYSICIANS	181197	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
188934	Fee-for-Service	1902844111	1902844111	1	1	ANCILLARY MANAGEMENT	1/2/2002	332BN1400X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	SOLUTIONS INC	720 COOL SPRINGS BLVD	STE 600	FRANKLIN	TN	37067	7260	00	None	35.94565297	-86.80557544	Williamson County
188942	Fee-for-Service	1740427657	1740427657	1	8	ALTAMED HEALTH SERVICES CORP	2/8/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	381 N ESPLANADE STREET	None	ORANGE	CA	92869	2909	30	06059	33.7933272	-117.8100421	Orange County
188958	Fee-for-Service	1992453930	1992453930	1	1	ANO ONE FACILITY FOR	9/29/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	THE ELDERLY INC	7907 STANSBURY	None	PANORAMA CITY	CA	91402	5216	19	06037	34.2143455	-118.4399947	Los Angeles County
189011	Fee-for-Service	1255707329	1255707329	1	1	AHMED, TINA M LCSW	9/16/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
189040	Fee-for-Service	1457444069	1457444069	1	1	ANESTHESIA ASSOC	1/1/1979	207LP2900X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	5333 HOLLISTER AVE	STE 130	SANTA BARBARA	CA	93111	3317	42	06083	34.43491982	-119.8105484	Santa Barbara County
189047	Fee-for-Service	1649293259	1649293259	1	1	AN, ARTHUR MD	9/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	61877	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
189058	Fee-for-Service	1508032442	1508032442	1	1	ARYAI, AREZOU A DO	6/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	9438	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
189060	Fee-for-Service	1861692485	1861692485	1	1	ALDOSS, IBRAHIM T MD	7/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111706	68	Hematology	0	In state provider	None	1441 EASTLAKE AVE	NOR 8302E	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
189105	Fee-for-Service	1164416657	1164416657	1	1	AG RANCHO MIRAGE LLC	10/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	39950 VISTA DEL SOL	None	RANCHO MIRAGE	CA	92270	3206	33	06065	33.75843067	-116.3976745	Riverside County
189123	Fee-for-Service	1134689946	1134689946	1	1	AFSHAR, AILEEN MD	2/6/2023	207R00000X	NA	Other	026	PHYSICIANS	181113	None	None	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
189126	Fee-for-Service	1215198379	1215198379	1	1	ATAY, SCOTT M MD	8/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149785	02	General Surgery	0	In state provider	None	1450 SAN PABLO ST	STE 6200	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
189137	Fee-for-Service	1144524893	1144524893	1	1	AFRICA, JONATHAN A S MD	8/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118737	40	Pediatrics	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	34	06067	38.56554	-121.4664615	Sacramento County
189187	Fee-for-Service	1528233418	1528233418	1	1	ATREJA, SURABHI M MD	7/1/2021	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	172091	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
189201	Fee-for-Service	1669460085	1669460085	1	1	AHMAD, SABA MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80424	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1350 W COVINA BLVD	None	SAN DIMAS	CA	91773	3245	19	06037	34.09906108	-117.8343639	Los Angeles County
189231	Fee-for-Service	1740427657	1740427657	1	8	ALTAMED HEALTH SERVICES CORP	2/8/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	381 N ESPLANADE STREET	None	ORANGE	CA	92869	2909	30	06059	33.7933272	-117.8100421	Orange County
189244	Fee-for-Service	1619203189	1619203189	1	1	ACH, EMILY L PHD	10/22/2014	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
189262	Fee-for-Service	1326579483	1326579483	1	1	A.N.A RESIDENTIAL CARE LLC	7/31/2017	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1046 E LANCASTER BLVD	None	LANCASTER	CA	93535	2752	19	06037	34.69682711	-118.1109074	Los Angeles County
189269	Fee-for-Service	1770654949	1770654949	1	1	ARORA, SHEILLY PHD	12/8/2006	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	STE 230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
189279	Fee-for-Service	1851509269	1851509269	1	1	ANDERSON,BRITNEY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	0000	00	None	39.742182	-104.8408515	Adams County
189286	Fee-for-Service	1669789186	1669789186	1	1	ALISAL UNION SCHOOL DIST	1/10/1995	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1441 DEL MONTE AVE	None	SALINAS	CA	93905	1902	27	06053	36.68184793	-121.6048012	Monterey County
189305	Fee-for-Service	1619288859	1619288859	1	1	AKINYEMI, YESIDE O MD	10/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121314	None	None	0	In state provider	None	3700 E SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.8601747	-118.148313	Los Angeles County
189326	Fee-for-Service	1851465819	1851465819	2	1	AGING CARE INC	10/28/2022	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	7277 HAYVENHURST AVE	B14	VAN NUYS	CA	91406	2860	19	06037	34.20317268	-118.4937001	Los Angeles County
189335	Fee-for-Service	1649293259	1649293259	1	1	AN, ARTHUR MD	9/21/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	61877	13	Neurology (M.D. only)	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
189340	Fee-for-Service	1447414099	1447414099	1	1	ALMOHAMMAD ALJOMAH, GHANIM	9/6/2023	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	167937	None	None	0	In state provider	MD	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
189350	Fee-for-Service	1861692485	1861692485	1	1	ALDOSS, IBRAHIM T MD	7/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	111706	41	Internal Medicine	0	In state provider	None	1441 EASTLAKE AVE	NOR 8302E	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
189411	Fee-for-Service	1629765680	1629765680	1	1	ARNOLD, SHARON LYNN	5/3/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5822 THELMA AVE	None	LA PALMA	CA	90623	1549	30	06059	33.85081447	-118.0314173	Orange County
189420	Fee-for-Service	1073069332	1073069332	1	1	AHMAD, MASOOD MD	4/15/2024	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	None	None	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
189428	Fee-for-Service	1144524893	1144524893	1	1	AFRICA, JONATHAN A S MD	8/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	118737	10	Gastroenterology (M.D. only)	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7053	34	06067	38.56554	-121.4664615	Sacramento County
189525	Fee-for-Service	1023191780	1023191780	1	1	A-V MERIDIEN MEDICAL GRP	3/12/1996	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	1007 W AVENUE M14	STE B1	PALMDALE	CA	93551	1443	19	06037	34.63305153	-118.148193	Los Angeles County
189541	Fee-for-Service	1376619577	1376619577	1	1	ASPIRAS, CATHERINE LMFT	7/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
189544	Fee-for-Service	1225233349	1225233349	1	1	ANESTHESIA CONSULTANTS	7/19/2007	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OF THE DESERT, INC	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
189585	Fee-for-Service	1740787829	1740787829	1	1	ARCINIEGAS CALLE, MARIA C MD	11/11/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	174315	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
189605	Fee-for-Service	1366947343	1366947343	1	1	ATALLAH, JULIANA MD	8/20/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
189653	Fee-for-Service	1124018031	1124018031	1	1	ADVENTIST HEALTH CLEARLAKE	7/1/1997	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	15630 18TH AVE	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
189677	Fee-for-Service	1285825927	1285825927	1	1	AYRA, JYOTI MD	11/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53103	24	Plastic Surgery	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
189700	Fee-for-Service	1629765680	1629765680	1	1	ARNOLD, SHARON LYNN	5/3/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5822 THELMA AVE	None	LA PALMA	CA	90623	1549	30	06059	33.85081447	-118.0314173	Orange County
189719	Fee-for-Service	1720175425	1720175425	1	1	ANGELL, SCOTT KENYON	5/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	77581	34	Urology and Urological Surgery	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
189757	Fee-for-Service	1093979205	1093979205	1	1	AZER, IBRAHIM W MD	5/3/2018	208600000X	NA	General Surgery	026	PHYSICIANS	151984	02	General Surgery	0	In state provider	None	315 MERCY AVE	STE 400	MERCED	CA	95340	8363	24	06047	37.33874349	-120.467493	Merced County
189758	Fee-for-Service	1184736357	1184736357	1	1	AGHAI, MEHRDAD MD	1/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	83156	18	Ophthalmology	0	In state provider	CENTURY EYE CARE MED CTR	1141 W REDONDO BEACH BLV	STE 101	GARDENA	CA	90247	3585	19	06037	33.89247036	-118.2941482	Los Angeles County
189768	Fee-for-Service	1093746752	1093746752	1	1	ADVANCE OCCUPATIONAL & HAND	12/15/2016	193400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	HAND THERAPY CENTER	22 ODYSSEY	SUITE 165	IRVINE	CA	92618	3607	30	06059	33.66719598	-117.7642461	Orange County
189788	Fee-for-Service	1730342114	1730342114	1	1	ATILOLA, OPEYEMI O MD	3/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	120909	01	General Practice	0	In state provider	None	1582 W SAN MARCOS BLVD	STE 100	SAN MARCOS	CA	92078	4081	37	06073	33.13145446	-117.202167	San Diego County
189789	Fee-for-Service	1609365824	1609365824	1	2	ANCHORED PSYCHIATRIC NURSING	11/20/2023	193400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	SERVICES, INC.	14081 YORBA ST	STE 105	TUSTIN	CA	92780	2050	30	06059	33.7582604	-117.8296904	Orange County
189806	Fee-for-Service	1528308004	1528308004	1	1	ADVENTIST HEALTH PHYSICIANS	5/23/2013	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	18990 COYOTE VALLEY RD	STE 5	HIDDEN VALLEY LKE	CA	95467	8339	17	06033	38.79462138	-122.5574782	Lake County
189815	Fee-for-Service	1023191780	1023191780	1	1	A-V MERIDIEN MEDICAL GRP	3/12/1996	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1007 W AVENUE M14	STE B1	PALMDALE	CA	93551	1443	19	06037	34.63305153	-118.148193	Los Angeles County
189852	Fee-for-Service	1346833712	1346833712	1	1	AD TRANSPORT LLC	9/6/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2993 FULTON AVE	STE. A	SACRAMENTO	CA	95821	4931	34	06067	38.619684	-121.4018145	Sacramento County
189871	Fee-for-Service	1497324388	1497324388	1	1	AUSTIN, THERESA	10/31/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	615 WEST AVE L	None	LANCASTER	CA	93545	7211	19	06037	34.6603515	-118.1419695	Los Angeles County
189879	Fee-for-Service	1174109797	1174109797	1	1	AGRAWAL, ADITYA MD	7/1/2024	207P00000X	NA	Other	026	PHYSICIANS	191758	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
189895	Fee-for-Service	1811616642	1811616642	1	1	ACHARYA, SHAMJANA NP	9/22/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	23180 HEMLOCK AVE	SUITE 201	MORENO VALLEY	CA	92557	8001	33	06065	33.94245952	-117.2585565	Riverside County
189944	Fee-for-Service	1124018031	1124018031	1	1	ADVENTIST HEALTH CLEARLAKE	7/1/1997	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	15630 18TH AVE	None	CLEARLAKE	CA	95422	9336	17	06033	38.93612361	-122.6201499	Lake County
189973	Fee-for-Service	1699792655	1699792655	1	1	AKERS, AMY H MD	4/24/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	77523	13	Neurology (M.D. only)	0	In state provider	None	2324 SACRAMENTO ST	None	SAN FRANCISCO	CA	94115	2383	38	06075	37.79020149	-122.4313011	San Francisco County
189976	Fee-for-Service	1023072253	1023072253	1	1	ALEMAN, EDGAR MD	10/31/1983	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	53591	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1505 WILSON TER	STE 150	GLENDALE	CA	91206	4076	19	06037	34.14960934	-118.2313491	Los Angeles County
189991	Fee-for-Service	1992169783	1992169783	1	1	AGTUCA, LINH DO	10/3/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17380	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
189993	Fee-for-Service	1043779903	1043779903	1	1	ANDRES, GAL MD	5/2/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	179058	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
190013	Fee-for-Service	1679068969	1679068969	1	1	AKGUN, YAMAC MD	7/6/2023	207ZP0213X	NA	Other	026	PHYSICIANS	182046	None	None	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
190017	Fee-for-Service	1558445239	1558445239	1	1	ALLEN, MATTHEW W MD	4/2/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	None	None	0	In state provider	None	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	04	06007	39.74352822	-121.8495394	Butte County
190038	Fee-for-Service	1891415139	1891415139	1	1	ATZ VALLEY CORPORATION	4/7/2022	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	2447 PACIFIC COAST HWY	SUITE 201	HERMOSA BEACH	CA	90254	2714	19	06037	33.87172011	-118.3950341	Los Angeles County
190051	Fee-for-Service	1174901094	1174901094	1	1	ABOU DARGHAM, HANADI MD	7/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153050	01	General Practice	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
190055	Fee-for-Service	1093746752	1093746752	1	1	ADVANCE OCCUPATIONAL & HAND	5/25/2010	193400000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	HAND THERAPY CENTER	22 ODYSSEY	SUITE 165	IRVINE	CA	92618	3607	30	06059	33.66719598	-117.7642461	Orange County
190057	Fee-for-Service	1558548503	1558548503	1	1	ASHRAFI, AMIR H MD	5/15/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102155	40	Pediatrics	0	In state provider	None	6430 SUNSET BLVD	STE 600	LOS ANGELES	CA	90028	7900	19	06037	34.09797681	-118.3299393	Los Angeles County
190092	Fee-for-Service	1295053858	1295053858	1	1	AVASCO MEDICAL SUPPLY INC	8/8/2018	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4268 E LOS ANGELES AVE	SUITE 102	SIMI VALLEY	CA	93063	3366	56	06111	34.271654	-118.7111799	Ventura County
190107	Fee-for-Service	1700087590	1700087590	1	1	ALAMEDA HEALTH SYSTEM	7/1/1971	282N00000X	NA	Hospitals	061	COUNTY HOSPITAL OUTPATIENT	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
190119	Fee-for-Service	1073849857	1073849857	1	1	ABERNETHY, MARY SUSAN LMFT	10/21/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	162 HACIENDA CARMEL	None	CARMEL	CA	93923	7946	27	06053	36.53784707	-121.8805623	Monterey County
190155	Fee-for-Service	1861620254	1861620254	1	1	ARORA, ANUPAM MD	4/10/2024	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
190166	Fee-for-Service	1720634652	1720634652	1	1	AMARIEI, LIVIU CRNA	1/1/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	869 CHERRY STREET	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
190207	Fee-for-Service	1861622334	1861622334	1	1	ALI, HUMA MD	2/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121824	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
190214	Fee-for-Service	1225800469	1225800469	1	1	ALUGBUE, DARLENE	9/25/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2373 COLORADO BLVD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
190223	Fee-for-Service	1104360627	1104360627	1	1	ABDELSAMIE, NISRIN NP	9/16/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
190230	Fee-for-Service	1679726103	1679726103	1	1	ANDRY, JAMES P MD	3/4/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	173003	None	None	0	In state provider	None	9834 GENESEE AVE	SUITE 228	LA JOLLA	CA	92037	1215	37	06073	32.884074	-117.225855	San Diego County
190297	Fee-for-Service	1952489403	1952489403	1	1	AYAD, MEDHAT S MD	4/20/2021	207L00000X	NA	Other	026	PHYSICIANS	55847	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
190310	Fee-for-Service	1134204407	1134204407	1	1	ANTHONY GOMEZ	2/26/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	760 BROADWAY	None	BROOKLYN	NY	11206	5317	00	None	40.700349	-73.9416015	Kings County
190324	Fee-for-Service	1528649969	1528649969	1	1	ALAVI, CYRUS A MD	8/21/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
190329	Fee-for-Service	1861012916	1861012916	1	1	ATTA HEALTHCARE INC	6/8/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1316 COFFEE RD	BLDG B2	MODESTO	CA	95355	3191	50	06099	37.66234964	-120.975634	Stanislaus County
190336	Fee-for-Service	1942729322	1942729322	1	1	AZURE HOME HEALTH INC	9/29/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2910 INLAND EMPIRE BLVD	STE 101	ONTARIO	CA	91764	4896	36	06071	34.06986	-117.589617	San Bernardino County
190344	Fee-for-Service	1851531487	1851531487	1	1	AGUINALDO, MICHAEL J MD	4/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105635	40	Pediatrics	0	In state provider	None	10800 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
190364	Fee-for-Service	1962168435	1962168435	1	1	ADMASSU, MERON M CRNA	2/16/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
190366	Fee-for-Service	1962633289	1962633289	1	1	AFSARI, ROUZBEH MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124032	41	Internal Medicine	0	In state provider	None	1500 S CENTRAL AVE	STE 300	GLENDALE	CA	91204	2587	19	06037	34.12736888	-118.257777	Los Angeles County
190407	Fee-for-Service	1942540497	1942540497	1	1	AFFILIATED PATHOLOGISTS OF	7/29/2013	193200000X	NA	Other	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	THE CENTRAL COAST	345 S HALCYON RD	None	ARROYO GRANDE	CA	93420	3817	40	06079	35.113419	-120.5915945	San Luis Obispo County
190409	Fee-for-Service	1487944336	1487944336	1	1	ATACY GOOD	12/18/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 N THIRD AVE	None	SANDPOINT	ID	83864	1507	00	None	48.27786153	-116.5503511	Bonner County
190434	Fee-for-Service	1659088714	1659088714	1	1	ACTINIUM MEDICAL CORPORATION	6/5/2023	261QP2300X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	101 E BEVERLY BLVD	100A	MONTEBELLO	CA	90640	4314	19	06037	34.01556395	-118.0983878	Los Angeles County
190443	Fee-for-Service	1396939575	1396939575	1	1	AVILA, SANDRA G MD	8/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	95714	01	General Practice	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5301	19	06037	34.06269295	-118.2030006	Los Angeles County
190450	Fee-for-Service	1679971436	1679971436	1	1	A P MEDS INC	4/1/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	26930 CHERRY HILLS BLVD	None	MENIFEE	CA	92856	2574	33	06065	33.71087108	-117.1899906	Riverside County
190455	Fee-for-Service	1821441221	1821441221	1	1	ATHENA BRASFIELD OD A PROFES	8/18/2016	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONAL CORPORATION	82227 US HWY 111	STE B2	INDIO	CA	92201	5668	33	06065	33.71471443	-116.2312195	Riverside County
190497	Fee-for-Service	1740556638	1740556638	1	1	ALLEN, SANDY R LMFT	9/7/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5623	19	06037	34.21980849	-118.4301135	Los Angeles County
190500	Fee-for-Service	1932582699	1932582699	1	9	AKSHAY MEHTA MD INC	1/17/2020	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
190512	Fee-for-Service	1922575760	1922575760	1	1	ADVANCED HOME HEALTH CARE	2/17/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	269 W ALAMEDA AVE	STE E	BURBANK	CA	91502	3302	19	06037	34.16723083	-118.3075057	Los Angeles County
190529	Fee-for-Service	1932183829	1932183829	1	1	AL-HASAN, MOHAMMAD MD	1/1/2002	207R00000X	NA	Other	026	PHYSICIANS	61093	None	None	0	In state provider	None	41 SANTA ANA RD	None	HOLLISTER	CA	95023	4016	35	06069	36.85662486	-121.4013221	San Benito County
190542	Fee-for-Service	1932283264	1932283264	1	1	ASSOCIATED PATHOLOGY	5/21/1991	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	MEDICAL GROUP INC	105A COOPER CT	None	LOS GATOS	CA	95032	7604	43	06085	37.23999545	-121.972994	Santa Clara County
190565	Fee-for-Service	1861091225	1861091225	1	1	AMARAL, AMBERLEE D CRNA	3/12/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
190580	Fee-for-Service	1689624652	1689624652	1	1	ANDRUS, DAN L MD	9/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	31470	08	Family Practice	0	In state provider	None	28780 SINGLE OAK DR	SUITE 160	TEMECULA	CA	92590	4080	33	06065	33.49890392	-117.1612965	Riverside County
190605	Fee-for-Service	1013012921	1013012921	1	1	ARROWHEAD RADIOLOGY	5/19/2003	2085N0904X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP, INC	600 N HIGHLAND SPRINGS A	None	BANNING	CA	92220	3046	33	06065	33.9316595	-116.9468639	Riverside County
190622	Fee-for-Service	1134163488	1134163488	1	1	ARIZONA CVS STORES LLC	1/31/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	1	Border provider	None	2350 MIRACLE MILE	None	BULLHEAD CITY	AZ	86442	7505	00	None	35.100045	-114.5947455	Mohave County
190673	Fee-for-Service	1134363252	1134363252	1	1	ABU-SHEHAB, NAEEM N MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115147	41	Internal Medicine	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
190683	Fee-for-Service	1124083274	1124083274	1	1	ANTAKI & ASSOCIATES	4/17/2003	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INFECTIOUS DISEASE MED	801 S CHEVY CHASE DR	STE 101	GLENDALE	CA	91205	4437	19	06037	34.136757	-118.2396195	Los Angeles County
190686	Fee-for-Service	1508850397	1508850397	1	1	AMON,HENRY G MD	3/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2003 LINCOLN WAY	None	COUEUR D'ALENE	ID	83814	2677	00	None	47.69465937	-116.7917936	Kootenai County
190711	Fee-for-Service	1487647293	1487647293	1	1	AHAD, ARSHAD MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144051	78	Neoplastic Diseases/Oncology	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
190718	Fee-for-Service	1720543762	1720543762	1	1	ADVANCED ANESTHESIA INCORPOR	10/1/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	ATED	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
190721	Fee-for-Service	1598795429	1598795429	1	1	AMBROSE, JOHN A MD	8/29/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87536	41	Internal Medicine	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
190773	Fee-for-Service	1538352554	1538352554	1	1	ARNOLD, ELIZABETH T MD	11/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99241	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
190775	Fee-for-Service	1376922914	1376922914	1	1	ALDEA INC	3/26/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 MYRTLE AVE	None	NAPA	CA	94558	4743	28	06055	38.3138497	-122.3023417	Napa County
190809	Fee-for-Service	1023636545	1023636545	1	1	AHMC SETON MEDICAL CENTER	1/27/2021	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	LLC	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
190827	Fee-for-Service	1689942294	1689942294	1	1	ACTIVE LIFE, LLC	2/6/2012	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2140 W CHAPMAN AVE	SUITE 103	ORANGE	CA	92868	2331	30	06059	33.78787403	-117.8757819	Orange County
190844	Fee-for-Service	1760409197	1760409197	1	1	ARRETZ, DESIREE S MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	53241	41	Internal Medicine	0	In state provider	None	1580 VALENCIA ST	STE 506	SAN FRANCISCO	CA	94110	4418	38	06075	37.74746923	-122.4202583	San Francisco County
190846	Fee-for-Service	1205413275	1205413275	1	1	AGDASHIAN, DAVID M	10/22/2024	208M00000X	NA	Other	026	PHYSICIANS	186992	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
190861	Fee-for-Service	1861450413	1861450413	1	1	ANAGNOST, MARY E	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1009 E LA HABRA BLVD	None	LA HABRA	CA	90631	5575	30	06059	33.93194357	-117.9351201	Orange County
190868	Fee-for-Service	1013680453	1013680453	1	1	ARKHAM OPERATIONS LLC	6/30/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	147 CRESCENT AVE	None	SUNNYVALE	CA	94087	2723	43	06085	37.35623004	-122.0305998	Santa Clara County
190879	Fee-for-Service	1184669137	1184669137	1	1	ANGLE, DONALD F MD	11/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	2400 S AVE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
190880	Fee-for-Service	1407230022	1407230022	1	1	ANTONIO N ROMERO MD, INC	12/29/2021	261QM2500X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	10230 ARTESIA BLVD	209	BELLFLOWER	CA	90706	6763	19	06037	33.8728276	-118.1160403	Los Angeles County
190888	Fee-for-Service	1609435098	1609435098	3	1	APEX RX INC	6/21/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	13309 VICTORY BLVD	STE A	VAN NUYS	CA	91401	1832	19	06037	34.18671151	-118.4228685	Los Angeles County
190918	Fee-for-Service	1033273164	1033273164	1	1	ALEJANDRO J NECOCHEA, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	520 S EAGLE RD	None	MERIDIAN	ID	83642	6351	00	None	43.600527	-116.3518425	Ada County
190957	Fee-for-Service	1962556076	1962556076	1	1	AK SURGERY CENTER, LLC	11/5/2019	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	13690 E 14TH ST	SUITE 200	SAN LEANDRO	CA	94578	2582	01	06001	37.71615361	-122.1438999	Alameda County
190976	Fee-for-Service	1265485155	1265485155	1	1	AMES, CHRISTOPHER P MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	60247	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	RM A808	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
191002	Fee-for-Service	1487647293	1487647293	1	1	AHAD, ARSHAD MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	144051	68	Hematology	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
191016	Fee-for-Service	1194315697	1194315697	1	1	ADEDURO, CHRISTIANAH NP	3/9/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95016168	-	NOT APPLICABLE	0	In state provider	None	45335 SIERRA HWY	None	LANCASTER	CA	93534	1611	19	06037	34.7068568	-118.1383834	Los Angeles County
191023	Fee-for-Service	1821295163	1821295163	1	1	ANANTHARAJ, ANGELA P MD	7/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102654	41	Internal Medicine	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
191024	Fee-for-Service	1386123719	1386123719	1	1	ALCOHOL & DRUG AWARENESS PRO	7/14/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1981 CHEROKEE RD	None	STOCKTON	CA	95205	2720	39	06077	37.97936569	-121.2634936	San Joaquin County
191036	Fee-for-Service	1194832493	1194832493	1	1	AMARA, SASHIBINDU MD	2/8/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	54465	41	Internal Medicine	0	In state provider	None	2250 HAYES ST	STE 504	SAN FRANCISCO	CA	94117	1078	38	06075	37.77302042	-122.45342	San Francisco County
191049	Fee-for-Service	1205218153	1205218153	1	1	ABEYSUNDARA, HESHANI W MD	1/8/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151850	08	Family Practice	0	In state provider	None	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4356	52	06103	40.14847323	-122.2180997	Tehama County
191073	Fee-for-Service	1346764776	1346764776	1	1	ALLY HOSPICE CORPORATION	8/24/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	202 E AIRPORT DR	SUITE 240	SAN BERNARDINO	CA	92408	3404	36	06071	34.06737938	-117.2834702	San Bernardino County
191098	Fee-for-Service	1023636545	1023636545	1	1	AHMC SETON MEDICAL CENTER	1/27/2021	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	LLC	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
191099	Fee-for-Service	1629266671	1629266671	1	1	AIKEN, SHEA D MD	7/18/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	101249	05	Anesthesiology	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
191120	Fee-for-Service	1710963400	1710963400	1	1	ALEXANDER, ANDREW G MD	12/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	50850	41	Internal Medicine	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
191145	Fee-for-Service	1376047647	1376047647	1	1	ALAM, MOHAMMAD MD	12/6/2022	207R00000X	NA	Other	026	PHYSICIANS	179808	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
191188	Fee-for-Service	1548807332	1548807332	1	1	ATTAIE HEALTHCARE INC	2/25/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4133 MOHR AVE	STE B	PLEASANTON	CA	94566	4750	01	06001	37.68195698	-121.8737212	Alameda County
191194	Fee-for-Service	1093475543	1093475543	1	1	AGUILAR, VLADIMIR NP	7/1/2022	363LC0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
191197	Fee-for-Service	1639260987	1639260987	1	1	AGNEW, CONNIE MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	53176	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	301 S FAIR OAKS AVE	STE 301	PASADENA	CA	91105	2562	19	06037	34.140348	-118.1504565	Los Angeles County
191208	Fee-for-Service	1578557229	1578557229	1	1	ARUL, INPAMANI S MD INC	8/31/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	33003	22	Pathology (M.D. only)	0	In state provider	None	38600 MEDICAL CENTER DR	None	PALMDALE	CA	93551	4483	19	06037	34.58364037	-118.1441012	Los Angeles County
191217	Fee-for-Service	1295759694	1295759694	1	1	ALI, MIR B MD	9/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	43033	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
191219	Fee-for-Service	1740290634	1740290634	1	1	ALTA CALIFORNIA MEDICAL	3/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	2925 SYCAMORE DR	STE 204	SIMI VALLEY	CA	93065	1208	56	06111	34.288398	-118.7439175	Ventura County
191253	Fee-for-Service	1538320916	1538320916	1	1	ALMAS, ROXANNE MD	5/3/2019	2080P0006X	NA	Psychiatry	026	PHYSICIANS	131233	26	Psychiatry (child)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
191293	Fee-for-Service	1699768903	1699768903	1	1	ALTA ORTHOPAEDIC MEDICAL	7/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	GROUP INC	511 BATH ST	None	SANTA BARBARA	CA	93101	3403	42	06083	34.41386476	-119.6993335	Santa Barbara County
191298	Fee-for-Service	1790942274	1790942274	1	1	ARORA, SANDEEP S MD	5/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122289	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
191326	Fee-for-Service	1033277579	1033277579	1	1	ALIABADI, MARGARET M NP	7/2/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
191335	Fee-for-Service	1659553162	1659553162	1	1	AUNG, THU H MD	5/25/2010	208M00000X	NA	Other	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	2640 E BARNETT RD	None	MEDFORD	OR	97504	4301	00	None	42.31645852	-122.834421	Jackson County
191339	Fee-for-Service	1093166795	1093166795	1	1	AHN, TERRIE S MD	5/12/2022	207K00000X	NA	Other	026	PHYSICIANS	162214	None	None	0	In state provider	None	1245 16TH STREET	303	SANTA MONICA	CA	90404	1265	19	06037	34.02726451	-118.4857138	Los Angeles County
191358	Fee-for-Service	1346764776	1346764776	1	1	ALLY HOSPICE CORPORATION	8/24/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	202 E AIRPORT DR	SUITE 240	SAN BERNARDINO	CA	92408	3404	36	06071	34.06737938	-117.2834702	San Bernardino County
191368	Fee-for-Service	1811275076	1811275076	1	1	ABDELHAMID, NOURELDIN M MD	3/6/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	170524	None	None	0	In state provider	None	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	38	06075	37.78594176	-122.421322	San Francisco County
191373	Fee-for-Service	1982458261	1982458261	1	1	ADAMS, KYRBE NICOLE	7/7/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	9593 VILLAGE TREE DR	None	ELK GROVE	CA	95758	1198	34	06067	38.41092	-121.407309	Sacramento County
191382	Fee-for-Service	1215983861	1215983861	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9831 CAMPO RD	None	SPRING VALLEY	CA	91977	1418	37	06073	32.74794448	-116.98407	San Diego County
191394	Fee-for-Service	1386123719	1386123719	1	2	ALCOHOL & DRUG AWARENESS PRO	11/17/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1981 CHEROKEE ROAD	OP MEETING ROOM	STOCKTON	CA	95205	2720	39	06077	37.97936569	-121.2634936	San Joaquin County
191430	Fee-for-Service	1871613356	1871613356	1	1	ALLEN, AMY	7/23/2010	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
191438	Fee-for-Service	1639579105	1639579105	1	1	ARMINE GHAZARYAN, MD INC	8/4/2014	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	115938	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1505 WILSON TERRACE	SUITE #170	GLENDALE	CA	91206	4071	19	06037	34.14960934	-118.2313491	Los Angeles County
191440	Fee-for-Service	1689624017	1689624017	1	1	ANDREW LIVINGSTON	11/21/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2060 E PARIS AVE SE	STE 100A	GRAND RAPIDS	MI	49546	6113	00	None	42.92606436	-85.5695008	Kent County
191464	Fee-for-Service	1871026823	1871026823	1	1	AWAD, AHMED MD	3/31/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
191471	Fee-for-Service	1841436193	1841436193	1	1	ALLEN, SCOTT R	8/23/2022	207ZP0102X	NA	Other	026	PHYSICIANS	169847	None	None	0	In state provider	None	250 S GRAND AVE	None	GLENDORA	CA	91741	4218	19	06037	34.132842	-117.872523	Los Angeles County
191479	Fee-for-Service	1881666741	1881666741	1	1	AMERIPATH CINCINNATI INC	11/13/2018	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	9844 REDHILL DR	None	CINCINNATI	OH	45242	5627	00	None	39.23754363	-84.3797489	Hamilton County
191508	Fee-for-Service	1295759694	1295759694	1	1	ALI, MIR B MD	9/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	43033	01	General Practice	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
191521	Fee-for-Service	1023075363	1023075363	1	1	AGGARWAL, VINOD K MD	1/24/2023	207RP1001X	NA	Pulmonology	026	PHYSICIANS	153542	None	None	0	In state provider	None	3000 Q STREET	2ND FLOOR	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
191522	Fee-for-Service	1033891320	1033891320	1	1	A & A ASSISTED LIV HOMES INC	9/19/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	9857 LA TUNA CANYON RD	None	SUN VALLEY	CA	91352	2254	19	06037	34.23487868	-118.3459961	Los Angeles County
191551	Fee-for-Service	1649566001	1649566001	1	1	ALI, ALYAN M MD	8/21/2017	390200000X	NA	Other	026	PHYSICIANS	123073	66	Emergency Medicine (Urgent Care)	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
191574	Fee-for-Service	1154432607	1154432607	1	2	ADVANCED OB/GYN	6/7/1991	174400000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	INFERTILITY MED GROUP	3420 BRISTOL ST	STE 330	COSTA MESA	CA	92626	6920	30	06059	33.6939082	-117.8853263	Orange County
191577	Fee-for-Service	1801644737	1801644737	1	1	ANDREAS MARWICK PSYCHOLOGIST	10/2/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1410 BELLEAIRE ST	None	OCEANSIDE	CA	92054	5502	37	06073	33.18768862	-117.3584409	San Diego County
191579	Fee-for-Service	1699768903	1699768903	1	1	ALTA ORTHOPAEDIC MEDICAL	12/12/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP INC	511 BATH ST	None	SANTA BARBARA	CA	93101	3403	42	06083	34.41386476	-119.6993335	Santa Barbara County
191623	Fee-for-Service	1184825416	1184825416	1	1	ALVAREZ, ANTONIO G MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115592	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
191643	Fee-for-Service	1912044181	1912044181	1	1	ANANDA, ANANDA P MD	7/31/1983	207R00000X	NA	Other	026	PHYSICIANS	35301	41	Internal Medicine	0	In state provider	None	501 W CHANNEL ISLANDS BL	STE 303	PORT HUENEME	CA	93041	2128	56	06111	34.17603362	-119.211875	Ventura County
191663	Fee-for-Service	1982458261	1982458261	1	1	ADAMS, KYRBE NICOLE	7/7/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	9593 VILLAGE TREE DR	None	ELK GROVE	CA	95758	1198	34	06067	38.41092	-121.407309	Sacramento County
191673	Fee-for-Service	1801947908	1801947908	1	1	AUTREY-MADDEN, MONICA V LMFT	10/3/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2335 COUNTRY HILLS DR	None	ANTIOCH	CA	94509	7319	07	06013	37.97021462	-121.7841321	Contra Costa County
191687	Fee-for-Service	1396945036	1396945036	1	1	ANSPIKIAN, ARA M MD	9/25/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	99106	36	Psychiatry	0	In state provider	None	1686 BARTON RD	None	REDLANDS	CA	90074	4701	36	06071	34.04833901	-117.2120103	San Bernardino County
191712	Fee-for-Service	1316925761	1316925761	2	1	ALTUWAIJRI, MARAYA MD	5/22/2024	2086S0129X	NA	General Surgery	026	PHYSICIANS	78502	02	General Surgery	0	In state provider	ENTER	114 PACIFICA	STE 370	IRVINE	CA	92618	3302	30	06059	33.66074638	-117.7539212	Orange County
191728	Fee-for-Service	1891419586	1891419586	2	1	AVENIDA	11/3/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	901 CIVIC CENTER DR	2ND FLOOR OFFICE NUMBER	SANTA ANA	CA	92703	2352	30	06059	33.75155572	-117.8778014	Orange County
191729	Fee-for-Service	1932173085	1932173085	1	1	ALZATE, GREGG D MD	1/1/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	42015	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
191737	Fee-for-Service	1538191499	1538191499	1	1	ALBERT, CHRISTINE M MD	11/6/2019	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	166159	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
191753	Fee-for-Service	1811056575	1811056575	1	1	AJIT-UPPAR, JASUIR KAUR	5/31/1991	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49427	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
191766	Fee-for-Service	1326551540	1326551540	1	1	ARAKI, REBECCA PT	10/21/2019	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
191785	Fee-for-Service	1740224856	1740224856	2	1	ALEXANDER, RUSSEL H MD	4/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	54958	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
191786	Fee-for-Service	1962963769	1962963769	1	1	ASAHI, MASUMI G DO	7/9/2023	390200000X	NA	Other	026	PHYSICIANS	20765	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
191793	Fee-for-Service	1700207982	1700207982	1	1	ASKLEPIUS HOME HEALTH INC	5/4/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14039 SHERMAN WAY	STE 202	VAN NUYS	CA	91405	2593	19	06037	34.20124448	-118.4390775	Los Angeles County
191795	Fee-for-Service	1255745584	1255745584	1	1	AFRA, ROBERT MD A	11/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	96247	None	None	0	In state provider	PROFESSIONAL CORPORATION	317 N EL CAMINO REAL	SUITE 405	ENCINITAS	CA	92024	2810	37	06073	33.05428107	-117.2615637	San Diego County
191797	Fee-for-Service	1518462589	1518462589	1	1	AYOUB, FAHED N MD	7/23/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	163479	04	Otology, Laryngology, Rhinology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
191818	Fee-for-Service	1538317730	1538317730	1	1	AL-SARRAF, LENA DO	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6339	01	General Practice	0	In state provider	None	5353 G ST	None	CHINO	CA	91710	5249	36	06071	34.00987149	-117.6880905	San Bernardino County
191836	Fee-for-Service	1730531468	1730531468	1	1	ADVENTIST HEALTH PHYSICIANS	11/23/2016	193200000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	999 S FAIRMONT AVENUE	SUITE 125	LODI	CA	95240	5141	39	06077	38.1206163	-121.2858323	San Joaquin County
191840	Fee-for-Service	1649566001	1649566001	1	1	ALI, ALYAN M MD	8/21/2017	390200000X	NA	Other	026	PHYSICIANS	123073	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	20103 LAKE CHABOT RD	None	CASTRO VALLEY	CA	94546	5305	01	06001	37.698264	-122.090112	Alameda County
191844	Fee-for-Service	1467126029	1467126029	1	1	ANDERSON, CHRISTINE R PT	8/12/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	116 S LASSEN ST	None	WILLOWS	CA	95988	3009	11	06021	39.52027795	-122.1995617	Glenn County
191865	Fee-for-Service	1154432607	1154432607	1	2	ADVANCED OB/GYN	6/7/1991	174400000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	INFERTILITY MED GROUP	3420 BRISTOL ST	STE 330	COSTA MESA	CA	92626	6920	30	06059	33.6939082	-117.8853263	Orange County
191868	Fee-for-Service	1699768903	1699768903	1	1	ALTA ORTHOPAEDIC MEDICAL	11/1/2024	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	511 BATH ST	None	SANTA BARBARA	CA	93101	3403	42	06083	34.41386476	-119.6993335	Santa Barbara County
191919	Fee-for-Service	1376765099	1376765099	1	1	AUER, CHRISTINA M LCSW	10/19/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10601 CIVIC CENTER DR	STE 100 A-D	RANCHO CUCAMONGA	CA	91730	3878	36	06071	34.1023554	-117.5735696	San Bernardino County
191928	Fee-for-Service	1043439813	1043439813	1	1	ANYAOHA, AMAKA L NP	12/11/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3900 E PACIFIC COAST HWY	None	LONG BEACH	CA	90804	2013	19	06037	33.78982251	-118.1462265	Los Angeles County
191930	Fee-for-Service	1477143915	1477143915	1	1	AGUILA, EILEEN	9/13/2023	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	12791 NEWPORT AVENUE	SUITE 101	TUSTIN	CA	92780	2785	30	06059	33.75168784	-117.808677	Orange County
191946	Fee-for-Service	1407297005	1407297005	1	1	ANAND, AMAR MD	10/19/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	149857	None	None	0	In state provider	None	155 GLEN COVE MARINA RD	SUITE 100	VALLEJO	CA	94591	7284	48	06095	38.07026311	-122.2123223	Solano County
192004	Fee-for-Service	1407934227	1407934227	1	1	ADAMS, BRETT L MD	6/5/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	71929	04	Otology, Laryngology, Rhinology	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
192017	Fee-for-Service	1942512744	1942512744	1	1	ARTER, JOEL L MD	5/25/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	171369	None	None	0	In state provider	None	2880 ATLANTIC AVE	SUITE 170	LONG BEACH	CA	90806	1715	19	06037	33.809382	-118.185001	Los Angeles County
192018	Fee-for-Service	1801254529	1801254529	1	1	ANGELES, JENIFER J CNM	3/17/2016	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3343 4TH AVENUE	None	SAN DIEGO	CA	92103	5703	37	06073	32.740353	-117.1612435	San Diego County
192026	Fee-for-Service	1962458463	1962458463	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8938 TRAUTWEIN RD	None	RIVERSIDE	CA	92508	9401	33	06065	33.88993729	-117.3244363	Riverside County
192034	Fee-for-Service	1730391616	1730391616	1	1	ACADEMIC MEDICAL CENTER INC	12/13/2016	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	2712 SAN GABRIEL BLVD	None	ROSEMEAD	CA	91770	3256	19	06037	34.061049	-118.0905315	Los Angeles County
192041	Fee-for-Service	1811056575	1811056575	1	1	AJIT-UPPAR, JASUIR KAUR	5/31/1991	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49427	01	General Practice	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
192076	Fee-for-Service	1700946019	1700946019	1	1	ANDERSON, LETITIA L MD	3/26/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
192113	Fee-for-Service	1194005132	1194005132	1	1	AMENT, EMILY E MD	3/19/2018	208600000X	NA	General Surgery	026	PHYSICIANS	114517	02	General Surgery	0	In state provider	None	2800 L STREET	200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
192126	Fee-for-Service	1194773424	1194773424	1	1	ANHALT, ELISA I MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61704	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
192141	Fee-for-Service	1659596435	1659596435	1	1	AGUILAR, ARTURO J MD	2/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119794	01	General Practice	0	In state provider	None	7677 CENTER AVE	STE 100	HUNTINGTON BEACH	CA	92647	3030	30	06059	33.736257	-117.995535	Orange County
192147	Fee-for-Service	1922404615	1922404615	1	1	ALAN CURAMENG	1/12/2015	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	285 BLUFFSIDE LANE	None	SIMI VALLEY	CA	93065	8334	56	06111	34.25693191	-118.8048087	Ventura County
192157	Fee-for-Service	1962597807	1962597807	1	3	ADVANCED CALIFORNIA MEDICAL	4/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	55154	41	Internal Medicine	0	In state provider	MEDICAL CENTER INC	291 E LEXINGTON AVE	STE A	EL CAJON	CA	92020	4536	37	06073	32.79268648	-116.959041	San Diego County
192233	Fee-for-Service	1457429086	1457429086	1	1	ACOB, CHERYL M NP	2/16/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2356 GOLD MEADOW WAY	STE 130	GOLD RIVER	CA	95670	6323	34	06067	38.622141	-121.2625395	Sacramento County
192240	Fee-for-Service	1891130100	1891130100	1	1	AKA, ALLISON MD	9/1/2020	208600000X	NA	General Surgery	026	PHYSICIANS	168804	02	General Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
192241	Fee-for-Service	1619964095	1619964095	1	1	ARORA, RAMESH K MD	9/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	42324	41	Internal Medicine	0	In state provider	None	14624 SHERMAN WAY	STE 603	VAN NUYS	CA	91405	2241	19	06037	34.20078354	-118.450843	Los Angeles County
192255	Fee-for-Service	1346354479	1346354479	1	1	AHMAD, JAVED MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55292	41	Internal Medicine	0	In state provider	None	81833 DR CARREON BLVD	STE 2	INDIO	CA	92201	5590	33	06065	33.70737252	-116.2365255	Riverside County
192258	Fee-for-Service	1306283239	1306283239	1	1	AL SHAREEF, IBRAHEEM MD	4/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136340	40	Pediatrics	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6862	24	06047	37.28825369	-120.4963159	Merced County
192299	Fee-for-Service	1699203471	1699203471	1	1	AKINKUOLIE, AKINTUNDE O MD	1/10/2022	207R00000X	NA	Other	026	PHYSICIANS	172627	None	None	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
192303	Fee-for-Service	1134568439	1134568439	1	1	AGUILAR, GENOVEVA MD	9/9/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	138877	-	NOT APPLICABLE	0	In state provider	None	1024 N MACLAY AVE	STE M13	SAN FERNANDO	CA	91340	1361	19	06037	34.29416058	-118.4264252	Los Angeles County
192308	Fee-for-Service	1629653761	1629653761	1	1	ACEBEDO, ETHELYNE JOYCE NP	8/7/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	333 UNIVERSITY AVE.	#140	SACRAMENTO	CA	95825	6535	34	06067	38.570976	-121.416651	Sacramento County
192328	Fee-for-Service	1811056575	1811056575	1	1	AJIT-UPPAR, JASUIR KAUR	5/31/1991	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	49427	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
192339	Fee-for-Service	1740907534	1740907534	1	1	ALATORRE, MARIA	10/28/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
192348	Fee-for-Service	1417950924	1417950924	1	1	ASANO, GARY W OD	1/27/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4700 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6082	19	06037	34.09812055	-118.2921165	Los Angeles County
192382	Fee-for-Service	1619383163	1619383163	1	1	AGRAWAL, VIKASH MD	7/27/2020	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	168886	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
192403	Fee-for-Service	1437147485	1437147485	1	2	ASSOCIATED SURGEONS OF	5/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SAN LUIS OBISPO	292 POSADA LN	STE C	TEMPLETON	CA	93465	4054	40	06079	35.5531447	-120.7214979	San Luis Obispo County
192428	Fee-for-Service	1194043042	1194043042	1	1	ATTARAN, ASHKAN MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	112062	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	5400 W HILLSDALE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
192446	Fee-for-Service	1962597807	1962597807	1	3	ADVANCED CALIFORNIA MEDICAL	4/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	55154	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MEDICAL CENTER INC	291 E LEXINGTON AVE	STE A	EL CAJON	CA	92020	4536	37	06073	32.79268648	-116.959041	San Diego County
192476	Fee-for-Service	1093752248	1093752248	1	1	ANGELES-RIPARIP, MELODY	9/9/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74398	08	Family Practice	0	In state provider	None	1001 E COOLEY DR	STE 106	COLTON	CA	92324	3941	36	06071	34.0546353	-117.3110923	San Bernardino County
192492	Fee-for-Service	1497811400	1497811400	1	1	ARZANIPOUR, DANNY MD	3/30/2010	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	108553	25	Physical Medicine and Rehabilitation	0	In state provider	None	975 SERANO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
192501	Fee-for-Service	1124349246	1124349246	1	1	ALONZO, JOANNE L DO	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14614	41	Internal Medicine	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
192521	Fee-for-Service	1083979116	1083979116	1	2	A COZY RETIREMENT HOME	6/9/2015	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	8609 BANFF VISTA DR	None	ELK GROVE	CA	95624	1707	34	06067	38.413242	-121.386609	Sacramento County
192529	Fee-for-Service	1891130100	1891130100	1	1	AKA, ALLISON MD	9/1/2020	208600000X	NA	General Surgery	026	PHYSICIANS	168804	28	Proctology (colon and rectal)	0	In state provider	None	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
192530	Fee-for-Service	1619964095	1619964095	1	1	ARORA, RAMESH K MD	9/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	42324	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	14624 SHERMAN WAY	STE 603	VAN NUYS	CA	91405	2241	19	06037	34.20078354	-118.450843	Los Angeles County
192543	Fee-for-Service	1346354479	1346354479	1	1	AHMAD, JAVED MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	55292	01	General Practice	0	In state provider	None	81833 DR CARREON BLVD	STE 2	INDIO	CA	92201	5590	33	06065	33.70737252	-116.2365255	Riverside County
192570	Fee-for-Service	1437417631	1437417631	1	1	AVIA HOME HEALTH SERVICES	8/28/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	1307 W 6TH ST	STE 119B	CORONA	CA	92882	1642	33	06065	33.87790309	-117.589666	Riverside County
192595	Fee-for-Service	1508940628	1508940628	1	1	AGARWAL, ANITA MD	10/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143103	18	Ophthalmology	0	In state provider	None	1445 BUSH STREET	None	SAN FRANCISCO	CA	94109	5520	38	06075	37.78855318	-122.4211311	San Francisco County
192640	Fee-for-Service	1841343258	1841343258	1	1	ATIENZA, CESAR A JR MD	11/5/2007	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	96046	20	Orthopedic Surgery	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
192641	Fee-for-Service	1891947925	1891947925	1	1	ALI, TAYYEBA K MD	1/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150277	18	Ophthalmology	0	In state provider	None	710 LAWRENCE EXPRESSWAY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
192651	Fee-for-Service	1104120385	1104120385	1	3	ALL CARE PHYSICAL THERAPY PC	8/4/2022	225X00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	.C.	599 S BARRANCA AVE	STE 555	COVINA	CA	91723	2791	19	06037	34.079373	-117.881338	Los Angeles County
192672	Fee-for-Service	1992982052	1992982052	1	1	ABNEY, JASON R DO	7/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	10200	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
192757	Fee-for-Service	1093839011	1093839011	1	1	ALBRIGHT, RONALD K MD	4/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	31800	41	Internal Medicine	0	In state provider	None	150 CARNATION DR	STE 1	FREEDOM	CA	95019	3132	44	06087	36.93711696	-121.7705737	Santa Cruz County
192791	Fee-for-Service	1124349246	1124349246	1	1	ALONZO, JOANNE L DO	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14614	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1531 ESPLANADE	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
192822	Fee-for-Service	1912950064	1912950064	1	1	ACUTE CARE MEDICAL GROUP	5/1/2001	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OF ORANGE, INC	1301 N ROSE DR	None	PLACENTIA	CA	92870	3802	30	06059	33.8868003	-117.8420447	Orange County
192829	Fee-for-Service	1053477059	1053477059	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7070 ARCHIBALD ST	None	EASTVALE	CA	92880	8718	33	06065	33.9592887	-117.5929724	Riverside County
192845	Fee-for-Service	1528440898	1528440898	1	1	ADVENTIST HEALTH PHYSICIANS	4/11/2016	193200000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1934 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	3957	19	06037	34.02025007	-118.1199011	Los Angeles County
192869	Fee-for-Service	1568620748	1568620748	1	1	ALLGEIER, ARIANA LCSW	2/14/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
192874	Fee-for-Service	1093005225	1093005225	1	1	ALTRE, ROHZAN G NP	11/4/2019	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	43112 N 15TH W	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
192878	Fee-for-Service	1740427657	1740427657	1	23	ALTAMED HEALTH SERVICES CORP	6/28/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	12712 ELIZABETH WAY	None	TUSTIN	CA	92780	2811	30	06059	33.7513663	-117.8053709	Orange County
192908	Fee-for-Service	1689096406	1689096406	1	1	ALTA NEWPORT HOSPITAL INC	5/6/2014	No Taxonomy Provided	NA	None	065	PEDIATRIC SUBACUTE CARE/LTC	-	-	NOT APPLICABLE	0	In state provider	None	14662 NEWPORT AVENUE	None	TUSTIN	CA	92780	6064	30	06059	33.73088521	-117.8293385	Orange County
192914	Fee-for-Service	1881753408	1881753408	1	1	ANDELIN, LISA C MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	61114	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
192931	Fee-for-Service	1275944555	1275944555	1	1	AMAR, KARUN MD	8/29/2019	208600000X	NA	General Surgery	026	PHYSICIANS	161808	20	Orthopedic Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
192938	Fee-for-Service	1629188404	1629188404	1	1	ANDERSON TERRELL,	12/23/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	8506	08	Family Practice	0	In state provider	TIFFANY DO	9089 BASELINE RD	STE 100	RANCHO CUCAMONGA	CA	91730	1295	36	06071	34.12151248	-117.6074505	San Bernardino County
192939	Fee-for-Service	1104120385	1104120385	1	3	ALL CARE PHYSICAL THERAPY PC	11/20/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	.C.	599 S BARRANCA AVE	STE 555	COVINA	CA	91723	2791	19	06037	34.079373	-117.881338	Los Angeles County
192957	Fee-for-Service	1447647664	1447647664	1	1	APSTEIN, TED E MD	8/28/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155287	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
192959	Fee-for-Service	1891735486	1891735486	1	1	AVERY, CHARLES H MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	26091	41	Internal Medicine	0	In state provider	None	903 W 7TH ST	None	OXNARD	CA	93030	6755	56	06111	34.19516303	-119.1889271	Ventura County
193002	Fee-for-Service	1356767867	1356767867	1	1	ANAHEIM URGENT CARE INC	1/4/2016	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5717 MELROSE AVENUE	None	LOS ANGELES	CA	90038	3807	19	06037	34.08352353	-118.3251015	Los Angeles County
193011	Fee-for-Service	1528473378	1528473378	1	1	ALVARADO, LUIS PSYD	6/4/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
193019	Fee-for-Service	1053026229	1053026229	1	1	AVILA-HANSEN, ALISSA T CD	5/22/2025	No Taxonomy Provided	NA	None	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	15	06029	0	0	None
193022	Fee-for-Service	1801900998	1801900998	1	1	APPLEGATE, PATRICIA J MD	2/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	45106	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
193042	Fee-for-Service	1356655450	1356655450	1	1	ALMAZAN, SUSAN U OD	11/18/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
193044	Fee-for-Service	1578574364	1578574364	1	1	AARON D OWENS M.D.	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4493	00	None	29.508012	-98.578683	Bexar County
193046	Fee-for-Service	1093839011	1093839011	1	1	ALBRIGHT, RONALD K MD	4/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	31800	45	Nephrology (Renal-Kidney)	0	In state provider	None	150 CARNATION DR	STE 1	FREEDOM	CA	95019	3132	44	06087	36.93711696	-121.7705737	Santa Cruz County
193082	Fee-for-Service	1487313649	1487313649	1	1	ASUNCION, VAUGHN JANSSEN PT	4/1/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7373 WEST LN	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
193099	Fee-for-Service	1629513395	1629513395	1	1	ABRAMOV, MARGARITA PSYD	4/13/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7111 N FRESNO ST	STE. 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
193128	Fee-for-Service	1932341823	1932341823	1	1	ASH, STEVEN S	4/8/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT STREET	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
193130	Fee-for-Service	1699883488	1699883488	1	1	AGUILERA, PATRICK MD	5/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80537	66	Emergency Medicine (Urgent Care)	0	In state provider	None	654 CAMINO DE LOS MARES	None	SAN CLEMENTE	CA	92673	2827	30	06059	33.45756029	-117.6497373	Orange County
193138	Fee-for-Service	1992377790	1992377790	1	1	ASRYAN, NAREK MD	7/23/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187556	08	Family Practice	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
193162	Fee-for-Service	1790099943	1790099943	1	1	AMINI, AFSANEH OD	12/27/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	844 EAST WASHINGTON AVE	None	EL CAJON	CA	92020	5328	37	06073	32.78766945	-116.95176	San Diego County
193167	Fee-for-Service	1740427657	1740427657	1	23	ALTAMED HEALTH SERVICES CORP	6/28/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	12712 ELIZABETH WAY	None	TUSTIN	CA	92780	2811	30	06059	33.7513663	-117.8053709	Orange County
193208	Fee-for-Service	1740822873	1740822873	1	1	ALARCON, ALESSA G	1/4/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2208 W 7TH ST	None	LOS ANGELES	CA	90057	4002	19	06037	34.05710805	-118.2782502	Los Angeles County
193228	Fee-for-Service	1104120385	1104120385	1	3	ALL CARE PHYSICAL THERAPY PC	8/4/2022	225X00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	.C.	599 S BARRANCA AVE	STE 555	COVINA	CA	91723	2791	19	06037	34.079373	-117.881338	Los Angeles County
193233	Fee-for-Service	1790114668	1790114668	1	1	ADVENTIST HEALTH PHYSICIANS	11/21/2014	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1419 N ACACIA AVENUE	STE 101	REEDLEY	CA	93654	2197	10	06019	36.60886182	-119.4510442	Fresno County
193239	Fee-for-Service	1306141106	1306141106	1	1	ALMEIDA-JONES, MYRIAM E MD	5/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129950	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
193244	Fee-for-Service	1285270652	1285270652	1	1	AU, MATTHEW PT	12/1/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4131 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3101	38	06075	37.78096053	-122.4637512	San Francisco County
193245	Fee-for-Service	1982113502	1982113502	1	1	ABUGHAZALEH, MICHAEL J	6/11/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
193262	Fee-for-Service	1902121437	1902121437	1	1	ASHKTORAB, SAMANEH MD	10/23/2020	207YX0007X	NA	ENT/Otolaryngology	026	PHYSICIANS	169396	04	Otology, Laryngology, Rhinology	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
193309	Fee-for-Service	1346530664	1346530664	1	1	ANDERSON, JAMES G MD	2/15/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	123380	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
193339	Fee-for-Service	1477751691	1477751691	1	1	ALBAY, DIANA T MD	12/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	94980	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
193345	Fee-for-Service	1285782292	1285782292	1	1	ADLER, LAWRENCE M MD	12/31/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	66065	08	Family Practice	0	In state provider	None	1800 WESTERN AVE	STE 200	SAN BERNARDINO	CA	92411	1353	36	06071	34.1315778	-117.3182453	San Bernardino County
193359	Fee-for-Service	1437106341	1437106341	1	1	ADAMS, ROBERT T. DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	411 W TIPTON ST	None	SEYMOUR	IN	47274	2363	00	None	38.95657186	-85.89183321	Jackson County
193371	Fee-for-Service	1104525492	1104525492	1	1	AB NON-EMERGENCY MEDICAL TRA	6/17/2023	347C00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	10605 BARRICHELLO ST	None	BAKERSFIELD	CA	93314	8211	15	06029	35.43274728	-119.120187	Kern County
193395	Fee-for-Service	1114949807	1114949807	1	1	ANGER, JENNIFER T MD	12/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	86966	34	Urology and Urological Surgery	0	In state provider	None	1260 15TH ST	STE 1200	SANTA MONICA	CA	90404	1147	19	06037	34.02648965	-118.4867439	Los Angeles County
193427	Fee-for-Service	1326747023	1326747023	1	1	APPLE URGENT CARE, INC	7/14/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	9889 MAGNOLIA AVE	A	RIVERSIDE	CA	92503	3580	33	06065	33.91635817	-117.4537999	Riverside County
193428	Fee-for-Service	1598703902	1598703902	1	1	AHLQUIST,THOMAS MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	0000	00	None	43.6124738	-116.1926844	Ada County
193437	Fee-for-Service	1962519322	1962519322	2	1	ACUTE CARE ALTERNATIVES INC	12/8/2017	332BP3500X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	16644 E JOHNSON DR	None	CITY OF INDUSTRY	CA	91745	2412	19	06037	34.0027685	-117.9459317	Los Angeles County
193502	Fee-for-Service	1821082256	1821082256	1	1	ATLURI, SATYAVATHI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5901 W INDIAN SCHOOL RD,	SUITE 1	PHOENIX	AZ	85033	0000	00	None	33.494724	-112.186827	Maricopa County
193512	Fee-for-Service	1013789106	1013789106	1	1	ALDERETTE, LEONARD J NP	1/25/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	151 N SUNRISE AVE	STE 1205	ROSEVILLE	CA	95661	2926	31	06061	38.74746043	-121.2655348	Placer County
193521	Fee-for-Service	1093977290	1093977290	1	1	AMIN, KASHYAP MD FACC	10/7/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	147284	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
193536	Fee-for-Service	1902310683	1902310683	1	1	APLA HEALTH & WELLNESS	1/1/2018	No Taxonomy Provided	NA	None	073	AIDS WAIVER SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3741 S LA BREA AVENUE	None	LOS ANGELES	CA	90016	5309	19	06037	34.01991	-118.355626	Los Angeles County
193539	Fee-for-Service	1114083771	1114083771	2	2	AEGIS TREATMENT CENTERS, LLC	6/5/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	8626 LOWER SACRAMENTO RO	41	STOCKTON	CA	95210	1835	39	06077	38.02905449	-121.3226622	San Joaquin County
193541	Fee-for-Service	1063779304	1063779304	1	1	ALANI HEALTH & WELLNESS	9/30/2014	261Q00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CENTER, A NURSING CORP	7121 WEST MANCHESTER AVE	None	LOS ANGELES	CA	90045	3508	19	06037	33.95988553	-118.4175	Los Angeles County
193554	Fee-for-Service	1669735064	1669735064	1	1	ABRAHAM, DANIEL MD	10/20/2022	207L00000X	NA	Other	026	PHYSICIANS	178020	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
193572	Fee-for-Service	1366025132	1366025132	1	1	ARAJ, MARY E NP	11/22/2024	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
193589	Fee-for-Service	1326247875	1326247875	1	1	ARELLANO, ESTYLAN D DO	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10793	66	Emergency Medicine (Urgent Care)	0	In state provider	None	555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.77920408	-117.0087711	San Diego County
193602	Fee-for-Service	1205106309	1205106309	1	1	ADVANCE MEDICAL SUPPLY	4/30/2012	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	441 E WHITTIER BLVD	SUITE A	LA HABRA	CA	90631	3982	30	06059	33.9391743	-117.9414025	Orange County
193607	Fee-for-Service	1942563143	1942563143	1	1	ANAND, RAJESH K MD	11/24/2019	207P00000X	NA	Other	026	PHYSICIANS	161851	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
193626	Fee-for-Service	1740675529	1740675529	1	1	AGBIM, CHISOM O MD	9/22/2023	2080P0204X	NA	Other	026	PHYSICIANS	144709	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
193672	Fee-for-Service	1083450050	1083450050	1	1	ANTONIO, ALYSSA NP	11/18/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
193676	Fee-for-Service	1538186382	1538186382	1	1	AIREY, KELLY J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 N 30TH ST	None	OMAHA	NE	68131	2137	00	None	41.2654263	-95.95644327	Douglas County
193680	Fee-for-Service	1518179001	1518179001	1	1	AMY NOEL VAHRENWALD	11/21/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
193696	Fee-for-Service	1922019785	1922019785	1	1	ASHLEY, KENNETH D	6/5/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	60172	40	Pediatrics	0	In state provider	None	3133 PROFESSIONAL DR	STE 20	AUBURN	CA	95603	2463	31	06061	38.9412	-121.100888	Placer County
193702	Fee-for-Service	1326332933	1326332933	2	1	ALL TOWN AMBULANCE LLC	1/21/2016	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	7755 HASKELL AVE	None	VAN NUYS	CA	91406	1906	19	06037	34.211853	-118.474956	Los Angeles County
193713	Fee-for-Service	1497058242	1497058242	1	1	ADVANTAGE PLUS MRI INC	8/17/2018	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	800 HOWE AVENUE	STE 250	SACRAMENTO	CA	95825	3965	34	06067	38.581146	-121.4145	Sacramento County
193716	Fee-for-Service	1326747023	1326747023	1	1	APPLE URGENT CARE, INC	7/14/2023	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	9889 MAGNOLIA AVE	A	RIVERSIDE	CA	92503	3580	33	06065	33.91635817	-117.4537999	Riverside County
193755	Fee-for-Service	1912161787	1912161787	1	1	ABDELGHANI, LOUI MD	8/22/2022	207RC0200X	NA	Other	026	PHYSICIANS	170753	None	None	0	In state provider	TES	1801 E MARCH LN	C300	STOCKTON	CA	95210	6657	39	06077	38.00315652	-121.2868715	San Joaquin County
193771	Fee-for-Service	1003838061	1003838061	1	1	AKOPYAN, ASMIK MD	12/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	67854	None	None	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
193792	Fee-for-Service	1447241880	1447241880	1	1	ARLETTE AOUAD M.D.	12/16/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2222 CHERRY ST	STE 1400	TOLEDO	OH	43608	2669	00	None	41.66865567	-83.5418674	Lucas County
193827	Fee-for-Service	1114083771	1114083771	2	2	AEGIS TREATMENT CENTERS, LLC	6/5/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	8626 LOWER SACRAMENTO RO	41	STOCKTON	CA	95210	1835	39	06077	38.02905449	-121.3226622	San Joaquin County
193830	Fee-for-Service	1013680982	1013680982	1	1	ALSTEEN, STEPHANIE D NP	2/28/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
193838	Fee-for-Service	1043294341	1043294341	1	1	ATKINS, WILLIAM A PT	2/3/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	577 EAST ELDER STREET	SUITE I	FALLBROOK	CA	92028	3079	37	06073	33.3801147	-117.2456536	San Diego County
193852	Fee-for-Service	1386395655	1386395655	1	1	ALL HEARTS HOME HEALTH CARE,	6/5/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	11350 VENTURA BLVD	SUITE 208	STUDIO CITY	CA	91604	3140	19	06037	34.14014506	-118.3774984	Los Angeles County
193860	Fee-for-Service	1104846054	1104846054	1	1	ALLEN, ANTHONY MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73148	41	Internal Medicine	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
193868	Fee-for-Service	1073680963	1073680963	1	1	ABDALLA, MOHAMAD A MD	4/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77865	05	Anesthesiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
193885	Fee-for-Service	1104246958	1104246958	1	1	ABAALKHAIL, NAWAF MD	12/10/2020	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1680 E 120 ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
193932	Fee-for-Service	1447295258	1447295258	1	1	ALTER, HALINA K MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37633	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	RM 12311	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
193935	Fee-for-Service	1881746022	1881746022	1	1	AUTUMN MEDICAL GROUP	7/15/2009	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	9200 COLIMA RD	STE 207	WHITTIER	CA	90605	1814	19	06037	33.95015827	-118.0054753	Los Angeles County
193974	Fee-for-Service	1093767105	1093767105	1	1	ANIL MOHIN MD FACC	3/9/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	APMC	2677 ZOE AVE	STE 108	HUNTINGTON PARK	CA	90255	4195	19	06037	33.9793143	-118.2230319	Los Angeles County
193979	Fee-for-Service	1114075900	1114075900	1	1	ANGELO, JOSEPH E MD	9/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	63356	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
194003	Fee-for-Service	1144643271	1144643271	1	1	ARC THERAPY SERVICES LLC	8/2/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	670 W NAPA STREET	SUITE B	SONOMA	CA	95476	6437	49	06097	38.29323811	-122.4708182	Sonoma County
194006	Fee-for-Service	1326747023	1326747023	1	1	APPLE URGENT CARE, INC	7/14/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	9889 MAGNOLIA AVE	A	RIVERSIDE	CA	92503	3580	33	06065	33.91635817	-117.4537999	Riverside County
194007	Fee-for-Service	1851836084	1851836084	1	1	ANKUR GUPTA MD INC	9/19/2018	2086S0129X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
194070	Fee-for-Service	1902396492	1902396492	1	1	ALAIDROOS, IMAAN MD	9/1/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	166607	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
194094	Fee-for-Service	1235465964	1235465964	1	1	ARTAL, DALIA MD	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115109	None	None	0	In state provider	None	16311 VENTURA BLVD	SUITE 120	ENCINO	CA	91436	2124	19	06037	34.15706864	-118.4885978	Los Angeles County
194095	Fee-for-Service	1508995655	1508995655	1	1	ASIAN AMERICANS FOR COMM	9/7/2017	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	INVOLVEMENT SANTA CLARA	2400 MOORPARK AVE	STE 300	SAN JOSE	CA	95128	2680	43	06085	37.3160785	-121.937121	Santa Clara County
194104	Fee-for-Service	1811071897	1811071897	1	1	ARIETTA, STEPHEN P MD	7/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	61292	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
194116	Fee-for-Service	1447671714	1447671714	1	1	ACE GASTROENTEROLOGY	12/29/2014	193400000X	NA	Other	026	PHYSICIANS	44716	10	Gastroenterology (M.D. only)	0	In state provider	ASSOCIATES INC	2006 N RIVERSIDE AVE	STE B	RIALTO	CA	92377	4697	36	06071	34.13670866	-117.3704994	San Bernardino County
194124	Fee-for-Service	1134343791	1134343791	1	1	ADVENT GROUP MINISTRIES, INC	4/9/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1200 W EDMUNDSON AVE	None	MORGAN HILL	CA	95037	9637	43	06085	37.10479583	-121.6619643	Santa Clara County
194136	Fee-for-Service	1669628764	1669628764	1	1	ARVANTIS, LEONIDAS D MD	1/1/2018	207ZP0102X	NA	Other	026	PHYSICIANS	152120	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
194152	Fee-for-Service	1689834392	1689834392	1	1	ARAKI, TAKAKO MD	11/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122609	67	Endocrinology	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
194172	Fee-for-Service	1972669257	1972669257	2	2	AEGIS TREATMENT CENTERS, LLC	5/15/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	909 AVALON BLVD	None	WILMINGTON	CA	90744	4503	19	06037	33.78151145	-118.2625995	Los Angeles County
194176	Fee-for-Service	1225116890	1225116890	1	1	AHLUWALIA, GURPREET K MD	5/11/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92352	01	General Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
194206	Fee-for-Service	1952464661	1952464661	1	1	ADENUGA, GBEMISOLA A MD	9/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	113495	41	Internal Medicine	0	In state provider	None	1520 SAN PABLO ST	STE 1000	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
194239	Fee-for-Service	1225259922	1225259922	1	1	ADULT DAY HLTH CARE OF	7/1/1993	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	MAD RIVER	3800 JANES RD	None	ARCATA	CA	95521	4742	12	06023	40.89645172	-124.0930637	Humboldt County
194255	Fee-for-Service	1013172519	1013172519	1	1	AUNG, THAN T MD INC	2/14/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	61610	41	Internal Medicine	0	In state provider	None	2421 OLD EUREKA WAY	None	REDDING	CA	96001	0336	45	06089	40.58604616	-122.4067716	Shasta County
194265	Fee-for-Service	1093767105	1093767105	1	1	ANIL MOHIN MD FACC	3/9/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	APMC	2677 ZOE AVE	STE 108	HUNTINGTON PARK	CA	90255	4195	19	06037	33.9793143	-118.2230319	Los Angeles County
194284	Fee-for-Service	1104267053	1104267053	1	1	ABBAS, DANISH MD	12/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138717	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
194293	Fee-for-Service	1326747023	1326747023	1	1	APPLE URGENT CARE, INC	7/14/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	9889 MAGNOLIA AVE	A	RIVERSIDE	CA	92503	3580	33	06065	33.91635817	-117.4537999	Riverside County
194297	Fee-for-Service	1801088869	1801088869	1	1	AMADOR, JOAN M LMFT	7/22/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	540 W BASELINE RD	SUITE 3	CLAREMONT	CA	91711	1612	19	06037	34.12158153	-117.723276	Los Angeles County
194312	Fee-for-Service	1972631950	1972631950	1	1	ALLEN, DENISE C DO	10/25/2017	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6684	01	General Practice	0	In state provider	None	1400 E CHURCH ST	BLDG 8	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
194328	Fee-for-Service	1083280457	1083280457	1	1	ASHAR, RICHA MD	12/9/2024	207R00000X	NA	Other	026	PHYSICIANS	191269	41	Internal Medicine	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
194349	Fee-for-Service	1386674000	1386674000	1	1	AFFUE, THEODORE MD	4/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	85320	34	Urology and Urological Surgery	0	In state provider	None	2061 ROSS AVENUE	SUITE A	EL CENTRO	CA	92243	3687	13	06025	32.7814167	-115.579257	Imperial County
194371	Fee-for-Service	1710035746	1710035746	1	1	AMR, DENA MD	5/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	78876	84	Surgery-Head and Neck	0	In state provider	None	5601 DE SOTO AVENUE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
194428	Fee-for-Service	1780640326	1780640326	1	1	AMERICAN MEDICAL AND	2/10/1990	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	EQUIPMENT SUPPLY	3725 UNION AVE	None	SAN JOSE	CA	95124	2813	43	06085	37.25948893	-121.931396	Santa Clara County
194435	Fee-for-Service	1053456921	1053456921	1	1	ADVANCED RESPIRATORY MED	9/26/2003	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	231 W VERNON AVE	STE 103	LOS ANGELES	CA	90037	2778	19	06037	34.0038305	-118.2774195	Los Angeles County
194459	Fee-for-Service	1972669257	1972669257	2	2	AEGIS TREATMENT CENTERS, LLC	5/15/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	909 AVALON BLVD	None	WILMINGTON	CA	90744	4503	19	06037	33.78151145	-118.2625995	Los Angeles County
194469	Fee-for-Service	1386670982	1386670982	1	1	ARAKI, MAY L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77689	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	207 S SANTA ANITA AVE	STE 335	SAN GABRIEL	CA	91776	1160	19	06037	34.10120583	-118.1065375	Los Angeles County
194477	Fee-for-Service	1104044130	1104044130	1	1	ABEDIN, SAMI MD	4/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	125023	30	Radiology	0	In state provider	None	470 PLUMAS BLVD	STE 101	YUBA CITY	CA	95991	5077	51	06101	39.13270038	-121.6141985	Sutter County
194484	Fee-for-Service	1215009113	1215009113	1	1	ALI, ASHMEAD MD	8/17/2021	207R00000X	NA	Other	026	PHYSICIANS	78625	None	None	0	In state provider	None	44725 10TH ST WEST	170	LANCASTER	CA	93534	4936	19	06037	34.695693	-118.1480965	Los Angeles County
194546	Fee-for-Service	1346301256	1346301256	2	1	ALPHA RESPIRATORY	8/19/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4320 MOUNTAIN LAKES BLVD	None	REDDING	CA	96003	1438	45	06089	40.63091482	-122.388573	Shasta County
194551	Fee-for-Service	1093767105	1093767105	1	1	ANIL MOHIN MD FACC	3/9/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	APMC	2677 ZOE AVE	STE 108	HUNTINGTON PARK	CA	90255	4195	19	06037	33.9793143	-118.2230319	Los Angeles County
194564	Fee-for-Service	1336659002	1336659002	1	1	ABS PSYCHOLOGY SERVICES CALI	7/31/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	FORNIA	9600 CENTER AVE	160	RANCHO CUCAMONGA	CA	91730	5838	36	06071	34.07922138	-117.5796173	San Bernardino County
194570	Fee-for-Service	1043579261	1043579261	1	1	ALLEN, MARGIE LMFT	12/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16275 MONTEREY RD	STE C	MORGAN HILL	CA	95037	5466	43	06085	37.11612997	-121.6448825	Santa Clara County
194582	Fee-for-Service	1285216291	1285216291	1	2	AALPHA LTC RX LLC	12/13/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2030 VALLEY ST	None	LOS ANGELES	CA	90057	2410	19	06037	34.06461469	-118.2710551	Los Angeles County
194586	Fee-for-Service	1700860822	1700860822	1	1	ALI, MAHMOUD I MD	10/11/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81127	05	Anesthesiology	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
194592	Fee-for-Service	1013451228	1013451228	1	1	AISHA CORPORATION	8/29/2017	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2001 E 4TH ST	STE 103	SANTA ANA	CA	92705	8765	30	06059	33.74826075	-117.8385386	Orange County
194599	Fee-for-Service	1932760139	1932760139	1	1	ADVENTIST HEALTH PHYSICIANS	10/4/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	481 PLUMAS BLVD	STE 201	YUBA CITY	CA	95991	5075	51	06101	39.13306148	-121.6140103	Sutter County
194703	Fee-for-Service	1639635865	1639635865	1	1	AMA HEALTHCARE INC	10/24/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR ST	SUITE 207	VAN NUYS	CA	91411	2398	19	06037	34.18570347	-118.450386	Los Angeles County
194751	Fee-for-Service	1669550463	1669550463	1	1	ANDREWS, BRET D DO	8/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	7816	13	Neurology (M.D. only)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
194758	Fee-for-Service	1134371289	1134371289	1	1	ADVANCED SLEEP MEDICINE SRVS	2/14/2011	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2080 CENTURY PARK E	# 1402	LOS ANGELES	CA	90067	2017	19	06037	34.05887194	-118.4122914	Los Angeles County
194763	Fee-for-Service	1184708372	1184708372	2	2	ALL MEDICAL SUPPLY &	2/17/2016	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	EQUIPMENT LLC	921 MARIN STREET	None	VALLEJO	CA	94590	5431	48	06095	38.104794	-122.2565465	Solano County
194783	Fee-for-Service	1962553586	1962553586	1	1	ANDREWS, MICHAEL L LMFT	7/22/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	90661	-	NOT APPLICABLE	0	In state provider	None	222 WEST VALERIO ST	READ BUILDING	SANTA BARBARA	CA	93101	2930	42	06083	34.42532284	-119.7137898	Santa Barbara County
194852	Fee-for-Service	1336659002	1336659002	1	1	ABS PSYCHOLOGY SERVICES CALI	7/31/2020	103TC0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	FORNIA	9600 CENTER AVE	160	RANCHO CUCAMONGA	CA	91730	5838	36	06071	34.07922138	-117.5796173	San Bernardino County
194870	Fee-for-Service	1104963974	1104963974	1	1	ANGEL VIEW INC	1/25/1991	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	WILLIAM DEMAREST/CANYON	3566 N EASTGATE RD	None	PALM SPRINGS	CA	92262	1415	33	06065	33.86208127	-116.554605	Riverside County
194886	Fee-for-Service	1013115815	1013115815	1	1	ACOSTA, LUISA	10/2/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
194912	Fee-for-Service	1952589707	1952589707	1	1	ANOTHER CHOICE ANOTHER	1/30/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	CHANCE	3500 FLORIN ROAD	ROOM A, 10 & B	SACRAMENTO	CA	95823	1767	34	06067	38.49408	-121.4674065	Sacramento County
194958	Fee-for-Service	1588110811	1588110811	1	1	ASHRAF, HARIS DO	4/30/2021	207P00000X	NA	Other	026	PHYSICIANS	18089	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
194969	Fee-for-Service	1417497298	1417497298	1	1	ALL CARE LIVING HOME INC	7/31/2017	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5450 TYRONE AVE	None	SHERMAN OAKS	CA	91401	4203	19	06037	34.17011175	-118.4443163	Los Angeles County
194992	Fee-for-Service	1508370875	1508370875	1	1	AKINS, MELANIE NP	10/4/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	752 MEDICAL CENTER CT	SUITE 302	CHULA VISTA	CA	91911	6661	37	06073	32.61800405	-117.0232585	San Diego County
194994	Fee-for-Service	1962949354	1962949354	1	1	AHMED, WAHEEDA S NP	4/5/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
195002	Fee-for-Service	1003983685	1003983685	1	2	ALLIANCE HEALTHCARE SERVICES	10/3/2019	261QR0200X	NA	Mammography/MRI Provider	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	INC	2500 MOWRY AVE	SUITE 170	FREMONT	CA	94538	1605	01	06001	37.555011	-121.9801005	Alameda County
195057	Fee-for-Service	1992833784	1992833784	1	1	ARNOLD-CLARK, JANET S MD	12/8/1993	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	78062	40	Pediatrics	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
195066	Fee-for-Service	1952517476	1952517476	1	1	ARYA, SHIPRA MD	12/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	152421	02	General Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	93605	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
195080	Fee-for-Service	1013394311	1013394311	1	1	ABOYE, REDIEAT A MD	8/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150890	01	General Practice	0	In state provider	None	5256 MISSION BLVD	None	RIVERSIDE	CA	92509	4624	33	06065	33.99261717	-117.3987262	Riverside County
195084	Fee-for-Service	1144302464	1144302464	1	1	ALISHARAN, ROBERT M MD	9/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108306	40	Pediatrics	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
195093	Fee-for-Service	1699006833	1699006833	1	1	AYCOCK, JON R PT	12/22/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4318 SPYRES WAY	None	MODESTO	CA	95356	9259	50	06099	37.70194177	-120.9988293	Stanislaus County
195143	Fee-for-Service	1518016443	1518016443	1	1	ARMSTRONG, RALPH H MD	1/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	22532	36	Psychiatry	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
195144	Fee-for-Service	1194868760	1194868760	1	3	ALFRED J COPPOLA JR MD INC	11/17/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	2215 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3602	15	06029	35.37327448	-119.0278665	Kern County
195186	Fee-for-Service	1760991590	1760991590	1	1	AVILEZ, LESLEY M	1/16/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	217 W CERRITOS AVE	None	ANAHEIM	CA	92805	6549	30	06059	33.81058193	-117.9065445	Orange County
195207	Fee-for-Service	1700962230	1700962230	1	1	AHMED, AMEENA T MD	1/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63435	41	Internal Medicine	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
195234	Fee-for-Service	1568864346	1568864346	1	1	ADVANTAGE AMBULANCE INC	12/18/2014	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1924 COMMERCIAL ST	B	ESCONDIDO	CA	92029	1254	37	06073	33.12422685	-117.1163869	San Diego County
195238	Fee-for-Service	1578094686	1578094686	1	1	AHMED OARK	2/27/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 PELHAM PKWY S	None	BRONX	NY	10461	1138	00	None	40.857111	-73.847448	Bronx County
195262	Fee-for-Service	1386649887	1386649887	3	1	ALUM ROCK PHARMACY, INC	1/16/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1855 ALUM ROCK AVE	SUITE A	SAN JOSE	CA	95116	1398	43	06085	37.35399602	-121.8531134	Santa Clara County
195312	Fee-for-Service	1831196492	1831196492	1	1	AUSTIN, CHRISTINE E MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	68786	40	Pediatrics	0	In state provider	None	2175 ROSALINE AVENUE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
195356	Fee-for-Service	1467427096	1467427096	1	1	ABRAHAM, THEODORE P MD	6/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147652	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
195361	Fee-for-Service	1306145743	1306145743	1	1	ADELEKE, JESSICA R DO	10/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	12579	01	General Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
195436	Fee-for-Service	1336108851	1336108851	1	1	AN, HYUNG W MD	3/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	64726	None	None	0	In state provider	None	6161 CLARK RD	None	PARADISE	CA	95969	4164	04	06007	39.76393327	-121.6036644	Butte County
195450	Fee-for-Service	1578504841	1578504841	2	1	AUNG, THAN T MD	4/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	61610	41	Internal Medicine	0	In state provider	None	2421 OLD EUREKA WAY	None	REDDING	CA	96001	0336	45	06089	40.58604616	-122.4067716	Shasta County
195463	Fee-for-Service	1427146356	1427146356	1	1	ANANDA, DEVI M MD	12/31/1985	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	54138	40	Pediatrics	0	In state provider	None	805 VETERANS BLVD	None	REDWOOD CITY	CA	94063	1734	41	06081	37.49076853	-122.2291439	San Mateo County
195474	Fee-for-Service	1316228729	1316228729	1	1	ALFONSO, KAREN K MD	7/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	119750	40	Pediatrics	0	In state provider	None	15 MAREBLU ST	STE 100	ALISO VIEJO	CA	92656	3015	30	06059	33.5729913	-117.703431	Orange County
195526	Fee-for-Service	1083020820	1083020820	1	1	AHN, SE JIN MD	4/22/2019	282N00000X	NA	Hospitals	026	PHYSICIANS	159414	30	Radiology	0	In state provider	None	1250 16TH ST	None	SANTA MONICA	CA	90404	1249	19	06037	34.02749142	-118.486063	Los Angeles County
195577	Fee-for-Service	1831291863	1831291863	1	1	AKHTAR, NAEEM M MD	11/1/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	45051	10	Gastroenterology (M.D. only)	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
195588	Fee-for-Service	1922259084	1922259084	1	1	ALONSO, SUSAN J LCSW	10/18/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	201 SAND CREEK RD	STE L	BRENTWOOD	CA	94513	2204	07	06013	37.94651523	-121.700681	Contra Costa County
195592	Fee-for-Service	1952387953	1952387953	1	1	ADUSUMALLI, MURALI D MD	11/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	84969	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
195594	Fee-for-Service	1306479936	1306479936	1	1	ARAGON MEDICAL TRANSPORT INC	4/14/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	.	33775 WISHING WELL	TRL	CATHEDRAL CITY	CA	92234	4562	33	06065	33.8030941	-116.4656978	Riverside County
195601	Fee-for-Service	1831196492	1831196492	1	1	AUSTIN, CHRISTINE E MD	2/8/2015	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	68786	08	Family Practice	0	In state provider	None	2175 ROSALINE AVENUE	None	REDDING	CA	96001	2509	45	06089	40.57278686	-122.3958519	Shasta County
195616	Fee-for-Service	1396746244	1396746244	1	1	ANGELA BARNET MD	2/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7900 LEES SUMMIT RD	None	KANSAS CITY	MO	64139	1236	00	None	38.972781	-94.394979	Jackson County
195627	Fee-for-Service	1700069549	1700069549	1	1	ACUTE CARE SURGERY MEDICAL G	5/9/2008	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	2800 L STREET	200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
195657	Fee-for-Service	1295732980	1295732980	1	1	ABUMERI, IMAD MD	1/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	53377	14	Neurological Surgery	0	In state provider	None	2601 OSWELL STREET	SUITE 101	BAKERSFIELD	CA	93306	3173	15	06029	35.39259632	-118.9496489	Kern County
195664	Fee-for-Service	1417144528	1417144528	1	1	ALI, RICHARD CO	3/30/2011	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	350 N WIGET LANE	SUITE 100	WALNUT CREEK	CA	94598	2479	07	06013	37.92948925	-122.0275099	Contra Costa County
195701	Fee-for-Service	1912011453	1912011453	1	1	ASHKENAZE, MARY K MD	5/31/1993	207P00000X	NA	Other	026	PHYSICIANS	72911	66	Emergency Medicine (Urgent Care)	0	In state provider	None	31872 COAST HWY	None	LAGUNA BEACH	CA	92651	6773	30	06059	33.49961197	-117.7420867	Orange County
195761	Fee-for-Service	1538719406	1538719406	1	1	ANDERSON, LYNDA D LMFT	5/31/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15431 ANACAPA RD	STE D	VICTORVILLE	CA	92392	2458	36	06071	34.50544107	-117.3250832	San Bernardino County
195793	Fee-for-Service	1609434307	1609434307	1	1	AULT-RICHE, JEANMARC R MD	6/16/2022	207P00000X	NA	Other	026	PHYSICIANS	177670	None	None	0	In state provider	None	7500 HOSPITAL DRIVE	None	SACRAMENTO	CA	95823	5403	34	06067	38.463381	-121.416183	Sacramento County
195821	Fee-for-Service	1427691435	1427691435	1	1	AGM HOSPICE CARE INC	7/16/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14401 GILMORE ST	STE 103	VAN NUYS	CA	91401	6237	19	06037	34.18766945	-118.446723	Los Angeles County
195858	Fee-for-Service	1962848978	1962848978	1	1	ARTOLA, ROSA T DO	2/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14903	41	Internal Medicine	0	In state provider	None	11600 INDIAN HILL RD	None	MISSION HILLS	CA	91345	1225	19	06037	34.2811228	-118.4588429	Los Angeles County
195863	Fee-for-Service	1447435813	1447435813	1	1	ALL DESERT RESPIRATORY	5/18/2020	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	42247 12TH STREET WEST	SUITE 115	LANCASTER	CA	93534	2313	19	06037	34.65080318	-118.1522526	Los Angeles County
195915	Fee-for-Service	1700069549	1700069549	1	1	ACUTE CARE SURGERY MEDICAL G	5/9/2008	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	2800 L STREET	200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
195937	Fee-for-Service	1457920316	1457920316	1	1	A & G HOME HEALTH INC	1/4/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11712 MOORPARK ST	SUITE 110	STUDIO CITY	CA	91604	2155	19	06037	34.1503315	-118.38825	Los Angeles County
195964	Fee-for-Service	1396918280	1396918280	1	1	AL-SAMARRAI, TEEB MD	12/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120271	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
195975	Fee-for-Service	1306075486	1306075486	1	1	ACCURSO, ERIN C PHD	11/23/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
196020	Fee-for-Service	1275156960	1275156960	1	1	ALTAMED HEALTH SERVICES CORP	8/13/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PARK	1900 E SLAUSON AVE	ROOM 100	HUNTINGTON PARK	CA	90255	2725	19	06037	33.9891357	-118.2389609	Los Angeles County
196037	Fee-for-Service	1508401761	1508401761	1	1	AHMAD BEACH SKIN MD INC	3/18/2024	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	320 SUPERIOR AVE	STE 260	NEWPORT BEACH	CA	92663	2778	30	06059	33.62657138	-117.9330754	Orange County
196088	Fee-for-Service	1730520636	1730520636	1	1	AHMED, ANJUM MD	9/27/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
196089	Fee-for-Service	1568622538	1568622538	1	1	AVEN GROUP, INC	7/14/2009	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	14044 VENTURA BOULEVARD	SUITE 303	SHERMAN OAKS	CA	91423	5248	19	06037	34.14924596	-118.438799	Los Angeles County
196097	Fee-for-Service	1932341096	1932341096	1	1	AGRAWAL, BIMAL P MD	2/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	104887	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
196110	Fee-for-Service	1427691435	1427691435	1	1	AGM HOSPICE CARE INC	7/16/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14401 GILMORE ST	STE 103	VAN NUYS	CA	91401	6237	19	06037	34.18766945	-118.446723	Los Angeles County
196121	Fee-for-Service	1215914114	1215914114	2	1	ADAMS, JOHN S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	48420	67	Endocrinology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
196132	Fee-for-Service	1477868917	1477868917	1	2	ALTAMIRANO, HUGO E MD	6/5/2024	207L00000X	NA	Other	026	PHYSICIANS	121792	05	Anesthesiology	0	In state provider	None	1255 TRAVIS BLVD	None	FAIRFIELD	CA	94533	4801	48	06095	38.25815459	-122.0487714	Solano County
196199	Fee-for-Service	1679566400	1679566400	1	1	AJAY PARIKH MD,	4/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	17800 SOUTH KEDZIE AVE	None	HAZEL CREST	IL	60429	2029	00	None	41.566383	-87.697116	Cook County
196204	Fee-for-Service	1700069549	1700069549	1	1	ACUTE CARE SURGERY MEDICAL G	5/9/2008	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	None	2800 L STREET	200	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
196224	Fee-for-Service	1770931487	1770931487	1	1	APPLEBY, AMY W MD	9/3/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	151048	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
196228	Fee-for-Service	1083709349	1083709349	1	1	ABRAMSON, MARIA L	6/1/1999	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	33292 ASTORIA ST	None	DANA POINT	CA	92629	1401	30	06059	33.47919449	-117.6870951	Orange County
196233	Fee-for-Service	1487939724	1487939724	1	1	AHMC SAN GABRIEL VALLEY	7/1/2015	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	MEDICAL CENTER LP	438 WEST LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
196235	Fee-for-Service	1134882616	1134882616	1	1	ADAMS, DENISE	1/23/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
196298	Fee-for-Service	1023060449	1023060449	1	1	AFGHAN, RAHIMA MD	10/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	67257	36	Psychiatry	0	In state provider	None	770 MAGNOLIA AVE	SUITE 1F	CORONA	CA	92879	3121	33	06065	33.85936872	-117.5534605	Riverside County
196304	Fee-for-Service	1861573560	1861573560	1	1	ARCADIA ADHC, INC	12/1/2009	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	None	288 E HUNTINGTON DR	None	MONROVIA	CA	91016	3524	19	06037	34.14040715	-117.9954397	Los Angeles County
196317	Fee-for-Service	1609851344	1609851344	1	2	ALESSI, RANDALL R OD	10/16/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
196324	Fee-for-Service	1669438792	1669438792	1	1	ALJURE, JUIO MD	12/31/1985	207T00000X	NA	General Surgery	026	PHYSICIANS	40893	14	Neurological Surgery	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
196326	Fee-for-Service	1528726809	1528726809	1	5	ACCESS CARE ANESTHESIA OF CA	5/2/2024	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	LIFORNIA PC	995 GATEWAY CENTER WAY	SUITE 207	SAN DIEGO	CA	92102	4544	37	06073	32.71405516	-117.1158459	San Diego County
196330	Fee-for-Service	1518935808	1518935808	1	1	ASGARIAN NAHVANDI, AFSHIN MD	9/13/2004	207R00000X	NA	Other	026	PHYSICIANS	86078	41	Internal Medicine	0	In state provider	None	1201 SOUTH ORANGE AVE	None	EL CAJON	CA	92020	7521	37	06073	32.77914448	-116.9639444	San Diego County
196345	Fee-for-Service	1790839348	1790839348	1	1	AIDS HEALTHCARE FNDTN	1/1/2005	No Taxonomy Provided	NA	None	073	AIDS WAIVER SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6255 W SUNSET BLVD	FL 21	LOS ANGELES	CA	90028	7422	19	06037	34.09802749	-118.3255515	Los Angeles County
196436	Fee-for-Service	1871524553	1871524553	1	1	AMIN, NAVINCHANDRA M MD	9/30/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	34159	41	Internal Medicine	0	In state provider	None	1830 FLOWER ST	None	BAKERSFIELD	CA	93305	4144	15	06029	35.3818329	-118.9710228	Kern County
196437	Fee-for-Service	1265852826	1265852826	1	1	AZER, MARK S DO	9/6/2019	207L00000X	NA	Other	026	PHYSICIANS	14425	05	Anesthesiology	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
196448	Fee-for-Service	1083213300	1083213300	1	1	ALLURE HEALTH CARE SERVICES	12/21/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	14557 GILMORE ST	UNIT 5	VAN NUYS	CA	91411	1602	19	06037	34.18767462	-118.4506597	Los Angeles County
196450	Fee-for-Service	1285073007	1285073007	1	1	AGLB INC	2/26/2014	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	10109 LA TUNA CANYON RD	None	SUN VALLEY	CA	91352	2102	19	06037	34.235415	-118.3511015	Los Angeles County
196468	Fee-for-Service	1912062225	1912062225	1	1	ALIPOUR, MASSOUD MD	3/31/1994	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	41647	41	Internal Medicine	0	In state provider	None	307 PLACENTIA AVE	STE 203	NEWPORT BEACH	CA	92663	3308	30	06059	33.62631386	-117.9310576	Orange County
196502	Fee-for-Service	1265922173	1265922173	1	1	ALFORD, RODNEY S PT	11/9/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1626 SWEETWATER	SUITES A & B	NATIONAL CITY	CA	91950	7645	37	06073	32.66147525	-117.0818981	San Diego County
196503	Fee-for-Service	1285642843	1285642843	1	1	ANDREWS, BRIAN T MD APC	7/28/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	None	45 CASTRO ST	STE 421	SAN FRANCISCO	CA	94114	1031	38	06075	37.76829732	-122.4357056	San Francisco County
196529	Fee-for-Service	1154696243	1154696243	1	1	ALEXANDER THURMAN	10/5/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1602 HATCHER LN	None	COLUMBIA	TN	38401	4827	00	None	35.60405647	-87.06363952	Maury County
196555	Fee-for-Service	1366008906	1366008906	1	1	ADJUSTABLE CARE LIFE INC	4/29/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2461 E ORANGETHORPE AVE	STE 221	FULLERTON	CA	92831	5302	30	06059	33.85968746	-117.886599	Orange County
196568	Fee-for-Service	1740298256	1740298256	1	1	ATHWAL, HARMOHINDER S MD	12/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81841	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
196616	Fee-for-Service	1528726809	1528726809	1	5	ACCESS CARE ANESTHESIA OF CA	5/2/2024	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	LIFORNIA PC	995 GATEWAY CENTER WAY	SUITE 207	SAN DIEGO	CA	92102	4544	37	06073	32.71405516	-117.1158459	San Diego County
196617	Fee-for-Service	1528440799	1528440799	1	1	AVG HOME HEALTH CARE INC	9/21/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	725 S GLENDALE AVE	UNIT E	GLENDALE	CA	91205	2395	19	06037	34.13774391	-118.2513154	Los Angeles County
196625	Fee-for-Service	1215321864	1215321864	1	1	ARMSTRONG, CAREN MD	8/27/2024	2084N0402X	NA	Neurology	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
196628	Fee-for-Service	1891954889	1891954889	1	1	AVINASH JUNEJA, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 W. MEETING STREET	None	LANCASTER	SC	29720	2202	00	None	34.71685822	-80.78743339	Lancaster County
196643	Fee-for-Service	1528151834	1528151834	1	1	ADV BUSINESS CONCEPTS	7/26/2005	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	AAA MEDICAL SUPPLY	620 W ROUTE 66	STE 108	GLENDORA	CA	91740	4166	19	06037	34.1286087	-117.8755695	Los Angeles County
196654	Fee-for-Service	1194855304	1194855304	2	1	ACE HEALTH SOLUTIONS	6/28/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1861 E THOUSAND OAKS BLV	None	THOUSAND OAKS	CA	91362	2912	56	06111	34.17645722	-118.8494016	Ventura County
196706	Fee-for-Service	1023074713	1023074713	1	1	AUERBACH, FREDERICK S MD	5/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	21267	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
196729	Fee-for-Service	1972679280	1972679280	1	1	ADVANCE HEALTH MEDICAL GROUP	10/1/2000	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	333 E MAGNOLIA BLVD	103	BURBANK	CA	91502	1153	19	06037	34.18467444	-118.31003	Los Angeles County
196731	Fee-for-Service	1679157549	1679157549	1	1	AAV HOME HEALTH INC	8/19/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3200 WILSHIRE BLVD	STE 902B	LOS ANGELES	CA	90010	1313	19	06037	34.06176518	-118.2920553	Los Angeles County
196741	Fee-for-Service	1992763205	1992763205	1	1	ADHYE, ABHIJIT A MD	7/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94870	None	None	0	In state provider	None	3285 CLAREMONT WAY	None	NAPA	CA	94558	3313	28	06055	38.32103673	-122.3025002	Napa County
196759	Fee-for-Service	1912062225	1912062225	1	1	ALIPOUR, MASSOUD MD	3/31/1994	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	41647	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	307 PLACENTIA AVE	STE 203	NEWPORT BEACH	CA	92663	3308	30	06059	33.62631386	-117.9310576	Orange County
196764	Fee-for-Service	1417903881	1417903881	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1930 N PLACENTIA AVE	None	FULLERTON	CA	92831	1522	30	06059	33.89122087	-117.8735324	Orange County
196813	Fee-for-Service	1023570710	1023570710	1	1	ABUNDANT LIFE SOLUTION	8/9/2020	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	4339 MCROBERTS DR	None	MATHER	CA	95655	3026	34	06067	38.545434	-121.270401	Sacramento County
196832	Fee-for-Service	1700991924	1700991924	1	1	ANWAR,HAROON P MD	12/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	62747	02	General Surgery	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
196843	Fee-for-Service	1366008906	1366008906	1	1	ADJUSTABLE CARE LIFE INC	4/29/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2461 E ORANGETHORPE AVE	STE 221	FULLERTON	CA	92831	5302	30	06059	33.85968746	-117.886599	Orange County
196894	Fee-for-Service	1821157587	1821157587	1	1	ABU-DALU, JOSEPH MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34741	02	General Surgery	0	In state provider	None	4867 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5969	19	06037	34.0981755	-118.295055	Los Angeles County
196907	Fee-for-Service	1528726809	1528726809	1	5	ACCESS CARE ANESTHESIA OF CA	5/2/2024	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	LIFORNIA PC	995 GATEWAY CENTER WAY	SUITE 207	SAN DIEGO	CA	92102	4544	37	06073	32.71405516	-117.1158459	San Diego County
196934	Fee-for-Service	1871660605	1871660605	1	1	ANEKWE, JOSEPH E MD	11/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92658	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
196939	Fee-for-Service	1033533153	1033533153	1	1	AVALON-CARVER COMMUNITY	5/14/2018	251S00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	4920 SOUTH AVALON BLVD	None	LOS ANGELES	CA	90011	4004	19	06037	33.998157	-118.265212	Los Angeles County
196963	Fee-for-Service	1699932962	1699932962	1	1	AYATI, MEHRDAD MD	8/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105372	08	Family Practice	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
196976	Fee-for-Service	1023316668	1023316668	1	1	ADVENTIST HEALTH PHYSICIANS	3/30/2011	207V00000X	NA	Obstetrics & Gynecology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1530 RAILROAD AVE	STE 101	ST HELENA	CA	94574	1850	28	06055	38.50733846	-122.4714652	Napa County
196982	Fee-for-Service	1083479463	1083479463	1	1	ANUJ BANSAL MD INC	4/15/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	323 S LEXINGTON ST	None	DELANO	CA	93215	3693	15	06029	35.75575551	-119.2408457	Kern County
197013	Fee-for-Service	1578503900	1578503900	1	1	AMY BACKER	9/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	13103 E MANSFIELD AVE	None	SPOKANE VLY	WA	99216	1642	00	None	47.67755045	-117.228357	Spokane County
197033	Fee-for-Service	1326024084	1326024084	1	1	AGGARWAL, ARCHANA MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	74682	None	None	0	In state provider	None	1000 NUT TREE RD	None	VACAVILLE	CA	95687	4100	48	06095	38.35581953	-121.9530257	Solano County
197045	Fee-for-Service	1811558588	1811558588	1	1	ADVANCED SURGICAL INSTITUTE	1/22/2022	174400000X	NA	Other	026	PHYSICIANS	None	24	Plastic Surgery	0	In state provider	None	250 S LA CIENEGA BLVD	None	BEVERLY HILLS	CA	90211	3302	19	06037	34.06366971	-118.376149	Los Angeles County
197046	Fee-for-Service	1902256894	1902256894	1	1	AZULAY, HILA MD	9/1/2022	207RP1001X	NA	Pulmonology	026	PHYSICIANS	159209	None	None	0	In state provider	None	2335 E KASHIAN LANE	SUITE 260	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
197053	Fee-for-Service	1851347405	1851347405	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2320 S BROADWAY	None	SANTA MARIA	CA	93454	7816	42	06083	34.91847	-120.435901	Santa Barbara County
197082	Fee-for-Service	1326153057	1326153057	1	1	ALVARADO, GLYNIS	4/1/2003	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	822 BREHLER AVE	None	SANGER	CA	93657	2717	10	06019	36.7041891	-119.5719775	Fresno County
197112	Fee-for-Service	1124097548	1124097548	1	1	AZER, MAHER A A MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	24828	45	Nephrology (Renal-Kidney)	0	In state provider	None	3810 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3302	30	06059	33.80299148	-118.0666755	Orange County
197123	Fee-for-Service	1548657356	1548657356	1	1	ALI, SAIMA Z	8/3/2023	207R00000X	NA	Other	026	PHYSICIANS	148033	None	None	0	In state provider	None	20101 LAKE CHABOT RD	4TH FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
197138	Fee-for-Service	1124266085	1124266085	1	1	ARAGON, STACIE L LCSW	2/23/2015	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 HOPE DRIVE	None	TUSTIN	CA	92828	0221	30	06059	33.71470753	-117.8323965	Orange County
197148	Fee-for-Service	1952411316	1952411316	1	1	ARMAN, KAMBIZ MD	1/1/1982	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	31970	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	15141 WHITTIER BLVD	STE 205	WHITTIER	CA	90603	2170	19	06037	33.94810044	-118.0039419	Los Angeles County
197189	Fee-for-Service	1629397914	1629397914	1	1	ABRAMS, EKI E MD	2/16/2011	207R00000X	NA	Other	026	PHYSICIANS	112429	41	Internal Medicine	0	In state provider	None	500 DOYLE PARK	STE 100	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
197227	Fee-for-Service	1922490960	1922490960	1	1	AGHABY COMPREHENSIVE	9/1/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	COMMUNITY HEALTH CENTER	349 W COMPTON BLVD	None	COMPTON	CA	90220	3110	19	06037	33.89598014	-118.2276822	Los Angeles County
197254	Fee-for-Service	1699932962	1699932962	1	1	AYATI, MEHRDAD MD	8/12/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105372	38	Geriatrics	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
197260	Fee-for-Service	1942371844	1942371844	1	1	ANWAR, IQBAL A MD	12/1/1997	204D00000X	NA	Other	026	PHYSICIANS	77198	20	Orthopedic Surgery	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
197270	Fee-for-Service	1891956678	1891956678	1	1	ABCEDE, HERMELINDA G MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	102652	13	Neurology (M.D. only)	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
197273	Fee-for-Service	1992191373	1992191373	1	1	ALCARAZ, MARIA G LMFT	7/14/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1695 SAN JACINTO	K	SAN JACINTO	CA	92583	5103	33	06065	33.770961	-116.954649	Riverside County
197299	Fee-for-Service	1164488961	1164488961	1	1	ALBERTO BRIZOLARA	6/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1380 E MEDICAL CENTER DR	None	ST GEORGE	UT	84790	2123	00	None	37.097622	-113.553828	Washington County
197316	Fee-for-Service	1568870657	1568870657	1	1	ARCH HEALTH PARTNERS	11/18/2014	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	9878 CARMEL MOUNTAIN RD	STE B	SAN DIEGO	CA	92129	2893	37	06073	32.96028359	-117.114844	San Diego County
197328	Fee-for-Service	1154555274	1154555274	1	1	ASRAT, WELANSA E MD	6/22/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	151473	None	None	0	In state provider	None	13993 PARK AVE	None	VICTORVILLE	CA	92392	2485	36	06071	34.50503628	-117.3265137	San Bernardino County
197332	Fee-for-Service	1003113192	1003113192	1	1	ADVENTIST HEALTH PHYSCIANS	3/30/2011	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	6 WOODLAND RD ST	STE 102	ST HELENA	CA	94574	9501	28	06055	38.54297115	-122.4754501	Napa County
197369	Fee-for-Service	1619922887	1619922887	1	1	ARMANN, KJARTAN D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	41413	40	Pediatrics	0	In state provider	None	340 DARDANELLI LN	STE 25	LOS GATOS	CA	95032	1418	43	06085	37.262079	-121.9673345	Santa Clara County
197370	Fee-for-Service	1326153057	1326153057	1	1	ALVARADO, GLYNIS	4/1/2003	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	822 BREHLER AVE	None	SANGER	CA	93657	2717	10	06019	36.7041891	-119.5719775	Fresno County
197385	Fee-for-Service	1801097043	1801097043	1	1	ANDRESKI, DAVID M	3/26/2015	261QU0200X	NA	Other	026	PHYSICIANS	134624	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
197392	Fee-for-Service	1477841641	1477841641	1	1	ALSAYEGH, ROOFAN MD	1/28/2022	207R00000X	NA	Other	026	PHYSICIANS	162648	None	None	0	In state provider	None	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
197398	Fee-for-Service	1134617103	1134617103	1	1	ATWAL, JASMAN MD	7/6/2022	207R00000X	NA	Other	026	PHYSICIANS	174133	None	None	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
197400	Fee-for-Service	1124097548	1124097548	1	1	AZER, MAHER A A MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	24828	41	Internal Medicine	0	In state provider	None	3810 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3302	30	06059	33.80299148	-118.0666755	Orange County
197513	Fee-for-Service	1922490960	1922490960	1	1	AGHABY COMPREHENSIVE	9/1/2017	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	COMMUNITY HEALTH CENTER	349 W COMPTON BLVD	None	COMPTON	CA	90220	3110	19	06037	33.89598014	-118.2276822	Los Angeles County
197518	Fee-for-Service	1336186097	1336186097	1	1	AZIZ, KHADIJA MD	9/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	53035	None	None	0	In state provider	None	4334 CENTRAL AVE	None	RIVERSIDE	CA	92506	2918	33	06065	33.95346346	-117.3993495	Riverside County
197555	Fee-for-Service	1043553027	1043553027	1	1	ALEMAN-BRIZUELA, VLADANA MD	10/14/2020	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	101 CIVIC CTR LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
197590	Fee-for-Service	1528138872	1528138872	1	1	AMERICAN HEALTH SERVICES, LL	11/6/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	C	1010 1/2 S. UNION AVE.	None	BAKERSFIELD	CA	93307	3642	15	06029	35.34390262	-119.0029241	Kern County
197602	Fee-for-Service	1477051423	1477051423	1	1	ADVENTIST HEALTH PHYSICIANS	9/18/2019	208G00000X	NA	General Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	401 I ST	None	MARYSVILLE	CA	95901	5626	58	06115	39.13882888	-121.5963884	Yuba County
197617	Fee-for-Service	1417587338	1417587338	1	1	ARNOLD, JEFFREY W OT	6/18/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	201 NORTH COLLEGE DR	SUITE 203	SANTA MARIA	CA	93454	4614	42	06083	34.954461	-120.424836	Santa Barbara County
197653	Fee-for-Service	1700858388	1700858388	1	1	ADKINS,MICHEAL O MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	VALLEY ANESTHESIOLOGY CO	2901 NORTH CENTRAL AVE	STE # 500	PHOENIX	AZ	85012	2738	00	None	33.480666	-112.0729905	Maricopa County
197726	Fee-for-Service	1437442878	1437442878	1	1	ACE HOME HEALTH CARE	12/12/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	& HOSPICE INC	85 MORAGA WAY	STE 100B	ORINDA	CA	94563	3012	07	06013	37.87761653	-122.1801635	Contra Costa County
197728	Fee-for-Service	1649758863	1649758863	1	1	ALLEN, KEYAIRA LMFT	12/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
197745	Fee-for-Service	1932582699	1932582699	1	5	AKSHAY MEHTA MD INC	1/17/2020	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	1300 W 7TH STREET	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
197778	Fee-for-Service	1215400882	1215400882	1	1	ADLER, KAYLYNN D LCSW	10/29/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SS	1430 EAST AVE	4A	CHICO	CA	95926	1629	04	06007	39.76116577	-121.8188568	Butte County
197789	Fee-for-Service	1245733328	1245733328	1	1	AMERICAN HERITAGE HOSPICE	8/21/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	1837 IRON POINT RD	SUITE 180	FOLSOM	CA	95630	8781	34	06067	38.643381	-121.146309	Sacramento County
197800	Fee-for-Service	1174744072	1174744072	1	2	ARGUETA, RAPHAEL A MD	11/20/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	98465	08	Family Practice	0	In state provider	None	8110 MANGO AVE	None	FONTANA	CA	92335	3603	36	06071	34.10549796	-117.4314604	San Bernardino County
197802	Fee-for-Service	1922490960	1922490960	1	1	AGHABY COMPREHENSIVE	9/1/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	COMMUNITY HEALTH CENTER	349 W COMPTON BLVD	None	COMPTON	CA	90220	3110	19	06037	33.89598014	-118.2276822	Los Angeles County
197809	Fee-for-Service	1932507704	1932507704	1	1	AUGAT, ROBERT V CRNA	12/23/2014	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
197816	Fee-for-Service	1770167199	1770167199	1	1	ANTOVICH, ASHLEY D MD	10/30/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1401 SPANOS CT	STE 130	MODESTO	CA	95355	2815	50	06099	37.66975543	-120.9724048	Stanislaus County
197827	Fee-for-Service	1023157146	1023157146	1	1	A CHILD'S VIEW	4/16/2004	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	SCHRAMM, KATHERYN D	10335 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	1809	33	06065	33.91134808	-117.4626388	Riverside County
197831	Fee-for-Service	1700069549	1700069549	1	3	ACUTE CARE SURGERY MEDICAL G	1/29/2020	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	ROUP INC.	1345 PAUL BUNYAN ROAD	UNIT A	SUSANVILLE	CA	96130	3159	18	06035	40.43531297	-120.6557201	Lassen County
197850	Fee-for-Service	1184791691	1184791691	1	1	ANKENMAN, ANNA K LCSW	10/29/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
197906	Fee-for-Service	1164229183	1164229183	1	1	ARMSTRONG, LA KIESHA BIRTH	2/28/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
197920	Fee-for-Service	1881824506	1881824506	1	1	ASHIKIAN, NAZELY MD	1/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	111519	34	Urology and Urological Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
197934	Fee-for-Service	1740884469	1740884469	1	1	ADDICTION RESEARCH AND TREAT	2/7/2022	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2158 SOLANO WAY	None	CONCORD	CA	94520	4700	07	06013	37.98985592	-122.0426709	Contra Costa County
197965	Fee-for-Service	1023386513	1023386513	1	1	ARBALLO, NATALIE B LCSW	7/6/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4785 N FIRST ST	None	FRESNO	CA	93726	0513	10	06019	36.80478	-119.7724585	Fresno County
197969	Fee-for-Service	1174545131	1174545131	1	1	AVEDIAN, AREK S MD INC	12/7/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63733	05	Anesthesiology	0	In state provider	None	225 S LAKE AVE	STE 535	PASADENA	CA	91101	3010	19	06037	34.141905	-118.1323975	Los Angeles County
197971	Fee-for-Service	1033877360	1033877360	1	1	AZIZ, SOFIA NP	12/27/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
197979	Fee-for-Service	1790833226	1790833226	1	2	AL-SHAIKH, RAAD A MD INC	3/9/2011	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	63005	20	Orthopedic Surgery	0	In state provider	None	11010 COMBIE ROAD	STE 200	AUBURN	CA	95602	8908	31	06061	39.04105091	-121.0788923	Nevada County
197997	Fee-for-Service	1093053571	1093053571	1	1	ASCENDA BIOSCIENCES LLC	11/14/2016	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	2001 WESTSIDE PKWY	SUITE 240	ALPHARETTA	GA	30004	7408	00	None	34.08332866	-84.27373713	Fulton County
198013	Fee-for-Service	1437237906	1437237906	1	1	AUBURN EYE CARE ASSOCIATES	9/7/2016	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3211 FORTUNE COURT	STE A	AUBURN	CA	95602	9245	31	06061	38.94234896	-121.1015805	Placer County
198015	Fee-for-Service	1437442878	1437442878	1	1	ACE HOME HEALTH CARE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	& HOSPICE INC	85 MORAGA WAY	STE 100B	ORINDA	CA	94563	3012	07	06013	37.87761653	-122.1801635	Contra Costa County
198054	Fee-for-Service	1184941809	1184941809	1	1	ANAND, VIKRAM C MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120864	77	Infectious Disease	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
198058	Fee-for-Service	1609247469	1609247469	1	1	AAA CARE RX INC	12/20/2018	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6729 VARIEL AVE	None	CANOGA PARK	CA	91303	2811	19	06037	34.19311924	-118.5928499	Los Angeles County
198078	Fee-for-Service	1235431768	1235431768	1	1	ABIFADEL PHARMACY SERVICES	1/11/2011	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	INC	360 E 7TH ST	SUITE F	UPLAND	CA	91786	6701	36	06071	34.08880374	-117.6465151	San Bernardino County
198079	Fee-for-Service	1245733328	1245733328	1	1	AMERICAN HERITAGE HOSPICE	8/21/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	1837 IRON POINT RD	SUITE 180	FOLSOM	CA	95630	8781	34	06067	38.643381	-121.146309	Sacramento County
198107	Fee-for-Service	1841229705	1841229705	1	1	ADVANCED MEDICAL SURGERY	2/17/2015	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER AMC	1117 LOS PALOS DRIVE	None	SALINAS	CA	93901	3853	27	06053	36.65750452	-121.6453892	Monterey County
198116	Fee-for-Service	1700069549	1700069549	1	3	ACUTE CARE SURGERY MEDICAL G	1/29/2020	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	89	Surgery-Traumatic	0	In state provider	ROUP INC.	1345 PAUL BUNYAN ROAD	UNIT A	SUSANVILLE	CA	96130	3159	18	06035	40.43531297	-120.6557201	Lassen County
198120	Fee-for-Service	1447207659	1447207659	1	1	AUERBACH, PATRICIA C	1/21/2025	207R00000X	NA	Other	026	PHYSICIANS	52207	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
198123	Fee-for-Service	1053946558	1053946558	1	1	ALHV LLC	8/6/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	24552 PASEO DE VALENCIA	None	LAGUNA HILLS	CA	92653	4236	30	06059	33.60586949	-117.7048346	Orange County
198126	Fee-for-Service	1063610004	1063610004	1	1	ANGENY-SHOWALTER, CHASSITY	9/6/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
198127	Fee-for-Service	1659436095	1659436095	1	3	AEGIS TREATMENT CENTERS, LLC	6/8/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1235 MCHENRY AVENUE	A & B	MODESTO	CA	95350	5370	50	06099	37.66105327	-120.9939108	Stanislaus County
198128	Fee-for-Service	1740724178	1740724178	1	1	ASWANI, STEVY CCC-SLP	10/23/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
198152	Fee-for-Service	1740427657	1740427657	1	7	ALTAMED HEALTH SERVICES CORP	11/7/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1010 WEST 17TH STREET	None	SANTA ANA	CA	92706	3504	30	06059	33.75995123	-117.8779266	Orange County
198166	Fee-for-Service	1871700716	1871700716	1	1	AVENIDAS ROSE KLEINER	7/1/1993	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	SENIOR DAY HEALTH CENTER	270 ESCUELA AVE	None	MOUNTAIN VIEW	CA	94040	1813	43	06085	37.39844479	-122.0930834	Santa Clara County
198189	Fee-for-Service	1336608637	1336608637	1	1	ABUDU, BOYA MD	6/19/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	183530	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
198208	Fee-for-Service	1942323290	1942323290	1	1	ANGUELOUCH, AMANDA R NP	2/23/2010	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	678 2ND ST W	None	SONOMA	CA	95476	6901	49	06097	38.28914695	-122.4617525	Sonoma County
198218	Fee-for-Service	1073024592	1073024592	1	1	ARANEO, SOPHIA LCSW	6/24/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3438 MENDOCINO AVE	STE B	SANTA ROSA	CA	95403	2275	49	06097	38.472282	-122.723991	Sonoma County
198223	Fee-for-Service	1740884469	1740884469	1	1	ADDICTION RESEARCH AND TREAT	2/7/2022	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2158 SOLANO WAY	None	CONCORD	CA	94520	4700	07	06013	37.98985592	-122.0426709	Contra Costa County
198235	Fee-for-Service	1154632602	1154632602	1	1	AKHAVEIN MOHAMMADI, ARASH M	3/12/2021	208800000X	NA	Other	026	PHYSICIANS	141504	None	None	0	In state provider	D	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
198300	Fee-for-Service	1437237906	1437237906	1	1	AUBURN EYE CARE ASSOCIATES	9/7/2016	152W00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3211 FORTUNE COURT	STE A	AUBURN	CA	95602	9245	31	06061	38.94234896	-121.1015805	Placer County
198304	Fee-for-Service	1437442878	1437442878	1	1	ACE HOME HEALTH CARE	12/12/2012	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	& HOSPICE INC	85 MORAGA WAY	STE 100B	ORINDA	CA	94563	3012	07	06013	37.87761653	-122.1801635	Contra Costa County
198318	Fee-for-Service	1619311560	1619311560	1	1	AU, FAILIN PHD	8/1/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3900 BROADWAY	None	OAKLAND	CA	94611	5616	01	06001	37.82664697	-122.25721	Alameda County
198346	Fee-for-Service	1780131482	1780131482	1	1	AGUAYO, JEANETTE LMFT	3/24/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	225 E CARRILLO ST	304	SANTA BARBARA	CA	93101	2121	42	06083	34.42430069	-119.6989389	Santa Barbara County
198367	Fee-for-Service	1972924611	1972924611	1	1	AKAPO, ADERONKE S DO	10/25/2021	207P00000X	NA	Other	026	PHYSICIANS	17937	None	None	0	In state provider	None	5000 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
198389	Fee-for-Service	1528009842	1528009842	1	1	AGRON, MICHAEL S MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	37045	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
198413	Fee-for-Service	1659436095	1659436095	1	3	AEGIS TREATMENT CENTERS, LLC	6/8/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1235 MCHENRY AVENUE	A & B	MODESTO	CA	95350	5370	50	06099	37.66105327	-120.9939108	Stanislaus County
198421	Fee-for-Service	1598300915	1598300915	1	1	AV TRANSPORTATION SERVICES,	11/11/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LLC	828 W LANCASTER BLVD	None	LANCASTER	CA	93534	2304	19	06037	34.697324	-118.1455397	Los Angeles County
198427	Fee-for-Service	1497048433	1497048433	1	1	A&A HEARING AIDS INC	3/29/2011	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	7720 PACIFIC BLVD	None	WALNUT PARK	CA	90255	6302	19	06037	33.96858887	-118.2251931	Los Angeles County
198431	Fee-for-Service	1467102723	1467102723	1	1	ALICIA HAGLUND MD A PROFESSI	10/5/2022	207P00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	ONAL CORPORATION	2705 LOMA VISTA RD	205	VENTURA	CA	93003	1581	56	06111	34.27504051	-119.2600018	Ventura County
198441	Fee-for-Service	1740427657	1740427657	1	7	ALTAMED HEALTH SERVICES CORP	11/7/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1010 WEST 17TH STREET	None	SANTA ANA	CA	92706	3504	30	06059	33.75995123	-117.8779266	Orange County
198448	Fee-for-Service	1215566914	1215566914	1	1	ABDOLCADER, YAHYA NP	2/14/2025	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1600 OWENS ST	None	SAN FRANCISCO	CA	94158	2261	38	06075	37.76850146	-122.3949365	San Francisco County
198479	Fee-for-Service	1811730856	1811730856	1	1	ADVENTIST HEALTH PHYSICIANS	11/7/2024	208G00000X	NA	General Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	530 W ACACIA ST	23	STOCKTON	CA	95203	2454	39	06077	37.96109625	-121.3011471	San Joaquin County
198487	Fee-for-Service	1013330620	1013330620	1	1	ACEVEDO-MORAN, STEPHANIE LM	5/1/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	FT	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
198493	Fee-for-Service	1598871527	1598871527	1	1	ANTON, MORNINGSTAR J OD	5/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9813	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
198524	Fee-for-Service	1881785368	1881785368	1	1	ADLER, ROBERT MD	1/1/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	26189	40	Pediatrics	0	In state provider	None	10833 LE CONTE AVE	# 22404	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
198604	Fee-for-Service	1578638649	1578638649	1	1	ABDELAAL, TAHA M	4/8/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	92596	40	Pediatrics	0	In state provider	None	8599 HAVEN AVENUE	SUITE 101	RANCHO CUCAMONGA	CA	91730	4849	36	06071	34.097364	-117.575693	San Bernardino County
198623	Fee-for-Service	1871818831	1871818831	1	1	AVILA, CESAR O MD	7/8/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117587	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1415 ROSS AVENUE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
198636	Fee-for-Service	1295733947	1295733947	2	1	ASHLEY MEDICAL, INC	12/3/2007	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ASHLEY MEDICAL, INC	1515 WASHINGTON ST	None	SAN DIEGO	CA	92103	2421	37	06073	32.75210394	-117.1490872	San Diego County
198639	Fee-for-Service	1932385325	1932385325	1	1	AYALA, JESUS A PT	12/28/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
198658	Fee-for-Service	1790084051	1790084051	1	1	AMBROSY, ANDREW P MD	10/15/2018	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	122239	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
198679	Fee-for-Service	1528009842	1528009842	1	1	AGRON, MICHAEL S MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	37045	01	General Practice	0	In state provider	None	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
198682	Fee-for-Service	1235177478	1235177478	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4550 E CHAPMAN AVE	None	ORANGE	CA	92869	4109	30	06059	33.78771649	-117.804402	Orange County
198683	Fee-for-Service	1518542679	1518542679	1	1	APP OF SOUTHERN ARIZONA HM L	3/16/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	2	Out of state provider	LC	6200 LA CHOLLA BLVD	None	TUCSON	AZ	85741	3529	00	None	32.320323	-111.009951	Pima County
198706	Fee-for-Service	1538304134	1538304134	1	2	ASPEN PEDIATRIC CLINIC INC.	7/14/2022	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	15203 11TH ST	SUITE C	VICTORVILLE	CA	92395	3737	36	06071	34.52758919	-117.2925085	San Bernardino County
198713	Fee-for-Service	1992335277	1992335277	1	1	AKINJERO, NIKE E CNP	2/4/2022	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	137 S ASPEN COURT	SUITE B	VISALIA	CA	93291	5381	54	06107	36.32885419	-119.3529996	Tulare County
198736	Fee-for-Service	1891003869	1891003869	1	1	ANTONIO HURTADO RODRIGUEZ MD	7/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	109646	None	None	0	In state provider	A PROFESSIONAL CORPORAT	630 N PARK AVE	None	POMONA	CA	91768	3621	19	06037	34.06375904	-117.7546884	Los Angeles County
198754	Fee-for-Service	1215153085	1215153085	1	1	ACCLAIM MEDICAL & HOME	9/14/2001	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	CARE SUPPLY	309 BROADWAY	None	CHULA VISTA	CA	91910	3501	37	06073	32.63735071	-117.091943	San Diego County
198768	Fee-for-Service	1821387572	1821387572	1	1	ABE, NAOMI MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137946	None	None	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
198769	Fee-for-Service	1003229212	1003229212	1	1	ALDEA, INC	8/21/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2310 1ST STREET	None	NAPA	CA	94559	2239	28	06055	38.29806271	-122.2989388	Napa County
198809	Fee-for-Service	1851525083	1851525083	1	1	ARNOLD, MICHELE K MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107387	05	Anesthesiology	0	In state provider	None	280 WEST MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
198811	Fee-for-Service	1558692954	1558692954	1	1	ABSTON, ALVIN L LMFT	4/28/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1003 E COOLEY DR,	STE 207	COLTON	CA	92324	3907	36	06071	34.05460945	-117.3107565	San Bernardino County
198817	Fee-for-Service	1629739453	1629739453	1	1	ARCADIA LIVING LLC	1/10/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	601 SUNSET BLVD	None	ARCADIA	CA	91007	6319	19	06037	34.13407928	-118.0668499	Los Angeles County
198818	Fee-for-Service	1801012927	1801012927	1	1	ARC OF SAN DIEGO	2/4/1985	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	9415 PRYOR DR	None	SANTEE	CA	92071	4113	37	06073	32.83083152	-116.9925359	San Diego County
198838	Fee-for-Service	1083320774	1083320774	1	1	ARTESIA COMMUNITY HEALTHCARE	3/1/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	11900 ARTESIA BLVD	None	ARTESIA	CA	90701	4039	19	06037	33.87297352	-118.078848	Los Angeles County
198860	Fee-for-Service	1295096279	1295096279	1	1	ALLEN FLORER FAMILY HOMES	4/25/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INC	5704 N WHEELER AVE	None	FRESNO	CA	93722	2541	10	06019	36.82047265	-119.8896115	Fresno County
198877	Fee-for-Service	1124750575	1124750575	1	1	ANICETE, ANTHONY PT	1/27/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
198891	Fee-for-Service	1578614533	1578614533	2	1	AAA HOME HEALTH SERVICES INC	1/27/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3806 W MAGNOLIA BLVD	#A	BURBANK	CA	91505	2819	19	06037	34.16738744	-118.3483752	Los Angeles County
198894	Fee-for-Service	1871621722	1871621722	1	1	ADVANCE TRANSIT	3/7/2006	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	DANO, EFREN	5111 ROLLING FIELD CT	None	ANTELOPE	CA	95843	4608	34	06067	38.716119	-121.345479	Sacramento County
198915	Fee-for-Service	1225427172	1225427172	1	1	AHLZADEH, GABRIELLE E MD	9/23/2020	207P00000X	NA	Other	026	PHYSICIANS	169081	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
198945	Fee-for-Service	1013356781	1013356781	1	1	ANDREW ERIE	10/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1210 W 18TH ST	STE LL03	SIOUX FALLS	SD	57104	4654	00	None	43.537329	-96.743223	Minnehaha County
198990	Fee-for-Service	1508103672	1508103672	1	1	AMIN, AJAYKUMAR APMC	10/23/2012	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	9715	None	None	0	In state provider	None	6901 S ATLANTIC AVE	None	BELL	CA	90201	3646	19	06037	33.97291242	-118.1878808	Los Angeles County
199012	Fee-for-Service	1568567220	1568567220	1	2	ALL FOR HEALTH, HEALTH	7/8/2009	193400000X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	HEALTH FOR ALL INC	520 EAST BROADWAY	None	GLENDALE	CA	91205	4926	19	06037	34.14630672	-118.2492813	Los Angeles County
199036	Fee-for-Service	1922157890	1922157890	1	1	ALAMEDA COUNTY CCS	8/4/1993	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	GLANKLER MTU	39207 SUNDALE DR	None	FREMONT	CA	94538	1916	01	06001	37.53958026	-121.9847928	Alameda County
199064	Fee-for-Service	1003059395	1003059395	1	1	AL-TARIQ, QUAZI Z MD	6/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114848	None	None	0	In state provider	None	1798 N GAREY AVENUE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
199090	Fee-for-Service	1174765960	1174765960	1	1	AHUJA, JASPREET S MD	10/21/2019	207RP1001X	NA	Pulmonology	026	PHYSICIANS	147027	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
199093	Fee-for-Service	1679766380	1679766380	1	1	ANDERSON, NICOLE M LCSW	1/15/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6136 MISSION GORGE RD	#106	SAN DIEGO	CA	92120	3494	37	06073	32.786064	-117.0977655	San Diego County
199115	Fee-for-Service	1194707471	1194707471	1	1	AYTUG, SERHAT MD	12/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55444	67	Endocrinology	0	In state provider	None	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	30	06059	33.89343304	-117.9279349	Orange County
199188	Fee-for-Service	1578620118	1578620118	1	1	ALTAMURA, PETER H	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3975 OLD REDWOOD HWY	None	SANTA ROSA	CA	95403	1719	49	06097	38.484045	-122.7376395	Sonoma County
199191	Fee-for-Service	1790119931	1790119931	1	1	AGUILAR, JACQUELINE A LCSW	10/19/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
199225	Fee-for-Service	1821464025	1821464025	1	1	ASADNEJAD, PARISA	5/25/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
199272	Fee-for-Service	1235217035	1235217035	1	1	ALYONO, DAVID MD	8/17/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86186	33	Thoracic Surgery	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
199280	Fee-for-Service	1376785865	1376785865	1	1	ABRAVESH, SOODABEH MD	2/22/2022	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	70930	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
199286	Fee-for-Service	1932756764	1932756764	1	5	ALTAMED HEALTH SERVICES	6/19/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MOBILE UNIT 2	1325 N ANAHEIM BLVD	STE 200	ANAHEIM	CA	92801	1202	30	06059	33.85331047	-117.9199617	Orange County
199292	Fee-for-Service	1114119427	1114119427	1	1	ALI, BILAL MD	7/19/2021	207RT0003X	NA	Other	026	PHYSICIANS	171617	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
199343	Fee-for-Service	1508392572	1508392572	1	1	AU, BRIAN	5/5/2022	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2131 SAN JOAQUIN HILLS	None	NEWPORT BEACH	CA	92660	6507	30	06059	33.61632004	-117.8687553	Orange County
199346	Fee-for-Service	1881604171	1881604171	2	1	ALLGEYER, DEAN O MD	1/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	53797	05	Anesthesiology	0	In state provider	None	18321 CLARK STREET	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
199356	Fee-for-Service	1619929734	1619929734	1	1	ASSISTED HOME RECOVERY INC	1/8/1999	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4450 WESTINGHOUSE STREET	STE 101	VENTURA	CA	93003	5787	56	06111	34.25886329	-119.2335372	Ventura County
199366	Fee-for-Service	1508159567	1508159567	1	1	ARZAMENDI, AUDREY E MD	11/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	114161	67	Endocrinology	0	In state provider	None	815 BAY AVE	None	CAPITOLA	CA	95010	2186	44	06087	36.98097987	-121.9554791	Santa Cruz County
199386	Fee-for-Service	1952460685	1952460685	1	1	ARELLANO, DEBRA F NP	10/21/2013	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	44105 15TH ST W	UNITS 401/3/5/7	LANCASTER	CA	93534	4088	19	06037	34.684218	-118.1568465	Los Angeles County
199395	Fee-for-Service	1235130618	1235130618	1	1	AI, EVERETT MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	38984	18	Ophthalmology	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
199406	Fee-for-Service	1417120106	1417120106	1	1	AZAB, NARDINE LMFT	3/1/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	710 S BROADWAY	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
199411	Fee-for-Service	1790745867	1790745867	1	1	APFELBAUM,JONATHAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	630 E MEDICAL DRIVE	None	BOUNTIFUL	UT	84010	4909	00	None	40.88671331	-111.8683023	Davis County
199417	Fee-for-Service	1083878227	1083878227	1	1	AROCHE, ANTULIO B DO	9/28/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	13631	None	None	0	In state provider	None	400 CAMARILLO RANCH RD	SUITE 101	CAMARILLO	CA	93012	5901	56	06111	34.220943	-119.0186825	Ventura County
199437	Fee-for-Service	1750353314	1750353314	1	1	ALVARADO, RUDOLPH C MD	12/1/1995	207R00000X	NA	Other	026	PHYSICIANS	79387	08	Family Practice	0	In state provider	None	1300 N FRESNO ST	STE 220	FRESNO	CA	93703	3843	10	06019	36.75998613	-119.7814674	Fresno County
199463	Fee-for-Service	1174682132	1174682132	1	1	AGNEW, ROBERT	11/26/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
199470	Fee-for-Service	1013947357	1013947357	1	1	ALIX MITCHELL, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 METROHEALTH DR	None	CLEVELAND	OH	44109	0000	00	None	41.46242416	-81.69888235	Cuyahoga County
199480	Fee-for-Service	1164136032	1164136032	1	1	ALL HEALTH HOLDINGS CORP	8/4/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	CARE & ASSISTED LIVING	2025 NORTH BUSH STREET	None	SANTA ANA	CA	92706	2817	30	06059	33.76317362	-117.8663228	Orange County
199486	Fee-for-Service	1285971820	1285971820	1	1	ARCH HEALTH PARTNERS	2/28/2013	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	488 E VALLEY PKWY	SUITE 201	ESCONDIDO	CA	92025	3398	37	06073	33.12523814	-117.0769715	San Diego County
199508	Fee-for-Service	1497813810	1497813810	1	1	ALTMAN, RUSS B MD	11/30/1990	207R00000X	NA	Other	026	PHYSICIANS	72413	41	Internal Medicine	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
199532	Fee-for-Service	1154717213	1154717213	1	1	ARORA, ROHIT DO	5/24/2018	207R00000X	NA	Other	026	PHYSICIANS	15219	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
199547	Fee-for-Service	1184820987	1184820987	1	1	APEX HEALTHCARE MEDICAL	7/28/2010	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTER INC	1225 E LATHAM AVE	STE #A	HEMET	CA	92543	4423	33	06065	33.74937952	-116.959626	Riverside County
199553	Fee-for-Service	1013538610	1013538610	1	2	ALEXANDER VALENZUELA LICENSE	5/9/2023	106H00000X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	D MARRIAGE FAMILY THERAP	15010 FIR ST	None	HESPERIA	CA	92345	4316	36	06071	34.39236128	-117.335741	San Bernardino County
199572	Fee-for-Service	1932756764	1932756764	1	5	ALTAMED HEALTH SERVICES	6/19/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE UNIT 2	1325 N ANAHEIM BLVD	STE 200	ANAHEIM	CA	92801	1202	30	06059	33.85331047	-117.9199617	Orange County
199611	Fee-for-Service	1093746752	1093746752	1	2	ADVANCE OCCUPATIONAL & HAND	8/22/2014	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	HERAPY	1520 BROOKHOLLOW DR.	37	SANTA ANA	CA	92705	5429	30	06059	33.7145683	-117.8475378	Orange County
199654	Fee-for-Service	1578537619	1578537619	1	1	ARUNAGIRI, GURUSWAMI MD	5/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	52679	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
199684	Fee-for-Service	1780651109	1780651109	1	1	ANDREW J DODGE	11/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	807 S PONDEROSA ST	None	PAYSON	AZ	85541	5542	00	None	34.230393	-111.321099	Gila County
199685	Fee-for-Service	1740427657	1740427657	1	27	ALTAMED HEALTH SERVICES CORP	8/2/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	9551 ORANGEWOOD AVENUE	None	GARDEN GROVE	CA	92841	1737	30	06059	33.79582145	-117.9663885	Orange County
199717	Fee-for-Service	1700131679	1700131679	1	1	ALL FOR HEALTH, HEALTH	7/9/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	FOR ALL INC	401 S GLENOAKS BLVD	SUITE 101	BURBANK	CA	91502	1448	19	06037	34.18077992	-118.3029503	Los Angeles County
199725	Fee-for-Service	1750353314	1750353314	1	1	ALVARADO, RUDOLPH C MD	12/1/1995	207R00000X	NA	Other	026	PHYSICIANS	79387	41	Internal Medicine	0	In state provider	None	1300 N FRESNO ST	STE 220	FRESNO	CA	93703	3843	10	06019	36.75998613	-119.7814674	Fresno County
199726	Fee-for-Service	1295994275	1295994275	1	1	ALADAG, BELIS M MD	3/26/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	117586	08	Family Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
199831	Fee-for-Service	1568921344	1568921344	1	1	ARCH, MUSTAFA DO	9/23/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20329	08	Family Practice	0	In state provider	None	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	19	06037	34.13998921	-118.7070142	Los Angeles County
199837	Fee-for-Service	1184820987	1184820987	1	1	APEX HEALTHCARE MEDICAL	5/1/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	CENTER INC	1225 E LATHAM AVE	STE #A	HEMET	CA	92543	4423	33	06065	33.74937952	-116.959626	Riverside County
199839	Fee-for-Service	1760657647	1760657647	1	1	ABRAHAM, BINNY MD	9/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	117099	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
199841	Fee-for-Service	1013538610	1013538610	1	2	ALEXANDER VALENZUELA LICENSE	8/18/2022	106H00000X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	D MARRIAGE FAMILY THERAP	15010 FIR ST	None	HESPERIA	CA	92345	4316	36	06071	34.39236128	-117.335741	San Bernardino County
199856	Fee-for-Service	1497041750	1497041750	1	1	ARAGUAS PODIATRY CORP	8/14/2017	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2410 COMMERCE TRAIL	None	IMPERIAL	CA	92251	4003	13	06025	32.827023	-115.577482	Imperial County
199901	Fee-for-Service	1093746752	1093746752	1	2	ADVANCE OCCUPATIONAL & HAND	8/22/2014	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	HERAPY	1520 BROOKHOLLOW DR.	37	SANTA ANA	CA	92705	5429	30	06059	33.7145683	-117.8475378	Orange County
199971	Fee-for-Service	1740427657	1740427657	1	27	ALTAMED HEALTH SERVICES CORP	8/2/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	9551 ORANGEWOOD AVENUE	None	GARDEN GROVE	CA	92841	1737	30	06059	33.79582145	-117.9663885	Orange County
199994	Fee-for-Service	1225533268	1225533268	1	1	AMIRI, YAMAH MD	8/20/2023	207L00000X	NA	Other	026	PHYSICIANS	186330	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
200005	Fee-for-Service	1700131679	1700131679	1	1	ALL FOR HEALTH, HEALTH	7/9/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	FOR ALL INC	401 S GLENOAKS BLVD	SUITE 101	BURBANK	CA	91502	1448	19	06037	34.18077992	-118.3029503	Los Angeles County
200027	Fee-for-Service	1174062780	1174062780	1	1	AREVALO, STEPHANIE R LCSW	3/28/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
200029	Fee-for-Service	1154486793	1154486793	1	1	ARSANJANI, AMIR H MD	8/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	81765	34	Urology and Urological Surgery	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
200035	Fee-for-Service	1255610739	1255610739	1	1	AHMADI, BEHROOZ MD APC	9/8/1975	No Taxonomy Provided	NA	None	026	PHYSICIANS	22029	10	Gastroenterology (M.D. only)	0	In state provider	None	5451 LA PALMA AVE	SUITE 34	LA PALMA	CA	90623	1731	30	06059	33.84643146	-118.038843	Orange County
200036	Fee-for-Service	1770855983	1770855983	1	1	ALBRIGHT, EUGENE, W MD INC	2/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	40864	None	None	0	In state provider	None	4500 BROCKTON AVE	STE 315	RIVERSIDE	CA	92501	4006	33	06065	33.97785263	-117.3836152	Riverside County
200057	Fee-for-Service	1396239000	1396239000	1	1	AEGIS HEALTH LLC	9/15/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	237 CHURCH AVENUE	None	CHULA VISTA	CA	91910	2702	37	06073	32.6437331	-117.0796962	San Diego County
200068	Fee-for-Service	1154947240	1154947240	1	1	AYOUB, NATALIE L MD	8/6/2024	390200000X	NA	Other	026	PHYSICIANS	178725	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
200095	Fee-for-Service	1861097388	1861097388	1	1	ALTERNATIVE HOSPICE CARE,INC	9/15/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	21151 S WESTERN AVE	SUITE 240	TORRANCE	CA	90501	1724	19	06037	33.83695304	-118.3092655	Los Angeles County
200118	Fee-for-Service	1114986692	1114986692	1	1	ALFAR, DOUGLAS MD	3/21/2019	207P00000X	NA	Other	026	PHYSICIANS	160554	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10 WOODLAND RD	None	ST HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
200130	Fee-for-Service	1013538610	1013538610	1	2	ALEXANDER VALENZUELA LICENSE	8/18/2022	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	D MARRIAGE FAMILY THERAP	15010 FIR ST	None	HESPERIA	CA	92345	4316	36	06071	34.39236128	-117.335741	San Bernardino County
200131	Fee-for-Service	1962787713	1962787713	1	1	ANDREASIAN, ROSETTE	4/22/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12100 EUCLID ST	None	GARDEN GROVE	CA	92840	3304	30	06059	33.786882	-117.9410535	Orange County
200150	Fee-for-Service	1164655817	1164655817	1	1	ABADIAN SHARIFABAD,	1/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	101780	None	None	0	In state provider	None	17100 EUCLID STREET	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
200174	Fee-for-Service	1205322047	1205322047	1	1	A PLUS HOME HEALTH	7/27/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	3455 WEST SHAW AVE	SUITE 107	FRESNO	CA	93711	3201	10	06019	36.805419	-119.8548675	Fresno County
200177	Fee-for-Service	1225008394	1225008394	1	1	AGGARWAL, SANGEETA MD	11/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52085	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
200193	Fee-for-Service	1043661069	1043661069	1	1	ARGADE, NINA DPM	1/19/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	12520 MAGNOLIA BLVD	#304	VALLEY VILLAGE	CA	91607	2355	19	06037	34.16485451	-118.406106	Los Angeles County
200202	Fee-for-Service	1538514245	1538514245	1	1	ARNOLD, COSBY G MD	7/1/2022	207P00000X	NA	Other	026	PHYSICIANS	178896	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
200206	Fee-for-Service	1558578005	1558578005	1	1	ALEXANDER, EDWARD A MD	1/21/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	45272	-	NOT APPLICABLE	0	In state provider	None	2032 MARENGO ST	None	LOS ANGELES	CA	90033	1319	19	06037	34.0566188	-118.2074593	Los Angeles County
200245	Fee-for-Service	1154731057	1154731057	1	1	AGUIRRE, CAMERINA LMFT	2/17/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
200266	Fee-for-Service	1417010604	1417010604	1	1	ABLELIGHT INC	10/15/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	COMMUNITIES INC	24842 MITHRA	None	MISSION VIEJO	CA	92691	4661	30	06059	33.6014586	-117.6821314	Orange County
200272	Fee-for-Service	1346328846	1346328846	1	1	ASAN, KELLY P MD	1/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93449	05	Anesthesiology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
200280	Fee-for-Service	1326635152	1326635152	1	1	ALL INCLUSIVE MEDICAL	3/6/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE, INC	5900 COYLE AVE	SUITE C-2	CARMICHAEL	CA	95608	0400	34	06067	38.6676	-121.3268445	Sacramento County
200286	Fee-for-Service	1538308275	1538308275	1	1	ARORA, TARUN MD	3/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87440	14	Neurological Surgery	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
200295	Fee-for-Service	1740390905	1740390905	1	1	AMBER D ROLLSTIN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
200325	Fee-for-Service	1255335956	1255335956	1	1	AWADALLA, NAGY S MD	9/20/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	47737	01	General Practice	0	In state provider	None	525 ROBERTS LN	None	BAKERSFIELD	CA	93308	4799	15	06029	35.40860151	-119.0317455	Kern County
200394	Fee-for-Service	1861097388	1861097388	1	1	ALTERNATIVE HOSPICE CARE,INC	9/15/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	21151 S WESTERN AVE	SUITE 240	TORRANCE	CA	90501	1724	19	06037	33.83695304	-118.3092655	Los Angeles County
200406	Fee-for-Service	1023075348	1023075348	1	1	AFATO, FAAFOUINA S MD	11/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	76223	41	Internal Medicine	0	In state provider	None	1429 COLUSA HWY	STE B	YUBA CITY	CA	95993	9092	51	06101	39.14182148	-121.6388115	Sutter County
200408	Fee-for-Service	1922337575	1922337575	1	2	ALISAL PHARMACIES, INC	3/1/2020	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	323 N SANBORN RD	STE A	SALINAS	CA	93905	2243	27	06053	36.67816118	-121.6259169	Monterey County
200415	Fee-for-Service	1629164868	1629164868	1	1	AMADOR FAMILY PH MED INC	2/4/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	605 NEW YORK RANCH RD	None	JACKSON	CA	95642	9328	03	06005	38.36077733	-120.7651246	Amador County
200421	Fee-for-Service	1174614267	1174614267	1	1	ARBER, DANIEL ALAN MD	5/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	49088	22	Pathology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
200457	Fee-for-Service	1508111212	1508111212	1	1	ADEBAYO FASANYA	3/10/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	211 CRAWFORD MEMORIAL DR	None	VAN BUREN	AR	72956	5322	00	None	35.43534	-94.338846	Crawford County
200458	Fee-for-Service	1417201120	1417201120	1	1	AMA HOSPICE AND PALLIATIVE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	6314 VAN NUYS BLVD	SUITE 222	VAN NUYS	CA	91401	6262	19	06037	34.18518362	-118.4487146	Los Angeles County
200462	Fee-for-Service	1316174014	1316174014	1	1	AHMAD, IRAM N MD	9/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	148368	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
200466	Fee-for-Service	1225008394	1225008394	1	1	AGGARWAL, SANGEETA MD	11/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52085	68	Hematology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
200479	Fee-for-Service	1457738460	1457738460	1	1	ANTOSSYAN, MERI DO	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13819	01	General Practice	0	In state provider	None	1204 S GLENDALE AVE	None	GLENDALE	CA	91204	2504	19	06037	34.13254482	-118.2521103	Los Angeles County
200524	Fee-for-Service	1235141268	1235141268	1	1	ADKINS, RICH E	9/1/2002	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	991 NUT TREE RD	None	VACAVILLE	CA	95687	4165	48	06095	38.35717814	-121.9531193	Solano County
200537	Fee-for-Service	1841585015	1841585015	1	1	ADOLESCENCE'S LAST RESORT	12/5/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3125 MCHENRY AVENUE	SUITE D	MODESTO	CA	95350	1451	50	06099	37.684179	-120.9942555	Stanislaus County
200618	Fee-for-Service	1134889595	1134889595	1	1	ADVENTIST HEALTH PHYSICIANS	6/14/2022	207RG0100X	NA	Gastroenterology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	232 HOSPITAL DR	STE B	UKIAH	CA	95482	4562	23	06045	39.15171863	-123.2035462	Mendocino County
200644	Fee-for-Service	1932246998	1932246998	1	1	ADDICOTT, ADRIENNE K PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
200647	Fee-for-Service	1376680140	1376680140	1	1	ANGEL VIEW INC	7/21/1999	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	66145 GRANADA AVE	None	DESERT HOT SPRING	CA	92240	4503	33	06065	33.95502939	-116.5076378	Riverside County
200666	Fee-for-Service	1215362512	1215362512	1	1	A&G SPINAL SOLUTIONS II LLC	11/6/2015	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3300 E SOUTH ST	SUITE 205A	LONG BEACH	CA	90805	4587	19	06037	33.86018093	-118.1537163	Los Angeles County
200670	Fee-for-Service	1346095114	1346095114	1	1	ANAYA, ITZEL	6/7/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3779 PIEDMONT	None	OAKLAND	CA	94611	5347	01	06001	37.82384659	-122.2558913	Alameda County
200688	Fee-for-Service	1831148501	1831148501	1	1	ABAZA, SAM MD	10/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	86393	07	Dermatology	0	In state provider	None	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	15	06029	35.356203	-119.0612695	Kern County
200695	Fee-for-Service	1023075348	1023075348	1	1	AFATO, FAAFOUINA S MD	11/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	76223	08	Family Practice	0	In state provider	None	1429 COLUSA HWY	STE B	YUBA CITY	CA	95993	9092	51	06101	39.14182148	-121.6388115	Sutter County
200701	Fee-for-Service	1518451921	1518451921	1	1	ARC CARE CENTER RIVERSIDE,	12/4/2018	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3495 JEFFERSON ST	None	RIVERSIDE	CA	92504	3519	33	06065	33.93247462	-117.4129569	Riverside County
200716	Fee-for-Service	1467886143	1467886143	1	1	AL-BUSAYYES, GHALIA MD	2/4/2019	207L00000X	NA	Other	026	PHYSICIANS	156230	05	Anesthesiology	0	In state provider	None	BUENA VISTA & ALAMEDA ST	None	BURBANK	CA	91505	4809	19	06037	34.158213	-118.328112	Los Angeles County
200723	Fee-for-Service	1245285659	1245285659	1	1	ABO, ALYSSA M MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108043	40	Pediatrics	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
200732	Fee-for-Service	1295296333	1295296333	1	1	ALBAYATI, ASSEEL MD	8/30/2023	207R00000X	NA	Other	026	PHYSICIANS	176805	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
200746	Fee-for-Service	1417201120	1417201120	1	1	AMA HOSPICE AND PALLIATIVE	3/21/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	6314 VAN NUYS BLVD	SUITE 222	VAN NUYS	CA	91401	6262	19	06037	34.18518362	-118.4487146	Los Angeles County
200751	Fee-for-Service	1225008394	1225008394	1	1	AGGARWAL, SANGEETA MD	11/15/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52085	78	Neoplastic Diseases/Oncology	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
200752	Fee-for-Service	1932110608	1932110608	1	1	ALVIDREZ, MIGUEL E NP	12/30/2019	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	202 W WILLOW AVE	SUITE 502	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
200768	Fee-for-Service	1073138608	1073138608	1	2	AMARI MEDICAL CORP	9/25/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
200769	Fee-for-Service	1861629321	1861629321	1	1	AHMAD, REGINACELESTE S MD	9/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	113304	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94040	2833	38	06075	37.76344756	-122.4581992	San Francisco County
200796	Fee-for-Service	1821413899	1821413899	1	1	ALBERT, SARAH M DO	7/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	13150	None	None	0	In state provider	None	18406 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.2206967	-118.5342638	Los Angeles County
200801	Fee-for-Service	1043475536	1043475536	1	1	AHMAD, MAZNA T MD	12/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	116686	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
200838	Fee-for-Service	1538798848	1538798848	1	1	ALEXA REEVES SMITH MD INC	6/19/2020	207T00000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	5395 RUFFIN RD	102	SAN DIEGO	CA	92123	1338	37	06073	32.832387	-117.1266225	San Diego County
200843	Fee-for-Service	1013415140	1013415140	1	1	ACUTE HOSPICE CARE INC	1/18/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8138 FOOTHILL BLVD	STE 320	SUNLAND	CA	91040	2900	19	06037	34.25963955	-118.310661	Los Angeles County
200846	Fee-for-Service	1417075029	1417075029	1	1	ARMADA, CRISOSTOMO A JR	12/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	5158	08	Family Practice	0	In state provider	ARMADA WELLNESS & LASER	10832 LAUREL ST	STE 102	RANCHO CUCAMONGA	CA	91730	7688	36	06071	34.10486789	-117.5684863	San Bernardino County
200852	Fee-for-Service	1396178067	1396178067	1	1	ATHENA MEDICAL GROUP OF THE	7/20/2015	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CENTRAL COAST INC	335 KATHERINE AVE	STE 1	SALINAS	CA	93901	3176	27	06053	36.65981144	-121.6491192	Monterey County
200875	Fee-for-Service	1689756017	1689756017	1	1	AL-SAKEM, SALIM	1/2/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1901 1ST AVE	None	NEW YORK	NY	10029	7494	00	None	40.784778	-73.9439055	New York County
200896	Fee-for-Service	1063755148	1063755148	1	1	AHN, JUSTIN MD	5/14/2019	208800000X	NA	Other	026	PHYSICIANS	160202	34	Urology and Urological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
200903	Fee-for-Service	1518948686	1518948686	1	1	APEX PHARMACY	10/3/2005	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	BESTCARE PHARMACY	1051 E. GRAND AVE	None	ARROYO GRANDE	CA	93420	2504	40	06079	35.11908066	-120.5952497	San Luis Obispo County
200915	Fee-for-Service	1184710121	1184710121	1	1	ANIGBOGU, NKOLI T MD	5/19/2022	207R00000X	NA	Other	026	PHYSICIANS	170662	None	None	0	In state provider	None	1050 KENDALL DR	SUITE F	SAN BERNARDINO	CA	92407	4125	36	06071	34.16464044	-117.3063239	San Bernardino County
200977	Fee-for-Service	1396783379	1396783379	1	16	ASANA INTEGRATED MEDICAL GRO	10/13/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP PC	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
200983	Fee-for-Service	1023075348	1023075348	1	1	AFATO, FAAFOUINA S MD	11/24/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	76223	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1429 COLUSA HWY	STE B	YUBA CITY	CA	95993	9092	51	06101	39.14182148	-121.6388115	Sutter County
201004	Fee-for-Service	1346274362	1346274362	1	2	AMERICAN DREAM HOME HEALTH	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	31194 LA BAYA DR	STE 107	WESTLAKE VILLAGE	CA	91362	6427	19	06037	34.15643887	-118.8025233	Los Angeles County
201005	Fee-for-Service	1508877473	1508877473	1	4	ANJANI THAKUR, MD, INC	10/23/2020	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	840 DELBON AVE	STE A	TURLOCK	CA	95382	2005	50	06099	37.51046091	-120.8383932	Stanislaus County
201010	Fee-for-Service	1245285659	1245285659	1	1	ABO, ALYSSA M MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108043	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
201040	Fee-for-Service	1255901534	1255901534	1	1	ALFARO, ALEXIS CRNA	12/15/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
201041	Fee-for-Service	1346747391	1346747391	1	1	ATILLO, RONALD MAR T NP	6/3/2022	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
201087	Fee-for-Service	1912206640	1912206640	1	1	ALVARADO ANESTHESIA	4/5/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES INC	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
201093	Fee-for-Service	1730667841	1730667841	1	3	ALLIANCE ANESTHESIA	10/24/2018	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ASSOCIATES INC	13100 STUDEBAKER RD	None	NORWALK	CA	90650	2581	19	06037	33.912594	-118.099152	Los Angeles County
201131	Fee-for-Service	1013415140	1013415140	1	1	ACUTE HOSPICE CARE INC	1/18/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8138 FOOTHILL BLVD	STE 320	SUNLAND	CA	91040	2900	19	06037	34.25963955	-118.310661	Los Angeles County
201133	Fee-for-Service	1942269030	1942269030	1	1	ANTOS, MARK MD	8/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	62515	10	Gastroenterology (M.D. only)	0	In state provider	None	2925 PALO VERDE AVE	None	LONG BEACH	CA	90815	1552	19	06037	33.809751	-118.1079275	Los Angeles County
201135	Fee-for-Service	1154403483	1154403483	1	1	ARTHRITIS & RHEUMATOLOGY	1/10/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	83	Rheumatology	0	In state provider	MEDICAL ASSOCIATES INC	120 LA CASA VIA	STE 204	WALNUT CREEK	CA	94598	3007	07	06013	37.91202407	-122.0419227	Contra Costa County
201144	Fee-for-Service	1457664518	1457664518	1	1	ALGRA, JEFFREY MD	9/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	121138	25	Physical Medicine and Rehabilitation	0	In state provider	None	3030 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
201148	Fee-for-Service	1679529523	1679529523	1	1	ADLER, SUSAN C MD	10/1/1999	207L00000X	NA	Other	026	PHYSICIANS	60253	40	Pediatrics	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
201166	Fee-for-Service	1902239668	1902239668	1	1	ACEVEDO, ANGELICA M	6/11/2021	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	115 MALL DRIVE	None	HANFORD	CA	93230	5786	16	06031	36.32396253	-119.6688834	Kings County
201169	Fee-for-Service	1376149609	1376149609	1	1	AQUINO, RAFAEL PAOLO H NP	4/5/2022	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
201183	Fee-for-Service	1295821189	1295821189	1	1	AWAD, NICOLE H MD	7/7/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	64729	08	Family Practice	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
201188	Fee-for-Service	1942254545	1942254545	1	1	ANDRIACCHI, MONICA M	7/1/1995	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3650 SOUTH ST	STE 208	LAKEWOOD	CA	90712	1525	19	06037	33.86019847	-118.149255	Los Angeles County
201199	Fee-for-Service	1205132859	1205132859	1	1	ASTRA HEALTH SERVICES, INC	7/4/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	16101 VENTURA BLVD	SUITE 155A	ENCINO	CA	91436	2510	19	06037	34.15646951	-118.4842635	Los Angeles County
201217	Fee-for-Service	1982688792	1982688792	1	1	ARON PHARMACY CORP	7/1/2003	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	BIXBY PHARMACY	3816 WOODRUFF AVE	STE 108	LONG BEACH	CA	90808	2145	19	06037	33.828102	-118.1165525	Los Angeles County
201232	Fee-for-Service	1194913608	1194913608	1	1	ADRIATICO, MARK MD	10/20/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106520	08	Family Practice	0	In state provider	None	10800 PARAMOUNT BLVD	SUITE 406	DOWNEY	CA	90241	4443	19	06037	33.94604301	-118.1354831	Los Angeles County
201239	Fee-for-Service	1023097383	1023097383	1	1	ALBRECHT, PEGGY N MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	52635	07	Dermatology	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
201246	Fee-for-Service	1326431594	1326431594	1	1	ALBANO, STEPHEN D DO	8/1/2022	207T00000X	NA	General Surgery	026	PHYSICIANS	15019	None	None	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
201249	Fee-for-Service	1417010604	1417010604	1	16	ABLELIGHT INC	2/10/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2146 E MITCHELL	None	CLOVIS	CA	93611	3135	10	06019	36.81412191	-119.6744586	Fresno County
201262	Fee-for-Service	1871033514	1871033514	1	1	ALLIANCE PHARMACY INC	11/20/2017	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1585 W BROADWAY	SUITE B	ANAHEIM	CA	92802	1327	30	06059	33.82896331	-117.9364135	Orange County
201292	Fee-for-Service	1508877473	1508877473	1	4	ANJANI THAKUR, MD, INC	10/23/2020	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	840 DELBON AVE	STE A	TURLOCK	CA	95382	2005	50	06099	37.51046091	-120.8383932	Stanislaus County
201360	Fee-for-Service	1699973578	1699973578	1	1	ARMSTRONG-KELSEY, BRECKEN J	11/22/2010	207P00000X	NA	Other	026	PHYSICIANS	96864	66	Emergency Medicine (Urgent Care)	0	In state provider	MD	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
201378	Fee-for-Service	1730667841	1730667841	1	3	ALLIANCE ANESTHESIA	10/24/2018	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	ASSOCIATES INC	13100 STUDEBAKER RD	None	NORWALK	CA	90650	2581	19	06037	33.912594	-118.099152	Los Angeles County
201384	Fee-for-Service	1558595090	1558595090	1	1	ADAMS, JACOB R DO	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13086	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2450 ASHBY AVE	SUITE 2737	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
201411	Fee-for-Service	1679935845	1679935845	1	1	ALI, SYED S MD	1/18/2021	207L00000X	NA	Other	026	PHYSICIANS	154824	None	None	0	In state provider	None	8700 BEVERLY BLVD	TSB-290	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
201416	Fee-for-Service	1699489815	1699489815	1	1	ACACIA GUEST HOME LLC	2/23/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2344 W BEATON WAY	None	ORANGE	CA	92868	1901	30	06059	33.79217517	-117.8783011	Orange County
201427	Fee-for-Service	1841814100	1841814100	1	1	ARMALINA HOSPICE INC	5/14/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	STE 103B	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
201437	Fee-for-Service	1679529523	1679529523	1	1	ADLER, SUSAN C MD	10/1/1999	207L00000X	NA	Other	026	PHYSICIANS	60253	05	Anesthesiology	0	In state provider	None	100 S SAN MATEO DR	None	SAN MATEO	CA	94401	3805	41	06081	37.5656736	-122.3254527	San Mateo County
201442	Fee-for-Service	1922170760	1922170760	1	1	ANDERSON, ELIZABETH T MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	19868	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
201449	Fee-for-Service	1093275620	1093275620	1	1	ALLEGIANCE HOME HEALTH	8/12/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	13609 VICTORY BLVD	SUITE 234	VAN NUYS	CA	91401	6436	19	06037	34.18671049	-118.429353	Los Angeles County
201471	Fee-for-Service	1285931378	1285931378	1	1	ADVENTIST HEALTH PHYSICIANS	3/30/2011	2086X0206X	NA	General Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	6 WOODLAND RD	STE 302	ST HELENA	CA	94574	9567	28	06055	38.54297115	-122.4754501	Napa County
201479	Fee-for-Service	1396881496	1396881496	1	1	AHMED, MOHAMED A MD	6/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145298	02	General Surgery	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
201487	Fee-for-Service	1205132859	1205132859	1	1	ASTRA HEALTH SERVICES, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	16101 VENTURA BLVD	SUITE 155A	ENCINO	CA	91436	2510	19	06037	34.15646951	-118.4842635	Los Angeles County
201489	Fee-for-Service	1497820278	1497820278	1	1	ALDERMAN, TRACY A PHD	2/28/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
201496	Fee-for-Service	1679717680	1679717680	1	1	ANAYA, JOSE P MD	9/12/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	113940	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
201527	Fee-for-Service	1124347844	1124347844	1	1	ARONSEN, TISHA LMFT	3/18/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6717 MORRO ROAD	None	ATASCADERO	CA	93422	4429	40	06079	35.48268576	-120.6658099	San Luis Obispo County
201555	Fee-for-Service	1255489233	1255489233	1	1	AKASHI, TARA M MD	9/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	89605	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
201587	Fee-for-Service	1659380137	1659380137	1	1	ARNETT, ERNEST MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	27317	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
201604	Fee-for-Service	1194776757	1194776757	1	1	ARKANSAS CHILDRENS HSP	7/23/1999	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	800 MARSHALL ST	None	LITTLE ROCK	AR	72202	3591	00	None	34.74346583	-92.29154425	Pulaski County
201630	Fee-for-Service	1477632628	1477632628	1	1	AJALAT, GEORGE M MD	9/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	43712	02	General Surgery	0	In state provider	None	238 W BADILLO ST	None	COVINA	CA	91723	1906	19	06037	34.08625462	-117.8933025	Los Angeles County
201672	Fee-for-Service	1558595090	1558595090	1	1	ADAMS, JACOB R DO	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13086	41	Internal Medicine	0	In state provider	None	2450 ASHBY AVE	SUITE 2737	BERKELEY	CA	94705	2067	01	06001	37.85646136	-122.2573894	Alameda County
201676	Fee-for-Service	1386319770	1386319770	1	1	ADJUSTING MOBILITY CA LLC	1/14/2022	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	215 S PACIFIC ST	SUITE 108	SAN MARCOS	CA	92078	2459	37	06073	33.14409344	-117.1961597	San Diego County
201718	Fee-for-Service	1841814100	1841814100	1	1	ARMALINA HOSPICE INC	5/14/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	STE 103B	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
201720	Fee-for-Service	1922619295	1922619295	1	1	ANL FACILITY HOME INC	11/4/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	12073 HIGHDALE ST	None	NORWALK	CA	90650	0104	19	06037	33.8940842	-118.0756325	Los Angeles County
201743	Fee-for-Service	1396178067	1396178067	1	3	ATHENA MEDICAL GROUP OF THE	5/9/2018	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	10 HARRIS CT	STE A2	MONTEREY	CA	93940	7823	27	06053	36.58063559	-121.820025	Monterey County
201748	Fee-for-Service	1396727335	1396727335	1	1	AFZAL, ANEETA MD	4/29/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	135305	36	Psychiatry	0	In state provider	None	3625 E THOUSAND OAKS BLV	SUITE #232	WESTLAKE VILLAGE	CA	91362	6932	19	06037	34.16480359	-118.8299997	Ventura County
201773	Fee-for-Service	1801366711	1801366711	3	1	ADVENTIST HEALTH TULARE	3/15/2019	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	869 N CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
201788	Fee-for-Service	1629203898	1629203898	1	1	ARSENAULT, SHAWNA B MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137053	25	Physical Medicine and Rehabilitation	0	In state provider	None	2425 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2215	34	06067	38.553012	-121.45545	Sacramento County
201808	Fee-for-Service	1750585345	1750585345	1	1	ABDULLA, NIHAL E MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120904	68	Hematology	0	In state provider	None	3851 KATELLA AVE	SUITE 125	LOS ALAMITOS	CA	90720	3379	30	06059	33.80319053	-118.0657305	Orange County
201822	Fee-for-Service	1043310808	1043310808	1	1	ALINEJAD, NIMA A MD	12/20/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
201827	Fee-for-Service	1336482165	1336482165	1	1	ARBELAEZ NOVAK, MARK J MD	3/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133178	01	General Practice	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
201830	Fee-for-Service	1548662182	1548662182	1	1	AZIZ, OMAR A MD	4/28/2023	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	182695	None	None	0	In state provider	None	852 E DANENBERG DR	None	EL CENTRO	CA	92243	8517	13	06025	32.773176	-115.5270465	Imperial County
201850	Fee-for-Service	1528726809	1528726809	1	2	ACCESS CARE ANESTHESIA OF CA	8/24/2023	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	LIFORNIA PC	12827 HARBOR BLVD	G1	GARDEN GROVE	CA	92840	5837	30	06059	33.77737896	-117.9151828	Orange County
201866	Fee-for-Service	1457582470	1457582470	1	1	AMIN, ELENA K MD	9/16/2019	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	154459	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
201867	Fee-for-Service	1417010604	1417010604	1	15	ABLELIGHT INC	2/11/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	COMMUNITIES INC	1830 ASHCROFT AVE	None	CLOVIS	CA	93611	5218	10	06019	36.79792774	-119.6810639	Fresno County
201877	Fee-for-Service	1932833480	1932833480	1	1	ARDEN GLEN HEALTHCARE LLC	8/1/2022	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3400 ALTA ARDEN EXPY	None	SACRAMENTO	CA	95825	2103	34	06067	38.59839	-121.3847865	Sacramento County
201892	Fee-for-Service	1194776757	1194776757	1	1	ARKANSAS CHILDRENS HSP	3/1/2003	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	800 MARSHALL ST	None	LITTLE ROCK	AR	72202	3591	00	None	34.74346583	-92.29154425	Pulaski County
201911	Fee-for-Service	1740427657	1740427657	1	28	ALTAMED HEALTH SERVICES CORP	8/14/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1930 WEST 10TH STREET	None	SANTA ANA	CA	92703	2045	30	06059	33.75337739	-117.8961121	Orange County
201949	Fee-for-Service	1033643671	1033643671	1	1	AUJLA, AMREET MD	9/11/2023	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	164424	None	None	0	In state provider	None	1187 E HERNDON AVE	SUITE 101	FRESNO	CA	93720	3166	10	06019	36.83640179	-119.7674647	Fresno County
201980	Fee-for-Service	1104991686	1104991686	1	1	ADHAMI, AFSHIN S MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	81919	None	None	0	In state provider	None	3030 TYLER AVE	None	EL MONTE	CA	91731	3352	19	06037	34.06368712	-118.0357209	Los Angeles County
201982	Fee-for-Service	1386959138	1386959138	1	1	A-Z MEDICAL TRANSPORTATION	2/14/2014	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LLC	2386 FAIR OAKS BLVD	STE 118	SACRAMENTO	CA	95825	4745	34	06067	38.573406	-121.406769	Sacramento County
201987	Fee-for-Service	1760670616	1760670616	1	1	ABDELWAHHAB, TAHA M	6/13/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	80 EUREKA SQ.	124	PACIFICA	CA	94044	2654	41	06081	37.6325943	-122.488748	San Mateo County
201993	Fee-for-Service	1942202825	1942202825	1	1	AKRAM, TAHIRA MD	9/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	54187	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4950 SAN BERNARDINO ST	STE 106	MONTCLAIR	CA	91763	2328	36	06071	34.07768363	-117.6968874	San Bernardino County
202005	Fee-for-Service	1912223017	1912223017	1	1	AIRAN, RAAG D MD	6/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141642	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
202032	Fee-for-Service	1396178067	1396178067	1	3	ATHENA MEDICAL GROUP OF THE	4/22/2022	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	10 HARRIS CT	STE A2	MONTEREY	CA	93940	7823	27	06053	36.58063559	-121.820025	Monterey County
202061	Fee-for-Service	1801366711	1801366711	3	1	ADVENTIST HEALTH TULARE	3/15/2019	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	869 N CHERRY ST	None	TULARE	CA	93274	2207	54	06107	36.220932	-119.337698	Tulare County
202075	Fee-for-Service	1114113008	1114113008	1	1	AVILA, ADRIAN LMFT	2/20/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2560 CATAMARAN WAY	STE 9	CHULA VISTA	CA	91914	4533	37	06073	32.65595994	-116.9580562	San Diego County
202077	Fee-for-Service	1629203898	1629203898	1	1	ARSENAULT, SHAWNA B MD	12/1/2015	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	None	2425 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2215	34	06067	38.553012	-121.45545	Sacramento County
202097	Fee-for-Service	1750585345	1750585345	1	1	ABDULLA, NIHAL E MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120904	78	Neoplastic Diseases/Oncology	0	In state provider	None	3851 KATELLA AVE	SUITE 125	LOS ALAMITOS	CA	90720	3379	30	06059	33.80319053	-118.0657305	Orange County
202102	Fee-for-Service	1538303516	1538303516	1	1	ALTAMED HEALTH SERVICES CORP	9/8/2010	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1814 W LINCOLN AVE	STE B	ANAHEIM	CA	92801	6730	30	06059	33.83241852	-117.946323	Orange County
202121	Fee-for-Service	1891806832	1891806832	1	1	ANDERSON, BRADFORD A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	60265	25	Physical Medicine and Rehabilitation	0	In state provider	None	2441 F ST	None	BAKERSFIELD	CA	93301	3821	15	06029	35.38195443	-119.0234967	Kern County
202138	Fee-for-Service	1528726809	1528726809	1	2	ACCESS CARE ANESTHESIA OF CA	8/24/2023	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	LIFORNIA PC	12827 HARBOR BLVD	G1	GARDEN GROVE	CA	92840	5837	30	06059	33.77737896	-117.9151828	Orange County
202150	Fee-for-Service	1285036996	1285036996	1	1	ALTA HOME HEALTH INC	7/27/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4605 LANKERSHIM BLVD	SUITE 718	NORTH HOLLYWOOD	CA	91602	1878	19	06037	34.15389329	-118.3679999	Los Angeles County
202190	Fee-for-Service	1356773360	1356773360	1	2	AL KURAISHI, MAYCE MD	3/1/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	142349	40	Pediatrics	0	In state provider	None	200 S WELLS RD	SUITE 100	VENTURA	CA	93004	1378	56	06111	34.29321532	-119.1597424	Ventura County
202191	Fee-for-Service	1205348059	1205348059	1	1	ATKINS, CLARA P PT	5/2/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
202194	Fee-for-Service	1346233822	1346233822	1	1	ANDERSON, GAIL A MD INC	4/30/1990	207L00000X	NA	Other	026	PHYSICIANS	35336	05	Anesthesiology	0	In state provider	None	1900 POINT WEST WAY	STE 222	SACRAMENTO	CA	95815	4704	34	06067	38.599677	-121.431447	Sacramento County
202200	Fee-for-Service	1740427657	1740427657	1	24	ALTAMED HEALTH SERVICES CORP	6/28/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	13822 PROSPECT AVENUE	None	SANTA ANA	CA	92705	2690	30	06059	33.76214673	-117.8204657	Orange County
202221	Fee-for-Service	1053607119	1053607119	1	1	AARONSON, JENIFER P MD	10/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128241	01	General Practice	0	In state provider	None	2110 N BELLFLOWER BLVD	None	LONG BEACH	CA	90815	3126	19	06037	33.795261	-118.125222	Los Angeles County
202229	Fee-for-Service	1366452799	1366452799	1	1	ANDERSON,QUENTIN N MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 CAMPBELL	None	TUCSON	AZ	85724	0000	00	None	32.240493	-110.9460825	Pima County
202275	Fee-for-Service	1356452114	1356452114	1	1	AW, FREDDY MD	10/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	42328	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
202302	Fee-for-Service	1063433530	1063433530	1	1	ABBOTT, BRIAN G. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	593 EDDY ST	None	PROVIDENCE	RI	02903	4923	00	None	41.81122992	-71.40713931	Providence County
202319	Fee-for-Service	1396178067	1396178067	1	3	ATHENA MEDICAL GROUP OF THE	11/28/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	10 HARRIS CT	STE A2	MONTEREY	CA	93940	7823	27	06053	36.58063559	-121.820025	Monterey County
202352	Fee-for-Service	1154781276	1154781276	1	1	AK BEAN FOUNDATION	4/25/2016	261QR0401X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	623 GREAT JONES STREET	None	FAIRFIELD	CA	94533	6005	48	06095	38.24881448	-122.0485767	Solano County
202387	Fee-for-Service	1538303516	1538303516	1	1	ALTAMED HEALTH SERVICES CORP	10/9/2009	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1814 W LINCOLN AVE	STE B	ANAHEIM	CA	92801	6730	30	06059	33.83241852	-117.946323	Orange County
202392	Fee-for-Service	1790890556	1790890556	1	2	ALJABI, FADI MD	2/23/2021	208M00000X	NA	Other	026	PHYSICIANS	102653	None	None	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
202426	Fee-for-Service	1528726809	1528726809	1	2	ACCESS CARE ANESTHESIA OF CA	8/24/2023	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	LIFORNIA PC	12827 HARBOR BLVD	G1	GARDEN GROVE	CA	92840	5837	30	06059	33.77737896	-117.9151828	Orange County
202439	Fee-for-Service	1144843319	1144843319	1	1	ASPER, MARIAM DO	8/22/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21189	08	Family Practice	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
202440	Fee-for-Service	1154649929	1154649929	1	1	ABOUSAIF, ALAA MD INC AMC	6/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52710	10	Gastroenterology (M.D. only)	0	In state provider	None	1010 W LA VETA AVE	STE 570	ORANGE	CA	92868	4300	30	06059	33.78028244	-117.8635552	Orange County
202474	Fee-for-Service	1255832333	1255832333	2	1	ABLE HEALTH GROUP LLC	2/14/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	41990 COOK ST	BLDG F STE 2004	PALM DESERT	CA	92211	6105	33	06065	33.748371	-116.356173	Riverside County
202477	Fee-for-Service	1770859985	1770859985	1	1	ARONSON, JENNY R MD	5/29/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	130700	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
202486	Fee-for-Service	1740427657	1740427657	1	24	ALTAMED HEALTH SERVICES CORP	6/28/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	13822 PROSPECT AVENUE	None	SANTA ANA	CA	92705	2690	30	06059	33.76214673	-117.8204657	Orange County
202505	Fee-for-Service	1538418629	1538418629	1	1	ALFARO, DANIEL L PT	5/21/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7033 N FRESNO ST STE 202	None	FRESNO	CA	93720	2976	10	06019	36.838044	-119.7813175	Fresno County
202515	Fee-for-Service	1689683278	1689683278	1	1	A. DE LA PENA, MD A MED	10/30/1991	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	GROUP, INC.	2715 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5746	19	06037	33.97390007	-118.2220232	Los Angeles County
202527	Fee-for-Service	1154377521	1154377521	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	989 AVENIDA PICO	None	SAN CLEMENTE	CA	92673	3908	30	06059	33.45544491	-117.6024147	Orange County
202544	Fee-for-Service	1396783379	1396783379	1	3	ASANA INTEGRATED MEDICAL GRO	10/13/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP PC	450 STANYAN ST	None	SAN FRANCISCO	CA	94117	1019	38	06075	37.7738933	-122.4544685	San Francisco County
202604	Fee-for-Service	1962799197	1962799197	1	1	ARNEJA, SARABJEET K MD	2/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145649	25	Physical Medicine and Rehabilitation	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
202610	Fee-for-Service	1487746814	1487746814	1	1	AARONSON, REBECCA C MD	2/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91396	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
202628	Fee-for-Service	1659315729	1659315729	1	1	AHMED, KABIR MD	8/24/2004	207L00000X	NA	Other	026	PHYSICIANS	69357	None	None	0	In state provider	None	7218 VAN NUYS BLVD	STE D	VAN NUYS	CA	91405	2255	19	06037	34.20173513	-118.4487045	Los Angeles County
202630	Fee-for-Service	1386092385	1386092385	1	1	ALLAN-SCHRIMSCHER, COREY DO	9/13/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
202648	Fee-for-Service	1023758117	1023758117	1	1	ASHLEY'S GARDEN ELDERLY CARE	3/5/2025	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	INC	7930 RHODES AVE	None	NORTH HOLLYWOOD	CA	91605	2331	19	06037	34.21473856	-118.4030751	Los Angeles County
202674	Fee-for-Service	1538303516	1538303516	1	1	ALTAMED HEALTH SERVICES CORP	10/9/2009	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1814 W LINCOLN AVE	STE B	ANAHEIM	CA	92801	6730	30	06059	33.83241852	-117.946323	Orange County
202678	Fee-for-Service	1609095090	1609095090	1	1	ALTURAS, SHANNON O OD	5/16/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	3658 S NOGALES ST	None	WEST COVINA	CA	91792	2714	19	06037	34.0113478	-117.8866414	Los Angeles County
202722	Fee-for-Service	1750324380	1750324380	1	1	ALLEMAND, CHERYL A LMFT	1/2/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	800 POLLARD RD	STE B207	LOS GATOS	CA	95032	1429	43	06085	37.26085007	-121.9698747	Santa Clara County
202746	Fee-for-Service	1801963723	1801963723	1	1	ARORA, DEEPAK MD	2/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78877	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
202762	Fee-for-Service	1255832333	1255832333	2	1	ABLE HEALTH GROUP LLC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	41990 COOK ST	BLDG F STE 2004	PALM DESERT	CA	92211	6105	33	06065	33.748371	-116.356173	Riverside County
202767	Fee-for-Service	1770859985	1770859985	1	1	ARONSON, JENNY R MD	5/29/2019	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	130700	77	Infectious Disease	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
202772	Fee-for-Service	1740291574	1740291574	1	1	ADAMS, RUENELL D	7/18/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	50672	01	General Practice	0	In state provider	None	8170 LAGUNA BLVD	STE 304	ELK GROVE	CA	95758	7903	34	06067	38.421054	-121.405365	Sacramento County
202775	Fee-for-Service	1740427657	1740427657	1	28	ALTAMED HEALTH SERVICES CORP	8/14/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1930 WEST 10TH STREET	None	SANTA ANA	CA	92703	2045	30	06059	33.75337739	-117.8961121	Orange County
202787	Fee-for-Service	1881468114	1881468114	1	1	AMIT RAINA MD INC	3/28/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	9080 COLIMA RD	None	WHITTIER	CA	90605	1600	19	06037	33.95062799	-118.0051627	Los Angeles County
202819	Fee-for-Service	1073806642	1073806642	1	1	ANGELS HOME HEALTH	7/1/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	555 S SUNRISE WAY	STE 217	PALM SPRINGS	CA	92264	7869	33	06065	33.814971	-116.528247	Riverside County
202830	Fee-for-Service	1073814232	1073814232	2	1	AMERICAN HOMEPATIENT INC	3/10/2016	332BX2000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3763 ARLINGTON AVE	SUITE 104	RIVERSIDE	CA	92506	2610	33	06065	33.94626774	-117.3994379	Riverside County
202839	Fee-for-Service	1538512629	1538512629	1	1	ANSARI, TAHA MD	7/8/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	177431	None	None	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
202879	Fee-for-Service	1255332334	1255332334	1	1	ALLEN, ARTHUR W JR MD	1/1/1982	207W00000X	NA	Ophthalmology	026	PHYSICIANS	35478	18	Ophthalmology	0	In state provider	None	2351 CLAY ST	STE 414	SAN FRANCISCO	CA	94115	1931	38	06075	37.79101512	-122.4316059	San Francisco County
202881	Fee-for-Service	1750358271	1750358271	1	1	AMARJYOT GILL MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9225 N 3RD ST	STE 304	PHOENIX	AZ	85020	2466	00	None	33.57054	-112.0692465	Maricopa County
202918	Fee-for-Service	1104182526	1104182526	1	1	AMY DOLL	1/6/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 N 7TH ST	None	BISMARCK	ND	58501	4439	00	None	46.808109	-100.782261	Burleigh County
202925	Fee-for-Service	1063850600	1063850600	1	1	ARAKAKI, RYAN Y MD	7/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	134026	07	Dermatology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
202933	Fee-for-Service	1750770608	1750770608	1	1	AINTABLIAN, IGHIA MD APC	10/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	42047	40	Pediatrics	0	In state provider	None	1510 SOUTH CENTRAL AVE	SUITE 450	GLENDALE	CA	91204	2510	19	06037	34.12709764	-118.2577911	Los Angeles County
202963	Fee-for-Service	1174988901	1174988901	1	1	ALBERTSONS LLC	7/6/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1608 BROADWAY	None	EL CAJON	CA	92021	5201	37	06073	32.80772851	-116.920116	San Diego County
203004	Fee-for-Service	1710243779	1710243779	1	1	ADKINS, SARAH H MD	4/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137086	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
203041	Fee-for-Service	1518055573	1518055573	1	1	ANDERSON, IAN C MD	2/11/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	49481	78	Neoplastic Diseases/Oncology	0	In state provider	None	3555 ROUND BARN CIR	None	SANTA ROSA	CA	95403	1757	49	06097	38.478717	-122.729715	Sonoma County
203061	Fee-for-Service	1740291574	1740291574	1	1	ADAMS, RUENELL D	7/18/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	50672	08	Family Practice	0	In state provider	None	8170 LAGUNA BLVD	STE 304	ELK GROVE	CA	95758	7903	34	06067	38.421054	-121.405365	Sacramento County
203074	Fee-for-Service	1003862012	1003862012	1	1	ACCENTCARE HOME HEALTH OF CA	8/5/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5050 MURPHY CANYON RD	STE 201	SAN DIEGO	CA	92123	4441	37	06073	32.83051691	-117.1202755	San Diego County
203088	Fee-for-Service	1730396128	1730396128	1	1	ALMA M MEDINA	10/9/2001	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1730 142ND AVE	None	SAN LEANDRO	CA	94578	1712	01	06001	37.71605062	-122.1341817	Alameda County
203120	Fee-for-Service	1316691769	1316691769	1	1	ALEXANDER, KATHERINE CNP	8/19/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
203123	Fee-for-Service	1316726458	1316726458	1	1	AZUL COUNSELING, INC	4/8/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41197 GOLDEN GATE CIR	201	MURRIETA	CA	92562	1422	33	06065	33.53652808	-117.1759195	Riverside County
203153	Fee-for-Service	1881888345	1881888345	1	1	ANDACHEH, IDEN D MD	4/25/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106941	02	General Surgery	0	In state provider	None	7111 INDIANA AVE	STE 100	RIVERSIDE	CA	92504	4557	33	06065	33.93924242	-117.3973049	Riverside County
203178	Fee-for-Service	1447470968	1447470968	1	1	ANTHONY S. OH, M.D., A MEDIC	11/2/2019	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	4950 SAN BERNARDINO ST	SUITE 200	MONTCLAIR	CA	91763	2212	36	06071	34.07768363	-117.6968874	San Bernardino County
203200	Fee-for-Service	1477714095	1477714095	1	1	ALEXANDER, DALE A PHD	10/8/2009	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4715 VIEWRIDGE AVE	#230	SAN DIEGO	CA	92123	1680	37	06073	32.82422034	-117.1210743	San Diego County
203203	Fee-for-Service	1417451196	1417451196	1	1	AMIN, MINA MD	6/9/2020	390200000X	NA	Other	026	PHYSICIANS	163540	07	Dermatology	0	In state provider	None	4900 W SUNSET BLVD	None	LOS ANGELES	CA	90027	5814	19	06037	34.0981225	-118.2965085	Los Angeles County
203209	Fee-for-Service	1598308850	1598308850	1	1	ACME CARE INC	11/6/2020	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	6253 N COLONIAL AVE	None	FRESNO	CA	93704	1437	10	06019	36.82738599	-119.8033408	Fresno County
203240	Fee-for-Service	1497986343	1497986343	1	1	ALGENDY, ABDALRAHMAN A MD	8/2/2023	207L00000X	NA	Other	026	PHYSICIANS	182277	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
203260	Fee-for-Service	1396912507	1396912507	1	1	AL-MUFTI, JENAN MD	10/17/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	37794	36	Psychiatry	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
203268	Fee-for-Service	1689069981	1689069981	1	1	ASQUITH, KERSTIN MD	10/15/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	143788	36	Psychiatry	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
203276	Fee-for-Service	1508097064	1508097064	1	1	AFIFI, NEGEAN DO	9/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12680	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
203290	Fee-for-Service	1497896054	1497896054	1	1	ALLEN, MARK PT	7/16/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	24331 EL TORO ROAD	SUITE 200	LAGUNA WOODS	CA	92637	3116	30	06059	33.60928782	-117.7295058	Orange County
203298	Fee-for-Service	1669556866	1669556866	1	1	AHN, THOMAS G MD	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	61939	67	Endocrinology	0	In state provider	None	2080 CENTURY PARK E	STE 1410	LOS ANGELES	CA	90067	2017	19	06037	34.05887194	-118.4122914	Los Angeles County
203330	Fee-for-Service	1518055573	1518055573	1	1	ANDERSON, IAN C MD	2/11/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	49481	01	General Practice	0	In state provider	None	3555 ROUND BARN CIR	None	SANTA ROSA	CA	95403	1757	49	06097	38.478717	-122.729715	Sonoma County
203342	Fee-for-Service	1013609585	1013609585	1	1	A PARADISE VILLA INC	2/22/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	9925 COLLETT AVE	None	NORTH HILLS	CA	91343	1619	19	06037	34.25144098	-118.4838554	Los Angeles County
203370	Fee-for-Service	1609948223	1609948223	1	1	ANDERSON, JACK M MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60266	40	Pediatrics	0	In state provider	None	3030 CHILDRENS WAY	STE 216	SAN DIEGO	CA	92123	4227	37	06073	32.798889	-117.150826	San Diego County
203371	Fee-for-Service	1396329900	1396329900	1	1	ACOSTA, MICHAEL T	7/20/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	960 E GREEN ST	STE L11	PASADENA	CA	91106	2412	19	06037	34.14451994	-118.1301695	Los Angeles County
203418	Fee-for-Service	1023219987	1023219987	1	1	AZAR, JOSEPH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 NE 139TH ST	None	VANCOUVER	WA	98686	0000	00	None	45.720117	-122.647986	Clark County
203444	Fee-for-Service	1336552439	1336552439	1	1	ARAGAM, GOWRI G MD	8/22/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	156440	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
203449	Fee-for-Service	1407384456	1407384456	1	1	AHMAD, AMMAR MD	9/27/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	164323	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
203476	Fee-for-Service	1669811733	1669811733	1	1	AFZAL, KOMAL DO	2/1/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	14853	40	Pediatrics	0	In state provider	None	1820 41ST AVE	STE D	CAPITOLA	CA	95010	2516	44	06087	36.975573	-121.964832	Santa Cruz County
203525	Fee-for-Service	1821259466	1821259466	1	1	ALI, HATEM M MD	3/5/2013	207RN0300X	NA	Nephrology	026	PHYSICIANS	108629	None	None	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4799	12	06023	40.78355148	-124.1420294	Humboldt County
203548	Fee-for-Service	1396912507	1396912507	1	1	AL-MUFTI, JENAN MD	10/17/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	37794	01	General Practice	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
203550	Fee-for-Service	1235452335	1235452335	1	3	ARTISAN FOOT AND ANKLE PODIA	12/23/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	ALISTS	26691 PLAZA DRIVE	201	MISSION VIEJO	CA	92691	6329	30	06059	33.56533763	-117.6645538	Orange County
203556	Fee-for-Service	1538152715	1538152715	1	1	ARTENOS, JOHN A MD	6/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	73956	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9333 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
203588	Fee-for-Service	1669556866	1669556866	1	1	AHN, THOMAS G MD	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	61939	41	Internal Medicine	0	In state provider	None	2080 CENTURY PARK E	STE 1410	LOS ANGELES	CA	90067	2017	19	06037	34.05887194	-118.4122914	Los Angeles County
203593	Fee-for-Service	1235234873	1235234873	1	1	AGUIRRE, FERNANDO A MD	10/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80801	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
203655	Fee-for-Service	1851449680	1851449680	1	1	ARMOR, BURD L MD	10/31/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	52696	01	General Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
203657	Fee-for-Service	1609948223	1609948223	1	1	ANDERSON, JACK M MD	7/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	60266	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3030 CHILDRENS WAY	STE 216	SAN DIEGO	CA	92123	4227	37	06073	32.798889	-117.150826	San Diego County
203689	Fee-for-Service	1619255783	1619255783	1	2	AGUILAR, JOSE L JR MD	7/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	122466	36	Psychiatry	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
203716	Fee-for-Service	1477738359	1477738359	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2955 ALPINE BLVD	None	ALPINE	CA	91901	2392	37	06073	32.83443413	-116.7499452	San Diego County
203726	Fee-for-Service	1629224381	1629224381	1	1	ABC PHARMACY INC	3/2/2010	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	ABC COMPOUNDING PHARMACY	16311 VENTURA BLVD	STE 110	ENCINO	CA	91436	4307	19	06037	34.15706864	-118.4885978	Los Angeles County
203761	Fee-for-Service	1508100074	1508100074	1	1	ARORA, PUNEET K MD	10/1/2018	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	156658	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
203792	Fee-for-Service	1891312153	1891312153	1	1	ANNA MUNOZ CHAVIRA MD A CA P	8/5/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	15141 WHITTIER BLVD	200	WHITTIER	CA	90603	2173	19	06037	33.94810044	-118.0039419	Los Angeles County
203815	Fee-for-Service	1396182143	1396182143	1	1	AYE, MOE M DO	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14296	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
203821	Fee-for-Service	1710691340	1710691340	1	1	ASAMSAMA, KRISTINA I NP	10/14/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
203838	Fee-for-Service	1235452335	1235452335	1	3	ARTISAN FOOT AND ANKLE PODIA	10/7/2022	213ES0103X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	ALISTS	26691 PLAZA DRIVE	201	MISSION VIEJO	CA	92691	6329	30	06059	33.56533763	-117.6645538	Orange County
203842	Fee-for-Service	1346250347	1346250347	1	1	AVALON MEDICAL DEVELOPMENT C	9/23/2022	261QC0050X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	CENTER	100 FALLS CANYON ROAD	None	AVALON	CA	90704	1563	19	06037	33.33904622	-118.3307237	Los Angeles County
203844	Fee-for-Service	1639258551	1639258551	1	2	ARKEN HEALTHCARE SERVICES	10/1/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	1700 IOWA AVE	STE 110	RIVERSIDE	CA	92507	2420	33	06065	33.996033	-117.3398135	Riverside County
203849	Fee-for-Service	1922591197	1922591197	1	1	ABU ZAANONA, MOHAMMED I MD	10/1/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	540 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4230	42	06083	34.42739162	-119.7253175	Santa Barbara County
203860	Fee-for-Service	1811401557	1811401557	1	1	AYLLON, MADELEINE MATILDE N	6/15/2020	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	P	8110 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21850103	-118.4310944	Los Angeles County
203867	Fee-for-Service	1902836943	1902836943	1	1	AMISUB OF NORTH CAROLINA	11/25/2009	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	INC	1135 CARTHAGE ST	None	SANFORD	NC	27330	4163	00	None	35.468658	-79.1871435	Lee County
203884	Fee-for-Service	1962464602	1962464602	2	1	AUEN, EDWARD L MD	1/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	1401 SPANOS COURT	SUITE 122	MODESTO	CA	95355	2812	50	06099	37.66975543	-120.9724048	Stanislaus County
203892	Fee-for-Service	1609048396	1609048396	1	1	ASHFAQ, ROBILA MD	6/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	66267	08	Family Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
203906	Fee-for-Service	1215973276	1215973276	1	1	AMENDOLA, KRISTA M MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	82076	40	Pediatrics	0	In state provider	None	2191 MOWRY AVE	STE 600C	FREMONT	CA	94538	1702	01	06001	37.55710897	-121.9814562	Alameda County
203913	Fee-for-Service	1629081005	1629081005	1	1	ASHRAF, IRMEEN M MD	10/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78367	40	Pediatrics	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
203918	Fee-for-Service	1194803981	1194803981	1	1	AXELSSON, KAREN L MD	11/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	68965	22	Pathology (M.D. only)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
203940	Fee-for-Service	1942220272	1942220272	1	2	AGUIRRE, FRANCISCO MD	12/1/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	70313	-	NOT APPLICABLE	0	In state provider	None	1820 J STREET	None	SACRAMENTO	CA	95811	3010	34	06067	38.57688	-121.4816625	Sacramento County
203954	Fee-for-Service	1740351667	1740351667	1	1	ACKLEY, SUZANNE MD	1/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	57221	01	General Practice	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
203956	Fee-for-Service	1003952342	1003952342	1	1	ARBITER, STANLEY I MD,	9/4/2018	207R00000X	NA	Other	026	PHYSICIANS	65519	41	Internal Medicine	0	In state provider	BELLER, LEONARD B MD, AN	1931 SUNSET BLVD	None	LOS ANGELES	CA	90026	3228	19	06037	34.07791565	-118.2619277	Los Angeles County
203967	Fee-for-Service	1013970524	1013970524	2	1	ATTAR, NASEEM A MD	3/24/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	55323	02	General Surgery	0	In state provider	None	4646 BROCKTON AVE	STE 302	RIVERSIDE	CA	92506	0172	33	06065	33.9760171	-117.3860626	Riverside County
203989	Fee-for-Service	1962419135	1962419135	1	1	ANDREWS, LUANN D LMFT	5/18/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3252 HOLIDAY COURT	SUITE 106	LA JOLLA	CA	92037	1807	37	06073	32.8705156	-117.2323734	San Diego County
204003	Fee-for-Service	1972685493	1972685493	1	1	ADVANCED PHYSICAL MEDICINE &	7/15/2013	2081P2900X	NA	Physical Medicine and Rehabilitation	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	REHAB GROUP INC	411 GRAND AVE	None	OAKLAND	CA	94610	5022	01	06001	37.80873036	-122.2535337	Alameda County
204033	Fee-for-Service	1538122106	1538122106	1	1	AQUINO, JESUSA T MD	1/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	52966	40	Pediatrics	0	In state provider	None	742 W HIGHLAND AVE	None	SAN BERNARDINO	CA	92405	3839	36	06071	34.13604853	-117.29952	San Bernardino County
204057	Fee-for-Service	1053976266	1053976266	1	1	ARCADIA CARE CENTER LLC	6/1/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1601 S BALDWIN AVE	None	ARCADIA	CA	91007	7930	19	06037	34.12102912	-118.0550068	Los Angeles County
204061	Fee-for-Service	1396005534	1396005534	1	1	AMAN, KUMIKO MD	1/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135978	01	General Practice	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
204091	Fee-for-Service	1407972490	1407972490	1	1	AQEEL, RUBINA MD	10/2/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	53565	None	None	0	In state provider	None	811 E 11TH ST	STE 205	UPLAND	CA	91786	4872	36	06071	34.1034335	-117.6398415	San Bernardino County
204128	Fee-for-Service	1346250347	1346250347	1	1	AVALON MEDICAL DEVELOPMENT C	3/28/1991	261QC0050X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER	100 FALLS CANYON ROAD	None	AVALON	CA	90704	1563	19	06037	33.33904622	-118.3307237	Los Angeles County
204133	Fee-for-Service	1922591197	1922591197	1	1	ABU ZAANONA, MOHAMMED I MD	10/1/2024	207RH0003X	NA	Oncology	026	PHYSICIANS	None	68	Hematology	0	In state provider	None	540 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4230	42	06083	34.42739162	-119.7253175	Santa Barbara County
204142	Fee-for-Service	1639414139	1639414139	1	2	APLA HEALTH & WELLNESS	3/4/2014	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3743 S LABREA AVE	None	LOS ANGELES	CA	90016	5309	19	06037	34.01991	-118.355626	Los Angeles County
204145	Fee-for-Service	1013369511	1013369511	1	1	ADAMS, CRISTEN	4/5/2024	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
204148	Fee-for-Service	1285178343	1285178343	1	2	ALIZAARA LLC	8/10/2021	347E00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	5150 E. CANDLEWOOD ST	20D	LAKEWOOD	CA	90712	1002	19	06037	33.85362254	-118.1326815	Los Angeles County
204154	Fee-for-Service	1902836943	1902836943	1	1	AMISUB OF NORTH CAROLINA	11/25/2009	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	INC	1135 CARTHAGE ST	None	SANFORD	NC	27330	4163	00	None	35.468658	-79.1871435	Lee County
204180	Fee-for-Service	1922523208	1922523208	1	1	ALCANTARA, CHELSEA M PSYD	5/10/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
204185	Fee-for-Service	1033286059	1033286059	1	1	ALBERT, MICHELLE A MD	8/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136053	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
204220	Fee-for-Service	1518405661	1518405661	1	1	ACAB, JOEL C MD	10/17/2020	207R00000X	NA	Other	026	PHYSICIANS	169809	41	Internal Medicine	0	In state provider	None	320 LENNON LANE	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
204252	Fee-for-Service	1104997097	1104997097	1	1	AJURIA, EDUARDO MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	40046	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
204261	Fee-for-Service	1962224824	1962224824	1	1	ABIDALI PROFESSIONAL MEDICAL	2/21/2025	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2001 MCHENRY AVE	STE L	MODESTO	CA	95350	3253	50	06099	37.67338576	-120.9942007	Stanislaus County
204268	Fee-for-Service	1871021931	1871021931	1	1	AGHAPY PHARMACY INC	7/10/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3853 STETSON AVE	STE 103	HEMET	CA	92545	9675	33	06065	33.7293005	-117.011457	Riverside County
204316	Fee-for-Service	1447338298	1447338298	1	1	AZIM, ABIDA MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	56222	01	General Practice	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
204349	Fee-for-Service	1003404708	1003404708	1	1	ARRIESGADO, MINNETT SHARON C	3/27/2023	225XP0019X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	OT	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
204352	Fee-for-Service	1982197703	1982197703	1	2	ADMINISTRATIVE SERVICES COOP	9/27/2021	344600000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ERATIVE, INC.	1515 190TH	250	GARDENA	CA	90248	4319	19	06037	33.85838352	-118.3064445	Los Angeles County
204356	Fee-for-Service	1235301714	1235301714	1	1	ALLEN, MATTHEW W MD	7/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111934	None	None	0	In state provider	None	963 BUTTE STREET	None	REDDING	CA	96001	0828	45	06089	40.58567535	-122.3853786	Shasta County
204381	Fee-for-Service	1578567178	1578567178	1	1	ARMSTRONG, JENNIFER D MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74400	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
204389	Fee-for-Service	1740427657	1740427657	1	9	ALTAMED HEALTH SERVICES CORP	5/10/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1010 NORTH BROADWAY	None	SANTA ANA	CA	92701	3408	30	06059	33.75401898	-117.8697112	Orange County
204393	Fee-for-Service	1639126410	1639126410	1	1	ACKERMAN, BARBARA C PHD	4/12/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
204400	Fee-for-Service	1558486233	1558486233	1	1	ADVENT GROUP MINISTRIES, INC	4/9/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	865 BLACK WALNUT CT	None	MORGAN HILL	CA	95037	3722	43	06085	37.13961467	-121.6413921	Santa Clara County
204417	Fee-for-Service	1346250347	1346250347	1	1	AVALON MEDICAL DEVELOPMENT C	7/18/2023	261QC0050X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CENTER	100 FALLS CANYON ROAD	None	AVALON	CA	90704	1563	19	06037	33.33904622	-118.3307237	Los Angeles County
204426	Fee-for-Service	1639414139	1639414139	1	2	APLA HEALTH & WELLNESS	3/4/2014	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	3743 S LABREA AVE	None	LOS ANGELES	CA	90016	5309	19	06037	34.01991	-118.355626	Los Angeles County
204439	Fee-for-Service	1881174043	1881174043	1	1	ALUDRA INC	6/4/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	13701 RIVERSIDE DR	SUITE 409	SHERMAN OAKS	CA	91423	2448	19	06037	34.15762986	-118.4316325	Los Angeles County
204454	Fee-for-Service	1962991604	1962991604	1	1	ALTRUITY HOME HEALTH &	4/6/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE LLC	1675 SHAFFER RD	SUITE 1	ATWATER	CA	95301	4456	24	06047	37.34811422	-120.5959613	Merced County
204468	Fee-for-Service	1770642399	1770642399	1	1	AVAZ, FARZIN M MD	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	75569	18	Ophthalmology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
204474	Fee-for-Service	1912014564	1912014564	1	1	ADVOCATE NORTHSIDE	6/10/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HEALTH SYSTEM	836 W WELLINGTON AVE	None	CHICAGO	IL	60657	5147	00	None	41.93635946	-87.65154	Cook County
204484	Fee-for-Service	1063890275	1063890275	1	1	ALGOS INC., A MEDICAL CORPOR	6/13/2019	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	2650 JONES WAY	SUITE 9	SIMI VALLEY	CA	93065	1203	56	06111	34.28861251	-118.745991	Ventura County
204495	Fee-for-Service	1366063851	1366063851	1	1	AHN, KAITLYN A DO	10/18/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21200	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
204510	Fee-for-Service	1093082281	1093082281	1	1	ANGELS ON EARTH HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4959 PALO VERDE ST	SUITE 202A	MONTCLAIR	CA	91763	2339	36	06071	34.08129954	-117.6966135	San Bernardino County
204525	Fee-for-Service	1427322635	1427322635	1	3	ADVANCED PAIN DIAGNOSTIC & S	6/24/2020	261QP3300X	NA	Other	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	OLUTIONS INC	480 DEL NORTE AVE	None	YUBA CITY	CA	95991	4125	51	06101	39.14337536	-121.6202241	Sutter County
204538	Fee-for-Service	1598185217	1598185217	1	1	AJURIA, EDUARDO MD	9/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129412	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
204562	Fee-for-Service	1669566147	1669566147	2	1	AKOPOV, SERGEY MD	12/31/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	72794	13	Neurology (M.D. only)	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	9998	33	06065	33.9760587	-117.3800672	Riverside County
204572	Fee-for-Service	1760661516	1760661516	1	1	AJMAL, LUBNA MD	8/20/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	97610	40	Pediatrics	0	In state provider	None	2650 S BRISTOL ST	STE 101-103	SANTA ANA	CA	92704	5751	30	06059	33.71118647	-117.885452	Orange County
204598	Fee-for-Service	1124575618	1124575618	1	1	AVEEVA HOSPICE	9/25/2018	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11860 MAGNOLIA AVE	SUITE I	RIVERSIDE	CA	92503	4911	33	06065	33.89534893	-117.4903478	Riverside County
204637	Fee-for-Service	1568498475	1568498475	1	1	ANDREWS, ROBERT J MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76492	04	Otology, Laryngology, Rhinology	0	In state provider	None	1301 20TH ST	STE 300	SANTA MONICA	CA	90404	2087	19	06037	34.02976782	-118.4812493	Los Angeles County
204658	Fee-for-Service	1336748201	1336748201	1	1	AVEEVA HOSPICE-SOUTH	11/5/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3741 MERCED DR	STE K	RIVERSIDE	CA	92503	4956	33	06065	33.89494008	-117.4890821	Riverside County
204659	Fee-for-Service	1275777641	1275777641	1	1	AGUILAR, JORGE MD	9/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	126542	05	Anesthesiology	0	In state provider	None	1601 YNAGCIO VALLEY ROAD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
204676	Fee-for-Service	1740427657	1740427657	1	9	ALTAMED HEALTH SERVICES CORP	5/10/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1010 NORTH BROADWAY	None	SANTA ANA	CA	92701	3408	30	06059	33.75401898	-117.8697112	Orange County
204678	Fee-for-Service	1386175388	1386175388	1	1	ARORA, SUMIT MD	8/12/2020	207P00000X	NA	Other	026	PHYSICIANS	169536	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18300 US HIGHWAY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
204700	Fee-for-Service	1528726809	1528726809	1	4	ACCESS CARE ANESTHESIA OF CA	5/2/2024	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	LIFORNIA PC	1660 3RD ST	None	LOS ANGELES	CA	90017	1138	19	06037	34.0607173	-118.2675891	Los Angeles County
204704	Fee-for-Service	1346250347	1346250347	1	1	AVALON MEDICAL DEVELOPMENT C	3/28/1991	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER	100 FALLS CANYON ROAD	None	AVALON	CA	90704	1563	19	06037	33.33904622	-118.3307237	Los Angeles County
204705	Fee-for-Service	1639414139	1639414139	1	2	APLA HEALTH & WELLNESS	3/4/2014	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	3743 S LABREA AVE	None	LOS ANGELES	CA	90016	5309	19	06037	34.01991	-118.355626	Los Angeles County
204723	Fee-for-Service	1881174043	1881174043	1	1	ALUDRA INC	6/4/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	13701 RIVERSIDE DR	SUITE 409	SHERMAN OAKS	CA	91423	2448	19	06037	34.15762986	-118.4316325	Los Angeles County
204738	Fee-for-Service	1790361939	1790361939	1	1	ALGOS INC., A MEDICAL CORPOR	3/29/2024	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	100 N STATE COLLEGE BLVD	SUITE H	FULLERTON	CA	92831	4236	30	06059	33.8708934	-117.8895465	Orange County
204741	Fee-for-Service	1588741441	1588741441	1	1	AUNG, MYO M MD	1/25/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81033	38	Geriatrics	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
204764	Fee-for-Service	1912014564	1912014564	1	1	ADVOCATE NORTHSIDE	9/10/2004	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HEALTH SYSTEM	836 W WELLINGTON AVE	None	CHICAGO	IL	60657	5147	00	None	41.93635946	-87.65154	Cook County
204770	Fee-for-Service	1063890275	1063890275	1	1	ALGOS INC., A MEDICAL CORPOR	1/3/2023	103TB0200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2650 JONES WAY	SUITE 9	SIMI VALLEY	CA	93065	1203	56	06111	34.28861251	-118.745991	Ventura County
204789	Fee-for-Service	1114054590	1114054590	1	1	ACORD, BRIAN L MD	11/30/1988	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	45319	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4060 4TH AVE	STE 520	SAN DIEGO	CA	92103	2121	37	06073	32.75053673	-117.1616539	San Diego County
204797	Fee-for-Service	1093082281	1093082281	1	1	ANGELS ON EARTH HOSPICE	4/15/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4959 PALO VERDE ST	SUITE 202A	MONTCLAIR	CA	91763	2339	36	06071	34.08129954	-117.6966135	San Bernardino County
204846	Fee-for-Service	1669014668	1669014668	1	1	AFFORDABLE UNIQUE CARE INC	8/17/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	13701 RIVERSIDE DR	#606	SHERMAN OAKS	CA	91423	2449	19	06037	34.15762986	-118.4316325	Los Angeles County
204847	Fee-for-Service	1639210743	1639210743	1	1	ALLEN, BRUCE L MD	1/31/1992	208600000X	NA	General Surgery	026	PHYSICIANS	30889	02	General Surgery	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
204887	Fee-for-Service	1124575618	1124575618	1	1	AVEEVA HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11860 MAGNOLIA AVE	SUITE I	RIVERSIDE	CA	92503	4911	33	06065	33.89534893	-117.4903478	Riverside County
204907	Fee-for-Service	1811066905	1811066905	1	1	ALVARADO ORTHOPEDIC MEDI	11/10/2020	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	GRP INC	5555 RESERVOIR DR	STE 104	SAN DIEGO	CA	92120	5198	37	06073	32.77628471	-117.0563688	San Diego County
204922	Fee-for-Service	1609255637	1609255637	1	1	ANBERRY TRANSITIONAL CARE	12/9/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	1000 WEST YOSEMITE AVE	None	MERCED	CA	95341	5141	24	06047	37.33201654	-120.4853355	Merced County
204935	Fee-for-Service	1154592921	1154592921	1	1	ALI, IRFAN MD	4/1/2021	2084N0402X	NA	Neurology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
204946	Fee-for-Service	1336748201	1336748201	1	1	AVEEVA HOSPICE-SOUTH	11/5/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3741 MERCED DR	STE K	RIVERSIDE	CA	92503	4956	33	06065	33.89494008	-117.4890821	Riverside County
204957	Fee-for-Service	1932582699	1932582699	1	1	AKSHAY MEHTA MD INC	1/17/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	3628 E IMPERIAL HWY	300	LYNWOOD	CA	90262	2646	19	06037	33.93070837	-118.2044557	Los Angeles County
204965	Fee-for-Service	1053362673	1053362673	1	1	ARNOTT, TIMOTHY J MD	3/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	87967	41	Internal Medicine	0	In state provider	None	6161 CLARK RD	#5	PARADISE	CA	95969	4164	04	06007	39.76393327	-121.6036644	Butte County
204968	Fee-for-Service	1265263719	1265263719	1	1	ASIDANYA, CHINWE	10/6/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
204989	Fee-for-Service	1528726809	1528726809	1	4	ACCESS CARE ANESTHESIA OF CA	5/2/2024	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	LIFORNIA PC	1660 3RD ST	None	LOS ANGELES	CA	90017	1138	19	06037	34.0607173	-118.2675891	Los Angeles County
204993	Fee-for-Service	1346250347	1346250347	1	1	AVALON MEDICAL DEVELOPMENT C	3/10/2022	261QC0050X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	CENTER	100 FALLS CANYON ROAD	None	AVALON	CA	90704	1563	19	06037	33.33904622	-118.3307237	Los Angeles County
205000	Fee-for-Service	1265444723	1265444723	1	1	AL-HAFEZ, MOHAMAD A MD	3/29/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81352	41	Internal Medicine	0	In state provider	None	4053 LONE TREE WAY	STE 101	ANTIOCH	CA	94531	6200	07	06013	37.97569499	-121.800733	Contra Costa County
205017	Fee-for-Service	1295775807	1295775807	2	1	AHO, CHRISTOPHER J MD	8/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	79102	14	Neurological Surgery	0	In state provider	None	12291 WASHINGTON BLVD	SUITE 102	WHITTIER	CA	90606	3817	19	06037	33.96734104	-118.0508773	Los Angeles County
205031	Fee-for-Service	1770918674	1770918674	1	1	ALO HA PSYCHOLOGICAL ASSOCIA	7/17/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3517 CAMINO DEL RIO S	302	SAN DIEGO	CA	92108	4029	37	06073	32.77777042	-117.1179225	San Diego County
205058	Fee-for-Service	1184736357	1184736357	1	2	AGHAI, MEHRDAD MD	6/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	83156	18	Ophthalmology	0	In state provider	CENTURY EYE CARE MED CTR	4477 W 118TH ST	STE 101	HAWTHORNE	CA	90250	2256	19	06037	33.92734752	-118.354221	Los Angeles County
205061	Fee-for-Service	1326509191	1326509191	1	1	AUDA, GREGORY S MD	7/18/2022	207R00000X	NA	Other	026	PHYSICIANS	180456	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
205079	Fee-for-Service	1063981439	1063981439	1	1	ADVENTIST HEALTH PHYSICIANS	7/20/2020	261QU0200X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	2563 N 11T AVE	109	HANFORD	CA	93230	1464	16	06031	36.359019	-119.6550735	Kings County
205090	Fee-for-Service	1528514148	1528514148	1	1	AFANASYEVA, ALEXANDRA LMFT	4/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13101 W WASHINGTON BLVD	232	CULVER CITY	CA	90066	5131	19	06037	33.99397583	-118.440813	Los Angeles County
205108	Fee-for-Service	1417675950	1417675950	1	1	ANGELIC HANDS SENIOR	10/25/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	SERVICES LLC	82397 STRADIVARI RD	None	INDIO	CA	92203	3825	33	06065	33.75178168	-116.2272807	Riverside County
205125	Fee-for-Service	1447210513	1447210513	1	1	ANTINORI, JAMES MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2055 N MAIN ST	None	TOOELE	UT	84074	9819	00	None	40.56668579	-112.2959013	Tooele County
205136	Fee-for-Service	1598734121	1598734121	1	1	ALI, ABDUL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8830 LONG POINT RD	STE 507	HOUSTON	TX	77055	3026	00	None	29.80310355	-95.50778821	Harris County
205141	Fee-for-Service	1093980807	1093980807	1	1	AMES, HAROLD PSYD	9/8/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	111 DEERWOOD RD	STE 200	SAN RAMON	CA	94583	4445	07	06013	37.77475997	-121.9892508	Contra Costa County
205162	Fee-for-Service	1730451089	1730451089	1	1	ALI, SONIA L MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123537	68	Hematology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
205176	Fee-for-Service	1588944789	1588944789	1	1	ADVANCED HEALTHCARE	1/12/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY, INC.	13129 BROOKHURST STREET	None	GARDEN GROVE	CA	92843	1079	30	06059	33.7721089	-117.9551894	Orange County
205184	Fee-for-Service	1750704250	1750704250	1	1	APOLLOMED CARE CLINIC A	11/4/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	PROFESSIONAL CORPORATION	3056 FLETCHER DRIVE	None	LOS ANGELES	CA	90065	2207	19	06037	34.11590478	-118.2443234	Los Angeles County
205185	Fee-for-Service	1285101006	1285101006	1	1	ARABIAN, ANI	2/10/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
205196	Fee-for-Service	1811066905	1811066905	1	1	ALVARADO ORTHOPEDIC MEDI	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GRP INC	5555 RESERVOIR DR	STE 104	SAN DIEGO	CA	92120	5198	37	06073	32.77628471	-117.0563688	San Diego County
205230	Fee-for-Service	1356408124	1356408124	1	1	ABUEG, FRANCIS R PHD	7/8/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
205266	Fee-for-Service	1740623792	1740623792	1	1	ALSBERGE, JOSEPH B MD	10/11/2017	390200000X	NA	Other	026	PHYSICIANS	135056	18	Ophthalmology	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
205282	Fee-for-Service	1528726809	1528726809	1	4	ACCESS CARE ANESTHESIA OF CA	5/2/2024	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	LIFORNIA PC	1660 3RD ST	None	LOS ANGELES	CA	90017	1138	19	06037	34.0607173	-118.2675891	Los Angeles County
205285	Fee-for-Service	1346250347	1346250347	1	1	AVALON MEDICAL DEVELOPMENT C	7/8/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CENTER	100 FALLS CANYON ROAD	None	AVALON	CA	90704	1563	19	06037	33.33904622	-118.3307237	Los Angeles County
205287	Fee-for-Service	1548655269	1548655269	1	1	ADAMS, RAGINI MD	11/13/2018	207PP0204X	NA	Other	026	PHYSICIANS	153328	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
205306	Fee-for-Service	1467589812	1467589812	1	1	AJIJOLA, OLUJIMI A MD	1/28/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108167	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
205307	Fee-for-Service	1538789987	1538789987	1	1	ACOSTA, AARON MARK DO	11/17/2023	207P00000X	NA	Other	026	PHYSICIANS	21247	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
205348	Fee-for-Service	1790731297	1790731297	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2035 HILLHURST AVE	None	LOS ANGELES	CA	90027	2702	19	06037	34.108785	-118.2874465	Los Angeles County
205353	Fee-for-Service	1912903626	1912903626	1	1	ACCARINO, STEVEN A MD	4/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
205359	Fee-for-Service	1629338603	1629338603	1	1	ANJELLY, DAVID MD	8/29/2019	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	162284	10	Gastroenterology (M.D. only)	0	In state provider	None	1595 SOQUEL DR	STE 140	SANTA CRUZ	CA	95065	1717	44	06087	36.98879599	-121.9826354	Santa Cruz County
205375	Fee-for-Service	1902367865	1902367865	1	1	A&M ALLIANCE HOME HEALTH	7/29/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	18401 BURBANK BLVD	STE 206	TARZANA	CA	91356	6608	19	06037	34.17187827	-118.5339035	Los Angeles County
205377	Fee-for-Service	1437449048	1437449048	1	1	ALI, ZAINAB MD	6/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	128655	40	Pediatrics	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3018	37	06073	32.781483	-117.007182	San Diego County
205390	Fee-for-Service	1992199251	1992199251	1	1	ADLER, BRANDON L MD	10/8/2019	207N00000X	NA	Dermatology	026	PHYSICIANS	145676	07	Dermatology	0	In state provider	None	1450 SAN PBLO ST	STE 2000	LOS ANGELES	CA	90033	5300	19	06037	34.06189518	-118.203256	Los Angeles County
205415	Fee-for-Service	1902905813	1902905813	1	1	ALBERTSON, NAOMI L MD	10/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	74542	01	General Practice	0	In state provider	None	1000 FRANKLIN PKWY	None	SAN MATEO	CA	94403	1922	41	06081	37.54350476	-122.2913782	San Mateo County
205425	Fee-for-Service	1316465834	1316465834	1	1	AGUIRRE VERDUGO, ISELA LCSW	10/16/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
205438	Fee-for-Service	1851735211	1851735211	1	1	AHDOOT, REBECCA S MD	2/17/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	132648	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
205452	Fee-for-Service	1730451089	1730451089	1	1	ALI, SONIA L MD	10/4/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	123537	78	Neoplastic Diseases/Oncology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
205472	Fee-for-Service	1750704250	1750704250	1	1	APOLLOMED CARE CLINIC A	11/4/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	PROFESSIONAL CORPORATION	3056 FLETCHER DRIVE	None	LOS ANGELES	CA	90065	2207	19	06037	34.11590478	-118.2443234	Los Angeles County
205499	Fee-for-Service	1568405355	1568405355	1	1	ANDERSON, DOUGLAS J MD	3/31/1989	207P00000X	NA	Other	026	PHYSICIANS	40673	66	Emergency Medicine (Urgent Care)	0	In state provider	None	17100 EUCLID ST	None	FOUNTAIN VALLEY	CA	92708	4004	30	06059	33.715035	-117.936993	Orange County
205504	Fee-for-Service	1710076815	1710076815	1	1	AURANG, AHMAD MD	12/4/1986	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	33519	08	Family Practice	0	In state provider	None	11041 LOS ALAMITOS BLVD	# D	LOS ALAMITOS	CA	90720	3201	30	06059	33.8023395	-118.0720275	Orange County
205507	Fee-for-Service	1396783379	1396783379	1	17	ASANA INTEGRATED MEDICAL GRO	10/13/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP PC	1531 ESPLANADE UNDEFINED	None	CHICO	CA	95926	3310	04	06007	39.74248474	-121.8493369	Butte County
205558	Fee-for-Service	1346250347	1346250347	1	2	AVALON MEDICAL DEVELOPMENT C	1/1/1993	282NC0060X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	100 FALLS CANYON RD	None	AVALON	CA	90704	1563	19	06037	33.33904622	-118.3307237	Los Angeles County
205562	Fee-for-Service	1659320984	1659320984	1	1	ANESTHESIA & ANALGESIA	11/2/1990	193200000X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	MEDICAL GROUP, INC	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
205568	Fee-for-Service	1699745497	1699745497	1	1	ANDES,LESLIE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2901 N CENTRAL AVE	STE 500	PHOENIX	AZ	85012	0000	00	None	33.480666	-112.0729905	Maricopa County
205569	Fee-for-Service	1851654776	1851654776	1	1	AL MASALMEH, OSSAMA	3/1/2024	208M00000X	NA	Other	026	PHYSICIANS	148449	41	Internal Medicine	0	In state provider	None	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.591699	-117.2368285	Riverside County
205572	Fee-for-Service	1346250347	1346250347	1	1	AVALON MEDICAL DEVELOPMENT C	4/3/2002	282NC0060X	NA	Hospitals	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	CENTER	100 FALLS CANYON ROAD	None	AVALON	CA	90704	1563	19	06037	33.33904622	-118.3307237	Los Angeles County
205583	Fee-for-Service	1891042958	1891042958	1	1	ALI, NOOR AZREEN B MD	12/8/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	170320	None	None	0	In state provider	None	5800 HOLLIS ST	None	EMERYVILLE	CA	94608	2016	01	06001	37.84043576	-122.2894291	Alameda County
205610	Fee-for-Service	1265129639	1265129639	1	1	ATUL SINGLA M.D., A PROFESSI	6/8/2023	193400000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	ONAL MEDICAL CORPORATION	820 S AKERS ST STE 130	None	VISALIA	CA	93277	8346	54	06107	36.323541	-119.349261	Tulare County
205616	Fee-for-Service	1114011103	1114011103	1	1	ARJOMAND, VIDA L OD	3/10/2011	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	330 N BRAND BLVD	STE 110	GLENDALE	CA	91203	2308	19	06037	34.15116156	-118.2549512	Los Angeles County
205640	Fee-for-Service	1548919921	1548919921	1	1	ANDREA T GARNICA	8/30/2024	193400000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	599 S BARRANCA AVE	#211	COVINA	CA	91723	2777	19	06037	34.079373	-117.881338	Los Angeles County
205643	Fee-for-Service	1235414343	1235414343	1	1	ADVANTAGE HEALTH SYSTEMS	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	9663 TIERRA GRANDE ST	STE 204	SAN DIEGO	CA	92126	4570	37	06073	32.89501952	-117.1213425	San Diego County
205653	Fee-for-Service	1457137689	1457137689	1	1	ALTADENA MEDICAL PHARMACY IN	11/21/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CORPORATED	2525 E FOOTHILL BLVD	STE 6	PASADENA	CA	91107	3485	19	06037	34.14984952	-118.098216	Los Angeles County
205670	Fee-for-Service	1972816601	1972816601	1	1	ABEL, DAWN M CNP	7/18/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
205681	Fee-for-Service	1730257932	1730257932	2	2	ALLERGY & ASTHMA ADULT & PED	8/20/2020	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	A	4000 CIVIC CENTER DRIVE	SUITE 300	SAN RAFAEL	CA	94903	4173	21	06041	38.0041783	-122.538861	Marin County
205750	Fee-for-Service	1063184455	1063184455	1	1	ALVARADO, NATHALIA LCSW	2/28/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
205775	Fee-for-Service	1952717480	1952717480	1	1	A-1 HOSPICE CARE CENTER 4 U	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6345 BALBOA BLVD	SUITE 168	ENCINO	CA	91316	5236	19	06037	34.18620241	-118.5011527	Los Angeles County
205805	Fee-for-Service	1629057393	1629057393	1	1	ACHAMALLAH, NAGUI S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	48988	36	Psychiatry	0	In state provider	None	532 OREGON ST	None	VALLEJO	CA	94590	3254	48	06095	38.1183693	-122.2491848	Solano County
205814	Fee-for-Service	1881748630	1881748630	1	1	AKSOY, OLCAY MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124307	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	# 365	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
205827	Fee-for-Service	1073043204	1073043204	1	2	AIDS HEALTHCARE FOUNDATION	12/3/2020	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4630 BORDER VILLAGE ROAD	STE K	SAN YSIDRO	CA	92173	3117	37	06073	32.54777512	-117.0357457	San Diego County
205845	Fee-for-Service	1346250347	1346250347	1	2	AVALON MEDICAL DEVELOPMENT C	1/1/1993	282NC0060X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	100 FALLS CANYON RD	None	AVALON	CA	90704	1563	19	06037	33.33904622	-118.3307237	Los Angeles County
205857	Fee-for-Service	1346250347	1346250347	1	1	AVALON MEDICAL DEVELOPMENT C	4/25/2024	261QC0050X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	CENTER	100 FALLS CANYON ROAD	None	AVALON	CA	90704	1563	19	06037	33.33904622	-118.3307237	Los Angeles County
205874	Fee-for-Service	1912760547	1912760547	1	1	AID DEPOT MEDICAL SUPPLY	5/23/2024	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	15664 MAIN ST	STE 210	HESPERIA	CA	92345	3412	36	06071	34.42448078	-117.3212841	San Bernardino County
205882	Fee-for-Service	1851646657	1851646657	1	1	AHMED, FARRES N U MD	11/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157784	30	Radiology	0	In state provider	None	150 PIONEER LN	None	BISHOP	CA	93514	2556	14	06027	37.36193834	-118.4073304	Inyo County
205886	Fee-for-Service	1821057407	1821057407	2	1	ARBOR VITA CORPORATION	7/19/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	48371 FREMONT BLVD	101	FREMONT	CA	94538	6554	01	06001	37.46685525	-121.9342344	Alameda County
205891	Fee-for-Service	1194868760	1194868760	1	4	ALFRED J COPPOLA JR MD INC	11/17/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	300 OLD RIVER RD	200	BAKERSFIELD	CA	93311	9506	15	06029	35.352648	-119.1122505	Kern County
205919	Fee-for-Service	1063891760	1063891760	1	1	ALDEA, INC	3/26/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2121 IMOLA AVENUE	None	NAPA	CA	94559	3625	28	06055	38.277783	-122.256963	Napa County
205920	Fee-for-Service	1700405701	1700405701	1	1	ALTAMED HEALTH SERVICES CORP	6/30/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	972 GOODRICH	ROOM 100	LOS ANGELES	CA	90022	4114	19	06037	34.01786727	-118.1546159	Los Angeles County
205925	Fee-for-Service	1548837172	1548837172	1	1	ALMASI, SAMUEL DO	5/15/2024	390200000X	NA	Other	026	PHYSICIANS	21803	08	Family Practice	0	In state provider	None	225 W BROADWAY	SUITE 100	GLENDALE	CA	91204	1393	19	06037	34.14673469	-118.257145	Los Angeles County
205931	Fee-for-Service	1235414343	1235414343	1	1	ADVANTAGE HEALTH SYSTEMS	2/20/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	9663 TIERRA GRANDE ST	STE 204	SAN DIEGO	CA	92126	4570	37	06073	32.89501952	-117.1213425	San Diego County
205949	Fee-for-Service	1578854808	1578854808	1	1	AYALON, ROY D MD INC	5/31/2011	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	102319	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	18411 CLARK ST	STE 107	TARZANA	CA	91356	6131	19	06037	34.16981538	-118.5337442	Los Angeles County
205961	Fee-for-Service	1366539843	1366539843	1	1	AFSHAR, NIMA MD	10/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	78500	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
205978	Fee-for-Service	1003816141	1003816141	1	2	ATMAJIAN, TIMOTHY K MD	4/17/2024	208D00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	77817	-	NOT APPLICABLE	0	In state provider	None	1804 OLIVE AVE	None	FRESNO	CA	93728	2619	10	06019	36.75748931	-119.8324108	Fresno County
206001	Fee-for-Service	1932513488	1932513488	1	1	AHOUBIM, AFSHIN MD	9/10/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	148220	45	Nephrology (Renal-Kidney)	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
206014	Fee-for-Service	1932150224	1932150224	1	1	ANTOSSYAN, LEVON MD INC	8/3/1994	261Q00000X	NA	Other	026	PHYSICIANS	53324	None	None	0	In state provider	None	1204 S CENTRAL AVE	None	GLENDALE	CA	91204	2504	19	06037	34.132059	-118.257791	Los Angeles County
206052	Fee-for-Service	1346657277	1346657277	1	1	ADVANCED CARE EMERGENCY	8/15/2014	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	1	Border provider	SPECIALISTS LLC	360 S LOLA LN	None	PAHRUMP	NV	89048	0884	00	None	36.214524	-116.025615	Nye County
206062	Fee-for-Service	1952717480	1952717480	1	1	A-1 HOSPICE CARE CENTER 4 U	7/7/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6345 BALBOA BLVD	SUITE 168	ENCINO	CA	91316	5236	19	06037	34.18620241	-118.5011527	Los Angeles County
206132	Fee-for-Service	1346250347	1346250347	1	2	AVALON MEDICAL DEVELOPMENT C	1/1/1993	282E00000X	NA	Hospitals	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	100 FALLS CANYON RD	None	AVALON	CA	90704	1563	19	06037	33.33904622	-118.3307237	Los Angeles County
206145	Fee-for-Service	1346250347	1346250347	1	1	AVALON MEDICAL DEVELOPMENT C	3/10/2022	261QC0050X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	CENTER	100 FALLS CANYON ROAD	None	AVALON	CA	90704	1563	19	06037	33.33904622	-118.3307237	Los Angeles County
206153	Fee-for-Service	1598080376	1598080376	1	1	ADLER, ALLISON C MD	10/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110457	41	Internal Medicine	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
206166	Fee-for-Service	1811962202	1811962202	1	1	AGARWAL, NEERU DO	3/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	11317	02	General Surgery	0	In state provider	None	4500 BROCKTON AVE	STE 316	RIVERSIDE	CA	92501	4135	33	06065	33.97785263	-117.3836152	Riverside County
206172	Fee-for-Service	1548617301	1548617301	1	1	ADVANCED SURGICARE LLC	11/12/2015	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2222 LAFAYETTE STREET	None	SANTA CLARA	CA	95050	2904	43	06085	37.36191641	-121.9487686	Santa Clara County
206206	Fee-for-Service	1063020766	1063020766	1	1	ALTO, LYSANDER C NP	7/5/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92411	1214	36	06071	34.131303	-117.3225325	San Bernardino County
206219	Fee-for-Service	1417012444	1417012444	1	1	ABAZARI, MINA MD	5/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	77017	01	General Practice	0	In state provider	None	1491 E LA PALMA AVE	B	ANAHEIM	CA	92805	1564	30	06059	33.84730519	-117.8982466	Orange County
206278	Fee-for-Service	1528695970	1528695970	1	1	ALAM, JAMAL Y DO	10/13/2022	390200000X	NA	Other	026	PHYSICIANS	19801	None	None	0	In state provider	None	1401 S GRANDE AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
206290	Fee-for-Service	1134187636	1134187636	1	1	ABU QARE, ABDUL ELAH Y	8/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	MD	1707 W CHARLESTON BLVD	STE 230	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
206291	Fee-for-Service	1932513488	1932513488	1	1	AHOUBIM, AFSHIN MD	9/10/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	148220	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
206312	Fee-for-Service	1568787943	1568787943	1	1	ABIGAIL POLZIN M.D.	8/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1305 W 18TH ST	None	SIOUX FALLS	SD	57105	0401	00	None	43.535484	-96.7428585	Minnehaha County
206351	Fee-for-Service	1497331193	1497331193	1	1	ARM HOSPICE INC	10/14/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1241 S GLENDALE AVE	SUITE 205	GLENDALE	CA	91205	3389	19	06037	34.13065269	-118.2524619	Los Angeles County
206352	Fee-for-Service	1578755252	1578755252	1	1	ABRAMYAN, MIKAYEL MD	11/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92425	40	Pediatrics	0	In state provider	None	1115 SOUTH SUNSET AVENUE	None	WEST COVINA	CA	91790	3940	19	06037	34.062852	-117.9446658	Los Angeles County
206356	Fee-for-Service	1922315654	1922315654	1	1	ANABI MEDICAL CORPORATION	2/9/2018	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	160 EAST ARTESIA STREET	SUITE 225	POMONA	CA	91767	2925	19	06037	34.07556833	-117.7507835	Los Angeles County
206447	Fee-for-Service	1821587585	1821587585	1	1	AOST HEALTHCARE SERVICES	9/10/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	48044	41	Internal Medicine	0	In state provider	None	10990 LOWER AZUSA RD	STE 4	EL MONTE	CA	91731	1353	19	06037	34.09217091	-118.027232	Los Angeles County
206463	Fee-for-Service	1679516314	1679516314	1	1	ANVAR, BARDIA A MD	3/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86336	02	General Surgery	0	In state provider	None	1913 E 5TH ST	None	LONG BEACH	CA	90802	2024	19	06037	33.77295768	-118.1682236	Los Angeles County
206468	Fee-for-Service	1427517812	1427517812	1	1	ADVENTIST HEALTH PHYSICIANS	8/9/2019	208600000X	NA	General Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	951 E. MERRITT AVE.	None	TULARE	CA	93274	2221	54	06107	36.22196755	-119.3334795	Tulare County
206480	Fee-for-Service	1417010604	1417010604	1	5	ABLELIGHT INC	1/29/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	COMMUNITIES INC	25281 MAWSON DR	None	LAGUNA HILLS	CA	92653	5241	30	06059	33.59490937	-117.6884699	Orange County
206489	Fee-for-Service	1982885398	1982885398	1	1	ANTHONY, DONNA M LCSW	12/5/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	442 W ESPLANADE AVE	SUITE 124	SAN JACINTO	CA	92583	5006	33	06065	33.77289454	-116.9647335	Riverside County
206506	Fee-for-Service	1780469163	1780469163	1	1	ANGELE, BRIANNA	6/20/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
206513	Fee-for-Service	1740427657	1740427657	1	2	ALTAMED HEALTH SERVICES CORP	4/26/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE	1400 N MAIN STREET	None	SANTA ANA	CA	92701	2304	30	06059	33.75688822	-117.8676134	Orange County
206531	Fee-for-Service	1932376514	1932376514	1	1	ARDESHIRPOUR-ZARTOSHTI,	11/3/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132714	02	General Surgery	0	In state provider	FARHAD MD	11370 ANDERSON ST	STE 2100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
206557	Fee-for-Service	1053998682	1053998682	1	1	AGWARAMGBO, NKEMDI E MD	7/15/2024	208M00000X	NA	Other	026	PHYSICIANS	None	70	Clinic (mixed specialty)	0	In state provider	None	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	01	06001	37.69819004	-122.0873124	Alameda County
206567	Fee-for-Service	1104412352	1104412352	1	1	ACKERMAN, KAMREN PT	3/7/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
206574	Fee-for-Service	1255891628	1255891628	1	1	ANGELS TOUCH HOME HEALTH	12/11/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	225 EAST BROADWAY	STE 215A	GLENDALE	CA	91205	1008	19	06037	34.14633765	-118.2529554	Los Angeles County
206591	Fee-for-Service	1932582699	1932582699	1	6	AKSHAY MEHTA MD INC	1/17/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	1141 W REDONDO BLVD	212	GARDENA	CA	90247	3586	19	06037	33.89247036	-118.2941482	Los Angeles County
206594	Fee-for-Service	1447887716	1447887716	1	1	AGYEI, AKOSUAH MD	1/6/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	8767 WILSHIRE BLVD	2ND AND 3RD FLOOR	BEVERLY HILLS	CA	90211	2714	19	06037	34.06704253	-118.3835029	Los Angeles County
206596	Fee-for-Service	1609880939	1609880939	1	1	ALWARD,WILLIAMS T MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1055 N 300 W	None	PROVO	UT	84604	0000	00	None	40.24788856	-111.6640034	Utah County
206597	Fee-for-Service	1447200860	1447200860	1	1	ALTMAN, ROBERT J MD	5/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	74028	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
206607	Fee-for-Service	1063887495	1063887495	1	1	ARNETT, KIMBERLY NP	2/14/2025	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95021152	-	NOT APPLICABLE	0	In state provider	None	4440 UNIVERSITY AVE	#1,#2,#3,#4,#5,#6,#7,#8,	RIVERSIDE	CA	92501	3199	33	06065	33.986006	-117.3833861	Riverside County
206631	Fee-for-Service	1942518519	1942518519	1	1	ANDREWS, SHERRY M MD	9/30/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114009	41	Internal Medicine	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
206636	Fee-for-Service	1588940449	1588940449	1	1	ALL IN ONE HOME HEALTH	3/21/2013	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY INC	1255 E HIGHLAND AVENUE	SUITE 216	SAN BERNARDINO	CA	92404	4653	36	06071	34.13584648	-117.259875	San Bernardino County
206637	Fee-for-Service	1497331193	1497331193	1	1	ARM HOSPICE INC	10/14/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1241 S GLENDALE AVE	SUITE 205	GLENDALE	CA	91205	3389	19	06037	34.13065269	-118.2524619	Los Angeles County
206639	Fee-for-Service	1194096727	1194096727	1	1	AZZINARO, ADELLENA M CRNA	1/23/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
206665	Fee-for-Service	1043632938	1043632938	1	1	ALTA NEWPORT HOSPITAL LLC	6/24/2015	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	14662 NEWPORT AVENUE	None	TUSTIN	CA	92780	6064	30	06059	33.73088521	-117.8293385	Orange County
206670	Fee-for-Service	1043872328	1043872328	1	1	ARCE, PATRICIA LCSW	7/18/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
206685	Fee-for-Service	1780211557	1780211557	1	1	AMASHTA, MICHAEL MD	11/16/2023	207P00000X	NA	Other	026	PHYSICIANS	183758	None	None	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
206689	Fee-for-Service	1881781334	1881781334	1	1	ALLEN, EDWARD CLARK MD	8/24/2004	2084P0800X	NA	Psychiatry	026	PHYSICIANS	48040	36	Psychiatry	0	In state provider	None	2365 NORTHSIDE DR	STE 320	SAN DIEGO	CA	92108	2709	37	06073	32.78295851	-117.1266482	San Diego County
206765	Fee-for-Service	1972742328	1972742328	1	1	ALLCARE FAMILY CLINIC, INC.	7/23/2010	193400000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1781 THIRD STREET	None	NORCO	CA	92860	2670	33	06065	33.91682263	-117.5617337	Riverside County
206767	Fee-for-Service	1396189445	1396189445	1	1	ASHWELL, ZACHARY MD	2/26/2025	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	2121 SANTA MONICA BLVD	None	SANTA MONICA	CA	90404	2302	19	06037	34.02980528	-118.4786605	Los Angeles County
206790	Fee-for-Service	1275586927	1275586927	1	1	ANNERUD,CAROLYN R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	347 N KUAKINI STREET	None	HONOLULU	HI	96817	2336	00	None	21.32247447	-157.8564644	Honolulu County
206798	Fee-for-Service	1255063558	1255063558	1	1	A CARING TOUCH BOARD AND	8/18/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	CARE II LLC	2108 OAK STREET	None	SANTA MONICA	CA	90405	5010	19	06037	34.01353434	-118.4627514	Los Angeles County
206801	Fee-for-Service	1740427657	1740427657	1	2	ALTAMED HEALTH SERVICES CORP	4/26/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MOBILE	1400 N MAIN STREET	None	SANTA ANA	CA	92701	2304	30	06059	33.75688822	-117.8676134	Orange County
206802	Fee-for-Service	1407043532	1407043532	1	1	A. B. SEE OPTICAL	1/31/1994	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	8488 W 3RD ST	None	LOS ANGELES	CA	90048	4112	19	06037	34.07328477	-118.3759624	Los Angeles County
206811	Fee-for-Service	1972998649	1972998649	1	1	APARICIO, SYLVIA NP	8/8/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1477 SHAW AVE	None	FRESNO	CA	93710	8022	10	06019	36.80832659	-119.7614085	Fresno County
206816	Fee-for-Service	1366694747	1366694747	1	2	ARIEL MALAMUD, A MEDICAL COR	11/4/2019	207RG0100X	NA	Gastroenterology	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	PORATION	1513 S GRAND AVE	330	LOS ANGELES	CA	90015	3070	19	06037	34.03596303	-118.266212	Los Angeles County
206838	Fee-for-Service	1518435536	1518435536	1	2	AMPLEX HEARING AIDS INC	1/27/2025	237700000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	745 PLUMAS STREET	None	YUBA CITY	CA	95991	4437	51	06101	39.13874665	-121.616783	Sutter County
206856	Fee-for-Service	1740799600	1740799600	1	1	ANITA MEHTA	10/23/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	222 N 7TH ST	None	BISMARCK	ND	58501	4436	00	None	46.807308	-100.782459	Burleigh County
206887	Fee-for-Service	1972695963	1972695963	1	1	ASTUDILLO, GODOFREDO MD	9/20/2007	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	26755	02	General Surgery	0	In state provider	None	970 KENISTON AVE	None	LOS ANGELES	CA	90019	1705	19	06037	34.05730693	-118.3359704	Los Angeles County
206890	Fee-for-Service	1235573783	1235573783	1	1	ATLURU, APARNA MD	11/5/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	142627	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
206904	Fee-for-Service	1831493394	1831493394	1	1	ANWAR AND VASEEMA ARASTU MD	5/6/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	INC	12675 LA MIRADA BLVD	STE 200	LA MIRADA	CA	90638	2200	19	06037	33.91589551	-118.0119734	Los Angeles County
206912	Fee-for-Service	1851040679	1851040679	1	2	ALL WAYS SERVICES LLC	4/1/2022	172A00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2394 PACHECO DR	None	MERCED	CA	95340	5601	24	06047	37.32705962	-120.4373625	Merced County
206933	Fee-for-Service	1750453726	1750453726	1	1	ALTER, ANTHONY H MD	11/30/1985	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	9970	20	Orthopedic Surgery	0	In state provider	None	9735 WILSHIRE BLVD	# 2	BEVERLY HILLS	CA	90212	2107	19	06037	34.06711051	-118.4074605	Los Angeles County
206952	Fee-for-Service	1043632938	1043632938	1	1	ALTA NEWPORT HOSPITAL LLC	6/24/2015	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	14662 NEWPORT AVENUE	None	TUSTIN	CA	92780	6064	30	06059	33.73088521	-117.8293385	Orange County
206964	Fee-for-Service	1194755678	1194755678	1	1	ANDREWS, SIARA B PSYD	2/1/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	12300 HERZOG RD	None	COURTLAND	CA	95615	9743	34	06067	38.310282	-121.5195435	Sacramento County
207054	Fee-for-Service	1831441690	1831441690	1	1	APPIAH, KWAME BOATENG	10/17/2012	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1180 SEA LAVENDER LN	None	BEAUMONT	CA	92223	8469	33	06065	33.94020357	-116.9601072	Riverside County
207082	Fee-for-Service	1699985747	1699985747	1	1	AMBROSE, JOSIAH B MD	2/25/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99517	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.76344756	-122.4581992	San Francisco County
207094	Fee-for-Service	1346450103	1346450103	1	1	ALTAMED HEALTH SERVICES	1/1/1997	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1701 ZONAL AVE	None	LOS ANGELES	CA	90033	1065	19	06037	34.06219051	-118.2106555	Los Angeles County
207099	Fee-for-Service	1235471061	1235471061	1	1	AMBARAM, RESHMA MD	12/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138329	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
207113	Fee-for-Service	1811098197	1811098197	1	1	ABIDARI, JENNIFER M MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85421	34	Urology and Urological Surgery	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
207125	Fee-for-Service	1518435536	1518435536	1	2	AMPLEX HEARING AIDS INC	7/13/2022	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	745 PLUMAS STREET	None	YUBA CITY	CA	95991	4437	51	06101	39.13874665	-121.616783	Sutter County
207148	Fee-for-Service	1912448226	1912448226	1	1	ALLAM, SHAMILI MD	9/1/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	157526	None	None	0	In state provider	None	11180 WARNER AVE	STE 269	FOUNTAIN VALLEY	CA	92708	7516	30	06059	33.71632048	-117.9334575	Orange County
207191	Fee-for-Service	1831493394	1831493394	1	1	ANWAR AND VASEEMA ARASTU MD	5/6/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	INC	12675 LA MIRADA BLVD	STE 200	LA MIRADA	CA	90638	2200	19	06037	33.91589551	-118.0119734	Los Angeles County
207225	Fee-for-Service	1548616196	1548616196	1	1	AGARWAL, AMI DO	3/15/2022	207L00000X	NA	Other	026	PHYSICIANS	18472	None	None	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
207240	Fee-for-Service	1457061046	1457061046	1	1	ALCALA, CELESTE PT	2/8/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1090 N PALM CANYON DR	STE D	PALM SPRINGS	CA	92262	4439	33	06065	33.83736372	-116.5467476	Riverside County
207262	Fee-for-Service	1760709687	1760709687	1	1	AETAS HEALTH SERVICES LLC	8/1/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7922 PALM STREET	None	LEMON GROVE	CA	91945	2956	37	06073	32.73475153	-117.028116	San Diego County
207314	Fee-for-Service	1639153562	1639153562	1	1	ANDRADA-BROWN, EMILY MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	64254	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
207342	Fee-for-Service	1831441690	1831441690	1	1	APPIAH, KWAME BOATENG	10/17/2012	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1180 SEA LAVENDER LN	None	BEAUMONT	CA	92223	8469	33	06065	33.94020357	-116.9601072	Riverside County
207351	Fee-for-Service	1295994275	1295994275	1	2	ALADAG, BELIS M MD	4/2/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	117586	-	NOT APPLICABLE	0	In state provider	None	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	07	06013	37.89859467	-122.0843018	Contra Costa County
207366	Fee-for-Service	1295735553	1295735553	1	1	ALONSO, REYNALDO H MD	11/30/2018	207R00000X	NA	Other	026	PHYSICIANS	151017	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
207384	Fee-for-Service	1346450103	1346450103	1	1	ALTAMED HEALTH SERVICES	1/1/1997	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1701 ZONAL AVE	None	LOS ANGELES	CA	90033	1065	19	06037	34.06219051	-118.2106555	Los Angeles County
207414	Fee-for-Service	1053321760	1053321760	1	1	ALEXANDER, MICHAEL P MD	6/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	26724	78	Neoplastic Diseases/Oncology	0	In state provider	None	1669 DOMINICAN WAY	None	SANTA CRUZ	CA	95065	1523	44	06087	36.99028149	-121.9807642	Santa Cruz County
207421	Fee-for-Service	1952359150	1952359150	2	3	ACCREDO HEALTH GROUP INC	12/4/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2410 WARDLOW	SUITE 101	CORONA	CA	92878	5192	33	06065	33.88181598	-117.6104141	Riverside County
207441	Fee-for-Service	1649091026	1649091026	1	2	AYNNA YEE SAE MD INC	12/16/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	3751 MONTGOMERY DR	None	SANTA ROSA	CA	95405	5214	49	06097	38.453472	-122.6758185	Sonoma County
207458	Fee-for-Service	1710660345	1710660345	1	1	AMANSEC, CRISTINA CCC-SLP	12/20/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
207475	Fee-for-Service	1861744138	1861744138	1	1	ALTA HOLLYWOOD HOSPITALS INC	10/14/2013	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	3828 DELMAS TERRACE	None	CULVER CITY	CA	90232	2713	19	06037	34.02308948	-118.3972101	Los Angeles County
207477	Fee-for-Service	1437147485	1437147485	1	1	ASSOCIATED SURGEONS OF	5/1/2002	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SAN LUIS OBISPO	77 CASA ST	STE 103	SAN LUIS OBISPO	CA	93405	5804	40	06079	35.29306786	-120.6650709	San Luis Obispo County
207484	Fee-for-Service	1053359356	1053359356	1	1	AHN, JEANIE J MD	7/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	65315	45	Nephrology (Renal-Kidney)	0	In state provider	None	1999 MOWRY AVE	STE R	FREMONT	CA	94538	1723	01	06001	37.55783419	-121.9808484	Alameda County
207570	Fee-for-Service	1194315697	1194315697	1	2	ADEDURO, CHRISTIANAH NP	3/13/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
207578	Fee-for-Service	1134422793	1134422793	1	1	ALLISON, ANDREW E MD	10/15/2020	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	2	Out of state provider	None	6410 FANNIN STREET	SUITE 1500	HOUSTON	TX	77030	5306	00	None	29.71419639	-95.39755562	Harris County
207581	Fee-for-Service	1154387926	1154387926	1	1	ALL CARE HOME HEALTH	11/8/1995	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PROVIDERS	100 W BROADWAY	STE 830	GLENDALE	CA	91210	1242	19	06037	34.14643795	-118.2564824	Los Angeles County
207600	Fee-for-Service	1639153562	1639153562	1	1	ANDRADA-BROWN, EMILY MD	12/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	64254	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
207606	Fee-for-Service	1891348991	1891348991	1	1	AVALOS, NOEL PT	5/28/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
207615	Fee-for-Service	1720308174	1720308174	1	1	AUSTIN, DAVID A MD	1/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	57848	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1788	19	06037	34.0696407	-118.3836988	Los Angeles County
207623	Fee-for-Service	1497511430	1497511430	1	1	ALTUS SCHOOLS SOUTHERN	7/1/2024	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA	111 FLETCHER PKWY	None	EL CAJON	CA	92020	2510	37	06073	32.80754853	-116.963001	San Diego County
207624	Fee-for-Service	1366004228	1366004228	1	1	A-1 REHAB & RECRUITMENT SERV	4/27/2022	225400000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	ICES INC	3700 HILBORN RD	SUITE 800	FAIRFIELD	CA	94534	7946	48	06095	38.29570636	-122.036339	Solano County
207626	Fee-for-Service	1417027095	1417027095	2	1	ADVENTIST HEALTH CLEARLAKE	12/30/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	487 S MAIN ST	None	LAKEPORT	CA	95453	5315	17	06033	39.03874681	-122.9152741	Lake County
207631	Fee-for-Service	1871529925	1871529925	1	1	AJIH, GODWIN OGUBIKE	3/27/2007	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	EGOSYSTEMS MED SUPPLIES	7420 S VERMONT AVE	None	LOS ANGELES	CA	90044	5129	19	06037	33.9720141	-118.2914265	Los Angeles County
207651	Fee-for-Service	1427160076	1427160076	1	1	ABRAMS, STEPHANIE H MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56044	40	Pediatrics	0	In state provider	None	1760 TERMINO AVENUE	SUITE 300	LONG BEACH	CA	90804	2105	19	06037	33.78889871	-118.1458784	Los Angeles County
207668	Fee-for-Service	1346450103	1346450103	1	1	ALTAMED HEALTH SERVICES	9/26/2008	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1701 ZONAL AVE	None	LOS ANGELES	CA	90033	1065	19	06037	34.06219051	-118.2106555	Los Angeles County
207681	Fee-for-Service	1003217654	1003217654	1	1	ADVENTIST HEALTH PHYSICIANS	10/28/2019	261QU0200X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1975 VERDUGO BLVD	A	LA CANADA FLINTRI	CA	91011	3018	19	06037	34.20501855	-118.219857	Los Angeles County
207686	Fee-for-Service	1982043733	1982043733	1	1	A'S HOSPICE	7/22/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5562 PHILADELPHIA STREET	SUITE 213	CHINO	CA	91710	2482	36	06071	34.03370384	-117.6837291	San Bernardino County
207688	Fee-for-Service	1942466859	1942466859	1	1	AZIZ, MUHAMMAD A MD	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125242	41	Internal Medicine	0	In state provider	None	1020 29TH ST	STE 120	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
207702	Fee-for-Service	1053321760	1053321760	1	1	ALEXANDER, MICHAEL P MD	6/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	26724	68	Hematology	0	In state provider	None	1669 DOMINICAN WAY	None	SANTA CRUZ	CA	95065	1523	44	06087	36.99028149	-121.9807642	Santa Cruz County
207724	Fee-for-Service	1831630011	1831630011	1	1	ALOISIO, GINA M MD	12/10/2023	2080P0204X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
207737	Fee-for-Service	1558413765	1558413765	1	1	ARVANITIDIS, DEMETRA S	10/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77808	40	Pediatrics	0	In state provider	MD	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
207738	Fee-for-Service	1043347578	1043347578	1	1	ARTEAGA, VERONICA A MD	3/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	86515	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
207740	Fee-for-Service	1073673349	1073673349	1	1	ALARCON, VINCENT JOHN C PT	6/5/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2230 W SUNNYSIDE AVE STE	None	VISALIA	CA	93277	7269	54	06107	36.303912	-119.3156595	Tulare County
207757	Fee-for-Service	1629311279	1629311279	1	1	ARMATAS, CHRISTINA MD	10/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132122	41	Internal Medicine	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
207759	Fee-for-Service	1235223959	1235223959	1	1	AL-KHADRA, EMAN MD	2/8/2015	2080P0203X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
207771	Fee-for-Service	1053359356	1053359356	1	1	AHN, JEANIE J MD	7/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	65315	41	Internal Medicine	0	In state provider	None	1999 MOWRY AVE	STE R	FREMONT	CA	94538	1723	01	06001	37.55783419	-121.9808484	Alameda County
207792	Fee-for-Service	1376056002	1376056002	1	5	AFFORDABLE SENIOR HOUSING FO	9/27/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	652 TRANQUILITY GLEN	None	ESCONDIDO	CA	92027	3984	37	06073	33.12426304	-117.0592583	San Diego County
207815	Fee-for-Service	1891744280	1891744280	1	1	AARON BINSTOCK M.D.	10/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4801 W 81ST ST	STE 108	MINNEAPOLIS	MN	55437	1111	00	None	44.85623947	-93.34035	Hennepin County
207910	Fee-for-Service	1114799178	1114799178	1	1	AV BRIDGES MENTAL HEALTH COR	5/16/2024	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1331 W. AVE J	STE 101A	LANCASTER	CA	93534	2946	19	06037	34.68946152	-118.155699	Los Angeles County
207912	Fee-for-Service	1417027095	1417027095	2	1	ADVENTIST HEALTH CLEARLAKE	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	487 S MAIN ST	None	LAKEPORT	CA	95453	5315	17	06033	39.03874681	-122.9152741	Lake County
207951	Fee-for-Service	1154709764	1154709764	1	1	AKAMINE, CHRISTINE M MD	5/25/2022	390200000X	NA	Other	026	PHYSICIANS	144113	None	None	0	In state provider	None	104 E OLIVE AVE	STE 100	REDLANDS	CA	92373	5255	36	06071	34.0540723	-117.1800104	San Bernardino County
207974	Fee-for-Service	1982043733	1982043733	1	1	A'S HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5562 PHILADELPHIA STREET	SUITE 213	CHINO	CA	91710	2482	36	06071	34.03370384	-117.6837291	San Bernardino County
207975	Fee-for-Service	1962548537	1962548537	1	1	ANKER, LARS MD	10/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90065	14	Neurological Surgery	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
207982	Fee-for-Service	1083612980	1083612980	1	2	ALLERGY MEDICAL GROUP OF THE	2/7/2023	207K00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	NORTH AREA INC.	935 RESERVE DR	None	ROSEVILLE	CA	95678	1340	31	06061	38.76381805	-121.2705078	Placer County
208035	Fee-for-Service	1093919680	1093919680	1	1	ANDRADE, ROSA M MD	12/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106912	77	Infectious Disease	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
208050	Fee-for-Service	1649413667	1649413667	1	1	AKMAL, MOHAMMAD AAMIR MD	9/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125902	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
208051	Fee-for-Service	1528145455	1528145455	1	1	APTE, DIPALI V MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	84780	18	Ophthalmology	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
208133	Fee-for-Service	1497803324	1497803324	1	1	ACOSTA, EDUARDO R MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	68115	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
208146	Fee-for-Service	1609325604	1609325604	1	1	ASLAM, RABIA MD	9/13/2021	207R00000X	NA	Other	026	PHYSICIANS	163541	None	None	0	In state provider	None	2734 EL CAMINO REAL	None	SANTA CLARA	CA	95051	3007	43	06085	37.35228637	-121.9754073	Santa Clara County
208149	Fee-for-Service	1285049890	1285049890	1	1	ARTHUR, D ANN MD	10/11/2021	207XX0801X	NA	Orthopedic Surgery	026	PHYSICIANS	140490	None	None	0	In state provider	None	850 FAIR OAKS AVE	STE 100	ARROYO GRANDE	CA	93420	3923	40	06079	35.11274104	-120.588873	San Luis Obispo County
208165	Fee-for-Service	1295230142	1295230142	1	1	ABDELSAYED, NATHAN MD	11/30/2023	163WP0000X	NA	Other	026	PHYSICIANS	179754	None	None	0	In state provider	None	1135 S SUNSET AVENUE	SUITE 401	WEST COVINA	CA	91790	3921	19	06037	34.06215064	-117.9453997	Los Angeles County
208177	Fee-for-Service	1295940229	1295940229	1	1	AZIMIAN, MORTEZA MD	7/8/2024	207RR0500X	NA	Other	026	PHYSICIANS	168660	83	Rheumatology	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
208193	Fee-for-Service	1114799178	1114799178	1	1	AV BRIDGES MENTAL HEALTH COR	5/16/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	1331 W. AVE J	STE 101A	LANCASTER	CA	93534	2946	19	06037	34.68946152	-118.155699	Los Angeles County
208201	Fee-for-Service	1427461532	1427461532	1	1	AHMAD, OWAIS MD	6/30/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140135	41	Internal Medicine	0	In state provider	None	2122 WEST KETTLEMAN LANE	None	LODI	CA	95242	2122	39	06077	38.11537452	-121.299291	San Joaquin County
208202	Fee-for-Service	1407364920	1407364920	1	1	ASHOOR, AMANDA	10/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	SUITE 200	RIVERSIDE	CA	92505	4408	33	06065	33.90100297	-117.49363	Riverside County
208219	Fee-for-Service	1447716725	1447716725	1	1	AHMAD, YOUSIF MD	8/21/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
208221	Fee-for-Service	1851744890	1851744890	1	1	AHMED, SANA LCSW	11/19/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
208313	Fee-for-Service	1336272806	1336272806	2	1	AGK INC	7/14/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	228 N GARFIELD AVE	STE 101	MONTEREY PARK	CA	91754	1746	19	06037	34.06461848	-118.1228384	Los Angeles County
208320	Fee-for-Service	1598057796	1598057796	1	1	ALCAM MEDICAL INC.	11/3/2020	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	15354 BONANZA RD.	A	VICTORVILLE	CA	92395	5829	36	06071	34.50337453	-117.3277755	San Bernardino County
208324	Fee-for-Service	1093919680	1093919680	1	1	ANDRADE, ROSA M MD	12/7/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106912	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
208333	Fee-for-Service	1841228764	1841228764	1	2	ARCADIA RADIOLOGY	1/1/1982	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GRP A PROF CORP	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	9220	19	06037	34.13489987	-118.0424069	Los Angeles County
208375	Fee-for-Service	1427462175	1427462175	1	1	AKHTAR, ADNAN DO INC	8/22/2014	207R00000X	NA	Other	026	PHYSICIANS	9286	41	Internal Medicine	0	In state provider	None	301 VICTORIA STREET	None	COSTA MESA	CA	92627	1995	30	06059	33.65258952	-117.9121545	Orange County
208414	Fee-for-Service	1104801034	1104801034	1	1	AHF HEALTHCARE CENTER	7/5/1994	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	WESTSIDE HEALTHCARE CLIN	99 N LA CIENEGA BLVD	STE 200	BEVERLY HILLS	CA	90211	2285	19	06037	34.06736471	-118.3763201	Los Angeles County
208422	Fee-for-Service	1083123129	1083123129	1	1	ABOLHOSSEINI, KASRA M	4/9/2018	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	12791 NEWPORT AVENUE	SUITE 101	TUSTIN	CA	92780	2785	30	06059	33.75168784	-117.808677	Orange County
208425	Fee-for-Service	1639548449	1639548449	1	1	AGVA LLC	2/1/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	15115 S VERMONT AVENUE	None	GARDENA	CA	90247	4101	19	06037	33.89416554	-118.2920769	Los Angeles County
208427	Fee-for-Service	1457926404	1457926404	1	1	ABDELGELIL, NOHA A MD	8/14/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
208477	Fee-for-Service	1114799178	1114799178	1	1	AV BRIDGES MENTAL HEALTH COR	5/16/2024	193200000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	None	1331 W. AVE J	STE 101A	LANCASTER	CA	93534	2946	19	06037	34.68946152	-118.155699	Los Angeles County
208506	Fee-for-Service	1942463047	1942463047	1	1	AURORA, DEBRA PHD	8/22/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1242 PARK ST	SUITE C	ALAMEDA	CA	94501	5500	01	06001	37.76187672	-122.2447503	Alameda County
208513	Fee-for-Service	1710100706	1710100706	1	1	AGUILERA, ADRIANA V DO	7/2/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	13914	None	None	0	In state provider	None	18800 DELAWARE ST	800	HUNTINGTON BEACH	CA	92648	6019	30	06059	33.68911733	-117.9931535	Orange County
208540	Fee-for-Service	1760900922	1760900922	1	1	ALL FOR HEALTH, HEALTH FOR	5/12/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ALL, INC	2048 MONTROSE AVE	None	MONTROSE	CA	91020	1605	19	06037	34.2059936	-118.2248206	Los Angeles County
208605	Fee-for-Service	1376986331	1376986331	1	1	ALLEN, GREGORY M MD	2/4/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	137373	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
208632	Fee-for-Service	1952632218	1952632218	1	1	ADVENT GROUP MINISTRIES, INC	1/22/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	535 ALKIRE ST	150	MORGAN HILL	CA	95037	4145	43	06085	37.12418434	-121.6617091	Santa Clara County
208643	Fee-for-Service	1366506834	1366506834	1	1	ARIS-MONTES, LINDA	2/26/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
208695	Fee-for-Service	1184803504	1184803504	1	1	ANDERSON, JANICE L LCSW	10/29/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2547 W SHAW AVE	STE 117	FRESNO	CA	93711	3321	10	06019	36.80804173	-119.8385565	Fresno County
208697	Fee-for-Service	1891853115	1891853115	1	1	AGUILERA, LYDIA C	7/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	40871	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	520 W BEVERLY BLVD	# 1	MONTEBELLO	CA	90640	3622	19	06037	34.01668544	-118.1034265	Los Angeles County
208752	Fee-for-Service	1750559431	1750559431	1	24	ALL STAR PHYSICAL THERAPY, I	5/31/2023	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	1090 N PALM CANYON DR	STE D	PALM SPRINGS	CA	92262	4439	33	06065	33.83736372	-116.5467476	Riverside County
208767	Fee-for-Service	1073856464	1073856464	1	1	ABOUZEID, CHRISTIANE M MD	12/23/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	134464	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
208770	Fee-for-Service	1164050399	1164050399	1	1	ALIAKBARIAN, HASSAN MD	10/18/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	520 N MAIN ST	SUITE 120	SANTA ANA	CA	92701	4623	30	06059	33.749316	-117.868123	Orange County
208772	Fee-for-Service	1285294876	1285294876	1	1	ALMA HOME HEALTH INC	12/7/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	35325 DATE PALM DRIVE	SUITE 123	CATHEDRAL CITY	CA	92234	7030	33	06065	33.79144444	-116.4581341	Riverside County
208799	Fee-for-Service	1245877315	1245877315	1	1	ACHARYA, SHAILENDRA NP	5/19/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
208824	Fee-for-Service	1154090736	1154090736	1	1	APARICIO-PHILLIPS, ARIANA O	6/29/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	D	6700 INDIANA AVE	STE 155	RIVERSIDE	CA	92506	4290	33	06065	33.94397483	-117.3905469	Riverside County
208829	Fee-for-Service	1760900922	1760900922	1	1	ALL FOR HEALTH, HEALTH FOR	5/12/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	ALL, INC	2048 MONTROSE AVE	None	MONTROSE	CA	91020	1605	19	06037	34.2059936	-118.2248206	Los Angeles County
208838	Fee-for-Service	1740451749	1740451749	1	1	ABDULNOUR, HUSAM A MD	4/20/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114666	40	Pediatrics	0	In state provider	None	830 SCENIC DR	None	MODESTO	CA	95350	6131	50	06099	37.64720049	-120.982338	Stanislaus County
208849	Fee-for-Service	1699702142	1699702142	1	1	ASHRAF, HADIA MD	7/30/2012	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	62197	08	Family Practice	0	In state provider	None	903 E DEVONSHIRE AVE	STE F	HEMET	CA	92543	3097	33	06065	33.75116958	-116.9627485	Riverside County
208853	Fee-for-Service	1811579774	1811579774	1	1	AKN PHARMACEUTICAL COMPANY,	5/11/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7345 MEDICAL CENTER DR	STE 100	WEST HILLS	CA	91307	1923	19	06037	34.20369349	-118.629837	Los Angeles County
208887	Fee-for-Service	1881863280	1881863280	1	1	AHN, EUGENE Y MD	8/20/2009	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	99302	08	Family Practice	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
208932	Fee-for-Service	1518070382	1518070382	1	1	ARSECULARATNE, LATIKA D	5/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89306	08	Family Practice	0	In state provider	None	1650 S EUCLID AVE	None	ONTARIO	CA	91762	5824	36	06071	34.043571	-117.6514065	San Bernardino County
208950	Fee-for-Service	1497500581	1497500581	1	1	ALVARADO, CYNTHIA PCD	5/17/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
208955	Fee-for-Service	1386291466	1386291466	1	1	ALTAMED HEALTH SERVICES	5/6/2021	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1325 N ANAHEIM BLVD	STE 101	ANAHEIM	CA	92801	1202	30	06059	33.85331047	-117.9199617	Orange County
208992	Fee-for-Service	1396783379	1396783379	1	5	ASANA INTEGRATED MEDICAL GRO	10/13/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP PC	170 ALAMEDA DE LAS PULGA	None	REDWOOD CITY	CA	94062	2751	41	06081	37.48093988	-122.2531826	San Mateo County
209037	Fee-for-Service	1750559431	1750559431	1	24	ALL STAR PHYSICAL THERAPY, I	5/31/2023	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	1090 N PALM CANYON DR	STE D	PALM SPRINGS	CA	92262	4439	33	06065	33.83736372	-116.5467476	Riverside County
209069	Fee-for-Service	1851492268	1851492268	1	1	ARIF, KHURAM	1/3/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88947	40	Pediatrics	0	In state provider	None	7911 LAGUNA BLVD	None	ELK GROVE	CA	95758	7920	34	06067	38.422971	-121.410873	Sacramento County
209093	Fee-for-Service	1932147378	1932147378	1	2	ALEXUS HOME HEALTHCARE INC	3/1/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4000 LONG BEACH BLVD	STE 221	LONG BEACH	CA	90807	2617	19	06037	33.830928	-118.189321	Los Angeles County
209173	Fee-for-Service	1790786333	1790786333	1	1	ALI, NAHEED P MD	4/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54393	41	Internal Medicine	0	In state provider	None	16580 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5795	36	06071	34.47092208	-117.3019138	San Bernardino County
209185	Fee-for-Service	1154902856	1154902856	1	1	ABJC GRACIOUS LIVING, INC.	11/8/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2141 N. EUCLID AVENUE	None	UPLAND	CA	91784	1475	36	06071	34.140987	-117.651508	San Bernardino County
209194	Fee-for-Service	1053416701	1053416701	1	1	ADAMSON, REX S MD	6/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85915	36	Psychiatry	0	In state provider	None	1878 E HATCH RD	None	MODESTO	CA	95351	5002	50	06099	37.60918253	-120.9613365	Stanislaus County
209201	Fee-for-Service	1689179798	1689179798	1	1	ARBOR POST ACUTE, LLC	4/1/2018	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1200 SPRINGFIELD DR	None	CHICO	CA	95928	6340	04	06007	39.73422459	-121.8042177	Butte County
209223	Fee-for-Service	1225024284	1225024284	1	1	ANESTHESIA MEDICAL GROUP	6/13/1989	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	OF SANTA MARIA	1400 E CHURCH ST	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
209229	Fee-for-Service	1568606036	1568606036	1	1	ALMARIO, CHRISTOPHER V MD	7/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121936	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
209242	Fee-for-Service	1386291466	1386291466	1	1	ALTAMED HEALTH SERVICES	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1325 N ANAHEIM BLVD	STE 101	ANAHEIM	CA	92801	1202	30	06059	33.85331047	-117.9199617	Orange County
209292	Fee-for-Service	1871290528	1871290528	1	1	ASTER GARDEN CARE HOME INC	5/11/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2046 ARNOLD DR	None	MARTINEZ	CA	94553	4321	07	06013	37.99224749	-122.084306	Contra Costa County
209296	Fee-for-Service	1609473453	1609473453	1	1	ANAHEIM POINT HEALTHCARE	10/11/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	& WELLNESS CENTRE LP	3415 W BALL RD	None	ANAHEIM	CA	92804	3708	30	06059	33.81728546	-118.0089495	Orange County
209321	Fee-for-Service	1376526822	1376526822	1	1	ANDREWS, JOHN D MD	1/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	PULMONARY MEDICINE ASSOC	236 W 6TH ST	STE 100	RENO	NV	89503	4549	00	None	39.53151304	-119.8186228	Washoe County
209355	Fee-for-Service	1417010604	1417010604	1	25	ABLELIGHT INC	2/11/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1088 W BROWNING AVE	None	FRESNO	CA	93711	2403	10	06019	36.81924048	-119.8104885	Fresno County
209396	Fee-for-Service	1609855949	1609855949	1	1	AKIONA, GLENN P MD	4/24/2023	207L00000X	NA	Other	026	PHYSICIANS	75795	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
209404	Fee-for-Service	1881640803	1881640803	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	133 W ROUTE 66	None	GLENDORA	CA	91740	6208	19	06037	34.12882549	-117.8650035	Los Angeles County
209418	Fee-for-Service	1386678498	1386678498	1	1	ARNAIZ, NILO O MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61314	41	Internal Medicine	0	In state provider	None	1245 16TH ST	STE 204	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
209419	Fee-for-Service	1629737184	1629737184	1	1	AG HOME HEALTH SERVICES	1/25/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7590 N GLENOAKS BLVD	STE 107	BURBANK	CA	91504	1011	19	06037	34.20858506	-118.3436243	Los Angeles County
209449	Fee-for-Service	1720061211	1720061211	1	1	ALBERTS, RICHARD MD	1/27/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87108	None	None	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
209453	Fee-for-Service	1699293134	1699293134	1	1	ALEXANDER, MICHELLE A LMFT	2/5/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	122279	-	NOT APPLICABLE	0	In state provider	None	2049 SKYLINE DR	None	LEMON GROVE	CA	91945	4221	37	06073	32.72729271	-117.0254695	San Diego County
209474	Fee-for-Service	1447613336	1447613336	1	1	ACUNA, MIGUEL A MD	1/12/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	163086	None	None	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
209493	Fee-for-Service	1467132910	1467132910	1	1	ANGULO, IRENE I DOULA	10/31/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
209500	Fee-for-Service	1184971640	1184971640	1	1	ARIKAT, AZZAH I MD	1/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	127256	None	None	0	In state provider	None	2001 FOURTH AVE	None	SAN DIEGO	CA	92101	2303	37	06073	32.72663119	-117.1611714	San Diego County
209513	Fee-for-Service	1467582494	1467582494	1	1	AUWINGER, ATOR Y MD	9/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	132179	41	Internal Medicine	0	In state provider	None	1020 29TH STREET	SUITE 480	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
209517	Fee-for-Service	1568606036	1568606036	1	1	ALMARIO, CHRISTOPHER V MD	7/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121936	10	Gastroenterology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
209523	Fee-for-Service	1568431088	1568431088	1	1	ANALYTIC PATH MED GRP IN	1/1/1979	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROSSMONT HOSP LAB	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
209530	Fee-for-Service	1386291466	1386291466	1	1	ALTAMED HEALTH SERVICES	5/1/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1325 N ANAHEIM BLVD	STE 101	ANAHEIM	CA	92801	1202	30	06059	33.85331047	-117.9199617	Orange County
209545	Fee-for-Service	1669880787	1669880787	1	1	ADVENTIST HEALTH PHYSICIANS	12/1/2014	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1700 E CESAR E CHAVEZ AV	STE 3000	LOS ANGELES	CA	90033	2424	19	06037	34.05101259	-118.217259	Los Angeles County
209565	Fee-for-Service	1396792339	1396792339	1	1	ARISMENDI, CHRISTOPHER M MD	4/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	73525	41	Internal Medicine	0	In state provider	None	420 W ACACIA ST	STE 3	STOCKTON	CA	95203	2498	39	06077	37.96135715	-121.2996632	San Joaquin County
209568	Fee-for-Service	1447427059	1447427059	1	1	ARMONA UNION ELEMENTARY	5/2/2007	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	11115 C ST	None	ARMONA	CA	93202	0368	16	06031	36.312084	-119.7070005	Kings County
209607	Fee-for-Service	1376526822	1376526822	1	1	ANDREWS, JOHN D MD	1/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	1	Border provider	PULMONARY MEDICINE ASSOC	236 W 6TH ST	STE 100	RENO	NV	89503	4549	00	None	39.53151304	-119.8186228	Washoe County
209623	Fee-for-Service	1053906990	1053906990	1	1	AUGUSTUS ELDER CARE HOME LLC	7/6/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	5105 SCHUYLER DR	None	CARMICHAEL	CA	95608	0832	34	06067	38.658006	-121.321863	Sacramento County
209626	Fee-for-Service	1639934409	1639934409	1	1	ANGEL'S HOME CARE LLC	9/6/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	427 CABO COURT	None	OCEANSIDE	CA	92058	7997	37	06073	33.23475406	-117.3245439	San Diego County
209646	Fee-for-Service	1609816743	1609816743	1	1	AGNESS, MARK S MD	10/31/1990	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	68116	01	General Practice	0	In state provider	None	12550 HESPERIA RD	None	VICTORVILLE	CA	92395	5873	36	06071	34.47928534	-117.2909553	San Bernardino County
209670	Fee-for-Service	1518340280	1518340280	1	1	ABOURBIH, SAMUEL R MD	8/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137128	34	Urology and Urological Surgery	0	In state provider	None	11370 ANDERSON ST	STE 2050	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
209691	Fee-for-Service	1891879961	1891879961	1	1	ANTOUNIAN, FRANCOIS S MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	37401	20	Orthopedic Surgery	0	In state provider	None	2100 WEBSTER ST	STE 115	SAN FRANCISCO	CA	94115	2374	38	06075	37.7904826	-122.4324477	San Francisco County
209705	Fee-for-Service	1386678498	1386678498	1	1	ARNAIZ, NILO O MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	61314	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1245 16TH ST	STE 204	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
209739	Fee-for-Service	1134106966	1134106966	1	1	AVNER, DAVID B. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3033 S PARKER RD	STE 800	AURORA	CO	80014	2938	00	None	39.6612	-104.8603095	Arapahoe County
209742	Fee-for-Service	1043520158	1043520158	1	1	A & T MEDICAL EQUIPMENT INC	8/11/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	34 E HUNTINGTON DR	None	ARCADIA	CA	91006	3209	19	06037	34.14000352	-118.0297683	Los Angeles County
209749	Fee-for-Service	1538893086	1538893086	1	1	ABDULMASIH, JOSEPH PT	5/20/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
209752	Fee-for-Service	1093784191	1093784191	1	1	ABDELHADI, ANWAR MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63976	41	Internal Medicine	0	In state provider	None	1310 W STEWART DR	STE 410	ORANGE	CA	92868	3855	30	06059	33.78236048	-117.8664975	Orange County
209799	Fee-for-Service	1497931828	1497931828	1	1	AMPLA HEALTH	1/1/2009	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MEDICAL & DENTAL	89 PUTNAM WAY	None	ARBUCKLE	CA	95912	9814	06	06011	39.02117456	-122.0619172	Colusa County
209818	Fee-for-Service	1386291466	1386291466	1	1	ALTAMED HEALTH SERVICES	12/23/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1325 N ANAHEIM BLVD	STE 101	ANAHEIM	CA	92801	1202	30	06059	33.85331047	-117.9199617	Orange County
209831	Fee-for-Service	1043858418	1043858418	1	1	AUSTIN, AALIYAH LCSW	3/13/2025	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
209867	Fee-for-Service	1124451307	1124451307	1	1	ADHAMI, SEPIDEH PSYD	2/25/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10470 FOOTHILL BLVD	SUITE 116	RANCHO CUCAMONGA	CA	91730	3754	36	06071	34.10659649	-117.576603	San Bernardino County
209896	Fee-for-Service	1356737290	1356737290	1	1	A PLACE TO TURN INC	8/22/2023	101Y00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5743 CORSA AVE	207	WESTLAKE VILLAGE	CA	91362	6464	56	06111	34.156863	-118.7994295	Los Angeles County
209902	Fee-for-Service	1114190261	1114190261	1	1	ASAMBADZE, EKATERINE K MD	10/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	5400 S RAINBOW BLVD	None	LAS VEGAS	NV	89119	1859	00	None	36.090072	-115.2405585	Clark County
209935	Fee-for-Service	1861445454	1861445454	1	1	ANTHONY E APOLLO MD	6/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	8TH AVE & C ST	None	SALT LAKE CTY	UT	84143	0001	00	None	40.778496	-111.8805615	Salt Lake County
209973	Fee-for-Service	1215115159	1215115159	1	1	AVICURE PHARMACY INC	6/16/2008	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1722 DESIRE AVE	#103	ROWLAND HEIGHTS	CA	91748	2969	19	06037	33.98725948	-117.8963129	Los Angeles County
209996	Fee-for-Service	1457988545	1457988545	1	1	ALVAREZ, DORA S MD	9/20/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	187466	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
210003	Fee-for-Service	1750044350	1750044350	1	1	ARGUETA-ALONSO, AMELIA LMFT	5/28/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
210006	Fee-for-Service	1821535949	1821535949	1	2	AMIRSHAHROKHI, DARYA	1/28/2019	222Z00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	23672 BIRTCHER DR	UNIT A	LAKE FOREST	CA	92630	1711	30	06059	33.63359204	-117.7170667	Orange County
210039	Fee-for-Service	1760564272	1760564272	2	1	AYVAZIAN, HERMOZ DPM	7/1/1991	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	1030 S GLENDALE AVE	STE 403	GLENDALE	CA	91205	2866	19	06037	34.13381535	-118.2519184	Los Angeles County
210046	Fee-for-Service	1548580855	1548580855	1	1	AWAAD, RANIA Y M MD	5/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	115077	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
210057	Fee-for-Service	1740374404	1740374404	1	1	ABBOTT, MYLES B MD	3/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	25178	40	Pediatrics	0	In state provider	None	5700 TELEGRAPH AVE	SUITE 100	OAKLAND	CA	94609	1710	01	06001	37.84323585	-122.2614659	Alameda County
210059	Fee-for-Service	1841678448	1841678448	1	1	ALCHI, RAMIZ MD	8/19/2022	207R00000X	NA	Other	026	PHYSICIANS	157913	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
210070	Fee-for-Service	1841786258	1841786258	1	1	AZIZ, KOMAL MD	8/16/2024	2080C0008X	NA	Psychiatry	026	PHYSICIANS	174387	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
210087	Fee-for-Service	1497931828	1497931828	1	1	AMPLA HEALTH	12/26/2007	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	MEDICAL & DENTAL	89 PUTNAM WAY	None	ARBUCKLE	CA	95912	9814	06	06011	39.02117456	-122.0619172	Colusa County
210088	Fee-for-Service	1861506917	1861506917	1	1	ALVERO, RUBEN J MD	8/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152510	67	Endocrinology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
210107	Fee-for-Service	1093293094	1093293094	1	1	ABDOLRASHIDI, MEGAN K PSYD	5/11/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
210127	Fee-for-Service	1629086269	1629086269	1	1	ANDREWS, JAMES E MD	2/28/1992	207P00000X	NA	Other	026	PHYSICIANS	70523	66	Emergency Medicine (Urgent Care)	0	In state provider	CENTRAL CA FACULTY MED	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
210136	Fee-for-Service	1891882247	1891882247	1	1	APPEL, MARVIN MD INC	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	34379	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2888 LONG BEACH BLVD	STE 215	LONG BEACH	CA	90806	1563	19	06037	33.809706	-118.189343	Los Angeles County
210156	Fee-for-Service	1023636545	1023636545	1	2	AHMC SETON MEDICAL CENTER	1/27/2021	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	600 MARINE BLVD	None	MOSS BEACH	CA	94038	9641	41	06081	37.52703039	-122.5075216	San Mateo County
210166	Fee-for-Service	1972745370	1972745370	1	1	ALARCON, ANTHONY J MD	12/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	112820	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
210184	Fee-for-Service	1356737290	1356737290	1	1	A PLACE TO TURN INC	8/22/2023	101Y00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	5743 CORSA AVE	207	WESTLAKE VILLAGE	CA	91362	6464	56	06111	34.156863	-118.7994295	Los Angeles County
210208	Fee-for-Service	1659436533	1659436533	1	1	ADDES, IRINA S	8/10/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	87216	36	Psychiatry	0	In state provider	None	3333 SKYPARK DR	SUITE 220	TORRANCE	CA	90505	5023	19	06037	33.81036565	-118.3466218	Los Angeles County
210213	Fee-for-Service	1316106271	1316106271	1	1	ANEJA, BEENU NP	12/27/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	SUITE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
210214	Fee-for-Service	1417249319	1417249319	1	1	ABONGWA, CHENUE MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135441	78	Neoplastic Diseases/Oncology	0	In state provider	None	25845 BARTON RD	SUITE F	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
210227	Fee-for-Service	1457542540	1457542540	1	1	ATWAL, PAUL S OD	10/28/2024	152WC0802X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
210258	Fee-for-Service	1790408490	1790408490	1	1	ACCESS BHC LICENSED CLINICAL	12/7/2022	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	SOCIAL WORKER PC	1717 CALIFORNIA STREET	1	HUNTINGTON BEACH	CA	92648	3145	30	06059	33.67288856	-117.9941203	Orange County
210267	Fee-for-Service	1336452184	1336452184	1	1	AZIZYAN, AVETIS MD	5/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119461	30	Radiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
210310	Fee-for-Service	1184822868	1184822868	1	1	ARKADIE, NICOLE L LCSW	12/14/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9565 BUSINESS CENTER DR	STE C	RANCHO CUCAMONGA	CA	91730	4560	36	06071	34.09805648	-117.595944	San Bernardino County
210317	Fee-for-Service	1417074956	1417074956	1	1	ABREU, VERA MARIA B LMFT	5/6/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
210331	Fee-for-Service	1164859708	1164859708	1	1	ALEVE HOSPICE CARE OF LOS	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	ANGELES INC	5121 VAN NUYS BLVD	SUITE 210-211	SHERMAN OAKS	CA	91403	1402	19	06037	34.163748	-118.448738	Los Angeles County
210332	Fee-for-Service	1073798997	1073798997	1	1	ADDEO, FREDA A LMFT	8/19/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	44-374 PALM STREET	None	INDIO	CA	92201	3117	33	06065	33.72380849	-116.227381	Riverside County
210358	Fee-for-Service	1235185745	1235185745	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	33601 DEL OBISPO	None	DANA POINT	CA	92629	2103	30	06059	33.47511226	-117.6850201	Orange County
210369	Fee-for-Service	1922071059	1922071059	1	1	ABDELMESSIH, NIVEEN K MD	4/4/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	88718	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
210374	Fee-for-Service	1497931828	1497931828	1	1	AMPLA HEALTH	10/22/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	MEDICAL & DENTAL	89 PUTNAM WAY	None	ARBUCKLE	CA	95912	9814	06	06011	39.02117456	-122.0619172	Colusa County
210376	Fee-for-Service	1861506917	1861506917	1	1	ALVERO, RUBEN J MD	8/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152510	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
210401	Fee-for-Service	1871500496	1871500496	1	1	ANDONYAN, ANN S MD	12/10/2019	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
210403	Fee-for-Service	1831445659	1831445659	1	1	AIKEN, MELANIE M MD	9/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128462	None	None	0	In state provider	None	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
210412	Fee-for-Service	1134441124	1134441124	1	1	ABDELBAKI, LINDA K LMFT	7/21/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4600 BROADWAY	STE 1100	SACRAMENTO	CA	95820	1527	34	06067	38.546127	-121.452669	Sacramento County
210421	Fee-for-Service	1639504251	1639504251	1	1	ALIBEIGI, SARVENAZ MD	11/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132182	41	Internal Medicine	0	In state provider	None	1411 EAST 31ST STREET	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
210422	Fee-for-Service	1255655023	1255655023	1	1	AGUIRRE, JOSE A MD PC RENO	1/12/2011	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	1	Border provider	None	235 W 6TH STREET	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
210443	Fee-for-Service	1023636545	1023636545	1	2	AHMC SETON MEDICAL CENTER	1/27/2021	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	600 MARINE BLVD	None	MOSS BEACH	CA	94038	9641	41	06081	37.52703039	-122.5075216	San Mateo County
210445	Fee-for-Service	1245321959	1245321959	1	1	ALTER, ALAN D MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	34041	40	Pediatrics	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
210450	Fee-for-Service	1710139589	1710139589	1	1	ABUNDIS-BARRERA, MARIA I MD	10/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102754	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
210458	Fee-for-Service	1831286814	1831286814	1	1	AHMAD,BEENA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7727 LAKE UNDERHILL RD	None	ORLANDO	FL	32867	0000	00	None	28.53926046	-81.2806335	Orange County
210460	Fee-for-Service	1770622292	1770622292	1	1	ANTELOPE HILLS MANOR	12/16/2002	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ICF DD-N INC	7311 34TH STREET	None	NORTH HIGHLANDS	CA	95660	2503	34	06067	38.699676	-121.38921	Sacramento County
210477	Fee-for-Service	1376143339	1376143339	1	1	ANTELOPE VALLEY OUTPATIENT I	6/4/2021	2085R0202X	NA	Mammography/MRI Provider	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	MAGING CENTER, LLC	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
210497	Fee-for-Service	1861886707	1861886707	1	1	ALGAZE, SANDRA D MD	9/1/2021	207RX0202X	NA	Oncology	026	PHYSICIANS	156237	None	None	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	19	06037	34.06169385	-118.2044698	Los Angeles County
210502	Fee-for-Service	1417249319	1417249319	1	1	ABONGWA, CHENUE MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135441	68	Hematology	0	In state provider	None	25845 BARTON RD	SUITE F	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
210516	Fee-for-Service	1104189620	1104189620	1	1	APEL, GREGORY M MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141549	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
210531	Fee-for-Service	1104026517	1104026517	1	1	ABERRA, TSEDAY	10/18/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4110 EDISON AVE	206A	CHINO	CA	91710	8417	36	06071	33.99723746	-117.7140555	San Bernardino County
210545	Fee-for-Service	1790408490	1790408490	1	1	ACCESS BHC LICENSED CLINICAL	4/26/2023	1041C0700X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SOCIAL WORKER PC	1717 CALIFORNIA STREET	1	HUNTINGTON BEACH	CA	92648	3145	30	06059	33.67288856	-117.9941203	Orange County
210559	Fee-for-Service	1346313590	1346313590	1	1	ASLAM, MUHAMMAD MD	10/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56159	40	Pediatrics	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
210584	Fee-for-Service	1225086507	1225086507	1	1	AAAMG INC A CALIFORNIA	1/1/1979	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	MEDICAL CORPORATION	725 E SANTA CLARA ST	STE 101	SAN JOSE	CA	95112	1936	43	06085	37.34328626	-121.8756374	Santa Clara County
210614	Fee-for-Service	1518030642	1518030642	1	1	AMHA MEDICAL GROUP INC	8/18/2009	2084P0800X	NA	Psychiatry	026	PHYSICIANS	41409	36	Psychiatry	0	In state provider	None	21081 S WESTERN AVE	STE 250	TORRANCE	CA	90509	2983	19	06037	33.83886841	-118.3093605	Los Angeles County
210617	Fee-for-Service	1629539887	1629539887	1	2	ADAMS, STERLING G DO	9/1/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19443	None	None	0	In state provider	None	1200 MARICOPA HWY	None	OJAI	CA	93023	3129	56	06111	34.44206499	-119.2631334	Ventura County
210618	Fee-for-Service	1164859708	1164859708	1	1	ALEVE HOSPICE CARE OF LOS	7/28/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	ANGELES INC	5121 VAN NUYS BLVD	SUITE 210-211	SHERMAN OAKS	CA	91403	1402	19	06037	34.163748	-118.448738	Los Angeles County
210638	Fee-for-Service	1922621374	1922621374	1	1	ARAM MKHITARIAN CORP	2/21/2023	261QP2300X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	CENTER	22024 LASSEN ST	100	CHATSWORTH	CA	91311	8335	19	06037	34.2499425	-118.6069365	Los Angeles County
210653	Fee-for-Service	1669159562	1669159562	1	1	ALTAMIRANO-WHITTAKER, DIANE	8/7/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
210663	Fee-for-Service	1497931828	1497931828	1	1	AMPLA HEALTH	1/1/2009	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MEDICAL & DENTAL	89 PUTNAM WAY	None	ARBUCKLE	CA	95912	9814	06	06011	39.02117456	-122.0619172	Colusa County
210666	Fee-for-Service	1750559431	1750559431	1	27	ALL STAR PHYSICAL THERAPY, I	9/19/2024	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	69730 HIGHWAY 111	100	RANCHO MIRAGE	CA	92270	2869	33	06065	33.7728798	-116.4474207	Riverside County
210714	Fee-for-Service	1841847001	1841847001	1	1	ALLIANCE FOR AFRICAN	1/30/2019	No Taxonomy Provided	Both NEMT & NMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	ASSISTANCE, INC	5952 EL CAJON BLVD	None	SAN DIEGO	CA	92115	3828	37	06073	32.76027883	-117.0693725	San Diego County
210720	Fee-for-Service	1639793755	1639793755	1	1	ASCEND HOME HEALTH CARE INC	2/23/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14435 HAMLIN ST	SUITE B-1	VAN NUYS	CA	91401	6205	19	06037	34.18869947	-118.447731	Los Angeles County
210737	Fee-for-Service	1770714834	1770714834	1	1	AGARWAL, PRASHANT MD	1/13/2022	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	173176	None	None	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
210774	Fee-for-Service	1285217539	1285217539	1	1	AVILA-CORTES, SERENA DO	9/20/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20423	08	Family Practice	0	In state provider	None	1135 S SUNSET AVE	SUITE 401	WEST COVINA	CA	91790	3937	19	06037	34.06215064	-117.9453997	Los Angeles County
210793	Fee-for-Service	1417249319	1417249319	1	1	ABONGWA, CHENUE MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135441	40	Pediatrics	0	In state provider	None	25845 BARTON RD	SUITE F	LOMA LINDA	CA	92354	3450	36	06071	34.04824949	-117.2401425	San Bernardino County
210801	Fee-for-Service	1356447627	1356447627	1	1	AMBEKAR, AVANTI MD	9/6/2006	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	83732	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
210810	Fee-for-Service	1235261652	1235261652	1	1	ALAMEDA COUNTY MED CTR	7/1/1998	310400000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SNF/DP	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1009	01	06001	37.7069698	-122.1191104	Alameda County
210818	Fee-for-Service	1982662003	1982662003	1	1	AYOTTE, KAREN M MD	4/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87579	30	Radiology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
210825	Fee-for-Service	1528407582	1528407582	1	1	ARQUERO, ALLISON G MD	10/7/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	167591	40	Pediatrics	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
210847	Fee-for-Service	1346313590	1346313590	1	1	ASLAM, MUHAMMAD MD	10/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	56159	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
210848	Fee-for-Service	1477517225	1477517225	1	1	ANNE ARUNDEL MEDICAL CENTER	4/16/2011	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2001 MEDICAL PKWY	None	ANNAPOLIS	MD	21401	3280	00	None	38.990376	-76.53357	Anne Arundel County
210902	Fee-for-Service	1427446335	1427446335	1	2	ANA S OSBORNE AND SCOTT S	9/29/2014	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	OSBORNE	2690 MARY LANE PLACE	None	ESCONDIDO	CA	92025	7754	37	06073	33.08829239	-117.0421081	San Diego County
210921	Fee-for-Service	1235495029	1235495029	1	1	ACACIO, SAMUEL S	4/27/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4501 SAND CREEK RD	None	ANTIOCH	CA	94531	8687	07	06013	37.94947636	-121.7752571	Contra Costa County
210935	Fee-for-Service	1841228764	1841228764	1	1	ARCADIA RADIOLOGY	1/1/1979	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GRP A PROF CORP	612 W DUARTE RD	STE 101	ARCADIA	CA	91007	9220	19	06037	34.12647805	-118.051994	Los Angeles County
210950	Fee-for-Service	1497931828	1497931828	1	1	AMPLA HEALTH	1/1/2009	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	MEDICAL & DENTAL	89 PUTNAM WAY	None	ARBUCKLE	CA	95912	9814	06	06011	39.02117456	-122.0619172	Colusa County
210955	Fee-for-Service	1164529772	1164529772	1	1	ALEXIS,JEAN CLAUDE	6/13/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	760 BROADWAY	None	BROOKLYN	NY	11206	4922	00	None	40.700349	-73.9416015	Kings County
210956	Fee-for-Service	1750559431	1750559431	1	27	ALL STAR PHYSICAL THERAPY, I	11/16/2023	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	69730 HIGHWAY 111	100	RANCHO MIRAGE	CA	92270	2869	33	06065	33.7728798	-116.4474207	Riverside County
210990	Fee-for-Service	1093763518	1093763518	1	1	AMERY REGIONAL MEDICAL CTR	5/23/2012	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	265 GRIFFIN ST E	None	AMERY	WI	54001	1439	00	None	45.29595628	-92.36099851	Polk County
211031	Fee-for-Service	1336286038	1336286038	1	1	ATHANASSAKI, IOANNA D MD	10/1/2021	2080P0205X	NA	Endocrinology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
211033	Fee-for-Service	1255592655	1255592655	1	1	AHMED, SAUD S MD	3/26/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	175621	None	None	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
211040	Fee-for-Service	1821501792	1821501792	1	2	ASIAN HEALTH SERVICES	1/12/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	190 11TH STREET	None	OAKLAND	CA	94607	4878	01	06001	37.79986277	-122.2662421	Alameda County
211046	Fee-for-Service	1902625247	1902625247	1	1	AFSANEH K ALISOBHANI, PSYD,	11/19/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	.C.	1101 DOVE ST	165	NEWPORT BEACH	CA	92660	2862	30	06059	33.6602824	-117.8647147	Orange County
211061	Fee-for-Service	1477027472	1477027472	1	1	AITCHESON, LYNETTE D RCP	9/20/2020	2279P1006X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
211104	Fee-for-Service	1215049903	1215049903	1	1	ALBERT, N ERICK MD	4/20/1979	208800000X	NA	Other	026	PHYSICIANS	23904	34	Urology and Urological Surgery	0	In state provider	None	830 S HAM LN	STE 26	LODI	CA	95242	7510	39	06077	38.123568	-121.2882225	San Joaquin County
211108	Fee-for-Service	1942615075	1942615075	1	1	AUNG, HTOO HTOO MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	147792	41	Internal Medicine	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
211142	Fee-for-Service	1790265478	1790265478	1	1	ANDERSON & ASSOCIATES A PSYC	5/13/2024	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	HOLOGICAL SERVICES COR	1470 MARIA LN STE 240	None	WALNUT CREEK	CA	94596	5399	07	06013	37.892501	-122.0566177	Contra Costa County
211184	Fee-for-Service	1164623088	1164623088	1	2	ANDERSON, PORTIA M LMFT	5/27/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	113890	-	NOT APPLICABLE	0	In state provider	None	815 BUENA VISTA WEST	None	SAN FRANCISCO	CA	94117	4108	38	06075	37.76921703	-122.4429461	San Francisco County
211201	Fee-for-Service	1790282960	1790282960	1	1	AYOMANOR, VIVIENNE A NP	8/31/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95008956	-	NOT APPLICABLE	0	In state provider	None	12021 S WILMINGTON AVE	BUILDING 18, SUITE 300	LOS ANGELES	CA	90059	3019	19	06037	33.922575	-118.2391785	Los Angeles
211222	Fee-for-Service	1588199632	1588199632	1	1	ACT-ASSOCIATES IN CLINICAL T	7/3/2023	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	HERAPY, A PSYCHOLOGICAL	22231 MULHOLLAND HWY	106	CALABASAS	CA	91302	5178	19	06037	34.14821793	-118.6123368	Los Angeles County
211234	Fee-for-Service	1851404628	1851404628	1	1	ANDERSON,KERRY S OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	VISION MAX OPTOMETRY	14335 PIPELINE AVE	STE A-5	CHINO	CA	91710	5642	36	06071	33.99328331	-117.7151702	San Bernardino County
211237	Fee-for-Service	1770839045	1770839045	1	1	ANGELES, JULIENNE A MD	4/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128728	01	General Practice	0	In state provider	None	3000 LAS POSITAS RD	None	LIVERMORE	CA	94551	9627	01	06001	37.69960369	-121.7628917	Alameda County
211243	Fee-for-Service	1912272733	1912272733	1	1	ADAN, SHEILA MARIE A DO	2/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12266	08	Family Practice	0	In state provider	None	4760 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6063	19	06037	34.09811852	-118.293408	Los Angeles County
211273	Fee-for-Service	1861599748	1861599748	1	1	ARRIETA, ANTONIO C MD	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	46432	01	General Practice	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
211283	Fee-for-Service	1609109123	1609109123	1	1	AYRAPETYAN, LILIT PSYD	6/27/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	595 E COLORADO BLVD STE	324	PASADENA	CA	91101	2021	19	06037	34.14588202	-118.1380722	Los Angeles County
211295	Fee-for-Service	1225139306	1225139306	1	1	ANTHENELLI, ROBERT M MD	8/2/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	44777	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
211309	Fee-for-Service	1114557485	1114557485	1	1	ALBANO, KHATYA LMFT	4/15/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	114506	-	NOT APPLICABLE	0	In state provider	None	3939 ATLANTIC AVE	SUITE 102	LONG BEACH	CA	90807	3535	19	06037	33.830073	-118.1851065	Los Angeles County
211334	Fee-for-Service	1770846941	1770846941	1	1	AWAJI, OBINNA N MD	10/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
211343	Fee-for-Service	1326667569	1326667569	1	1	ADVENTIST HEALTH PHYSICIANS	7/20/2020	261QU0200X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	2103 E PROSPERITY AVE	None	TULARE	CA	93274	7754	54	06107	36.2258337	-119.3138206	Tulare County
211348	Fee-for-Service	1144911637	1144911637	1	1	ACHUGBU, AUTUMN ROXANNE	7/22/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	16908 SADDLEBROOK LANE	None	MORENO VALLEY	CA	92551	2423	33	06065	33.87505022	-117.2218203	Riverside County
211367	Fee-for-Service	1891752606	1891752606	1	1	AMOURA, NAHIA J MD	10/22/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	15	Obstetrics (D.O. only)	0	In state provider	None	2210 E ILLINOIS AVE	SUITE 408	FRESNO	CA	93701	2168	10	06019	36.74500687	-119.7846885	Fresno County
211377	Fee-for-Service	1295300424	1295300424	1	1	ASHISH PATEL MD INC	9/21/2021	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	348 RHEEM	None	MORAGA	CA	94556	1516	07	06013	37.86118691	-122.1278716	Contra Costa County
211405	Fee-for-Service	1235562687	1235562687	1	1	AUR, RADIN DPM	3/27/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1810 GRAND CANAL BLVD	2	STOCKTON	CA	95207	8110	39	06077	37.98632376	-121.328172	San Joaquin County
211633	Fee-for-Service	1922729383	1922729383	1	1	ABADI, STEVEN DPM	4/4/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	20130 LAKE CHABOT ROAD	SUITE 202	CASTRO VALLEY	CA	94546	5306	01	06001	37.69738066	-122.087041	Alameda County
211636	Fee-for-Service	1144911637	1144911637	1	1	ACHUGBU, AUTUMN ROXANNE	7/22/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	16908 SADDLEBROOK LANE	None	MORENO VALLEY	CA	92551	2423	33	06065	33.87505022	-117.2218203	Riverside County
211667	Fee-for-Service	1326575382	1326575382	1	1	ALAM, ASSAD MD	1/2/2023	207P00000X	NA	Other	026	PHYSICIANS	166691	None	None	0	In state provider	None	1 QUALITY DR	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
211671	Fee-for-Service	1467498808	1467498808	1	1	APRIL M NORTH MD	5/16/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 BRIDGE ST	None	EAST JORDAN	MI	49727	9383	00	None	45.15050183	-85.13782918	Charlevoix County
211688	Fee-for-Service	1346745031	1346745031	1	1	ANAVIM, ALEXANDER MD	10/14/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	4640 ADMIRALTY WAY	STE 102	MARINA DEL REY	CA	90292	6629	19	06037	33.98120707	-118.4409729	Los Angeles County
211695	Fee-for-Service	1922620301	1922620301	1	1	AYYANAR, SIVARANJANI MD	3/14/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	None	36	Psychiatry	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
211699	Fee-for-Service	1104085109	1104085109	1	1	ACEBEDO, CHRISTOPHER D M NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
211707	Fee-for-Service	1134850696	1134850696	1	1	ADVANCE DME AND MEDICAL SUPP	7/7/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	LIES, LLC	670 S JEFFERSON ST	A	PLACENTIA	CA	92870	6638	30	06059	33.86400053	-117.837012	Orange County
211741	Fee-for-Service	1679035661	1679035661	1	1	ASSIOUN, JUSTIN J MD	1/3/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	176917	None	None	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
211749	Fee-for-Service	1942739487	1942739487	1	1	ASSIBEY, ROBERT MD	6/25/2020	390200000X	NA	Other	026	PHYSICIANS	164191	01	General Practice	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
211754	Fee-for-Service	1831790567	1831790567	1	1	ABAD, JORDAN N PT	1/29/2021	2251X0800X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	277 RANCHEROS DR	STE. 150	SAN MARCOS	CA	92069	2976	37	06073	33.13859391	-117.1604009	San Diego County
211770	Fee-for-Service	1437172533	1437172533	1	1	ANDERSON, KENNETH L III	7/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	5441	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
211799	Fee-for-Service	1144929647	1144929647	1	1	AMAAZEE, TOIMBIE S	5/25/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
211810	Fee-for-Service	1629341805	1629341805	1	1	ADVANCED SLEEP MEDICINE SRVS	7/3/2018	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	6215 FERRIS SQ	SUITE 120	SAN DIEGO	CA	92121	3251	37	06073	32.89075717	-117.1822656	San Diego County
211814	Fee-for-Service	1255651477	1255651477	1	1	AHMAD, SHOAIB MD	2/18/2025	207RP1001X	NA	Pulmonology	026	PHYSICIANS	184989	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
211841	Fee-for-Service	1114430998	1114430998	1	1	ARCATA-MAD RIVER AMBULANCE	12/1/2017	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LLC	220 F ST	None	ARCATA	CA	95521	6616	12	06023	40.86322131	-124.0867448	Humboldt County
211847	Fee-for-Service	1558995084	1558995084	1	1	ATIENZA, NEO NP	1/4/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	301 VICTORIA STREET	None	COSTA MESA	CA	92627	1995	30	06059	33.65258952	-117.9121545	Orange County
211868	Fee-for-Service	1003971003	1003971003	1	1	AMOLIK, SHARMILA P MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	76753	41	Internal Medicine	0	In state provider	None	625 LINCOLN AVE	None	SAN JOSE	CA	95126	3705	43	06085	37.31809479	-121.9082315	Santa Clara County
211885	Fee-for-Service	1710365325	1710365325	1	1	ARROYO, SERGIO E MD	4/7/2019	390200000X	NA	Other	026	PHYSICIANS	160429	13	Neurology (M.D. only)	0	In state provider	None	1001 POTRERO AVE	RM 4M62	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
211886	Fee-for-Service	1194166082	1194166082	1	1	AMBROSIO RAMIREZ, ELIZABET	5/16/2020	1041S0200X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	275 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1106	43	06085	37.23951066	-121.8013511	Santa Clara County
211895	Fee-for-Service	1073951851	1073951851	1	1	ANGELICAL HOSPICE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14349 VICTORY BLVD	SUITE 204	VAN NUYS	CA	91401	6522	19	06037	34.18669646	-118.4460435	Los Angeles County
211912	Fee-for-Service	1124341326	1124341326	1	1	ANANDAM, JAISHREELIN L MD	6/2/2010	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	109951	40	Pediatrics	0	In state provider	None	12791 CABEZUT RD	None	SONORA	CA	95370	5928	55	06109	37.98642769	-120.3656431	Tuolumne County
211923	Fee-for-Service	1104959089	1104959089	1	1	ALAMEDA COUNTY MED CTR	7/1/1998	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	EASTMONT WELLNESS CTR	6955 FOOTHILL BLVD	STE 200	OAKLAND	CA	94605	2426	01	06001	37.76924146	-122.1732586	Alameda County
211950	Fee-for-Service	1780842724	1780842724	1	1	ASSOCIATED KIDNEY SPECIALIST	11/23/2010	207RN0300X	NA	Nephrology	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	OF THE NORTH BAY INC	715 S POINT BLVD	STE C	PETALUMA	CA	94954	6835	49	06097	38.25753127	-122.6461294	Sonoma County
211993	Fee-for-Service	1861456600	1861456600	1	1	AIKEN COUNTY	8/21/2016	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	621 YORK ST NE	None	AIKEN	SC	29801	4017	00	None	33.569955	-81.712305	Aiken County
211998	Fee-for-Service	1568495182	1568495182	1	1	ALBERS, UNNA MC PHERSON	12/1/1997	207R00000X	NA	Other	026	PHYSICIANS	61351	41	Internal Medicine	0	In state provider	MD	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
212018	Fee-for-Service	1396810446	1396810446	1	1	AZUS, JEFFREY L OD	10/14/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
212045	Fee-for-Service	1467879304	1467879304	1	1	ALBARRACIN, ZAIDA L MD	6/3/2019	207R00000X	NA	Other	026	PHYSICIANS	144272	41	Internal Medicine	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
212052	Fee-for-Service	1407478068	1407478068	1	1	ATRIUM HOSPICE INC	7/29/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11490 BURBANK BLVD	STE 301	PASADENA	CA	91107	7328	19	06037	0	0	None
212079	Fee-for-Service	1275645301	1275645301	1	1	AJAY, VERMA K MD INC	5/31/1995	207RH0003X	NA	Oncology	026	PHYSICIANS	43439	68	Hematology	0	In state provider	None	1555 EAST ST	STE 230	REDDING	CA	96001	1153	45	06089	40.58440354	-122.3880021	Shasta County
212100	Fee-for-Service	1255651477	1255651477	1	1	AHMAD, SHOAIB MD	2/18/2025	207RP1001X	NA	Pulmonology	026	PHYSICIANS	184989	41	Internal Medicine	0	In state provider	None	2170 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	7026	09	06017	38.91229842	-119.9978133	El Dorado County
212102	Fee-for-Service	1104972736	1104972736	1	1	ALEXANDER, JULIAN P MD	5/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	41692	18	Ophthalmology	0	In state provider	None	1056 WASHINGTON ST	None	RED BLUFF	CA	96080	2747	52	06103	40.18035253	-122.2388455	Tehama County
212182	Fee-for-Service	1073951851	1073951851	1	1	ANGELICAL HOSPICE	11/4/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14349 VICTORY BLVD	SUITE 204	VAN NUYS	CA	91401	6522	19	06037	34.18669646	-118.4460435	Los Angeles County
212183	Fee-for-Service	1518993914	1518993914	1	1	ALEJOS, JUAN C MD	10/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	65214	40	Pediatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
212184	Fee-for-Service	1528097730	1528097730	1	1	AL-SADEK, AHMED F MD	12/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	93004	66	Emergency Medicine (Urgent Care)	0	In state provider	None	345 S HALCYON RD	None	ARROYO GRANDE	CA	93420	3896	40	06079	35.113419	-120.5915945	San Luis Obispo County
212202	Fee-for-Service	1104959089	1104959089	1	1	ALAMEDA COUNTY MED CTR	7/1/1998	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	EASTMONT WELLNESS CTR	6955 FOOTHILL BLVD	STE 200	OAKLAND	CA	94605	2426	01	06001	37.76924146	-122.1732586	Alameda County
212207	Fee-for-Service	1295487361	1295487361	1	2	A&J SPEEDY TRANSPORTATION LL	3/28/2023	347C00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	C	1800 E OLD RANCH RD	APT 126	COLTON	CA	92324	6464	36	06071	34.05116365	-117.2977927	San Bernardino County
212221	Fee-for-Service	1396298261	1396298261	1	1	AVELING, DONALD L LMFT	10/14/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1881 COMMERCENTER DRIVE	SUITE 232	SAN BERNARDINO	CA	92408	3479	36	06071	34.06789529	-117.2822533	San Bernardino County
212260	Fee-for-Service	1740427657	1740427657	1	19	ALTAMED HEALTH SERVICES CORP	6/5/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	811 EAST BISHOP STREET	None	SANTA ANA	CA	92701	6205	30	06059	33.73955445	-117.8575245	Orange County
212280	Fee-for-Service	1760428452	1760428452	1	1	ANDYA, MICHAEL D MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	69223	41	Internal Medicine	0	In state provider	None	101 MARGARET LN	STE A	GRASS VALLEY	CA	95945	4207	29	06057	39.23003572	-121.0469625	Nevada County
212281	Fee-for-Service	1710035753	1710035753	1	1	ALAIMO, MARIA MD	9/30/1992	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	75253	08	Family Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
212284	Fee-for-Service	1346677523	1346677523	1	1	AHARONI, PAOLA M CRNA	9/20/2017	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
212286	Fee-for-Service	1861626814	1861626814	1	1	ANAND, GOBIND S MD	7/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120739	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
212309	Fee-for-Service	1366948010	1366948010	1	1	AYULO, VICTOR MD	6/7/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
212315	Fee-for-Service	1205050796	1205050796	1	1	AXELSSON, LENA LMFT	10/30/2024	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14583 BIG BASIN WAY	STE 2B	SARATOGA	CA	95070	6072	43	06085	37.25598369	-122.0357593	Santa Clara County
212338	Fee-for-Service	1407478068	1407478068	1	1	ATRIUM HOSPICE INC	7/29/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11490 BURBANK BLVD	STE 301	PASADENA	CA	91107	7328	19	06037	0	0	None
212344	Fee-for-Service	1669427514	1669427514	1	1	ANANDA, RAJESWARI MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	31897	13	Neurology (M.D. only)	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
212369	Fee-for-Service	1275645301	1275645301	1	1	AJAY, VERMA K MD INC	5/31/1995	207RH0003X	NA	Oncology	026	PHYSICIANS	43439	78	Neoplastic Diseases/Oncology	0	In state provider	None	1555 EAST ST	STE 230	REDDING	CA	96001	1153	45	06089	40.58440354	-122.3880021	Shasta County
212378	Fee-for-Service	1477592616	1477592616	1	1	ADAM FOX MD	10/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	505 S 336TH ST	STE 600	FEDERAL WAY	WA	98003	0000	00	None	47.30005468	-122.3272224	King County
212450	Fee-for-Service	1972374726	1972374726	1	1	ANDERSON, EVERLEE OT	3/29/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
212453	Fee-for-Service	1801383799	1801383799	1	1	AROM, GABRIEL A MD	6/30/2024	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	163578	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
212484	Fee-for-Service	1528097730	1528097730	1	1	AL-SADEK, AHMED F MD	12/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	93004	41	Internal Medicine	0	In state provider	None	345 S HALCYON RD	None	ARROYO GRANDE	CA	93420	3896	40	06079	35.113419	-120.5915945	San Luis Obispo County
212503	Fee-for-Service	1932582251	1932582251	1	1	AKRAMIAN, WENDY L PSYD	8/22/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	410 12TH ST	STE 325	OAKLAND	CA	94607	4497	01	06001	37.80268778	-122.2712274	Alameda County
212521	Fee-for-Service	1558692954	1558692954	1	2	ABSTON, ALVIN L LMFT	1/11/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8320 MISSION BLVD	4	RIVERSIDE	CA	92509	2970	33	06065	34.0117585	-117.464886	Riverside County
212550	Fee-for-Service	1740427657	1740427657	1	19	ALTAMED HEALTH SERVICES CORP	6/5/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	811 EAST BISHOP STREET	None	SANTA ANA	CA	92701	6205	30	06059	33.73955445	-117.8575245	Orange County
212582	Fee-for-Service	1801197793	1801197793	1	1	AQUINO, AMALIA M	10/14/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
212585	Fee-for-Service	1861413551	1861413551	1	1	AMRO, NAIL MD	9/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99941	41	Internal Medicine	0	In state provider	None	3466 MT DIABLO BLVD	STE C100	LAFAYETTE	CA	94549	3952	07	06013	37.89256947	-122.1150289	Contra Costa County
212588	Fee-for-Service	1215392733	1215392733	1	1	AINO HOME HEALTH INC	5/2/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	9010 CORBIN AVE	UNIT 4A	NORTHRIDGE	CA	91324	3344	19	06037	34.23447488	-118.5622843	Los Angeles County
212599	Fee-for-Service	1619227055	1619227055	1	1	ALGOS INC., A MEDICAL CORPOR	6/15/2018	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	13193 CENTRAL AVE	SUITE 220	CHINO	CA	91710	4179	36	06071	34.01406506	-117.6891684	San Bernardino County
212634	Fee-for-Service	1356802797	1356802797	1	1	ARAM, ALEXANDER MD	5/16/2024	208600000X	NA	General Surgery	026	PHYSICIANS	181793	02	General Surgery	0	In state provider	None	10880 WILSHIRE BLVD	1101	LOS ANGELES	CA	90024	4112	19	06037	34.05897499	-118.4431123	Los Angeles County
212711	Fee-for-Service	1841392552	1841392552	1	1	ANTHONY, JULIAN N MD	8/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82316	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1901 4TH AVE	STE 200	SAN DIEGO	CA	92101	8315	37	06073	32.72528373	-117.1611335	San Diego County
212721	Fee-for-Service	1942411657	1942411657	1	1	ALPERN, JOEL A MD	10/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	102880	10	Gastroenterology (M.D. only)	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
212730	Fee-for-Service	1972559995	1972559995	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 E SEPULVEDA BLVD	None	CARSON	CA	90745	6323	19	06037	33.80793675	-118.2727856	Los Angeles County
212754	Fee-for-Service	1093212292	1093212292	1	1	ARCHIBALD-SEIFFER, NOAH MD	8/1/2022	207L00000X	NA	Other	026	PHYSICIANS	175655	None	None	0	In state provider	None	995 BLANCO CIR	# A	SALINAS	CA	93901	4447	27	06053	36.65488958	-121.6372749	Monterey County
212795	Fee-for-Service	1376658146	1376658146	1	1	ANDO, YUMI E MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	63006	41	Internal Medicine	0	In state provider	None	795 WILLOW RD	BLDG 334	MENLO PARK	CA	94025	2539	41	06081	37.466676	-122.160384	San Mateo County
212818	Fee-for-Service	1649414855	1649414855	1	1	ABDELMELEK, SAM W MD	12/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106876	41	Internal Medicine	0	In state provider	None	21840 NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
212831	Fee-for-Service	1609134725	1609134725	1	1	ATIENZA, ROBERT G MD	8/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	137783	22	Pathology (M.D. only)	0	In state provider	None	250 HOSPITAL PARKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
212889	Fee-for-Service	1396802021	1396802021	1	1	ANDERSON, ATHENA E MD	1/17/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81380	08	Family Practice	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
212892	Fee-for-Service	1417035098	1417035098	1	1	AMINIAN, VALEH MD	7/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	77154	41	Internal Medicine	0	In state provider	None	280 HOSPITAL PARKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23931375	-121.8014189	Santa Clara County
212900	Fee-for-Service	1790794972	1790794972	1	1	ABSHIRE, JAMES K MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	49679	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
212911	Fee-for-Service	1336499763	1336499763	1	1	AUNG, NAW A MD	3/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123605	41	Internal Medicine	0	In state provider	None	2335 E KASHIAN LN	STE 450	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
212924	Fee-for-Service	1902831514	1902831514	1	1	ADULT AND PEDIATRIC	9/1/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ORTHOPAEDIC SPECIALISTS	1310 W STEWART DR	STE 508	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
212950	Fee-for-Service	1114180197	1114180197	1	1	AHMED, SAMINA MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103776	78	Neoplastic Diseases/Oncology	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
212968	Fee-for-Service	1023271822	1023271822	2	1	ACTIVE LIFE MED PRDT INC	2/29/2024	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3030 ARDEN WAY	None	SACRAMENTO	CA	95825	2049	34	06067	38.59542	-121.393557	Sacramento County
212978	Fee-for-Service	1659647964	1659647964	1	1	ATSINA, KWAME B MD	7/1/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	143475	41	Internal Medicine	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
212979	Fee-for-Service	1548913312	1548913312	1	1	ALL WAYS HOME HEALTH CARE IN	12/8/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4107 E LIVE OAK AVE	STE H	ARCADIA	CA	92262	6784	19	06037	34.1097117	-118.0145369	Los Angeles County
212998	Fee-for-Service	1841392552	1841392552	1	1	ANTHONY, JULIAN N MD	8/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82316	34	Urology and Urological Surgery	0	In state provider	None	1901 4TH AVE	STE 200	SAN DIEGO	CA	92101	8315	37	06073	32.72528373	-117.1611335	San Diego County
213076	Fee-for-Service	1801943246	1801943246	1	1	ANDERSON, RACHEL K PHD	2/11/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
213125	Fee-for-Service	1235363052	1235363052	1	1	ASSUREX HEALTH INC	8/25/2015	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	6000 S MASON- MONTGOMERY	None	MASON	OH	45040	3706	00	None	39.35357413	-84.30947396	Warren County
213144	Fee-for-Service	1457918740	1457918740	1	1	ABDEL-HAMID, MOSTAFA K MD	10/18/2024	207P00000X	NA	Other	026	PHYSICIANS	186932	70	Clinic (mixed specialty)	0	In state provider	None	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
213150	Fee-for-Service	1558703439	1558703439	1	1	AGUIAR, CHERI LCSW	8/17/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	230 N MAIN ST	None	JACKSON	CA	95642	2332	03	06005	38.35080235	-120.7750013	Amador County
213172	Fee-for-Service	1912025123	1912025123	1	1	AUDIO RX HEARING SERVICE	2/1/1995	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	6333 WILSHIRE BLVD	STE 307	LOS ANGELES	CA	90048	5723	19	06037	34.06355697	-118.366413	Los Angeles County
213181	Fee-for-Service	1740255371	1740255371	1	1	ALKA S PALEKAR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5230 CENTRE AVE	None	PITTSBURGH	PA	15232	0000	00	None	40.45554129	-79.93971305	Allegheny County
213188	Fee-for-Service	1700241692	1700241692	1	1	ALBERTSONS LLC	7/6/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8850 FOOTHILL BLVD	None	RANCHO CUCAMONGA	CA	91730	3334	36	06071	34.108308	-117.612144	San Bernardino County
213201	Fee-for-Service	1649329889	1649329889	1	1	ARAKAWA, GORDON K MD	11/28/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116984	30	Radiology	0	In state provider	None	3941 J ST	None	SACRAMENTO	CA	95819	3624	34	06067	38.570652	-121.4535465	Sacramento County
213230	Fee-for-Service	1427094960	1427094960	1	1	ADVANCED ORTHOPAEDICS &	9/26/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	SPORTS MEDICINE MED ASSC	802 MAGNOLIA AVE	STE 106	CORONA	CA	92879	3125	33	06065	33.8596449	-117.5529774	Riverside County
213238	Fee-for-Service	1114180197	1114180197	1	1	AHMED, SAMINA MD	8/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103776	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
213246	Fee-for-Service	1366545568	1366545568	1	2	AMACHER, KATHRYN M DO	6/18/2021	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	5091	None	None	0	In state provider	None	1255 TRAVIS BLVD,	None	FAIRFIELD	CA	94533	4801	48	06095	38.25815459	-122.0487714	Solano County
213268	Fee-for-Service	1104119908	1104119908	1	1	ARGUELLES, STEPHANIE R LCSW	11/28/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2008 MORSE AVE	None	SACRAMENTO	CA	95825	2135	34	06067	38.601801	-121.391613	Sacramento County
213271	Fee-for-Service	1639945082	1639945082	1	1	ADAMS, CHELSEA BIRTH DOULA	2/2/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
213293	Fee-for-Service	1134175789	1134175789	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	30901 RIVERSIDE DR	None	LAKE ELSINORE	CA	92530	4934	33	06065	33.68550069	-117.3658249	Riverside County
213349	Fee-for-Service	1689831059	1689831059	1	1	APEX HOME HEALTHCARE &	4/10/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	SUPPLIES INC	1435 N. WATERMAN AVE	STE B	SAN BERNARDINO	CA	92404	5326	36	06071	34.125768	-117.2787635	San Bernardino County
213433	Fee-for-Service	1457918740	1457918740	1	1	ABDEL-HAMID, MOSTAFA K MD	10/18/2024	207P00000X	NA	Other	026	PHYSICIANS	186932	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
213457	Fee-for-Service	1649656950	1649656950	1	1	AUSPICE HOME CARE SOLUTIONS	1/2/2019	No Taxonomy Provided	Both NEMT & NMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	6319 N FRESNO STREET	SUITE 105	FRESNO	CA	93710	5211	10	06019	36.8287238	-119.7814178	Fresno County
213476	Fee-for-Service	1871838276	1871838276	1	1	A-1 HOSPICE CARE INC	9/29/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	217 EAST ALAMEDA AVENUE	SUITE 306	BURBANK	CA	91502	2621	19	06037	34.17516147	-118.2991383	Los Angeles County
213512	Fee-for-Service	1053357905	1053357905	2	2	ADVANCED RESPIRATORY, INC.	3/23/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	1020 COUNTYROAD F W	None	SAINT PAUL	MN	55126	2910	00	None	45.06469749	-93.14345596	Ramsey County
213514	Fee-for-Service	1295501294	1295501294	1	1	ATWOOD, CHRISTINE A RCP	12/29/2023	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
213554	Fee-for-Service	1962565556	1962565556	1	1	ASSOCIATED FAMILY PHYSICIANS	10/22/2012	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INC	8110 TIMBERLAKE WAY	None	SACRAMENTO	CA	95823	5401	34	06067	38.463075	-121.414347	Sacramento County
213566	Fee-for-Service	1699271262	1699271262	1	1	ALOOR, ROHIT MD	9/13/2023	207RN0300X	NA	Nephrology	026	PHYSICIANS	173576	None	None	0	In state provider	None	1501 SUPERIOR AVE	205	NEWPORT BEACH	CA	92663	3640	30	06059	33.62918676	-117.9305675	Orange County
213583	Fee-for-Service	1821164450	1821164450	1	1	ASHABI, ELLA LAC	11/11/2020	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	23722 BIRTCHER DR	None	LAKE FOREST	CA	92630	1771	30	06059	33.63324607	-117.7161206	Orange County
213590	Fee-for-Service	1982620118	1982620118	1	1	AXELROD, YEKATERINA K MD	10/3/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	105111	14	Neurological Surgery	0	In state provider	None	2025 MORSE AVENUE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
213613	Fee-for-Service	1093995136	1093995136	1	1	ABLA, ADIB A MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125065	14	Neurological Surgery	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
213628	Fee-for-Service	1598792459	1598792459	1	1	AGARWAL, CHHAYA MD	7/31/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	45531	40	Pediatrics	0	In state provider	None	1359 W AVENUE J	None	LANCASTER	CA	93534	2935	19	06037	34.68945451	-118.156581	Los Angeles County
213647	Fee-for-Service	1376583120	1376583120	1	1	ALINAGHIAN, S MOHSEN OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	INC	62 CORPORATE PARK	STE 115	IRVINE	CA	92606	3131	30	06059	33.69197468	-117.8247858	Orange County
213684	Fee-for-Service	1831156116	1831156116	1	1	ALMADEN, VIRGILIO C MD	9/18/1996	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	39833	01	General Practice	0	In state provider	None	120 S 6TH ST	None	BRAWLEY	CA	92227	2430	13	06025	32.97836955	-115.5319748	Imperial County
213688	Fee-for-Service	1265565089	1265565089	2	1	ABBOTT, CATHY L LMFT	12/26/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2937 VENEMAN AVE	B240	MODESTO	CA	95356	9041	50	06099	37.68940892	-121.0483835	Stanislaus County
213695	Fee-for-Service	1760579379	1760579379	1	1	ABEDI, SHAHLA MD	6/8/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	A PROFESSIONAL CORP	15 MAREBLU	STE 260	ALISO VIEJO	CA	92656	3056	30	06059	33.5729913	-117.703431	Orange County
213702	Fee-for-Service	1326194317	1326194317	1	1	ANDERSON VALLEY AMB SVC	1/1/1979	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	18025 BLATTNER ROAD	None	PHILO	CA	95466	9458	23	06045	39.0662393	-123.4431717	Mendocino County
213708	Fee-for-Service	1952358350	1952358350	1	1	APODACA, LORENZO A MD	10/31/1983	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	46726	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
213725	Fee-for-Service	1699032805	1699032805	1	1	ARANEZ, VIVIAN T MD	6/22/2020	207K00000X	NA	Other	026	PHYSICIANS	166595	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
213729	Fee-for-Service	1083056634	1083056634	1	1	ANNORENO, MICHAEL LCSW	11/7/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
213762	Fee-for-Service	1871838276	1871838276	1	1	A-1 HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	217 EAST ALAMEDA AVENUE	SUITE 306	BURBANK	CA	91502	2621	19	06037	34.17516147	-118.2991383	Los Angeles County
213771	Fee-for-Service	1902894314	1902894314	1	1	ANTOIN, HUSSAM Y MD	9/10/2008	207L00000X	NA	Other	026	PHYSICIANS	88484	05	Anesthesiology	0	In state provider	None	18300 US HWY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
213792	Fee-for-Service	1881032811	1881032811	1	1	AGUIRRE, ROBERTO G	12/2/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9209 COLIMA RD	4600	WHITTIER	CA	90605	1800	19	06037	33.9505367	-118.0054552	Los Angeles County
213822	Fee-for-Service	1235891953	1235891953	1	1	AMOS, MARIA F NP	2/1/2022	363LC0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
213828	Fee-for-Service	1316344179	1316344179	1	1	ARBULU, MIGUEL MD	7/11/2021	207P00000X	NA	Other	026	PHYSICIANS	144988	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27200 CALAROGA	None	HAYWARD	CA	94545	4339	01	06001	37.63347961	-122.0897735	Alameda County
213891	Fee-for-Service	1396783379	1396783379	1	8	ASANA INTEGRATED MEDICAL GRO	10/13/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP PC	914 PINE ST	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
213895	Fee-for-Service	1558334706	1558334706	1	1	AGNEY, THOMAS L MD	12/22/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
213908	Fee-for-Service	1053887760	1053887760	1	1	ANTHONY, SHARON NP	12/1/2021	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
213918	Fee-for-Service	1962529552	1962529552	1	1	ALQARWANI, LATIKA LMFT	12/11/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	42640	-	NOT APPLICABLE	0	In state provider	None	650 HOWE AVE	BLDG 400	SACRAMENTO	CA	95825	4731	34	06067	38.577294	-121.4146395	Sacramento County
213923	Fee-for-Service	1407364292	1407364292	1	1	ARELLANO, HAILEY H LMFT	2/4/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3400 DOUGLAS BLVD	STE 225	ROSEVILLE	CA	95661	4283	31	06061	38.74390969	-121.2319271	Placer County
213927	Fee-for-Service	1417010604	1417010604	1	14	ABLELIGHT INC	6/2/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	25315 PARTHENON AVE	None	MISSION VIEJO	CA	92691	3809	30	06059	33.61096522	-117.6885523	Orange County
213948	Fee-for-Service	1518629575	1518629575	1	1	ALTAIS MEDICAL GROUP - RIVER	2/17/2023	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SIDE, INC.	4646 BROCKTON AVE	STE 201 AND 202	RIVERSIDE	CA	92506	0102	33	06065	33.9760171	-117.3860626	Riverside County
213954	Fee-for-Service	1295293363	1295293363	1	1	ADVENTIST HEALTH PHYSICIANS	7/31/2019	207V00000X	NA	Obstetrics & Gynecology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	111 RALEY BLVD	STE 220	CHICO	CA	95928	8351	04	06007	39.71601447	-121.790817	Butte County
213962	Fee-for-Service	1306431895	1306431895	1	1	ALUNA CARE INC	10/20/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10545 BURBANK BLVD	STE 109	NORTH HOLLYWOOD	CA	91601	2248	19	06037	34.1721655	-118.3608315	Los Angeles County
213976	Fee-for-Service	1700883949	1700883949	2	1	ARARAT PHARMACY GROUP INC	9/8/2015	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1248 S GLENDALE AVE	SUITE M	GLENDALE	CA	91205	3269	19	06037	34.13092321	-118.252366	Los Angeles County
213992	Fee-for-Service	1043242670	1043242670	1	1	AHMED, JAMIL MD	5/18/2011	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	90461	25	Physical Medicine and Rehabilitation	0	In state provider	None	840 S AKERS ST	None	VISALIA	CA	93277	8309	54	06107	36.322398	-119.3484285	Tulare County
214002	Fee-for-Service	1457461667	1457461667	1	1	AUMAN, CATHERINE I MFT	11/4/2014	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2566 OVERLAND AVE	SUITE 500 B	LOS ANGELES	CA	90064	5600	19	06037	34.0391707	-118.4227571	Los Angeles County
214008	Fee-for-Service	1417489733	1417489733	1	1	AVERY, BETTY LMFT	4/6/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17059 MAIN ST	None	HESPERIA	CA	92345	6067	36	06071	34.4199033	-117.2908045	San Bernardino County
214025	Fee-for-Service	1588031025	1588031025	1	1	ALBERS, CHERYL M CNM	1/6/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
214071	Fee-for-Service	1972965291	1972965291	1	1	ARONOW-WERNER, SARAH PEARL	10/5/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	152392	15	Obstetrics (D.O. only)	0	In state provider	MD	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
214079	Fee-for-Service	1699138966	1699138966	1	1	ALTIERI, LISA B MD	10/20/2020	207N00000X	NA	Dermatology	026	PHYSICIANS	151529	07	Dermatology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
214122	Fee-for-Service	1295831741	1295831741	1	1	ANDERSEN, JAMES S MD	5/6/1991	2086S0122X	NA	General Surgery	026	PHYSICIANS	71255	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
214176	Fee-for-Service	1619429420	1619429420	1	1	ALINA ZALA INC.	12/27/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3737 MARTIN LUTHER KING	#101	LYNWOOD	CA	90262	3513	19	06037	33.92872742	-118.2006921	Los Angeles County
214236	Fee-for-Service	1255403879	1255403879	1	1	AHN, HYUNAH MD	1/31/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91886	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
214241	Fee-for-Service	1518387364	1518387364	1	1	AMUYUNZU, ESTHER N A MD	11/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	139410	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
214251	Fee-for-Service	1306431895	1306431895	1	1	ALUNA CARE INC	10/20/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10545 BURBANK BLVD	STE 109	NORTH HOLLYWOOD	CA	91601	2248	19	06037	34.1721655	-118.3608315	Los Angeles County
214259	Fee-for-Service	1023192861	1023192861	1	1	AFSHAR, PAYAM MD	12/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	95089	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
214278	Fee-for-Service	1295821296	1295821296	1	1	ASPEN MEDICAL GROUP INC	2/25/2005	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	9041 MAGNOLIA AVE	STE 305	RIVERSIDE	CA	92503	3957	33	06065	33.92541585	-117.4378266	Riverside County
214280	Fee-for-Service	1417656919	1417656919	1	1	AMBULATORY SURGERY ACCESS CO	3/21/2024	172V00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	312 SUTTER ST	STE 608	SAN FRANCISCO	CA	94108	4305	38	06075	37.78960942	-122.4058114	San Francisco County
214282	Fee-for-Service	1740427657	1740427657	1	1	ALTAMED HEALTH SERVICES CORP	4/1/2009	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	SANTA ANA, MAIN	1400 N MAIN ST	None	SANTA ANA	CA	92701	2321	30	06059	33.75688822	-117.8676134	Orange County
214290	Fee-for-Service	1538281845	1538281845	1	1	ARORA, KARISHMA MD	7/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	105196	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD.	None	LOS ANGELES	CA	90048	0000	19	06037	34.07671715	-118.3799413	Los Angeles County
214299	Fee-for-Service	1952740680	1952740680	1	1	ALJANABI, AMJED A MD	2/6/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	160229	08	Family Practice	0	In state provider	None	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	33	06065	33.85626255	-117.5559289	Riverside County
214323	Fee-for-Service	1659788917	1659788917	1	1	ALFORD, JESSICA LMFT	12/11/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
214335	Fee-for-Service	1760646897	1760646897	1	1	AFOH-MANIN, NANAEFUA B MD	8/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122206	66	Emergency Medicine (Urgent Care)	0	In state provider	None	250 SOUTH GRAND AVENUE	None	GLENDORA	CA	91741	4218	19	06037	34.132842	-117.872523	Los Angeles County
214358	Fee-for-Service	1972965291	1972965291	1	1	ARONOW-WERNER, SARAH PEARL	10/5/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	152392	09	Gynecology (D.O. only)	0	In state provider	MD	1550 GATEWAY BLVD	None	FAIRFIELD	CA	94533	6901	48	06095	38.2629133	-122.0560176	Solano County
214359	Fee-for-Service	1962510016	1962510016	1	1	AUDREY JIRICKO	4/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4401 HARRISON BLVD	None	OGDEN	UT	84403	3195	00	None	41.18328	-111.9536955	Weber County
214362	Fee-for-Service	1063436939	1063436939	1	1	AGUET, JAIME C	7/31/1985	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	52128	None	None	0	In state provider	None	740 N SEQUOIA STREET	None	LINDSAY	CA	93247	0000	54	06107	36.21153089	-119.0960162	Tulare County
214418	Fee-for-Service	1518435536	1518435536	1	3	AMPLEX HEARING AIDS INC	1/27/2025	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2717 EL CAMINO AVE	None	SACRAMENTO	CA	95821	5903	34	06067	38.611188	-121.3988535	Sacramento County
214424	Fee-for-Service	1518244474	1518244474	1	1	AT MEDICAL TRANSPORTATION	6/24/2011	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	LLC	408 N BLACKSTONE AVE	None	FRESNO	CA	93701	1917	10	06019	36.748845	-119.7905145	Fresno County
214456	Fee-for-Service	1083363493	1083363493	1	1	ANTILLON, JESSICA J MD	4/25/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	191153	41	Internal Medicine	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
214485	Fee-for-Service	1124391941	1124391941	1	1	ABDIN, ELISABETH MD	9/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134768	41	Internal Medicine	0	In state provider	None	2030 SUTTER PLACE	STE 1300	DAVIS	CA	95616	6201	57	06113	38.56292466	-121.7715423	Yolo County
214517	Fee-for-Service	1063510097	1063510097	1	1	ADVANCED CARE SCRIPTS INC	3/27/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	6251 CHANCELLOR DR	STE 101	ORLANDO	FL	32809	5684	00	None	28.468071	-81.413764	Orange County
214521	Fee-for-Service	1992330690	1992330690	1	1	AFFORDABLE URGENT CARE, INC	9/2/2020	261QP2300X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	21300 SHERMAN WAY	STE. 3	CANOGA PARK	CA	91303	3672	19	06037	34.20095853	-118.5957675	Los Angeles County
214543	Fee-for-Service	1508939588	1508939588	1	1	AZIZ, SHERIF A MD	5/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102114	36	Psychiatry	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	91225	6720	36	06071	34.072245	-117.4319685	San Bernardino County
214549	Fee-for-Service	1316018310	1316018310	1	1	ABILITY HOMECARE INC	10/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SHERMAN OAKS HLTH REHAB	14401 HUSTON ST	None	SHERMAN OAKS	CA	91423	1721	19	06037	34.15943446	-118.4466825	Los Angeles County
214570	Fee-for-Service	1740427657	1740427657	1	1	ALTAMED HEALTH SERVICES CORP	4/1/2009	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	SANTA ANA, MAIN	1400 N MAIN ST	None	SANTA ANA	CA	92701	2321	30	06059	33.75688822	-117.8676134	Orange County
214573	Fee-for-Service	1285164129	1285164129	1	1	AHMED, ADEEL J MD	9/23/2021	207R00000X	NA	Other	026	PHYSICIANS	172427	None	None	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
214602	Fee-for-Service	1104920552	1104920552	2	1	A & H PHARMACY GROUP, INC.	5/5/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4849 VAN NUYS BLVD	STE 101A	SHERMAN OAKS	CA	91403	2181	19	06037	34.159113	-118.4487465	Los Angeles County
214605	Fee-for-Service	1568082113	1568082113	1	1	ADERY, LAURA L PHD	9/28/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	760 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8353	19	06037	34.07067	-118.4432445	Los Angeles County
214618	Fee-for-Service	1750317624	1750317624	1	1	AXELROD, DAVID M MD	5/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85299	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
214620	Fee-for-Service	1154193035	1154193035	1	1	A SWEET HOME CARE	11/8/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	25141 HIGHSPRING AVE	None	NEWHALL	CA	91321	3415	19	06037	34.37579923	-118.5498384	Los Angeles County
214631	Fee-for-Service	1104817071	1104817071	1	1	ALLELO & ASSOCIATES INC	9/21/1999	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	PALOS VERDES HEALTH CARE	26303 WESTERN AVE	None	LOMITA	CA	90717	3521	19	06037	33.783417	-118.3100375	Los Angeles County
214653	Fee-for-Service	1164623088	1164623088	1	1	ANDERSON, PORTIA M LMFT	12/14/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2700 INTERNATIONAL BLVD	# 22	OAKLAND	CA	94601	1508	01	06001	37.78067498	-122.2312906	Alameda County
214690	Fee-for-Service	1619984911	1619984911	1	1	ARON, GARY S MD	8/1/1995	207R00000X	NA	Other	026	PHYSICIANS	36108	41	Internal Medicine	0	In state provider	None	1660 SAN CARLOS AVE	None	SAN CARLOS	CA	94070	2022	41	06081	37.50328418	-122.2655795	San Mateo County
214705	Fee-for-Service	1518435536	1518435536	1	3	AMPLEX HEARING AIDS INC	1/27/2025	237600000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2717 EL CAMINO AVE	None	SACRAMENTO	CA	95821	5903	34	06067	38.611188	-121.3988535	Sacramento County
214716	Fee-for-Service	1164724514	1164724514	1	1	AMIN, SHEFALEE MD	5/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104383	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6201	19	06037	34.09817553	-118.293237	Los Angeles County
214728	Fee-for-Service	1336478916	1336478916	1	1	AROMAS - SAN JUAN	12/15/2008	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	2300 SAN JUAN HIGHWAY	None	SAN JUAN BAUTISTA	CA	95045	9557	35	06069	36.880371	-121.554348	San Benito County
214735	Fee-for-Service	1467222190	1467222190	1	1	A2 MEDICAL TRANSPORTATION PL	3/25/2024	2278P4000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	US LLC	421 SUMMIT CT	None	YREKA	CA	96097	2245	47	06093	41.73820258	-122.6502464	Siskiyou County
214774	Fee-for-Service	1437630282	1437630282	1	1	ANAYA, KRISTINA M AU	7/20/2019	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3180 ARDEN WY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
214789	Fee-for-Service	1982082046	1982082046	1	1	AMADI, UGOCHUKWU MD	8/28/2020	208M00000X	NA	Other	026	PHYSICIANS	161577	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
214795	Fee-for-Service	1154884351	1154884351	1	1	AYOUBY, QAIS MD	9/17/2022	207R00000X	NA	Other	026	PHYSICIANS	177222	None	None	0	In state provider	None	800 SOUTH MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
214797	Fee-for-Service	1730667841	1730667841	1	2	ALLIANCE ANESTHESIA	10/24/2018	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	ASSOCIATES INC	4060 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2526	19	06037	34.02390148	-118.184319	Los Angeles County
214801	Fee-for-Service	1275681058	1275681058	1	1	ANDRYJOWICZ, ESTEBAN MD	8/26/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	55816	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
214842	Fee-for-Service	1699348425	1699348425	1	1	AGUITE, ALFRED Y LMFT	5/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3609 SACRAMENTO ST	None	SAN FRANCISCO	CA	94118	1709	38	06075	37.78748183	-122.4522257	San Francisco County
214859	Fee-for-Service	1740427657	1740427657	1	1	ALTAMED HEALTH SERVICES CORP	4/1/2009	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	SANTA ANA, MAIN	1400 N MAIN ST	None	SANTA ANA	CA	92701	2321	30	06059	33.75688822	-117.8676134	Orange County
214864	Fee-for-Service	1447407275	1447407275	1	1	AHN, YVONNE J MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110711	05	Anesthesiology	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
214895	Fee-for-Service	1659139426	1659139426	1	1	ARNOLD, JENNIFER MARIE	3/26/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	5822 THELMA AVE	None	LA PALMA	CA	90623	1549	30	06059	33.85081447	-118.0314173	Orange County
214924	Fee-for-Service	1801494430	1801494430	1	1	ARC PSYCHOLOGICAL SERVICES	8/18/2021	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	S	1819 CLIFF DR	F	SANTA BARBARA	CA	93109	1650	42	06083	34.40137954	-119.7214154	Santa Barbara County
214934	Fee-for-Service	1881271823	1881271823	1	1	ASPET HOME HEALTH	7/11/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4605 LANKERSHIM BLVD	STE 601	NORTH HOLLYWOOD	CA	91602	1862	19	06037	34.15389329	-118.3679999	Los Angeles County
214989	Fee-for-Service	1992454888	1992454888	1	1	ANDERSON, BRANDON MD	10/21/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191338	08	Family Practice	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
215006	Fee-for-Service	1851499115	1851499115	1	1	ANDERSON, WENDY G MD	3/6/2008	207R00000X	NA	Other	026	PHYSICIANS	100142	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
215016	Fee-for-Service	1023498607	1023498607	1	1	ASHRAF, HAMAD R MD	12/13/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
215024	Fee-for-Service	1932277597	1932277597	1	1	AIDAR-CURRIER, RENATA LCSW	7/28/2015	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	625 3RD AVE	None	CHULA VISTA	CA	91910	5703	37	06073	32.62998356	-117.0754419	San Diego County
215038	Fee-for-Service	1073724688	1073724688	1	1	ANDERSON PHYSICAL THERAPY	2/2/2016	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	INC	202 PROVIDENCE MINE RD	STE 206	NEVADA CITY	CA	95959	2946	29	06057	39.25034906	-121.0306425	Nevada County
215043	Fee-for-Service	1548670599	1548670599	1	1	AHMADPOUR, ARJANG MD	3/4/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	1131 WILSHIRE BLVD	100	SANTA MONICA	CA	90401	2072	19	06037	34.02509887	-118.4909994	Los Angeles County
215048	Fee-for-Service	1023125176	1023125176	1	1	AFRA, SOHAIL K MD	6/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	76251	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
215058	Fee-for-Service	1871824169	1871824169	1	1	ANGELCARE HOME HEALTH	11/30/2012	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PROVIDERS INC	710 RIMPAU AVENUE	SUITE 202	CORONA	CA	92879	5725	33	06065	33.87375	-117.5526465	Riverside County
215060	Fee-for-Service	1639104227	1639104227	1	1	AUSTIN, SUZANNE M MD	5/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	41567	41	Internal Medicine	0	In state provider	None	455 OCONNOR DR	STE 210	SAN JOSE	CA	95128	1632	43	06085	37.326654	-121.939897	Santa Clara County
215078	Fee-for-Service	1033329677	1033329677	1	1	ARANGUA, LUIS A T MD	11/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	79651	01	General Practice	0	In state provider	None	26520 CACTUS AVE	STE A2006	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
215082	Fee-for-Service	1730667841	1730667841	1	2	ALLIANCE ANESTHESIA	10/24/2018	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	ASSOCIATES INC	4060 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2526	19	06037	34.02390148	-118.184319	Los Angeles County
215115	Fee-for-Service	1609109644	1609109644	1	1	ABANONU, KASEY L MD	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
215129	Fee-for-Service	1083766893	1083766893	1	1	AMOG, ANA L MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80658	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
215144	Fee-for-Service	1740427657	1740427657	1	1	ALTAMED HEALTH SERVICES CORP	4/1/2009	261QC1500X	NA	Other	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	SANTA ANA, MAIN	1400 N MAIN ST	None	SANTA ANA	CA	92701	2321	30	06059	33.75688822	-117.8676134	Orange County
215148	Fee-for-Service	1609555176	1609555176	1	1	ALDOTRANSPORT	7/13/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	27201 PUERTA REAL	STE 300	MISSION VIEJO	CA	92691	8590	30	06059	33.56706221	-117.6710883	Orange County
215158	Fee-for-Service	1104273309	1104273309	1	1	ANKER, YEN NP	10/1/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95003992	-	NOT APPLICABLE	0	In state provider	None	265 S ANITA DR	202	ORANGE	CA	92868	3346	30	06059	33.78499409	-117.8811837	Orange County
215161	Fee-for-Service	1942428669	1942428669	1	1	AMERICAN MOBILITY PRO CO	6/9/2006	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	KUIZON, JESLE GEN PTR	1313 W ROBINHOOD DR	STE A8	STOCKTON	CA	95207	5509	39	06077	37.99870982	-121.3232809	San Joaquin County
215164	Fee-for-Service	1265597611	1265597611	2	2	AEGIS TREATMENT CENTERS, LLC	6/12/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2045 AND 2055 SAVIERS RD	9, 10, 11 & 12	OXNARD	CA	93033	3651	56	06111	34.179219	-119.1776065	Ventura County
215166	Fee-for-Service	1699043992	1699043992	1	1	ASSALY, SHIREN G	3/25/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	270 INTERNATIONAL CIRCLE	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
215184	Fee-for-Service	1720131808	1720131808	1	1	ANURADHA, AURORA G PHD	7/18/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1400 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2612	41	06081	37.48892015	-122.218747	San Mateo County
215186	Fee-for-Service	1659139426	1659139426	1	1	ARNOLD, JENNIFER MARIE	3/26/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	5822 THELMA AVE	None	LA PALMA	CA	90623	1549	30	06059	33.85081447	-118.0314173	Orange County
215191	Fee-for-Service	1699310425	1699310425	1	1	ATTENTIVE SENIOR CARE II LLC	9/10/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6149 E LOWE AVE	None	FRESNO	CA	93727	5652	10	06019	36.732276	-119.6793248	Fresno County
215202	Fee-for-Service	1326139825	1326139825	1	1	ASHRAFZADEH, AMIN MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	79534	18	Ophthalmology	0	In state provider	None	880 DELBON AVE	None	TURLOCK	CA	95382	2005	50	06099	37.51046554	-120.8381799	Stanislaus County
215210	Fee-for-Service	1730672056	1730672056	1	1	AUNG, AYE M MD	7/27/2022	207RS0010X	NA	Other	026	PHYSICIANS	138550	None	None	0	In state provider	None	1717 S MAIN STREET	None	MILPITAS	CA	95035	6756	43	06085	37.40594287	-121.9029593	Santa Clara County
215213	Fee-for-Service	1801494430	1801494430	1	1	ARC PSYCHOLOGICAL SERVICES	8/18/2021	101YM0800X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	S	1819 CLIFF DR	F	SANTA BARBARA	CA	93109	1650	42	06083	34.40137954	-119.7214154	Santa Barbara County
215242	Fee-for-Service	1972608032	1972608032	1	1	ABLAN, DANILO N MD	4/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146478	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
215245	Fee-for-Service	1528014982	1528014982	1	1	ACCENTCARE HOME HEALTH	4/30/1998	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA, INC	3636 BIRCH ST	STE 195	NEWPORT BEACH	CA	92660	2644	30	06059	33.66287355	-117.8715888	Orange County
215256	Fee-for-Service	1144331224	1144331224	1	3	AMIRHAMZEH, MEHRDAD MD INC	6/22/2018	208G00000X	NA	General Surgery	026	PHYSICIANS	86572	02	General Surgery	0	In state provider	None	177 W EL PORTAL DR	STE B	MERCED	CA	95348	2848	24	06047	37.32688193	-120.4707294	Merced County
215282	Fee-for-Service	1356408231	1356408231	1	1	ATCHINSON, DEBRA S OD	6/3/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7601 STONERIDGE DRIVE	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
215294	Fee-for-Service	1205002904	1205002904	1	1	ANTELOPE HILLS MANOR	2/3/2006	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ICF DD-N INC	5355 KLAMATH DR	None	SACRAMENTO	CA	95842	2651	34	06067	38.683602	-121.339701	Sacramento County
215319	Fee-for-Service	1114937679	1114937679	1	1	ANDERSON, FRANK L DO	9/28/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	14680	None	None	0	In state provider	None	18300 HWY 18	None	APPLE VALLEY	CA	92307	2206	36	06071	34.5406159	-117.2658221	San Bernardino County
215339	Fee-for-Service	1760623854	1760623854	1	1	AVILA, MELDY NP	7/31/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3529 FIRESTONE BLVD	None	SOUTH GATE	CA	90280	3031	19	06037	33.95422949	-118.2050894	Los Angeles County
215351	Fee-for-Service	1427237221	1427237221	1	1	ALVAREZ, PAMELA L MD INC	6/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	98180	13	Neurology (M.D. only)	0	In state provider	None	24910 LAS BRISAS RD	STE 115	MURRIETA	CA	92562	4035	33	06065	33.57522424	-117.1828078	Riverside County
215374	Fee-for-Service	1255615530	1255615530	1	1	ALEXANDER, NATASHA MD	2/5/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	125684	41	Internal Medicine	0	In state provider	None	1851 N RIVERSIDE AVE	None	RIALTO	CA	92376	8069	36	06071	34.133238	-117.3704145	San Bernardino County
215405	Fee-for-Service	1750559431	1750559431	1	23	ALL STAR PHYSICAL THERAPY, I	5/25/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	224 N RIVERSIDE AVE	SUITE A	RIALTO	CA	92376	5968	36	06071	34.10345211	-117.3705328	San Bernardino County
215429	Fee-for-Service	1710938287	1710938287	1	1	ABSHIER, STANLEY R MD	8/24/2004	207L00000X	NA	Other	026	PHYSICIANS	52320	05	Anesthesiology	0	In state provider	None	12373 LEWIS ST	STE 102	GARDEN GROVE	CA	92840	4676	30	06059	33.78307435	-117.8981519	Orange County
215433	Fee-for-Service	1740427657	1740427657	1	1	ALTAMED HEALTH SERVICES CORP	8/1/2013	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	SANTA ANA, MAIN	1400 N MAIN ST	None	SANTA ANA	CA	92701	2321	30	06059	33.75688822	-117.8676134	Orange County
215454	Fee-for-Service	1265597611	1265597611	2	2	AEGIS TREATMENT CENTERS, LLC	6/12/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2045 AND 2055 SAVIERS RD	9, 10, 11 & 12	OXNARD	CA	93033	3651	56	06111	34.179219	-119.1776065	Ventura County
215463	Fee-for-Service	1073563706	1073563706	1	2	ANTELOPE VALLEY FAMILY OPTOM	7/29/2024	152W00000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	ETRY	2720 E PALMDALE BLVD	SUITE 133	PALMDALE	CA	93550	4930	19	06037	34.58012347	-118.0800855	Los Angeles County
215486	Fee-for-Service	1780442699	1780442699	1	1	ALEXIS GOMEZ, REGISTERED NUR	11/14/2024	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	SE PRACTITIONER, A PROFE	3000 EAST 1ST STREET	W1	LOS ANGELES	CA	90063	2807	19	06037	34.04032875	-118.2022726	Los Angeles County
215498	Fee-for-Service	1104928936	1104928936	1	1	ALCERRO, RAMON DC	3/1/2001	No Taxonomy Provided	NA	None	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	1520 STATE ST	STE A	SANTA BARBARA	CA	93101	2556	42	06083	34.42667264	-119.7089638	Santa Barbara County
215543	Fee-for-Service	1447428420	1447428420	1	1	ADAMCZAK, JOANNA E MD	8/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	116982	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3020 CHILDRENS WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
215544	Fee-for-Service	1144331224	1144331224	1	3	AMIRHAMZEH, MEHRDAD MD INC	6/22/2018	208G00000X	NA	General Surgery	026	PHYSICIANS	86572	33	Thoracic Surgery	0	In state provider	None	177 W EL PORTAL DR	STE B	MERCED	CA	95348	2848	24	06047	37.32688193	-120.4707294	Merced County
215561	Fee-for-Service	1093790974	1093790974	1	1	ALBUQUERQUE AMB SERVICE	1/1/1994	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4012 4TH ST NW	None	ALBUQUERQUE	NM	87107	3551	00	None	35.12444128	-106.6439286	Bernalillo County
215582	Fee-for-Service	1396783379	1396783379	1	11	ASANA INTEGRATED MEDICAL GRO	10/13/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP PC	1600 ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
215598	Fee-for-Service	1790721025	1790721025	1	1	ALEXANDER, GERALD J MD	10/1/1998	174400000X	NA	Other	026	PHYSICIANS	81353	20	Orthopedic Surgery	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
215603	Fee-for-Service	1942779400	1942779400	1	1	ALEXANDER, MICHELLE C LCSW	4/24/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	108095	-	NOT APPLICABLE	0	In state provider	None	2801 BRISTOL STREET	STE 200	COSTA MESA	CA	92626	5996	30	06059	33.67474907	-117.889122	Orange County
215655	Fee-for-Service	1265598817	1265598817	2	2	AEGIS TREATMENT CENTERS, LLC	6/5/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3707 E SHIELDS AVENUE	None	FRESNO	CA	93726	7029	10	06019	36.77969052	-119.7632025	Fresno County
215675	Fee-for-Service	1376891374	1376891374	1	1	ATUL AGGARWAL MD CARDIOLOGY	4/3/2013	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	53451	None	None	0	In state provider	CLINIC	9330 STOCKDALE HWY	STE 200	BAKERSFIELD	CA	93311	3616	15	06029	35.35452946	-119.106351	Kern County
215690	Fee-for-Service	1982637021	1982637021	1	1	ARBOLEDA, HAYDEE T MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	46477	41	Internal Medicine	0	In state provider	None	2211 W MAGNOLIA BLVD	None	BURBANK	CA	91506	1753	19	06037	34.1728873	-118.3320905	Los Angeles County
215710	Fee-for-Service	1871370569	1871370569	1	1	ANCESTRAL LACTATION LLC	9/16/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
215753	Fee-for-Service	1629394002	1629394002	1	1	ABDALLA, BASMAH A MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135144	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365,420,120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
215772	Fee-for-Service	1780442699	1780442699	1	1	ALEXIS GOMEZ, REGISTERED NUR	11/14/2024	363LP0808X	NA	Nurse Practitioner	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	SE PRACTITIONER, A PROFE	3000 EAST 1ST STREET	W1	LOS ANGELES	CA	90063	2807	19	06037	34.04032875	-118.2022726	Los Angeles County
215782	Fee-for-Service	1003816141	1003816141	1	1	ATMAJIAN, TIMOTHY K MD	12/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77817	01	General Practice	0	In state provider	FRESNO SHIELDS MED CNTR	3030 N FRESNO ST	STE 101	FRESNO	CA	93703	1124	10	06019	36.77828036	-119.7815087	Fresno County
215807	Fee-for-Service	1518002898	1518002898	1	1	ADVANCED MEDICAL	2/9/2007	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	ANALYSIS LLC	1941 WALKER AVE	None	MONROVIA	CA	91016	4846	19	06037	34.12948203	-118.0002828	Los Angeles County
215943	Fee-for-Service	1265598817	1265598817	2	2	AEGIS TREATMENT CENTERS, LLC	6/5/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	3707 E SHIELDS AVENUE	None	FRESNO	CA	93726	7029	10	06019	36.77969052	-119.7632025	Fresno County
216006	Fee-for-Service	1134586050	1134586050	1	1	ALLEN, JENNIFER LYNN LMFT	1/2/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	26485 CARMEL RANCHO BLVD	STE 5	CARMEL	CA	93923	8706	27	06053	36.53938515	-121.9047851	Monterey County
216046	Fee-for-Service	1447812540	1447812540	1	1	ARSHAD, WAQAAR A MD	8/14/2022	207R00000X	NA	Other	026	PHYSICIANS	19961	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
216047	Fee-for-Service	1215407952	1215407952	1	1	ACEPTIO HEALTH CARE SERVICES	4/13/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	9198 GREENBACK LANE	STE 102	ORANGEVALE	CA	95662	4770	34	06067	38.677905	-121.2122655	Sacramento County
216056	Fee-for-Service	1346200391	1346200391	1	1	AGARWAL, SANJAY MD	3/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131031	41	Internal Medicine	0	In state provider	None	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
216137	Fee-for-Service	1942579115	1942579115	1	1	ANDRAE-HAMMOND, MARIA MD	9/10/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118226	41	Internal Medicine	0	In state provider	None	140 BROOKWOOD ROAD	STE 201	ORINDA	CA	94563	3047	07	06013	37.87712752	-122.1816965	Contra Costa County
216140	Fee-for-Service	1457691578	1457691578	1	1	ALFARO, ROBIN A LCSW	1/19/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
216162	Fee-for-Service	1740548932	1740548932	1	1	ARASU, VIGNESH A MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122844	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X55	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
216202	Fee-for-Service	1336155035	1336155035	1	1	ADAIR, JOHN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
216208	Fee-for-Service	1356538508	1356538508	1	1	ALVAREZ, MARIA J PHD	11/19/2018	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
216222	Fee-for-Service	1376690966	1376690966	1	1	ANESTHESIA AND INTENSIVE	8/19/2011	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	CARE SPECIALIST LLP	657 TOWN CENTER DRIVE	None	LAS VEGAS	NV	89134	6367	00	None	36.180999	-115.3174815	Clark County
216226	Fee-for-Service	1699084525	1699084525	2	1	ADVENTIST HEALTH MEDICAL	11/1/2016	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CENTER TEHACHAPI	9350 NORTH LOOP BLVD	None	CALIFORNIA CITY	CA	93505	2269	15	06029	35.13319573	-117.9617515	Kern County
216242	Fee-for-Service	1881846475	1881846475	1	1	AHMAD, HOSAM MD	9/26/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115626	41	Internal Medicine	0	In state provider	None	317 WEST PUEBLO STREET	None	SANTA BARBARA	CA	93105	4310	42	06083	34.42967671	-119.7228362	Santa Barbara County
216282	Fee-for-Service	1427633023	1427633023	1	1	ALFA ALLIANCE HOSPICE INC	9/29/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6454 VAN NUYS BLVD	STE 41	VAN NUYS	CA	91401	1445	19	06037	34.187886	-118.448714	Los Angeles County
216284	Fee-for-Service	1508877473	1508877473	1	5	ANJANI THAKUR, MD, INC	7/29/2021	208600000X	NA	General Surgery	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5924 STONERIDGE DR	STE 200	PLEASANTON	CA	94588	2887	01	06001	37.69132593	-121.8988844	Alameda County
216308	Fee-for-Service	1588790059	1588790059	1	1	ARENSON, DAVID MD	2/28/1986	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	41137	10	Gastroenterology (M.D. only)	0	In state provider	None	3941 J ST	STE 450	SACRAMENTO	CA	95819	3633	34	06067	38.570652	-121.4535465	Sacramento County
216309	Fee-for-Service	1801923719	1801923719	1	1	AOKI, ELLEN M MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	63333	40	Pediatrics	0	In state provider	None	222 WEST 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
216330	Fee-for-Service	1316310840	1316310840	1	1	ALGHAMDI, ASMA MD	7/28/2020	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	167529	38	Geriatrics	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
216344	Fee-for-Service	1952480006	1952480006	1	1	ABDUL, ALEEM MUHAMMAD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	51324	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
216424	Fee-for-Service	1467803924	1467803924	1	1	ALEXANDER, DEBORAH	1/10/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
216443	Fee-for-Service	1457395253	1457395253	1	1	ANTONIO DAVILA M.D.	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	475 S DOBSON RD	None	CHANDLER	AZ	85224	5605	00	None	33.29768043	-111.8761089	Maricopa County
216460	Fee-for-Service	1255741542	1255741542	1	1	AUNG, NAY M MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	150494	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
216462	Fee-for-Service	1275124844	1275124844	1	1	AAR HEALTHCARE PC	6/16/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	ATMENT CENTER	1595 GRAND AVE	100	SAN MARCOS	CA	92078	2450	37	06073	33.14530488	-117.1982671	San Diego County
216504	Fee-for-Service	1639558455	1639558455	1	1	ADAMSON, PAUL C MD	4/12/2021	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	154218	None	None	0	In state provider	None	1245 16TH STREET	SUITE 125, 204, 307	SANTA MONICA	CA	90404	1240	19	06037	34.02726451	-118.4857138	Los Angeles County
216505	Fee-for-Service	1972130169	1972130169	1	1	ADVANCED CARE HOSPICE INC	6/9/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6931 VAN NUYS BLVD	SUITE 315-1	VAN NUYS	CA	91405	3937	19	06037	34.19649	-118.448787	Los Angeles County
216512	Fee-for-Service	1699084525	1699084525	2	1	ADVENTIST HEALTH MEDICAL	11/1/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTER TEHACHAPI	9350 NORTH LOOP BLVD	None	CALIFORNIA CITY	CA	93505	2269	15	06029	35.13319573	-117.9617515	Kern County
216514	Fee-for-Service	1790469807	1790469807	1	1	AJE WELL PHARMACY CO	9/15/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	860 HARBOUR WAY S	E	RICHMOND	CA	94804	3648	07	06013	37.91994587	-122.3600608	Contra Costa County
216532	Fee-for-Service	1629331715	1629331715	1	1	ANDERSEN, CARL-ERIK S MD	8/22/2016	2084P0800X	NA	Psychiatry	026	PHYSICIANS	126223	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
216544	Fee-for-Service	1710566708	1710566708	1	1	ASKARI-ATAPOUR, BAHAREH MD	6/26/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	7202 MILLBROOK	105	FRESNO	CA	93720	3341	10	06019	36.83958089	-119.7645538	Fresno County
216549	Fee-for-Service	1629691209	1629691209	1	1	ANTELOPE VALLEY NEONATOLOGY	8/3/2020	2080N0001X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP	1600 W AVE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
216571	Fee-for-Service	1427633023	1427633023	1	1	ALFA ALLIANCE HOSPICE INC	9/29/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6454 VAN NUYS BLVD	STE 41	VAN NUYS	CA	91401	1445	19	06037	34.187886	-118.448714	Los Angeles County
216574	Fee-for-Service	1508877473	1508877473	1	5	ANJANI THAKUR, MD, INC	7/29/2021	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5924 STONERIDGE DR	STE 200	PLEASANTON	CA	94588	2887	01	06001	37.69132593	-121.8988844	Alameda County
216581	Fee-for-Service	1194781351	1194781351	1	1	ADLER, JOSHUA S MD	1/1/2000	207R00000X	NA	Other	026	PHYSICIANS	73842	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
216611	Fee-for-Service	1801884200	1801884200	1	1	AKKAWAY, EDWARD S MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	72465	05	Anesthesiology	0	In state provider	None	3530 WILSHIRE BLVD	STE 350	LOS ANGELES	CA	90010	2335	19	06037	34.06171652	-118.301427	Los Angeles County
216615	Fee-for-Service	1316310840	1316310840	1	1	ALGHAMDI, ASMA MD	7/28/2020	207QG0300X	NA	Adult Primary Care	026	PHYSICIANS	167529	08	Family Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
216644	Fee-for-Service	1215299102	1215299102	1	1	ANAYA, YANETT MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124587	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1001 POTRERO AVE	RD 6D	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
216665	Fee-for-Service	1528127107	1528127107	1	1	AMANIOS, TEDROS MD	4/13/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	78364	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
216689	Fee-for-Service	1932756764	1932756764	1	11	ALTAMED HEALTH SERVICES	4/11/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	8710 MOODY STREET	None	CYPRESS	CA	90630	2220	30	06059	33.83614183	-118.0458137	Orange County
216702	Fee-for-Service	1508877473	1508877473	1	1	ANJANI THAKUR, MD, INC	5/25/2004	208600000X	NA	General Surgery	026	PHYSICIANS	66588	None	None	0	In state provider	None	1329 SPANOS CT AVE	STE C-1	MODESTO	CA	95355	2806	50	06099	37.66976149	-120.9731145	Stanislaus County
216707	Fee-for-Service	1821249194	1821249194	1	1	ALDUNCIN, NIDIA MD	12/10/2009	390200000X	NA	Other	026	PHYSICIANS	105491	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
216710	Fee-for-Service	1396783379	1396783379	1	7	ASANA INTEGRATED MEDICAL GRO	10/13/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP PC	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
216760	Fee-for-Service	1538256797	1538256797	1	1	ALEXANDER LEVKOFF	11/25/2013	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1320 EATON RD	None	SAN DIMAS	CA	91773	2831	19	06037	34.10518313	-117.8337171	Los Angeles County
216762	Fee-for-Service	1871122846	1871122846	1	1	ALL DAY HIGH QUALITY CARE	2/7/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE	14640 VICTORY BLVD	STE 222	VAN NUYS	CA	91411	1623	19	06037	34.18663255	-118.452402	Los Angeles County
216767	Fee-for-Service	1992814396	1992814396	1	1	ALFIDI, MARY MD	7/27/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171193	None	None	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
216792	Fee-for-Service	1972130169	1972130169	1	1	ADVANCED CARE HOSPICE INC	6/9/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6931 VAN NUYS BLVD	SUITE 315-1	VAN NUYS	CA	91405	3937	19	06037	34.19649	-118.448787	Los Angeles County
216793	Fee-for-Service	1972616100	1972616100	1	1	AGUILERA, GEMELIA H MD	2/28/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	46585	41	Internal Medicine	0	In state provider	None	3761 BEVERLY BLVD	None	LOS ANGELES	CA	90004	3528	19	06037	34.07634048	-118.291014	Los Angeles County
216800	Fee-for-Service	1699084525	1699084525	2	1	ADVENTIST HEALTH MEDICAL	11/1/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTER TEHACHAPI	9350 NORTH LOOP BLVD	None	CALIFORNIA CITY	CA	93505	2269	15	06029	35.13319573	-117.9617515	Kern County
216807	Fee-for-Service	1174345771	1174345771	1	1	ABINADER, CARINE NP	10/28/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
216875	Fee-for-Service	1093882995	1093882995	1	1	ABOSEIF, SHERIF R MD	9/30/1992	208800000X	NA	Other	026	PHYSICIANS	48911	34	Urology and Urological Surgery	0	In state provider	None	400 PARNASSUS AVE	STE A610	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
216890	Fee-for-Service	1750307674	1750307674	1	1	AMERICAN RIVER REHABILITATIO	6/4/2019	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	N, INCORPORATED	12055 PERSIMMON TER	STE. 130	AUBURN	CA	95603	3808	31	06061	38.9114322	-121.0758582	Placer County
216895	Fee-for-Service	1649634841	1649634841	1	1	AKAS, MICHAEL N NP	9/12/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	37491 ENTERPISE DRIVE	None	BURNEY	CA	96013	4379	45	06089	40.88784451	-121.6526265	Shasta County
216953	Fee-for-Service	1922186683	1922186683	1	1	AMIN, MIHIR J MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	67615	41	Internal Medicine	0	In state provider	None	1001 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
216975	Fee-for-Service	1881897338	1881897338	1	1	ARELLANO, LETICIA H PSYD	11/8/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	800 SERENO DR	None	VALLEJO	CA	94589	2411	48	06095	38.12792924	-122.2506587	Solano County
216978	Fee-for-Service	1932756764	1932756764	1	11	ALTAMED HEALTH SERVICES	4/11/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	8710 MOODY STREET	None	CYPRESS	CA	90630	2220	30	06059	33.83614183	-118.0458137	Orange County
216980	Fee-for-Service	1427507383	1427507383	1	1	ABIGAILS MEDICAL SUPPLIES	1/25/2019	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	3837 PLAZA DRIVE	STE 801	OCEANSIDE	CA	92056	4627	37	06073	33.18246128	-117.2908982	San Diego County
216990	Fee-for-Service	1750559431	1750559431	1	26	ALL STAR PHYSICAL THERAPY, I	6/2/2023	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	8215 ROCHESTER AVE.	SUITE 110	RANCHO CUCAMONGA	CA	91730	0727	36	06071	34.10428657	-117.5456898	San Bernardino County
216999	Fee-for-Service	1104016872	1104016872	1	1	ABBO, JOSEF A MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	102 E LAKE MEAD PKWY	None	HENDERSON	NV	89015	5775	00	None	36.03815706	-114.9842287	Clark County
217008	Fee-for-Service	1841748191	1841748191	1	1	ANAYA-BACA, SUSANA LCSW	3/10/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
217028	Fee-for-Service	1346402989	1346402989	1	1	AFRASHTEH, AFSHIN MD	3/11/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106629	08	Family Practice	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
217046	Fee-for-Service	1851647382	1851647382	1	1	ACCURATE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3925 ROSEMEAD BLVD	SUITE 201	ROSEMEAD	CA	91770	1933	19	06037	34.07930385	-118.0732531	Los Angeles County
217049	Fee-for-Service	1871122846	1871122846	1	1	ALL DAY HIGH QUALITY CARE	2/7/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE	14640 VICTORY BLVD	STE 222	VAN NUYS	CA	91411	1623	19	06037	34.18663255	-118.452402	Los Angeles County
217055	Fee-for-Service	1972931244	1972931244	1	1	AHWOUH LESLEY EBU	10/23/2013	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	251 PEPPERTREE WAY	None	PITTSBURG	CA	94565	7065	07	06013	38.0029041	-121.8710158	Contra Costa County
217069	Fee-for-Service	1043696727	1043696727	1	1	AVULA, SIVASUBRAMAN V MD	5/17/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	167041	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
217071	Fee-for-Service	1043497779	1043497779	1	1	APGAR, SARAH K MD	10/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137430	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
217090	Fee-for-Service	1326186529	1326186529	1	2	ADDICTION RESEARCH AND TREAT	10/21/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	4920 AVALON BLVD.	None	LOS ANGELES	CA	90011	4004	19	06037	33.998157	-118.265212	Los Angeles County
217135	Fee-for-Service	1811962202	1811962202	1	2	AGARWAL, NEERU DO	10/10/2019	208600000X	NA	General Surgery	026	PHYSICIANS	11317	02	General Surgery	0	In state provider	None	1180 N INDIAN CANYON DR	STE E420	PALM SPRINGS	CA	92262	4868	33	06065	33.839505	-116.5455735	Riverside County
217137	Fee-for-Service	1417010604	1417010604	1	8	ABLELIGHT INC	1/28/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	25161 HARTOG ST	None	LAGUNA HILLS	CA	92653	5029	30	06059	33.59776792	-117.6907787	Orange County
217147	Fee-for-Service	1710931258	1710931258	1	1	ARMIJO, CRISTINA A MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	66184	40	Pediatrics	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
217152	Fee-for-Service	1851336218	1851336218	1	1	ABAJIAN, JERRY L MD	5/31/1987	207L00000X	NA	Other	026	PHYSICIANS	60758	05	Anesthesiology	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
217155	Fee-for-Service	1841612959	1841612959	1	1	ALOHA FAMILY OPTOMETRY INC	4/29/2014	No Taxonomy Provided	NA	None	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1874 N PLACENTIA AVE	None	PLACENTIA	CA	92870	2303	30	06059	33.89612263	-117.8722666	Orange County
217156	Fee-for-Service	1699768713	1699768713	1	1	ADVANCED PAIN MANAGEMENT	10/9/2019	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	39700 BOB HOPE DR	SUITE 204	RANCHO MIRAGE	CA	92270	3267	33	06065	33.760683	-116.4080645	Riverside County
217164	Fee-for-Service	1629684659	1629684659	1	1	ARYA SENIOR CARE HOME LLC	11/20/2020	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	18554 OLALEE WAY	None	APPLE VALLEY	CA	92307	1403	36	06071	34.54846512	-117.2594306	San Bernardino County
217190	Fee-for-Service	1861678260	1861678260	1	1	AMANI, MOJDEH LMFT	6/17/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	103550	-	NOT APPLICABLE	0	In state provider	None	100 E WARDLOW ROAD	None	LONG BEACH	CA	90807	4417	19	06037	33.8188341	-118.1923297	Los Angeles County
217212	Fee-for-Service	1851616106	1851616106	1	1	ANGELUCCI, ANDREA DO	7/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	11012	08	Family Practice	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
217234	Fee-for-Service	1124513692	1124513692	1	1	ANGLIN, MASON T LMFT	2/19/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	121211	-	NOT APPLICABLE	0	In state provider	None	1352 COLUSA HWY	SUITE C	YUBA CITY	CA	95993	9147	51	06101	39.14177255	-121.635963	Sutter County
217235	Fee-for-Service	1902329782	1902329782	1	1	AGSE, LLC	9/1/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1220 S ELISEO DR	None	GREENBRAE	CA	94904	2006	21	06041	37.94396821	-122.5357002	Marin County
217237	Fee-for-Service	1366545568	1366545568	1	3	AMACHER, KATHRYN M DO	6/18/2021	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	5091	None	None	0	In state provider	None	585 NUT TREE CT.	None	VACAVILLE	CA	95687	3353	48	06095	38.36167248	-121.9482153	Solano County
217244	Fee-for-Service	1669051116	1669051116	1	1	AHMED, PALWASHA DPM	8/23/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	2089 VALE RD	STE 12	SAN PABLO	CA	94806	3847	07	06013	37.95396781	-122.3375393	Contra Costa County
217247	Fee-for-Service	1659394427	1659394427	1	1	ANDREWS, DANIEL E III MD	5/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40516	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1131 TRANCAS ST	None	NAPA	CA	94558	2907	28	06055	38.32318203	-122.2977818	Napa County
217250	Fee-for-Service	1093282907	1093282907	1	1	ALJOMARD, BASSAM MD	9/20/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	173568	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
217259	Fee-for-Service	1346854973	1346854973	1	1	A HOME FOR OUR VETERANS	5/5/2021	261QM0801X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	AMS	1811 W 236TH ST	None	TORRANCE	CA	90501	5742	19	06037	33.81128314	-118.3111109	Los Angeles County
217278	Fee-for-Service	1750559431	1750559431	1	26	ALL STAR PHYSICAL THERAPY, I	6/2/2023	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	8215 ROCHESTER AVE.	SUITE 110	RANCHO CUCAMONGA	CA	91730	0727	36	06071	34.10428657	-117.5456898	San Bernardino County
217288	Fee-for-Service	1417359027	1417359027	1	1	ARREOLA, FRANCISCO LMFT	11/21/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	UNIT 203	UPLAND	CA	91786	4167	36	06071	34.10424442	-117.6701797	San Bernardino County
217292	Fee-for-Service	1396783379	1396783379	1	19	ASANA INTEGRATED MEDICAL GRO	10/13/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP PC	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
217294	Fee-for-Service	1073979704	1073979704	1	1	AKOPIAN, ERIK MD	11/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139573	66	Emergency Medicine (Urgent Care)	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
217332	Fee-for-Service	1851647382	1851647382	1	1	ACCURATE HOSPICE INC	3/26/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3925 ROSEMEAD BLVD	SUITE 201	ROSEMEAD	CA	91770	1933	19	06037	34.07930385	-118.0732531	Los Angeles County
217333	Fee-for-Service	1174690911	1174690911	1	1	ALONSO, ROBERTO NP	2/27/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4801 COFFEE RD	None	BAKERSFIELD	CA	93308	9424	15	06029	35.403066	-119.0923565	Kern County
217340	Fee-for-Service	1225018880	1225018880	1	1	ARCOVEDO, RODOLFO MD	1/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51718	02	General Surgery	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
217343	Fee-for-Service	1972931244	1972931244	1	1	AHWOUH LESLEY EBU	10/23/2013	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	251 PEPPERTREE WAY	None	PITTSBURG	CA	94565	7065	07	06013	38.0029041	-121.8710158	Contra Costa County
217346	Fee-for-Service	1104250836	1104250836	1	1	ALL LINKED HOME HEALTH INC	12/13/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6819 SEPULVEDA BLVD	STE 211	VAN NUYS	CA	91405	4440	19	06037	34.194564	-118.4662195	Los Angeles County
217356	Fee-for-Service	1295929529	1295929529	1	1	ARANDA, SCARLETTE G LCSW	1/13/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
217380	Fee-for-Service	1750321568	1750321568	1	1	ASSIL, KAMYAR MD	10/18/2018	208VP0014X	NA	Other	026	PHYSICIANS	81184	None	None	0	In state provider	None	3525 LOMA VISTA RD	STE A	VENTURA	CA	93003	3101	56	06111	34.27680789	-119.2480851	Ventura County
217403	Fee-for-Service	1659494037	1659494037	1	1	ABC UNIFIED SCHOOL DIST	10/4/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	16700 NORWALK BLVD	None	CERRITOS	CA	90703	1838	19	06037	33.879519	-118.070244	Los Angeles County
217454	Fee-for-Service	1215940523	1215940523	1	1	ACADIA HOSPITAL	10/27/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	268 STILLWATER AVE	None	BANGOR	ME	04401	3980	00	None	44.820504	-68.7632535	Penobscot County
217473	Fee-for-Service	1932770096	1932770096	1	1	ASTER HOME HEALTH SERVICES	5/24/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	19737 VENTURA BLVD	STE 310B	WOODLAND HILLS	CA	91364	2664	19	06037	34.17249119	-118.5635388	Los Angeles County
217493	Fee-for-Service	1760560593	1760560593	1	1	AIYAR, SYAMALA R MD	9/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	40551	40	Pediatrics	0	In state provider	C B O VALLEJO	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
217497	Fee-for-Service	1982159075	1982159075	1	1	ANGEL GARCIA, ANAHI E LMFT	8/6/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1255 W COLTON AVE STE 58	None	REDLANDS	CA	92374	2861	36	06071	34.06285254	-117.20178	San Bernardino County
217530	Fee-for-Service	1316966344	1316966344	1	1	AXIS PHYSICAL THERAPY	10/10/2022	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	505 E ROMIE LN	SUITE#I	SALINAS	CA	93901	4031	27	06053	36.65998191	-121.6461895	Monterey County
217534	Fee-for-Service	1659394427	1659394427	1	1	ANDREWS, DANIEL E III MD	5/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	40516	41	Internal Medicine	0	In state provider	None	1131 TRANCAS ST	None	NAPA	CA	94558	2907	28	06055	38.32318203	-122.2977818	Napa County
217549	Fee-for-Service	1194011213	1194011213	1	1	ABRAHAM, HAZELMAEARTAP MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132280	41	Internal Medicine	0	In state provider	None	155 GLASSON WAY	None	GRASS VALLEY	CA	95945	5723	29	06057	39.22820863	-121.0465856	Nevada County
217556	Fee-for-Service	1881721959	1881721959	1	1	ACADEMIC SURGICAL	9/23/1988	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	ONCOLOGY ASSOC A MED GRP	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
217568	Fee-for-Service	1538404256	1538404256	1	1	ANESTHESIA PROVIDER GROUP IN	3/5/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	C	4682 ONTARIO MILLS PKWY	None	ONTARIO	CA	91764	5104	36	06071	34.069446	-117.549036	San Bernardino County
217578	Fee-for-Service	1548353956	1548353956	1	1	ARDIGO, GREGORY J MD	12/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	75943	66	Emergency Medicine (Urgent Care)	0	In state provider	None	40404 CALIFORNIA OAKS RD	STE C	MURRIETA	CA	92562	5786	33	06065	33.57857707	-117.1998797	Riverside County
217595	Fee-for-Service	1073774808	1073774808	1	1	AHMED, SHAMOONA MD	12/21/2018	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	657 NORTH TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
217627	Fee-for-Service	1225018880	1225018880	1	1	ARCOVEDO, RODOLFO MD	1/26/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	51718	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
217642	Fee-for-Service	1154947810	1154947810	1	1	AZIMI, VAHID MD	1/21/2025	207ZC0006X	NA	Other	026	PHYSICIANS	None	22	Pathology (M.D. only)	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
217644	Fee-for-Service	1457524332	1457524332	1	1	ALLAN M ANDERSEN M.D.	1/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
217645	Fee-for-Service	1770612756	1770612756	1	1	ALHAMBRA HOSP MED CTR LP	7/2/1998	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	100 S RAYMOND AVE	None	ALHAMBRA	CA	91801	3199	19	06037	34.09027878	-118.1450083	Los Angeles County
217651	Fee-for-Service	1154872414	1154872414	1	1	A N T HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	13629 1/2 VICTORY BLVD	None	VAN NUYS	CA	91401	1735	19	06037	34.1867373	-118.4299049	Los Angeles County
217676	Fee-for-Service	1144601303	1144601303	1	1	ALTOS HEALTH PARTNERS	7/17/2024	2084P0800X	NA	Psychiatry	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	2500 GRANT ROAD	2500 GRANT ROAD	MOUNTAIN VIEW	CA	94040	4302	43	06085	37.36893518	-122.0779448	Santa Clara County
217678	Fee-for-Service	1033474234	1033474234	1	1	ALAVI, MAYSA MD	3/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130668	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
217691	Fee-for-Service	1447265137	1447265137	1	1	AWDYKOVYCH, MARTA MD	7/31/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	44027	40	Pediatrics	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
217728	Fee-for-Service	1750319778	1750319778	1	1	ALESH, ISSA G MD	10/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128313	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	399 EAST HIGHLAND AVENUE	SUITE 307	SAN BERNARDINO	CA	92404	2853	36	06071	34.1358627	-117.2757898	San Bernardino County
217731	Fee-for-Service	1154415644	1154415644	1	1	ARCINUE, EDGARDO L MD	8/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	39203	40	Pediatrics	0	In state provider	None	100 CONGRESS STREET	None	PASADENA	CA	91106	0000	19	06037	34.13395172	-118.1534955	Los Angeles County
217741	Fee-for-Service	1013585967	1013585967	1	1	AZUR HOME HEALTH CARE	7/9/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	451 W BONITA AVE	STE 15	SAN DIMAS	CA	91773	2514	19	06037	34.10669446	-117.815607	Los Angeles County
217743	Fee-for-Service	1639604192	1639604192	1	1	ADEDURO, LINDA I NP	11/21/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
217759	Fee-for-Service	1073897849	1073897849	1	1	ANTONETTE HARVILL	11/23/2019	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	888 SWIFT BLVD	None	RICHLAND	WA	99352	3514	00	None	46.28046647	-119.28231	Benton County
217824	Fee-for-Service	1023252483	1023252483	1	1	AZIMI, AVA MD	4/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138485	None	None	0	In state provider	None	3687 MT DIABLO BLVD	SUITE 200	LAFAYETTE	CA	94549	3746	07	06013	37.8898926	-122.1304235	Contra Costa County
217825	Fee-for-Service	1982084703	1982084703	1	1	ADHIKARY, RAJEEB	7/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150665	01	General Practice	0	In state provider	None	1020 29TH ST	STE 120	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
217865	Fee-for-Service	1285948943	1285948943	1	1	ALTAFI, RASHID MD	7/19/2023	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	179542	None	None	0	In state provider	None	141 NORTH MAIN STREET	None	LAKE ELSINORE	CA	92530	4118	33	06065	33.66881794	-117.3273839	Riverside County
217891	Fee-for-Service	1255566832	1255566832	1	1	ALFORD, JENNIFER L PHD	5/19/2014	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1625 STOCKTON BLVD	None	SACRAMENTO	CA	95816	7097	34	06067	38.56554	-121.4664615	Sacramento County
217925	Fee-for-Service	1609970292	1609970292	1	1	ANDREWS, BRIAN MD	5/7/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	35062	None	None	0	In state provider	UCI DEPT OF MEDICINE	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
217933	Fee-for-Service	1174960892	1174960892	1	1	ALKOV, DANIELLE F MD	4/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133847	01	General Practice	0	In state provider	None	1001 POTRERO AVE	BLDG 80 WARD 83	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
217935	Fee-for-Service	1932756764	1932756764	1	4	ALTAMED HEALTH SERVICES	8/7/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1800 W BALL RD	None	ANAHEIM	CA	92804	5516	30	06059	33.81787448	-117.9467235	Orange County
217940	Fee-for-Service	1154872414	1154872414	1	1	A N T HOSPICE INC	9/18/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	13629 1/2 VICTORY BLVD	None	VAN NUYS	CA	91401	1735	19	06037	34.1867373	-118.4299049	Los Angeles County
217975	Fee-for-Service	1033131107	1033131107	1	2	AIDS HEALTHCARE FOUNDATION	10/2/2020	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1400 S GRAND AVE	STE 801	LOS ANGELES	CA	90015	3068	19	06037	34.03692236	-118.2655238	Los Angeles County
217979	Fee-for-Service	1447265137	1447265137	1	1	AWDYKOVYCH, MARTA MD	7/31/1987	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	44027	01	General Practice	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
217985	Fee-for-Service	1851667299	1851667299	1	1	AHN, JASON J MD	8/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141998	None	None	0	In state provider	None	757 WESTWOOD PLAZA	RM 14-19	LOS ANGELES	CA	90095	0001	19	06037	34.06633051	-118.4452686	Los Angeles County
218011	Fee-for-Service	1861402950	1861402950	1	1	ADORADOR ENTERPRISES	7/10/2018	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1676 EAST 6TH ST	None	BEAUMONT	CA	92223	2550	33	06065	33.92948188	-116.9484306	Riverside County
218013	Fee-for-Service	1740346386	1740346386	1	2	AEGIS TREATMENT CENTERS, LLC	6/2/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	11776 MARIPOSA ROAD	101, 103, & 104	HESPERIA	CA	92345	1622	36	06071	34.46463128	-117.3491141	San Bernardino County
218018	Fee-for-Service	1750319778	1750319778	1	1	ALESH, ISSA G MD	10/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128313	01	General Practice	0	In state provider	None	399 EAST HIGHLAND AVENUE	SUITE 307	SAN BERNARDINO	CA	92404	2853	36	06071	34.1358627	-117.2757898	San Bernardino County
218030	Fee-for-Service	1962668061	1962668061	1	1	ALVAREZ, IMELDA A LMFT	12/20/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
218110	Fee-for-Service	1649363789	1649363789	1	1	AFUAPE, OLUYEMISI S MD	5/1/1983	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	32631	40	Pediatrics	0	In state provider	None	50 ALESSANDRO PL	STE 100	PASADENA	CA	91105	4012	19	06037	34.13101049	-118.151532	Los Angeles County
218129	Fee-for-Service	1174687958	1174687958	1	1	APEX HLTH CARE GRP, INC	3/10/2006	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	329 N GARFIELD AVE	None	MONTEREY PARK	CA	91754	1706	19	06037	34.065981	-118.122907	Los Angeles County
218135	Fee-for-Service	1366119281	1366119281	1	1	ALGOS INC., A MEDICAL CORPOR	10/27/2022	208VP0000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	5370 HOLLISTER AVE	SUITE B	SANTA BARBARA	CA	93111	2303	42	06083	34.43515116	-119.8118045	Santa Barbara County
218144	Fee-for-Service	1356572622	1356572622	1	1	AHMED, SYED A MD	7/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119459	41	Internal Medicine	0	In state provider	None	THREE MEDICAL PLAZA	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
218158	Fee-for-Service	1043749757	1043749757	1	1	AFSHAR, AMIRHOSSEIN MD	9/9/2020	207R00000X	NA	Other	026	PHYSICIANS	165244	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
218166	Fee-for-Service	1447267547	1447267547	1	1	ABTIN, FEREIDOUN MD	7/7/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105323	30	Radiology	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
218170	Fee-for-Service	1316947658	1316947658	1	2	ADVANCED MEDICAL IMAGING INC	11/3/2020	2471S1302X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1849 IRON POINT RD	160	FOLSOM	CA	95630	8842	34	06067	38.644173	-121.1454765	Sacramento County
218177	Fee-for-Service	1679567366	1679567366	1	1	ABRAHAMS, JOLINE H MD	9/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	60599	22	Pathology (M.D. only)	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
218184	Fee-for-Service	1962429431	1962429431	1	1	AHMED, OMER MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	51617	41	Internal Medicine	0	In state provider	None	15201 11TH ST	STE 400	VICTORVILLE	CA	92395	3735	36	06071	34.52725895	-117.2925031	San Bernardino County
218185	Fee-for-Service	1376597781	1376597781	1	1	AGOMO HM MED SUPP, INC	8/20/2004	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	AGOMO HOME MEDICAL SUPPL	10638 BURBANK BLVD	None	NORTH HOLLYWOOD	CA	91601	2511	19	06037	34.17211555	-118.362897	Los Angeles County
218191	Fee-for-Service	1114962610	1114962610	1	1	AZAD, HABIB MD	7/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	81238	45	Nephrology (Renal-Kidney)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
218195	Fee-for-Service	1134312523	1134312523	1	1	ALINGOG, KAREN D MD	1/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97045	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
218221	Fee-for-Service	1528308806	1528308806	1	1	ADVENTIST HEALTH PHYSICIANS	5/23/2013	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	18990 COYOTE VALLEY RD	STE 10	HIDDEN VALLEY LKE	CA	95467	8339	17	06033	38.79462138	-122.5574782	Lake County
218228	Fee-for-Service	1932756764	1932756764	1	4	ALTAMED HEALTH SERVICES	8/7/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1800 W BALL RD	None	ANAHEIM	CA	92804	5516	30	06059	33.81787448	-117.9467235	Orange County
218236	Fee-for-Service	1659358786	1659358786	1	1	AMORY,DAVID W MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70831	20	Orthopedic Surgery	0	In state provider	None	1635 LAKE SAN MARCOS DR	None	SAN MARCOS	CA	92078	4661	37	06073	33.12584927	-117.211016	San Diego County
218261	Fee-for-Service	1659539906	1659539906	1	1	ACACIA FAMILY MED GRP	9/29/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	8036 SAN MIGUEL CANYON R	None	PRUNEDALE	CA	93907	1208	27	06053	36.8007891	-121.6653293	Monterey County
218262	Fee-for-Service	1033424734	1033424734	1	1	AID & CARE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2751 E CHAPMAN AVE	SUITE 101	FULLERTON	CA	92831	3710	30	06059	33.8743446	-117.8815517	Orange County
218270	Fee-for-Service	1386786408	1386786408	1	1	ASHBROOK, CYNTHIA A MD	9/1/1988	207K00000X	NA	Other	026	PHYSICIANS	63996	08	Family Practice	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
218301	Fee-for-Service	1740346386	1740346386	1	2	AEGIS TREATMENT CENTERS, LLC	6/2/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	11776 MARIPOSA ROAD	101, 103, & 104	HESPERIA	CA	92345	1622	36	06071	34.46463128	-117.3491141	San Bernardino County
218308	Fee-for-Service	1750319778	1750319778	1	1	ALESH, ISSA G MD	10/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128313	41	Internal Medicine	0	In state provider	None	399 EAST HIGHLAND AVENUE	SUITE 307	SAN BERNARDINO	CA	92404	2853	36	06071	34.1358627	-117.2757898	San Bernardino County
218309	Fee-for-Service	1609960483	1609960483	1	1	ANSARI, NASRIN K MD	12/8/2006	207L00000X	NA	Other	026	PHYSICIANS	91887	05	Anesthesiology	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
218327	Fee-for-Service	1669602124	1669602124	1	1	ASHWINIKUMAR, PATEL N	10/12/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
218339	Fee-for-Service	1790999373	1790999373	1	1	ALTAMED HEALTH SVS	6/14/1999	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ALTAMED GRAND PLAZA ADHC	701 W CESAR E CHAVEZ AVE	STE 201	LOS ANGELES	CA	90012	2185	19	06037	34.06104367	-118.2443411	Los Angeles County
218340	Fee-for-Service	1063011344	1063011344	1	1	AMHH HEALTH SERVICES, INC.	10/23/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	14542 VENTURA BLVD	SUITE 206A	SHERMAN OAKS	CA	91403	5512	19	06037	34.15111125	-118.4500521	Los Angeles County
218349	Fee-for-Service	1245387604	1245387604	1	1	ACOSTA-ANTONS, LINDA A LCSW	5/16/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1153 LINCOLN AVE	STE I	SAN JOSE	CA	95125	3351	43	06085	37.30758265	-121.9004774	Santa Clara County
218384	Fee-for-Service	1538402003	1538402003	1	1	ASANTE PHYSICIAN PARTNERS	7/25/2013	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	1	Border provider	None	2911 SISKIYOU BLVD	None	MEDFORD	OR	97504	8179	00	None	42.31964683	-122.8279156	Jackson County
218410	Fee-for-Service	1851658926	1851658926	1	1	ABEDI, MARYAM LMFT	5/11/2020	103K00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	315 CENTENNIAL WAY	None	TUSTIN	CA	92780	3714	30	06059	33.743016	-117.8188045	Orange County
218451	Fee-for-Service	1831453075	1831453075	1	1	AFSHARTAVANA, NAHAL	7/28/2016	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 CAMARILLO RANCH ROAD	SUITE 209	CAMARILLO	CA	93012	5903	56	06111	34.220943	-119.0186825	Ventura County
218456	Fee-for-Service	1578950820	1578950820	1	1	ARSHIA ROOHIAN DPM INC.	4/23/2024	193400000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	24331 EL TORO ROAD	SUITE 370	LAGUNA WOODS	CA	92637	2752	30	06059	33.60928782	-117.7295058	Orange County
218466	Fee-for-Service	1114576824	1114576824	2	1	ARELLANO, IDANIA LMFT	2/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	615 BROOKSIDE AVE	A	REDLANDS	CA	92373	4673	36	06071	34.05284171	-117.1901247	San Bernardino County
218469	Fee-for-Service	1962429431	1962429431	1	1	AHMED, OMER MD	10/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	51617	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	15201 11TH ST	STE 400	VICTORVILLE	CA	92395	3735	36	06071	34.52725895	-117.2925031	San Bernardino County
218480	Fee-for-Service	1114962610	1114962610	1	1	AZAD, HABIB MD	7/31/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	81238	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
218512	Fee-for-Service	1750331344	1750331344	1	1	ATCHISON, MELVIN L CRNA	2/8/2015	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	05	Anesthesiology	0	In state provider	None	650 SANITARIUM RD	None	DEER PARK	CA	94576	9714	28	06055	38.5417293	-122.4756328	Napa County
218524	Fee-for-Service	1952036683	1952036683	1	1	ADVENTIST HEALTH PHYSICIANS	7/13/2023	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	9508 STOCKDALE HWY	110	BAKERSFIELD	CA	93311	3622	15	06029	35.35453237	-119.1086014	Kern County
218527	Fee-for-Service	1942438684	1942438684	1	1	ANG, CHRISTOPHER R MD	10/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114091	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
218534	Fee-for-Service	1396783379	1396783379	1	14	ASANA INTEGRATED MEDICAL GRO	10/13/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP PC	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
218551	Fee-for-Service	1033424734	1033424734	1	1	AID & CARE HOSPICE INC	9/5/2012	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2751 E CHAPMAN AVE	SUITE 101	FULLERTON	CA	92831	3710	30	06059	33.8743446	-117.8815517	Orange County
218560	Fee-for-Service	1548423221	1548423221	1	1	AARON STEVENS, D.O.	9/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1600 W ANTELOPE DR	None	LAYTON	UT	84041	1120	00	None	41.091012	-111.995523	Davis County
218588	Fee-for-Service	1295475093	1295475093	1	1	ALMOND HOUSE ASSISTED LIVING	5/12/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	LLC	6135 ALMOND AVE	None	ORANGEVALE	CA	95662	4408	34	06067	38.678256	-121.240278	Sacramento County
218617	Fee-for-Service	1417479288	1417479288	1	1	ACOSTAMADIEDO, JENNIFER MD	11/11/2020	207R00000X	NA	Other	026	PHYSICIANS	170693	None	None	0	In state provider	None	1680 E 120 ST	None	LOS ANGELES	CA	90059	3026	19	06037	33.92456051	-118.2417525	Los Angeles County
218626	Fee-for-Service	1790999373	1790999373	1	1	ALTAMED HEALTH SVS	6/14/1999	261QA0600X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	ALTAMED GRAND PLAZA ADHC	701 W CESAR E CHAVEZ AVE	STE 201	LOS ANGELES	CA	90012	2185	19	06037	34.06104367	-118.2443411	Los Angeles County
218627	Fee-for-Service	1396127825	1396127825	1	1	AKHAVAN, SINA MD	6/14/2019	207P00000X	NA	Other	026	PHYSICIANS	156094	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
218641	Fee-for-Service	1952900680	1952900680	1	1	AMA HOSPICE CARE INC	5/3/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	350 10TH AVE	SUITE 1020	SAN DIEGO	CA	91201	7496	37	06073	32.708898	-117.1555415	San Diego County
218671	Fee-for-Service	1538402003	1538402003	1	1	ASANTE PHYSICIAN PARTNERS	7/25/2013	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	2911 SISKIYOU BLVD	None	MEDFORD	OR	97504	8179	00	None	42.31964683	-122.8279156	Jackson County
218678	Fee-for-Service	1447206073	1447206073	1	1	ADAN, OLGA M MD	8/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	75425	40	Pediatrics	0	In state provider	None	1850 N RIVERSIDE AVE	None	RIALTO	CA	92376	8071	36	06071	34.132905	-117.3704675	San Bernardino County
218684	Fee-for-Service	1275581753	1275581753	1	1	AMY SCHELL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
218704	Fee-for-Service	1679681340	1679681340	1	1	A.C.T. MEDICAL SUPP, INC	2/2/2006	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	A.C.T MEDICAL SUPPLIES	2928 WESTMINSTER AVE	None	SEAL BEACH	CA	90740	5053	30	06059	33.7594287	-118.0801913	Orange County
218751	Fee-for-Service	1811210974	1811210974	1	1	ALEJANDRE, HILDA MD	6/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130603	41	Internal Medicine	0	In state provider	None	210 CANAL STREET	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
218753	Fee-for-Service	1316101793	1316101793	1	1	ANJANA UPPAL	5/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 PELHAM PKWY S	None	BRONX	NY	10461	1138	00	None	40.857111	-73.847448	Bronx County
218794	Fee-for-Service	1417500737	1417500737	1	1	AZPEITIA, CANDACE E	11/17/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9324 W STOCKTON BLVD	None	ELK GROVE	CA	95758	8012	34	06067	38.418309	-121.3939665	Sacramento County
218825	Fee-for-Service	1124513692	1124513692	1	2	ANGLIN, MASON T LMFT	8/2/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1130 CONROY LN	SUITE 150	ROSEVILLE	CA	95661	4154	31	06061	38.73792807	-121.2748427	Placer County
218851	Fee-for-Service	1457518276	1457518276	1	1	ADLER, MARGARET M MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	109903	13	Neurology (M.D. only)	0	In state provider	None	21840 S NORMANDIE AVE	None	TORRANCE	CA	90502	2047	19	06037	33.82982744	-118.2991395	Los Angeles County
218874	Fee-for-Service	1114325743	1114325743	1	1	ARMSTRONG, SARA LMFT	12/13/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	97496	-	NOT APPLICABLE	0	In state provider	None	2015 PIONEER COURT	SUITE B	SAN MATEO	CA	94403	1736	41	06081	37.54712403	-122.3120681	San Mateo County
218909	Fee-for-Service	1124042692	1124042692	1	1	ARMOUR, REBECCA L. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3303 SW BOND AVE	None	PORTLAND	OR	97239	4501	00	None	45.49894088	-122.6708542	Multnomah County
218910	Fee-for-Service	1467831008	1467831008	1	1	ALDEA, INC	3/26/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	920 YOUNT STREET	None	NAPA	CA	94559	1808	28	06055	38.30451816	-122.2885707	Napa County
218930	Fee-for-Service	1982782322	1982782322	1	1	ADAME, AARON D	7/31/1993	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6537 GREENLEAF AVE	None	WHITTIER	CA	90601	4108	19	06037	33.98157473	-118.0373941	Los Angeles County
218934	Fee-for-Service	1952900680	1952900680	1	1	AMA HOSPICE CARE INC	5/3/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	350 10TH AVE	SUITE 1020	SAN DIEGO	CA	91201	7496	37	06073	32.708898	-117.1555415	San Diego County
218936	Fee-for-Service	1124018031	1124018031	1	2	ADVENTIST HEALTH CLEARLAKE	2/11/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	15322 LAKESHORE DR	SUITE 201	CLEARLAKE	CA	95422	9815	17	06033	38.95045805	-122.6255271	Lake County
218984	Fee-for-Service	1396944104	1396944104	1	1	AGARWAL, ANUSHREE MD	10/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130602	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
218996	Fee-for-Service	1912433103	1912433103	1	1	ANDRADE, LIWAYWAY R MD	4/30/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
219013	Fee-for-Service	1407391535	1407391535	1	1	ART OF NURSING HOME CARE INC	11/20/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	20121 VENTURA BLVD	STE 206	WOODLAND HILLS	CA	91364	2558	19	06037	34.17068268	-118.5718406	Los Angeles County
219031	Fee-for-Service	1396140513	1396140513	1	1	ALTOBELLI, ERIKA C LCSW	5/26/2017	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6333 TELEGRAPH AVE	SUITE 201G	OAKLAND	CA	94609	1359	01	06001	37.84914135	-122.260702	Alameda County
219045	Fee-for-Service	1760546915	1760546915	1	1	AHERN, CAROL A MD	12/9/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	80132	01	General Practice	0	In state provider	None	3317 CHANATE RD	STE 2F	SANTA ROSA	CA	95404	1737	49	06097	38.470896	-122.708889	Sonoma County
219058	Fee-for-Service	1619244357	1619244357	1	1	AYERS, FREDA S LCSW	11/16/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
219065	Fee-for-Service	1568567220	1568567220	1	1	ALL FOR HEALTH, HEALTH	11/21/2005	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	FOR ALL, INC	519 E BROADWAY	None	GLENDALE	CA	91205	1110	19	06037	34.14636593	-118.2492244	Los Angeles County
219081	Fee-for-Service	1780618918	1780618918	1	1	AZIZZADEH, ALI MD	8/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	86711	01	General Practice	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
219084	Fee-for-Service	1962469791	1962469791	1	1	ARUN LAKSHMIPATHY M.D.	7/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5150 N 16TH ST	STE B232	PHOENIX	AZ	85016	3990	00	None	33.51222	-112.0479705	Maricopa County
219093	Fee-for-Service	1861439846	1861439846	1	1	ANDREWS, AUBREY C	1/4/2006	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	800 N TUSTIN AVE	STE 1	SANTA ANA	CA	92705	3605	30	06059	33.752241	-117.8342255	Orange County
219103	Fee-for-Service	1275963811	1275963811	1	1	ARMOUR, SUSAN LMFT	2/1/2023	101YA0400X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3655 ALAMO ST	SUITE 300	SIMI VALLEY	CA	93063	2187	56	06111	34.28646704	-118.7257456	Ventura County
219113	Fee-for-Service	1275987216	1275987216	1	1	ARCA, CHRIS D MD	4/14/2023	390200000X	NA	Other	026	PHYSICIANS	153243	None	None	0	In state provider	None	215 W. 4TH ST	None	PERRIS	CA	92570	2010	33	06065	33.78233553	-117.2305035	Riverside County
219124	Fee-for-Service	1548214497	1548214497	1	1	ADVANCED EYECARE CENTER INC	6/16/2006	193400000X	NA	Other	026	PHYSICIANS	74216	18	Ophthalmology	0	In state provider	None	19582 BEACH BLVD	STE 102	HUNTINGTON BEACH	CA	92648	2996	30	06059	33.67831649	-117.9885198	Orange County
219133	Fee-for-Service	1922029354	1922029354	1	1	ALVARADO, MICHAEL D MD	8/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96393	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
219157	Fee-for-Service	1164931499	1164931499	1	1	ALEXANDER, BREONA CCC-SLP	1/8/2025	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	667 LIGHTHOUSE AVE	201	PACIFIC GROVE	CA	93950	2644	27	06053	36.62205802	-121.9200608	Monterey County
219183	Fee-for-Service	1144055302	1144055302	1	1	AH ADDICTION CARE OF CALIFOR	1/9/2025	101YA0400X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	500 CAPITOL MALL	SUITE 2350	SACRAMENTO	CA	95814	4737	34	06067	38.578059	-121.501422	Sacramento County
219211	Fee-for-Service	1790841815	1790841815	1	1	ABIDOYE, OYEWALE O MD	12/5/2008	207RH0003X	NA	Oncology	026	PHYSICIANS	98243	78	Neoplastic Diseases/Oncology	0	In state provider	None	9850 GENESEE AVE	SUITE 400	LA JOLLA	CA	92037	1212	37	06073	32.882913	-117.226341	San Diego County
219257	Fee-for-Service	1619140951	1619140951	1	1	ARROYO INPATIENT	4/1/2008	208M00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	PHYSICIANS INC	345 S HALCYON RD	None	ARROYO GRANDE	CA	93420	3896	40	06079	35.113419	-120.5915945	San Luis Obispo County
219262	Fee-for-Service	1013413467	1013413467	1	1	ALVAREZ, ANGEL MD	8/2/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	163539	None	None	0	In state provider	None	1650 RESPONSE ROAD	None	SACRAMENTO	CA	95815	4807	34	06067	38.596581	-121.4303535	Sacramento County
219272	Fee-for-Service	1457329872	1457329872	1	1	ASUNCION, ALFREDO JR MD	1/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	68010	22	Pathology (M.D. only)	0	In state provider	None	3301 C STREET	SUITE 200-E	SACRAMENTO	CA	95816	3363	34	06067	38.579877	-121.456143	Sacramento County
219280	Fee-for-Service	1912433103	1912433103	1	1	ANDRADE, LIWAYWAY R MD	4/30/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
219301	Fee-for-Service	1467516369	1467516369	1	1	AZARMIPUR, MALLY DO	12/14/2007	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2068 W AVE J	None	LANCASTER	CA	93536	5913	19	06037	34.6893627	-118.1678057	Los Angeles County
219302	Fee-for-Service	1316558315	1316558315	1	2	ALLISON M LANDA MA LMFT LICE	5/14/2021	101Y00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	CE FOR GROWTH	25096 JEFFERSON	STE C	MURRIETA	CA	92562	1706	33	06065	33.55467605	-117.2033531	Riverside County
219312	Fee-for-Service	1750559431	1750559431	1	19	ALL STAR PHYSICAL THERAPY, I	3/27/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	27722 CLINTON KEITH RD.,	#B	MURRIETA	CA	92562	0000	33	06065	33.59891845	-117.1765297	Riverside County
219321	Fee-for-Service	1235472200	1235472200	1	1	ABOUYARED, MARIANNE MD	8/12/2019	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	162587	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
219324	Fee-for-Service	1710298476	1710298476	1	1	ALUNNI, MARISA L MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	118878	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
219332	Fee-for-Service	1740255330	1740255330	1	1	ARANEZ, JOSE T	9/29/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	51587	None	None	0	In state provider	None	460 GREENFIELD AVE	STE 1	HANFORD	CA	93230	3500	16	06031	36.3296463	-119.6581535	Kings County
219334	Fee-for-Service	1760546915	1760546915	1	1	AHERN, CAROL A MD	12/9/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	80132	08	Family Practice	0	In state provider	None	3317 CHANATE RD	STE 2F	SANTA ROSA	CA	95404	1737	49	06097	38.470896	-122.708889	Sonoma County
219342	Fee-for-Service	1851546121	1851546121	1	1	ALI, SLAMAT MD	7/26/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	145592	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1100 MAGELLAN DR	None	TEHACHAPI	CA	93561	1380	15	06029	35.14690796	-118.4506925	Kern County
219353	Fee-for-Service	1568567220	1568567220	1	1	ALL FOR HEALTH, HEALTH	7/15/2005	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	FOR ALL, INC	519 E BROADWAY	None	GLENDALE	CA	91205	1110	19	06037	34.14636593	-118.2492244	Los Angeles County
219393	Fee-for-Service	1417190059	1417190059	1	1	ARRAMREDDY, ROHINI MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	106636	45	Nephrology (Renal-Kidney)	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
219395	Fee-for-Service	1477688612	1477688612	1	1	AMANTIA, MONICA R MD	4/10/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89230	30	Radiology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
219403	Fee-for-Service	1477914232	1477914232	1	3	ARTHRITIS AND RHEUMATISM CEN	4/15/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	83	Rheumatology	0	In state provider	TER INC., A MEDICAL CO	6600 MADISON AVE	STE. 2	CARMICHAEL	CA	95608	0645	34	06067	38.663028	-121.310271	Sacramento County
219406	Fee-for-Service	1801117072	1801117072	1	1	ADAL, JACOB PSYD	2/19/2019	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	27201 TOURNEY ROAD	SUITE 201	VALENCIA	CA	91355	5393	19	06037	34.41741018	-118.5770409	Los Angeles County
219422	Fee-for-Service	1871116566	1871116566	1	1	ALTAMED HEALTH SERVICES CORP	8/11/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	E	12751 HARBOR BLVD	ROOM 100	GARDEN GROVE	CA	92840	5800	30	06059	33.77746612	-117.9151381	Orange County
219445	Fee-for-Service	1659997765	1659997765	1	1	ALHENDY, MOHAMMED MD	12/26/2024	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	184441	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
219471	Fee-for-Service	1144055302	1144055302	1	1	AH ADDICTION CARE OF CALIFOR	1/9/2025	101YA0400X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	500 CAPITOL MALL	SUITE 2350	SACRAMENTO	CA	95814	4737	34	06067	38.578059	-121.501422	Sacramento County
219488	Fee-for-Service	1023192663	1023192663	1	1	ALBAN, RODRIGO F MD	8/29/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	92657	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
219489	Fee-for-Service	1114290665	1114290665	1	1	AGUIRRE, JANELLE LMFT	3/18/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
219497	Fee-for-Service	1790841815	1790841815	1	1	ABIDOYE, OYEWALE O MD	12/5/2008	207RH0003X	NA	Oncology	026	PHYSICIANS	98243	41	Internal Medicine	0	In state provider	None	9850 GENESEE AVE	SUITE 400	LA JOLLA	CA	92037	1212	37	06073	32.882913	-117.226341	San Diego County
219520	Fee-for-Service	1306896485	1306896485	1	1	AUERBACH, STUART R DO	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	8356	None	None	0	In state provider	None	1600 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
219537	Fee-for-Service	1215543921	1215543921	1	1	ALESYA HOSPICE, INC	6/22/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8121 FOOTHILL BLVD	None	SUNLAND	CA	91040	2955	19	06037	34.2596885	-118.3097925	Los Angeles County
219544	Fee-for-Service	1306069737	1306069737	1	2	ADVANCED HOME HEALTH INC	8/5/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	BRANCH	1528 PLUMAS CT	SUITE 300	YUBA CITY	CA	95991	2960	51	06101	39.15297032	-121.6186294	Sutter County
219551	Fee-for-Service	1285720243	1285720243	1	1	AUH, JANE S MD	10/1/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	71580	40	Pediatrics	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
219556	Fee-for-Service	1336406958	1336406958	1	1	AL BADRI, AHMED MD	12/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136364	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
219598	Fee-for-Service	1750559431	1750559431	1	19	ALL STAR PHYSICAL THERAPY, I	4/30/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	27722 CLINTON KEITH RD.,	#B	MURRIETA	CA	92562	0000	33	06065	33.59891845	-117.1765297	Riverside County
219639	Fee-for-Service	1568567220	1568567220	1	1	ALL FOR HEALTH, HEALTH	7/15/2005	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	FOR ALL, INC	519 E BROADWAY	None	GLENDALE	CA	91205	1110	19	06037	34.14636593	-118.2492244	Los Angeles County
219640	Fee-for-Service	1114378130	1114378130	1	1	ANDREW PRINDLE	6/24/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1003 WILLOW CREEK RD	None	PRESCOTT	AZ	86301	1641	00	None	34.558992	-112.481901	Yavapai County
219656	Fee-for-Service	1841985348	1841985348	1	1	ARROYO, ELYDE	7/30/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	37	06073	0	0	None
219659	Fee-for-Service	1396220612	1396220612	1	1	ADVANCED QUALITY HOME HEALTH	6/12/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	3212 LOMA VISTA RD	STE 260	VENTURA	CA	93003	3042	56	06111	34.2760182	-119.2530926	Ventura County
219665	Fee-for-Service	1164586103	1164586103	2	1	ALCAM MEDICAL INC	3/19/2015	335E00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1760 CHICAGO AVE	STE L21	RIVERSIDE	CA	92507	2326	33	06065	33.995538	-117.348333	Riverside County
219675	Fee-for-Service	1477939890	1477939890	1	1	AMG RESIDENTIAL CARE HOMES	9/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	INC	7641 N MANSIONETTE DR	None	FRESNO	CA	93720	3618	10	06019	36.84662184	-119.7518183	Fresno County
219698	Fee-for-Service	1851393086	1851393086	1	1	AMIR, AHMAD A MD	1/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84926	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	821 E CHAPEL ST	STE 204	SANTA MARIA	CA	93454	4619	42	06083	34.95428347	-120.4236585	Santa Barbara County
219699	Fee-for-Service	1447604657	1447604657	1	1	AMY L. SEEGERS MD	6/4/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	939 CAROLINE ST	None	PORT ANGELES	WA	98362	3909	00	None	48.11505263	-123.4151177	Clallam County
219714	Fee-for-Service	1750582557	1750582557	1	1	ALAMEDA COUNTY MED CTR	2/7/2008	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	EASTMONT WELLNESS CTR	6955 FOOTHILL BLVD	STE 200	OAKLAND	CA	94605	2426	01	06001	37.76924146	-122.1732586	Alameda County
219732	Fee-for-Service	1396799516	1396799516	1	1	ASCHER, NANCY L MD	4/29/1999	208600000X	NA	General Surgery	026	PHYSICIANS	63147	02	General Surgery	0	In state provider	None	533 PARNASSUS AVE	# U370	SAN FRANCISCO	CA	94143	2208	38	06075	37.76304484	-122.4592904	San Francisco County
219735	Fee-for-Service	1255916441	1255916441	1	1	ALL STATE HOSPICE CARE	7/6/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	45 WEST EASY STREET	STE 21	SIMI VALLEY	CA	93065	1610	56	06111	34.27870825	-118.7986474	Ventura County
219745	Fee-for-Service	1922145796	1922145796	1	1	ANGEL VIEW INC	1/14/1997	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	BETTY&MARTIN RUSSELL HSE	66770 HACIENDA AVE	None	DESERT HOT SPRING	CA	92240	5810	33	06065	33.95417501	-116.496379	Riverside County
219768	Fee-for-Service	1134275951	1134275951	1	1	AVANESIAN, AIDA AC	2/8/2015	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	ACUHEALTH O M CLINIC	5250 SANTA MONICA BLVD	STE 304	LOS ANGELES	CA	90029	1255	19	06037	34.09077051	-118.3046976	Los Angeles County
219778	Fee-for-Service	1982064754	1982064754	1	1	AKHAVAN-HEIDARI, MEHDI MD	6/1/2016	193200000X	NA	Other	026	PHYSICIANS	140502	02	General Surgery	0	In state provider	INC	1617 NORTH CALIFORNIA ST	SUITE D1	STOCKTON	CA	95204	6117	39	06077	37.9697906	-121.2890104	San Joaquin County
219781	Fee-for-Service	1831195122	1831195122	1	1	ARTH, CHRIS MD	11/15/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	35475	40	Pediatrics	0	In state provider	P O BOX 358	10038 MEADOW WAY	UNIT B	TRUCKEE	CA	96161	4974	29	06057	39.32685	-120.2105955	Nevada County
219795	Fee-for-Service	1396783379	1396783379	1	4	ASANA INTEGRATED MEDICAL GRO	10/13/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP PC	2550 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	52	06103	40.14847323	-122.2180997	Tehama County
219828	Fee-for-Service	1215543921	1215543921	1	1	ALESYA HOSPICE, INC	6/22/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8121 FOOTHILL BLVD	None	SUNLAND	CA	91040	2955	19	06037	34.2596885	-118.3097925	Los Angeles County
219836	Fee-for-Service	1285720243	1285720243	1	1	AUH, JANE S MD	10/1/2000	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	71580	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
219838	Fee-for-Service	1366993008	1366993008	1	1	ASNADIMOGHADDAM, KIANA LMFT	4/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
219841	Fee-for-Service	1487135448	1487135448	1	2	A2Z DIAGNOSTICS LLC	10/12/2021	193200000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	6 INDUSTRIAL WAY WEST	STE F19	EATONTOWN	NJ	07724	2268	00	None	40.27602483	-74.04835869	Monmouth County
219882	Fee-for-Service	1063566842	1063566842	1	1	AMINZADEH, ARASTOU MD	8/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92270	36	Psychiatry	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
219937	Fee-for-Service	1952333635	1952333635	1	2	AMPLA HEALTH	7/14/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MOBILE	2800 LINCOLN BLVD	None	OROVILLE	CA	95966	5961	04	06007	39.5019672	-121.5515919	Butte County
219941	Fee-for-Service	1902237100	1902237100	1	1	ASSOCIATED REHABILITATION PR	9/27/2019	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	6348, 6350 APPIAN WAY	None	CARMICHAEL	CA	95608	0724	34	06067	38.663244	-121.3161255	Sacramento County
219953	Fee-for-Service	1164586103	1164586103	2	1	ALCAM MEDICAL INC	7/23/2010	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1760 CHICAGO AVE	STE L21	RIVERSIDE	CA	92507	2326	33	06065	33.995538	-117.348333	Riverside County
219958	Fee-for-Service	1295271286	1295271286	1	1	AGHAJANI, ASAL A MD	5/24/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151639	08	Family Practice	0	In state provider	None	200 MEDICAL PLAZA #530	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
219982	Fee-for-Service	1073723144	1073723144	1	1	AMIT MITTAL M.D.	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2800 LITTLE ELM PKWY	None	LITTLE ELM	TX	75068	6650	00	None	33.16848623	-96.89116072	Denton County
219983	Fee-for-Service	1427286582	1427286582	1	1	ABE, BOLATITO M MD	12/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122841	08	Family Practice	0	In state provider	None	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
219986	Fee-for-Service	1851393086	1851393086	1	1	AMIR, AHMAD A MD	1/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84926	18	Ophthalmology	0	In state provider	None	821 E CHAPEL ST	STE 204	SANTA MARIA	CA	93454	4619	42	06083	34.95428347	-120.4236585	Santa Barbara County
220008	Fee-for-Service	1174068316	1174068316	1	1	AMARE HOSPICE	2/22/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	21151 S WESTERN AVE	#162	TORRANCE	CA	90501	1724	19	06037	33.83695304	-118.3092655	Los Angeles County
220014	Fee-for-Service	1811955354	1811955354	1	1	ASANTE, KRISTI A MD	3/21/2022	207R00000X	NA	Other	026	PHYSICIANS	169993	None	None	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
220021	Fee-for-Service	1285762278	1285762278	2	1	ABILITY PATHWAYS	6/19/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED	8712 NORRIS AVE	None	SUN VALLEY	CA	91352	3403	19	06037	34.2273662	-118.3700517	Los Angeles County
220025	Fee-for-Service	1255916441	1255916441	1	1	ALL STATE HOSPICE CARE	7/6/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	45 WEST EASY STREET	STE 21	SIMI VALLEY	CA	93065	1610	56	06111	34.27870825	-118.7986474	Ventura County
220028	Fee-for-Service	1689235558	1689235558	1	1	AU, SARA	9/25/2024	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
220086	Fee-for-Service	1841395597	1841395597	1	1	AKHAVAN, NIMA MD	8/20/2009	2084P0800X	NA	Psychiatry	026	PHYSICIANS	98589	36	Psychiatry	0	In state provider	None	13652 CANTARA STREET	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
220109	Fee-for-Service	1801385893	1801385893	1	1	ARENDT KOSEC, VICTORIA A MD	7/22/2022	2085R0204X	NA	Other	026	PHYSICIANS	163764	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
220135	Fee-for-Service	1700175577	1700175577	1	1	ALANIZ, MATEO A MD	8/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124388	01	General Practice	0	In state provider	None	678 3RD AVE	None	CHULA VISTA	CA	91911	5736	37	06073	32.62870793	-117.0750108	San Diego County
220176	Fee-for-Service	1174504443	1174504443	1	1	ALI, MOHAMED REDA MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80020	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
220222	Fee-for-Service	1477512457	1477512457	1	1	ANUPAM B KHARBANDA MD	5/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2525 CHICAGO AVE	None	MINNEAPOLIS	MN	55404	4518	00	None	44.95666589	-93.26255996	Hennepin County
220223	Fee-for-Service	1922016484	1922016484	1	2	ADAMS, KAREN E	6/30/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	186905	15	Obstetrics (D.O. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
220225	Fee-for-Service	1952333635	1952333635	1	2	AMPLA HEALTH	7/14/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE	2800 LINCOLN BLVD	None	OROVILLE	CA	95966	5961	04	06007	39.5019672	-121.5515919	Butte County
220226	Fee-for-Service	1962790618	1962790618	1	1	AL HARASH, ABDALHAMID MD	7/31/2020	207R00000X	NA	Other	026	PHYSICIANS	167575	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
220228	Fee-for-Service	1851311344	1851311344	1	1	ANGKUSTSIRI, KATHLEEN MD	6/22/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89109	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
220257	Fee-for-Service	1821722257	1821722257	1	1	ADVENTIST HEALTH PHYSICIANS	4/14/2023	208600000X	NA	General Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	530 W ACACIA ST	1	STOCKTON	CA	95203	2454	39	06077	37.96109625	-121.3011471	San Joaquin County
220265	Fee-for-Service	1417010604	1417010604	1	7	ABLELIGHT INC	1/20/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	COMMUNITIES INC	24575 MOSQUERO LANE	None	MISSION VIEJO	CA	92691	4910	30	06059	33.60604419	-117.6636959	Orange County
220268	Fee-for-Service	1528117660	1528117660	1	1	ANGELES, HERMENEGILDO MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	66103	38	Geriatrics	0	In state provider	None	1850 SULLIVAN AVE	STE 310	DALY CITY	CA	94015	2204	41	06081	37.68085904	-122.4728842	San Mateo County
220295	Fee-for-Service	1912973645	1912973645	1	1	ANTHONY GENIA	1/13/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5200 FAIRVIEW BLVD	None	WYOMING	MN	55092	8013	00	None	45.32172586	-92.99989785	Chisago County
220300	Fee-for-Service	1174068316	1174068316	1	1	AMARE HOSPICE	2/22/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	21151 S WESTERN AVE	#162	TORRANCE	CA	90501	1724	19	06037	33.83695304	-118.3092655	Los Angeles County
220345	Fee-for-Service	1952670341	1952670341	1	3	ANNETTE A CORONEL-PEREY MD I	12/27/2024	208000000X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	NC	1045 W REDONDO BEACH BLV	SUITE 100	GARDENA	CA	90247	4128	19	06037	33.89247044	-118.2931941	Los Angeles County
220365	Fee-for-Service	1073192027	1073192027	1	1	AMEZCUA, EDUARDO MD	2/5/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	26538 MOULTON PARKWAY	SUITE 38E	LAGUNA HILLS	CA	92653	8232	30	06059	33.57744684	-117.702553	Orange County
220392	Fee-for-Service	1225564834	1225564834	2	1	ALAM, DAUOOD Z MD	8/19/2022	207P00000X	NA	Other	026	PHYSICIANS	178258	None	None	0	In state provider	None	1205 E NORTH STREET	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
220406	Fee-for-Service	1154428027	1154428027	1	1	ABDENUR, JOSE E MD	7/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	83870	40	Pediatrics	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
220417	Fee-for-Service	1992203996	1992203996	1	1	ADVENTIST HEALTH PHYSICIANS	9/5/2024	208800000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1531 PLUMAS CT	STE B	YUBA CITY	CA	95991	2966	51	06101	39.15297377	-121.6185928	Sutter County
220420	Fee-for-Service	1932582699	1932582699	1	7	AKSHAY MEHTA MD INC	1/17/2020	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	None	1145 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3511	19	06037	33.89242734	-118.2947128	Los Angeles County
220442	Fee-for-Service	1659833416	1659833416	1	1	ALI, UMAIR MD	8/8/2024	363LC0200X	NA	Nurse Practitioner	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
220465	Fee-for-Service	1174504443	1174504443	1	1	ALI, MOHAMED REDA MD	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	80020	10	Gastroenterology (M.D. only)	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
220509	Fee-for-Service	1962790618	1962790618	1	1	AL HARASH, ABDALHAMID MD	7/31/2020	207R00000X	NA	Other	026	PHYSICIANS	167575	83	Rheumatology	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
220510	Fee-for-Service	1922016484	1922016484	1	2	ADAMS, KAREN E	6/30/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	186905	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
220533	Fee-for-Service	1093048761	1093048761	1	1	ARIZONA CVS STORES, L.L.C.	1/30/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	1	Border provider	None	4744 S HIGHWAY 95	None	FORT MOHAVE	AZ	86426	9377	00	None	35.018973	-114.5974545	Mohave County
220552	Fee-for-Service	1386086635	1386086635	1	1	ARNOLD, STACY MD	2/10/2025	207ZP0102X	NA	Other	026	PHYSICIANS	None	22	Pathology (M.D. only)	0	In state provider	None	20001 S RANCHO WAY	None	COMPTON	CA	90220	6318	19	06037	33.8498073	-118.2223737	Los Angeles County
220554	Fee-for-Service	1801236740	1801236740	1	1	ACERON, KEITH R DPM	7/29/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	5 CENTERPOINTE DRIVE	None	LA PALMA	CA	90623	1050	30	06059	33.86168254	-118.0308375	Orange County
220556	Fee-for-Service	1528117660	1528117660	1	1	ANGELES, HERMENEGILDO MD	7/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	66103	41	Internal Medicine	0	In state provider	None	1850 SULLIVAN AVE	STE 310	DALY CITY	CA	94015	2204	41	06081	37.68085904	-122.4728842	San Mateo County
220579	Fee-for-Service	1861464273	1861464273	1	1	APPLETON, ROBERT S MD	6/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	88927	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
220584	Fee-for-Service	1699857706	1699857706	1	1	ABID, MOHAMMAD ARSHAD MD	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	48105	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	81709 DR CARREON BLVD	STE A1	INDIO	CA	92201	5509	33	06065	33.70733082	-116.2400326	Riverside County
220617	Fee-for-Service	1386722130	1386722130	1	1	ARORA, AMIT MD	6/20/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	77657	78	Neoplastic Diseases/Oncology	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
220729	Fee-for-Service	1033886999	1033886999	1	2	ADDE TRANSPORT LLC	1/25/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	3774 GROVE ST	K1	LEMON GROVE	CA	91945	1878	37	06073	32.74642662	-117.0271281	San Diego County
220751	Fee-for-Service	1811982382	1811982382	1	1	ALLISON M LAMONT, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	600 EAST BLVD	None	ELKHART	IN	46514	2483	00	None	41.67924431	-85.99202423	Elkhart County
220758	Fee-for-Service	1932415957	1932415957	2	1	ALBIDRES, DIANA NP	11/26/2012	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5015 WHITTIER BLVD	None	LOS ANGELES	CA	90022	3116	19	06037	34.02129255	-118.1613094	Los Angeles County
220794	Fee-for-Service	1568057941	1568057941	1	1	ALLEGRO HOME HEALTH INC	11/3/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	433 AIRPORT BLVD	STE 129	BURLINGAME	CA	94010	2029	41	06081	37.59070087	-122.3398729	San Mateo County
220796	Fee-for-Service	1447804133	1447804133	1	1	ADA E GONZALES LCSW INC	11/30/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1145 E CLARK AVE	STE K	SANTA MARIA	CA	93455	5173	42	06083	34.8650893	-120.4170345	Santa Barbara County
220816	Fee-for-Service	1588076798	1588076798	1	1	AMEND, GREGORY MD	3/23/2020	390200000X	NA	Other	026	PHYSICIANS	139616	34	Urology and Urological Surgery	0	In state provider	None	1001 POTRERO AVE	3A20	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
220836	Fee-for-Service	1265548879	1265548879	1	1	APRIA HEALTHCARE LLC	6/7/2024	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	None	505 - 507 PECH ROAD	None	MEDFORD	OR	97502	3182	00	None	42.38037052	-122.884596	Jackson County
220839	Fee-for-Service	1386086635	1386086635	1	1	ARNOLD, STACY MD	2/10/2025	207ZP0102X	NA	Other	026	PHYSICIANS	None	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	20001 S RANCHO WAY	None	COMPTON	CA	90220	6318	19	06037	33.8498073	-118.2223737	Los Angeles County
220847	Fee-for-Service	1932756764	1932756764	1	10	ALTAMED HEALTH SERVICES	4/11/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	4631 LA PALMA AVENUE	None	LA PALMA	CA	90623	1620	30	06059	33.8463439	-118.0514711	Orange County
220866	Fee-for-Service	1861071607	1861071607	1	1	ADVENTIST HEALTH PHYSICIANS	10/22/2021	208800000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	23 N MAIN ST	201	ANGELS CAMP	CA	95222	9365	05	06009	38.08274503	-120.5591725	Calaveras County
220867	Fee-for-Service	1396774139	1396774139	1	1	ABBASSI, SHAHRAM MD	12/19/2009	207LP2900X	NA	Other	026	PHYSICIANS	51286	05	Anesthesiology	0	In state provider	None	3800 JANES RD	None	ARCATA	CA	95521	0005	12	06023	40.89645172	-124.0930637	Humboldt County
220889	Fee-for-Service	1629835426	1629835426	1	1	ALTURA CENTERS FOR HEALTH	9/11/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1134 E CARTMILL AVENUE	None	TULARE	CA	93274	9615	54	06107	36.24056145	-119.3308446	Tulare County
220907	Fee-for-Service	1871735365	1871735365	1	1	ASHOUR, SYLVIA MD	8/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	97354	05	Anesthesiology	0	In state provider	None	1420 S CENTRAL AVE	None	GLENDALE	CA	91204	2508	19	06037	34.12811155	-118.2577764	Los Angeles County
220915	Fee-for-Service	1881845766	1881845766	1	1	AMANS, MATTHEW R MD	6/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	115476	30	Radiology	0	In state provider	None	1001 POTRERO AVE	RM 1X	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
220962	Fee-for-Service	1700319563	1700319563	1	1	ALI, SYED A MD	7/18/2022	207RC0200X	NA	Other	026	PHYSICIANS	175098	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
220981	Fee-for-Service	1962436311	1962436311	1	1	ASSIL, KERRY K MD	4/30/1988	207W00000X	NA	Ophthalmology	026	PHYSICIANS	62647	18	Ophthalmology	0	In state provider	None	225 DICKINSON ST	None	SAN DIEGO	CA	92103	1910	37	06073	32.75514083	-117.1655414	San Diego County
220986	Fee-for-Service	1497946115	1497946115	1	1	AMPARO, EUGENIO G MD	9/30/1986	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	41052	30	Radiology	0	In state provider	None	2525 STOCKTON BLVD	# 2008	SACRAMENTO	CA	95817	2207	34	06067	38.551311	-121.454433	Sacramento County
220995	Fee-for-Service	1972219319	1972219319	1	1	AKIMOV, AMANDA M CCC-SLP	2/3/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	633 WEST FIFTH STREET	OFFICE #2876B	LOS ANGELES	CA	90071	2005	19	06037	34.05071143	-118.25466	Los Angeles County
221021	Fee-for-Service	1528002557	1528002557	1	1	AMEND, WILLIAM J MD	6/11/1998	207RN0300X	NA	Nephrology	026	PHYSICIANS	23829	45	Nephrology (Renal-Kidney)	0	In state provider	UCSF	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
221023	Fee-for-Service	1992011035	1992011035	1	1	AJAY KUMAR PACHIPULUSU M.D	10/12/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	701 PARK AVE	None	MINNEAPOLIS	MN	55415	1623	00	None	44.97241797	-93.26300044	Hennepin County
221043	Fee-for-Service	1154613727	1154613727	1	1	ARAKAL, SHIRLEY CRNA	4/9/2012	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
221061	Fee-for-Service	1326665324	1326665324	1	1	A GRADE HOSPICE AND	2/1/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	8700 RESEDA BLVD	UNIT 202E	NORTHRIDGE	CA	91324	4189	19	06037	34.229988	-118.536062	Los Angeles County
221073	Fee-for-Service	1639584287	1639584287	1	1	AGRAWAL, VINIT MD	1/2/2020	207R00000X	NA	Other	026	PHYSICIANS	161031	41	Internal Medicine	0	In state provider	None	465 W PUTNAM AVENUE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
221075	Fee-for-Service	1578336483	1578336483	1	1	AHAIWE, CHIOMA F NP	2/9/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
221094	Fee-for-Service	1558604835	1558604835	1	1	ASCHER, SIMON B MD	5/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135057	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
221104	Fee-for-Service	1649474800	1649474800	1	1	ACOSTA, I. MD INC	10/31/1987	208600000X	NA	General Surgery	026	PHYSICIANS	26640	02	General Surgery	0	In state provider	None	1808 VERDUGO BLVD	STE 409	GLENDALE	CA	91208	1487	19	06037	34.2056211	-118.2154553	Los Angeles County
221125	Fee-for-Service	1780608901	1780608901	1	1	ATRAY, NAVEEN K MD FACS	2/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	93005	45	Nephrology (Renal-Kidney)	0	In state provider	None	77 CADILLAC DR	STE 130	SACRAMENTO	CA	95825	8337	34	06067	38.572551	-121.4181585	Sacramento County
221129	Fee-for-Service	1417363086	1417363086	1	1	ALKATIB, RHONDA E MD	12/16/2019	207R00000X	NA	Other	026	PHYSICIANS	163910	41	Internal Medicine	0	In state provider	None	10350 BARNES CANYON RD	STE 200	SAN DIEGO	CA	92121	2709	37	06073	32.9005814	-117.1946684	San Diego County
221136	Fee-for-Service	1932756764	1932756764	1	10	ALTAMED HEALTH SERVICES	4/11/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	4631 LA PALMA AVENUE	None	LA PALMA	CA	90623	1620	30	06059	33.8463439	-118.0514711	Orange County
221152	Fee-for-Service	1518188366	1518188366	1	1	AQUINO, MADELAINE MD INC	10/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85500	25	Physical Medicine and Rehabilitation	0	In state provider	None	123 S COMMERCE ST	STE E	STOCKTON	CA	95202	2837	39	06077	37.95105947	-121.2920715	San Joaquin County
221155	Fee-for-Service	1477746972	1477746972	1	1	ANDERSON, PATRICIA LMFT	1/14/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	317 S CARRILLO RD	None	OJAI	CA	93023	3604	56	06111	34.43910034	-119.2643768	Ventura County
221176	Fee-for-Service	1629835426	1629835426	1	1	ALTURA CENTERS FOR HEALTH	9/11/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1134 E CARTMILL AVENUE	None	TULARE	CA	93274	9615	54	06107	36.24056145	-119.3308446	Tulare County
221197	Fee-for-Service	1346571833	1346571833	1	1	ASLAN, IVY P R MD	4/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99943	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
221228	Fee-for-Service	1255646980	1255646980	1	1	ALPHAONE AMBULANCE MEDICAL	12/30/2010	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	10461 OLD PLACERVILLE	SUITE 110 & 120	SACRAMENTO	CA	95827	2508	34	06067	38.571804	-121.3079445	Sacramento County
221245	Fee-for-Service	1649355132	1649355132	1	1	ALEGENT HEALTH	12/17/2006	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	16901 LAKESIDE HILLS CT	None	OMAHA	NE	68130	2318	00	None	41.23701829	-96.18157861	Douglas County
221335	Fee-for-Service	1447267125	1447267125	1	1	ANDRY, DAVID B	1/22/2018	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
221348	Fee-for-Service	1326665324	1326665324	1	1	A GRADE HOSPICE AND	2/1/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE INC	8700 RESEDA BLVD	UNIT 202E	NORTHRIDGE	CA	91324	4189	19	06037	34.229988	-118.536062	Los Angeles County
221365	Fee-for-Service	1932756764	1932756764	1	1	ALTAMED HEALTH SERVICES	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1325 N ANAHEIM BLVD	STE 200	ANAHEIM	CA	92801	1202	30	06059	33.85331047	-117.9199617	Orange County
221469	Fee-for-Service	1982817177	1982817177	1	1	ARORA, GITANJLI MD	9/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93602	40	Pediatrics	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
221483	Fee-for-Service	1346571833	1346571833	1	1	ASLAN, IVY P R MD	4/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	99943	67	Endocrinology	0	In state provider	None	505 PARNASSUS AVENUE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.7634502	-122.4579779	San Francisco County
221533	Fee-for-Service	1760843759	1760843759	1	1	ACOSTA, NICOLE M LMFT	11/19/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
221534	Fee-for-Service	1649355132	1649355132	1	1	ALEGENT HEALTH	12/17/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	16901 LAKESIDE HILLS CT	None	OMAHA	NE	68130	2318	00	None	41.23701829	-96.18157861	Douglas County
221544	Fee-for-Service	1487651758	1487651758	1	1	ANDREW J FIEDLER M.D.	10/3/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	615 N MICHIGAN ST	None	SOUTH BEND	IN	46601	1033	00	None	41.68395312	-86.2505452	St. Joseph County
221553	Fee-for-Service	1164477683	1164477683	1	1	AMADOR, KELLIE J	6/11/2021	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
221555	Fee-for-Service	1346545142	1346545142	1	1	AZADMANESH SAMIMI, SIAVASH	10/19/2020	207ZP0102X	NA	Other	026	PHYSICIANS	135924	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	MD	183 E 8TH AVE	None	CHICO	CA	95926	2341	04	06007	39.74568757	-121.8498156	Butte County
221560	Fee-for-Service	1205253416	1205253416	1	1	AHMED, BIRJEES MD	12/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	102 E LAKE MEAD PKWY	None	HENDERSON	NV	89015	5775	00	None	36.03815706	-114.9842287	Clark County
221576	Fee-for-Service	1194386854	1194386854	1	1	AYUBY, AWISTA MD	4/7/2023	207R00000X	NA	Other	026	PHYSICIANS	176230	None	None	0	In state provider	None	275 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5641	01	06001	37.82397231	-122.2578822	Alameda County
221578	Fee-for-Service	1932229515	1932229515	1	1	ALY, HOWAYDA A PSYD	4/5/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	15235 BURBANK BLVD	STE A2	SHERMAN OAKS	CA	91411	3555	19	06037	34.17211848	-118.465128	Los Angeles County
221594	Fee-for-Service	1376056002	1376056002	1	6	AFFORDABLE SENIOR HOUSING FO	9/27/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	662 TRANQUILITY GLEN	None	ESCONDIDO	CA	92027	3984	37	06073	33.1240834	-117.0590405	San Diego County
221617	Fee-for-Service	1609301340	1609301340	1	1	ANTWI-BADU, PHILIP NP	8/3/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1114 6TH ST	None	MODESTO	CA	95354	2203	50	06099	37.63901905	-121.0057149	Stanislaus County
221653	Fee-for-Service	1932756764	1932756764	1	1	ALTAMED HEALTH SERVICES	12/23/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1325 N ANAHEIM BLVD	STE 200	ANAHEIM	CA	92801	1202	30	06059	33.85331047	-117.9199617	Orange County
221681	Fee-for-Service	1083003867	1083003867	1	1	AGUIRRE, ELIZABETH A CNM	8/14/2017	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
221689	Fee-for-Service	1811570146	1811570146	1	1	A BETTER TOMORROW CARE CORP	5/25/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2830 FRANCIS AVE	None	LOS ANGELES	CA	90005	1212	19	06037	34.05680037	-118.2873346	Los Angeles County
221780	Fee-for-Service	1770847287	1770847287	1	1	ACTION THERAPY INC	10/16/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12431 MAGNOLIA ST	None	GARDEN GROVE	CA	92841	3321	30	06059	33.781941	-117.975478	Orange County
221787	Fee-for-Service	1053037358	1053037358	1	1	ACCESS PREMIER MEDICAL TRANS	1/11/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	PORT LLC	1737 WYANDOTTE AVE	None	OROVILLE	CA	95966	5920	04	06007	39.50026634	-121.5520616	Butte County
221795	Fee-for-Service	1720012925	1720012925	1	1	AMERICAN MEDICAL RESPONSE	11/27/1990	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	WEST	930 SOUTH A ST	None	SANTA ROSA	CA	95404	5439	49	06097	38.429298	-122.713713	Sonoma County
221803	Fee-for-Service	1558724823	1558724823	1	1	ALVAREZ, FRANCISCO N MD	12/27/2019	208M00000X	NA	Other	026	PHYSICIANS	162155	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
221840	Fee-for-Service	1891960563	1891960563	1	1	ATLURI, KEERTHI MD	4/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	149570	25	Physical Medicine and Rehabilitation	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
221842	Fee-for-Service	1871771626	1871771626	1	1	ANOTHER CHOICE ANOTHER	1/30/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	CHANCE	2040 ETHAN WAY	MAIN OFFICE	SACRAMENTO	CA	95825	0118	34	06067	38.602674	-121.418748	Sacramento County
221845	Fee-for-Service	1801880505	1801880505	1	1	ALPER, MICHAEL R MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	67014	41	Internal Medicine	0	In state provider	None	87 FENTON ST	STE 100	LIVERMORE	CA	94550	4183	01	06001	37.676565	-121.7834555	Alameda County
221852	Fee-for-Service	1417010604	1417010604	1	13	ABLELIGHT INC	6/2/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	COMMUNITIES INC	24431 REGINA ST	None	MISSION VIEJO	CA	92691	4715	30	06059	33.60746658	-117.6824077	Orange County
221869	Fee-for-Service	1871878678	1871878678	1	1	ADAMS-PIPER, EMILY R MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	118574	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
221881	Fee-for-Service	1346288305	1346288305	1	1	ABAS, NADER AZIZ MD	6/30/1986	207P00000X	NA	Other	026	PHYSICIANS	39740	08	Family Practice	0	In state provider	None	400 S 2ND AVE	STE 103	BARSTOW	CA	92311	2805	36	06071	34.894656	-117.0262295	San Bernardino County
221887	Fee-for-Service	1508941097	1508941097	1	1	ALEGENT HEALTH-BERGAN MERCY	5/24/2010	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HEALTH SYSTEM	7500 MERCY ROAD	None	OMAHA	NE	68124	2319	00	None	41.23788049	-96.0306885	Douglas County
221896	Fee-for-Service	1750559431	1750559431	1	14	ALL STAR PHYSICAL THERAPY, I	4/30/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	29645 RANCHO CALIFORNIA	SUITE 234	TEMECULA	CA	92591	6200	33	06065	33.50627123	-117.1431728	Riverside County
221942	Fee-for-Service	1932756764	1932756764	1	1	ALTAMED HEALTH SERVICES	5/6/2021	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1325 N ANAHEIM BLVD	STE 200	ANAHEIM	CA	92801	1202	30	06059	33.85331047	-117.9199617	Orange County
221975	Fee-for-Service	1093843088	1093843088	2	1	ABILITY PATHWAYS	6/19/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED	10528 CROCKETT STREET	None	SUN VALLEY	CA	91352	4120	19	06037	34.220147	-118.3606696	Los Angeles County
222016	Fee-for-Service	1386642197	1386642197	1	2	ALL-MED HOME HEALTH SERVICES	7/9/2019	251E00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	, INC.	16661 VENTURA BLVD	SUITE 503	ENCINO	CA	91436	1914	19	06037	34.15820737	-118.496492	Los Angeles County
222086	Fee-for-Service	1902406929	1902406929	1	1	AMSTUTZ, NICOLE E CNM	1/3/2023	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
222094	Fee-for-Service	1598770349	1598770349	1	1	ANTELOPE VALLEY PHYSICAL THE	7/9/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3167 RANCHO VISTA BLVD	SUITE D	PALMDALE	CA	93551	5517	19	06037	34.60343243	-118.1875714	Los Angeles County
222107	Fee-for-Service	1346397551	1346397551	2	2	AEGIS TREATMENT CENTERS, LLC	6/8/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	625 E MAIN STREET	None	SANTA PAULA	CA	93060	2608	56	06111	34.35196586	-119.0663619	Ventura County
222145	Fee-for-Service	1013361393	1013361393	1	1	ABBY MEDICAL ASSOCIATES INC	12/13/2016	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	565 W SHAW AVE	None	CLOVIS	CA	93612	3229	10	06019	36.80858654	-119.7221713	Fresno County
222157	Fee-for-Service	1861635146	1861635146	1	1	ALAMEDA COUNTY CCS	4/1/2009	No Taxonomy Provided	NA	None	046	REHABILITATION CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1040 FLORENCE RD	ROOM 7	LIVERMORE	CA	94550	5543	01	06001	37.66914	-121.7752805	Alameda County
222169	Fee-for-Service	1346288305	1346288305	1	1	ABAS, NADER AZIZ MD	6/30/1986	207P00000X	NA	Other	026	PHYSICIANS	39740	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 S 2ND AVE	STE 103	BARSTOW	CA	92311	2805	36	06071	34.894656	-117.0262295	San Bernardino County
222172	Fee-for-Service	1457541005	1457541005	1	1	AMERICARE EMS POLK COUNTY	10/31/2010	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	201 E 4TH ST	None	LIVINGSTON	TX	77351	0000	00	None	30.7194892	-94.93195404	Polk County
222178	Fee-for-Service	1508941097	1508941097	1	1	ALEGENT HEALTH-BERGAN MERCY	5/24/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	HEALTH SYSTEM	7500 MERCY ROAD	None	OMAHA	NE	68124	2319	00	None	41.23788049	-96.0306885	Douglas County
222179	Fee-for-Service	1437653755	1437653755	1	1	AGBAYANI, NESTOR A MD	9/21/2022	207P00000X	NA	Other	026	PHYSICIANS	176344	None	None	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
222184	Fee-for-Service	1750559431	1750559431	1	14	ALL STAR PHYSICAL THERAPY, I	3/27/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	29645 RANCHO CALIFORNIA	SUITE 234	TEMECULA	CA	92591	6200	33	06065	33.50627123	-117.1431728	Riverside County
222185	Fee-for-Service	1386867927	1386867927	1	1	ARNHYM, ANNE M NP	8/30/2010	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
222196	Fee-for-Service	1629145529	1629145529	1	1	ARNSTEIN, NELSON MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	54909	42	Nuclear Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
222216	Fee-for-Service	1225456726	1225456726	1	1	AMINI, NIMA MD	1/24/2021	207ZD0900X	NA	Other	086	MEDICAL DIRECTORS	149624	-	NOT APPLICABLE	0	In state provider	None	30500 ARRASTRE CANYON RD	None	ACTON	CA	93510	2160	19	06037	34.449291	-118.1973465	Los Angeles County
222229	Fee-for-Service	1932756764	1932756764	1	1	ALTAMED HEALTH SERVICES	5/1/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1325 N ANAHEIM BLVD	STE 200	ANAHEIM	CA	92801	1202	30	06059	33.85331047	-117.9199617	Orange County
222256	Fee-for-Service	1083857817	1083857817	1	1	ANDRADE, KRISTINE E MD	9/16/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	106633	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
222257	Fee-for-Service	1326149279	1326149279	1	1	AGAR, TREVOR M LCSW	7/31/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
222273	Fee-for-Service	1124009923	1124009923	1	1	ALVIDREZ, VIRGINIA MD	3/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87759	08	Family Practice	0	In state provider	None	275 W HERNDON AVE	None	CLOVIS	CA	93612	0204	10	06019	36.83766747	-119.715174	Fresno County
222291	Fee-for-Service	1548766264	1548766264	1	1	ALESHAKI, JOSEPH S DO	1/9/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	19942	None	None	0	In state provider	None	8701 CUYAMACA ST	None	SANTEE	CA	92071	4253	37	06073	32.83439779	-116.98366	San Diego County
222325	Fee-for-Service	1881655462	1881655462	1	1	ARBABI, NASRIN MD	2/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	62748	08	Family Practice	0	In state provider	None	386 E 'H'ST	STE 210	CHULA VISTA	CA	91910	7483	37	06073	32.63995805	-117.0482026	San Diego County
222332	Fee-for-Service	1134193923	1134193923	1	1	AHMED, KHALID BASHIR MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33354	02	General Surgery	0	In state provider	None	101 E BEVERLY BLVD	STE 103	MONTEBELLO	CA	90640	4314	19	06037	34.01556395	-118.0983878	Los Angeles County
222337	Fee-for-Service	1437786944	1437786944	1	1	ALLSUP, VICTORIA G MD	7/15/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	187106	40	Pediatrics	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
222369	Fee-for-Service	1598788929	1598788929	1	1	AMBAT, MA TERESA C MD	2/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	133302	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
222374	Fee-for-Service	1033100516	1033100516	1	1	ANNADURAI, BALA MD	3/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	56197	41	Internal Medicine	0	In state provider	None	2147 MOWRY AVE	STE D4	FREMONT	CA	94538	1724	01	06001	37.55758233	-121.9810516	Alameda County
222394	Fee-for-Service	1346397551	1346397551	2	2	AEGIS TREATMENT CENTERS, LLC	6/8/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	625 E MAIN STREET	None	SANTA PAULA	CA	93060	2608	56	06111	34.35196586	-119.0663619	Ventura County
222420	Fee-for-Service	1952311680	1952311680	1	1	ADVANCE SURGEONS MEDICAL	8/1/2000	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	GROUP INC	328 S 1ST STREET	SUITES F AND G	ALHAMBRA	CA	91801	3789	19	06037	34.09104553	-118.1252904	Los Angeles County
222430	Fee-for-Service	1811332034	1811332034	1	1	AU, DIANE LAC	12/29/2018	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	801 TRAEGER AVE	STE 209	SAN BRUNO	CA	94066	3048	41	06081	37.62782298	-122.4223337	San Mateo County
222468	Fee-for-Service	1750559431	1750559431	1	14	ALL STAR PHYSICAL THERAPY, I	3/27/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	29645 RANCHO CALIFORNIA	SUITE 234	TEMECULA	CA	92591	6200	33	06065	33.50627123	-117.1431728	Riverside County
222485	Fee-for-Service	1629145529	1629145529	1	1	ARNSTEIN, NELSON MD	6/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	54909	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
222506	Fee-for-Service	1770599706	1770599706	1	1	ALLEN, ROBERT A MD	2/23/1982	207R00000X	NA	Other	026	PHYSICIANS	26723	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4001 J ST	None	SACRAMENTO	CA	95819	3626	34	06067	38.570526	-121.4521695	Sacramento County
222596	Fee-for-Service	1962963140	1962963140	1	1	ALANIZ, IRENE E NP	9/22/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	852 S ROBERTSON BLVD	None	LOS ANGELES	CA	90035	1601	19	06037	34.06139351	-118.3835652	Los Angeles County
222612	Fee-for-Service	1295400869	1295400869	1	1	AMERICAN PRIME HEALTHCARE	10/7/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	2180 HARVARD STREET	STE 330	SACRAMENTO	CA	95815	3317	34	06067	38.60568	-121.4345385	Sacramento County
222622	Fee-for-Service	1134193923	1134193923	1	1	AHMED, KHALID BASHIR MD	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	33354	20	Orthopedic Surgery	0	In state provider	None	101 E BEVERLY BLVD	STE 103	MONTEBELLO	CA	90640	4314	19	06037	34.01556395	-118.0983878	Los Angeles County
222625	Fee-for-Service	1215243092	1215243092	1	1	ALLOS, ZIAD I MD	8/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124718	08	Family Practice	0	In state provider	None	310 SANTA FE DR	None	ENCINITAS	CA	92024	5110	37	06073	33.038406	-117.285354	San Diego County
222636	Fee-for-Service	1336383942	1336383942	1	1	ADVANCED MEDICAL XRAY INC	1/19/2010	No Taxonomy Provided	NA	None	028	PORTABLE X-RAY	-	-	NOT APPLICABLE	0	In state provider	None	1323 S MYRTLE AVENUE	None	MONROVIA	CA	91016	4150	19	06037	34.13721796	-118.0008491	Los Angeles County
222651	Fee-for-Service	1245415710	1245415710	1	1	AMAR PARKASH SHARMA, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	10229 N. 92ND ST	None	SCOTTSDALE	AZ	85258	4562	00	None	33.579099	-111.878703	Maricopa County
222703	Fee-for-Service	1174991129	1174991129	1	1	AYALA, MARIA B LPCC	5/18/2020	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1305 TOMMYDON	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
222743	Fee-for-Service	1982702429	1982702429	1	1	AUSTIN, LEE S MD	6/30/1984	207N00000X	NA	Dermatology	026	PHYSICIANS	43777	07	Dermatology	0	In state provider	None	7365 CARNELIAN ST	STE 137	RANCHO CUCAMONGA	CA	91730	1100	36	06071	34.12038413	-117.6160525	San Bernardino County
222760	Fee-for-Service	1093014284	1093014284	1	1	ARTINIAN, HOVIG K MD	10/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128722	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
222766	Fee-for-Service	1902422439	1902422439	1	1	ARNOLD, CRISTA NP	9/3/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	95014764	-	NOT APPLICABLE	0	In state provider	None	1459 E THOUSAND OAKS BLV	None	THOUSAND OAKS	CA	91362	6221	56	06111	34.17803055	-118.8544931	Ventura County
222770	Fee-for-Service	1538747639	1538747639	1	1	ABUSLEME, STEPHANO M MD	9/27/2022	390200000X	NA	Other	026	PHYSICIANS	20233	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
222773	Fee-for-Service	1427094770	1427094770	1	1	ANIREDDY, DIVESH R MD	4/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	10	Gastroenterology (M.D. only)	1	Border provider	None	1025 W 24TH ST	STE 17	YUMA	AZ	85364	8371	00	None	32.683824	-114.631668	Yuma County
222775	Fee-for-Service	1689680092	1689680092	1	1	ALTAMIRANO, JAIME A MD	10/1/1999	207R00000X	NA	Other	026	PHYSICIANS	68701	41	Internal Medicine	0	In state provider	None	15243 VANOWEN ST	STE 504A	VAN NUYS	CA	91405	3605	19	06037	34.19394848	-118.4654115	Los Angeles County
222784	Fee-for-Service	1801804901	1801804901	1	1	ALVAREZ, FERNANDO MD	3/31/1993	174400000X	NA	Other	026	PHYSICIANS	71517	41	Internal Medicine	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
222805	Fee-for-Service	1053795708	1053795708	1	2	ADVANCED HEART & VASCULAR PH	7/8/2022	207RI0011X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	YSICIANS INC	4646 BROCKTON AVE	STE 301	RIVERSIDE	CA	92506	0103	33	06065	33.9760171	-117.3860626	Riverside County
222817	Fee-for-Service	1922171644	1922171644	1	1	ARORA, MANINDER P MD	1/1/1993	2084N0402X	NA	Neurology	026	PHYSICIANS	42567	40	Pediatrics	0	In state provider	None	4440 BROCKTON AVE	STE 130	RIVERSIDE	CA	92501	4026	33	06065	33.97764104	-117.3838896	Riverside County
222823	Fee-for-Service	1295742138	1295742138	1	1	AGUILAR, FLEX MD	11/1/2000	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	64940	08	Family Practice	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
222899	Fee-for-Service	1295400869	1295400869	1	1	AMERICAN PRIME HEALTHCARE	10/7/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	2180 HARVARD STREET	STE 330	SACRAMENTO	CA	95815	3317	34	06067	38.60568	-121.4345385	Sacramento County
222907	Fee-for-Service	1063823607	1063823607	1	1	ADIB, NINA OT	3/5/2021	101YM0800X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
222941	Fee-for-Service	1780469049	1780469049	1	1	ADVANCECARE PHARMACY INC	1/4/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3225 E PACIFIC COAST HWY	STE E	SIGNAL HILL	CA	90755	1807	19	06037	33.78988546	-118.153719	Los Angeles County
222958	Fee-for-Service	1538199526	1538199526	1	1	AMBROSE, MICHAEL P AU	11/18/2020	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2054 W AVENUE K	None	LANCASTER	CA	93536	5216	19	06037	34.6749447	-118.16784	Los Angeles County
222978	Fee-for-Service	1629430376	1629430376	1	1	AGARWAL, ANKIT MD	5/17/2022	2085R0203X	NA	Other	026	PHYSICIANS	176205	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
223007	Fee-for-Service	1699489815	1699489815	1	2	ACACIA GUEST HOME LLC	6/14/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1516 W LA PALMA AVE	None	ANAHEIM	CA	92801	0900	30	06059	33.8470788	-117.939239	Orange County
223024	Fee-for-Service	1659597714	1659597714	1	1	ANDREW LARS BAKKE M.D.	11/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 BROADWAY N	None	FARGO	ND	58102	3641	00	None	46.885068	-96.7872375	Cass County
223072	Fee-for-Service	1063071744	1063071744	1	1	AMERICAN ATA HOME HEALTH	10/21/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY INC	5311 TOPANGA CANYON BLVD	UNIT 202	WOODLAND HILLS	CA	91364	1771	19	06037	34.166313	-118.6059365	Los Angeles County
223105	Fee-for-Service	1922171644	1922171644	1	1	ARORA, MANINDER P MD	1/1/1993	2084N0402X	NA	Neurology	026	PHYSICIANS	42567	13	Neurology (M.D. only)	0	In state provider	None	4440 BROCKTON AVE	STE 130	RIVERSIDE	CA	92501	4026	33	06065	33.97764104	-117.3838896	Riverside County
223216	Fee-for-Service	1558752931	1558752931	1	1	ACCESS PSYCHOLOGY SERVICES P	3/3/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	C	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
223223	Fee-for-Service	1083224141	1083224141	1	1	AEGIS TREATMENT CENTERS, LLC	1/11/2021	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1450 BESSIE AVE	B	TRACY	CA	95376	3456	39	06077	37.74417912	-121.4330212	San Joaquin County
223248	Fee-for-Service	1700221934	1700221934	1	1	ATMAKURI, MALIKA MD	12/28/2020	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	169989	None	None	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
223251	Fee-for-Service	1942471404	1942471404	1	1	ADVANCED PAIN SURGICAL CENTE	3/18/2022	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	R INC	7230 MEDICAL CENTER DR	SUITE 500	WEST HILLS	CA	91307	1907	19	06037	34.20172814	-118.6294322	Los Angeles County
223254	Fee-for-Service	1023820206	1023820206	1	1	AMIRIAN, MAGDEN MAGGIE NP	4/4/2025	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4855 SANTA MONICA BLVD	102	LOS ANGELES	CA	90029	2654	19	06037	34.09087851	-118.2953115	Los Angeles County
223277	Fee-for-Service	1750511804	1750511804	1	1	ANNA GHAZANCHYAN	3/14/2012	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	801 S CHEVY CHASE DR	SUITE 60	GLENDALE	CA	91205	4437	19	06037	34.136757	-118.2396195	Los Angeles County
223278	Fee-for-Service	1568172328	1568172328	1	1	ACH PHARMACY INC	4/17/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7640 TAMPA AVE	STE 103	RESEDA	CA	91335	1713	19	06037	34.20951144	-118.5534786	Los Angeles County
223292	Fee-for-Service	1184681439	1184681439	1	1	ADAMS, JAMES M MD	3/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80150	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
223315	Fee-for-Service	1104398601	1104398601	1	1	AURSES HEALTHCARE	8/15/2019	2086S0129X	NA	General Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	1045 ATLANTIC AVE	STE 512	LONG BEACH	CA	90813	3422	19	06037	33.780267	-118.1850795	Los Angeles County
223325	Fee-for-Service	1700267382	1700267382	1	1	ALI, ARHAM MD	9/1/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	153925	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
223329	Fee-for-Service	1639236912	1639236912	1	1	AREVALO, LAURA L LMFT	6/24/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4224 FOWLER LANE	201	DIAMOND SPRINGS	CA	95619	9775	09	06017	38.69418919	-120.8132217	El Dorado County
223348	Fee-for-Service	1740716828	1740716828	1	1	AL-DAHHAN, ZAID MD	8/5/2022	207RN0300X	NA	Nephrology	026	PHYSICIANS	170249	None	None	0	In state provider	None	631 E GRAND AVENUE	None	ESCONDIDO	CA	92025	4402	37	06073	33.12468152	-117.073451	San Diego County
223416	Fee-for-Service	1548754401	1548754401	1	1	ALCAM MEDICAL INC.	11/12/2020	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	12950 HAWTHORNE BLVD	None	HAWTHORNE	CA	90250	4408	19	06037	33.91450297	-118.3523466	Los Angeles County
223438	Fee-for-Service	1972985158	1972985158	1	1	ABU-LIBDEH, REEM A MD	4/26/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	147321	36	Psychiatry	0	In state provider	None	11303 WASHINGTON BLVD	SUITE 100	LOS ANGELES	CA	90095	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
223439	Fee-for-Service	1497019004	1497019004	1	1	ABDELSHEHID, COROLLOS S MD	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	134455	01	General Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
223485	Fee-for-Service	1952590523	1952590523	1	2	ACEVEDO, MANUEL E MD INC	11/18/2008	193400000X	NA	Other	026	PHYSICIANS	74961	08	Family Practice	0	In state provider	None	1818 N ORANGE GROVE AVE	STE 305	POMONA	CA	91767	3028	19	06037	34.07694934	-117.7489598	Los Angeles County
223487	Fee-for-Service	1073212775	1073212775	1	1	APPLE URGENT CARE, INC	7/14/2023	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	82013 DOCTOR CARREON BLV	STE G	INDIO	CA	92201	4832	33	06065	33.70738152	-116.233002	Riverside County
223493	Fee-for-Service	1649597162	1649597162	1	1	AFSAHI, AZADEH P LMFT	3/18/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2545 S EUCLID AVE	None	ONTARIO	CA	91762	6620	36	06071	34.02683603	-117.6505972	San Bernardino County
223501	Fee-for-Service	1538549654	1538549654	1	2	ARTHUR PO-FEI CHOU MD INC	6/16/2022	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	None	120 W HELLMAN AVE	SUITE 204	MONTEREY PARK	CA	91754	1205	19	06037	34.06972847	-118.124154	Los Angeles County
223502	Fee-for-Service	1558752931	1558752931	1	1	ACCESS PSYCHOLOGY SERVICES P	4/20/2024	103T00000X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	C	750 B	2870	SAN DIEGO	CA	92101	8114	37	06073	32.71782447	-117.157905	San Diego County
223512	Fee-for-Service	1083224141	1083224141	1	1	AEGIS TREATMENT CENTERS, LLC	1/11/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1450 BESSIE AVE	B	TRACY	CA	95376	3456	39	06077	37.74417912	-121.4330212	San Joaquin County
223531	Fee-for-Service	1730380007	1730380007	1	1	ALSHARIF, KAIS MD	9/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105368	25	Physical Medicine and Rehabilitation	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
223572	Fee-for-Service	1962434381	1962434381	1	1	ASSEMI, SHAHROKH MD	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2020 PALOMINO LANE	STE 100	LAS VEGAS	NV	89106	4894	00	None	36.16257648	-115.170696	Clark County
223574	Fee-for-Service	1104921832	1104921832	2	1	AHN, PHILLIP C MD	8/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	52241	13	Neurology (M.D. only)	0	In state provider	None	520 S VIRGIL AVE	SUITE 205	LOS ANGELES	CA	90020	1425	19	06037	34.064487	-118.2870305	Los Angeles County
223585	Fee-for-Service	1821566100	1821566100	1	1	AURORA DRUGS, L.L.C.	8/22/2019	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	404 S PROSPECTORS RD.	C	DIAMOND BAR	CA	91765	1617	19	06037	34.01758335	-117.8122858	Los Angeles County
223598	Fee-for-Service	1336227412	1336227412	1	1	ANSLEY, DEBORAH R MD	8/3/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72740	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7601 STONERIDGE DR	None	PLEASANTON	CA	94588	4501	01	06001	37.69013379	-121.9265243	Alameda County
223606	Fee-for-Service	1063623387	1063623387	1	1	ALAS-POCASANGRE, JUAN L	12/22/2003	261QP2300X	NA	Other	026	PHYSICIANS	55051	08	Family Practice	0	In state provider	ALAS MEDICAL CLINIC INC	545 N SAN GABRIEL AVE	None	AZUSA	CA	91702	2939	19	06037	34.131537	-117.908859	Los Angeles County
223620	Fee-for-Service	1376056002	1376056002	1	1	AFFORDABLE SENIOR HOUSING FO	9/27/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	612 TRANQUILITY GLEN	None	ESCONDIDO	CA	92027	3984	37	06073	33.12521215	-117.0598794	San Diego County
223653	Fee-for-Service	1629421235	1629421235	1	1	AVNON, HANNA R LCSW	2/13/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3625 E THOUSAND OAKS BLV	106	WESTLAKE VILLAGE	CA	91362	3551	19	06037	34.16480359	-118.8299997	Ventura County
223663	Fee-for-Service	1447370804	1447370804	1	2	ALLERGY & ASTHMA MEDICAL CLI	5/24/2019	207K00000X	NA	Other	026	PHYSICIANS	None	03	Allergy	0	In state provider	STHMA MEDICAL ASSOCIATES	750 W OLIVE AVE	SUITE 103	MERCED	CA	95348	2436	24	06047	37.31917248	-120.480657	Merced County
223667	Fee-for-Service	1124777594	1124777594	1	1	AP RX SUPPLIERS INC	5/24/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	618 W CHAPMAN AVE	None	PLACENTIA	CA	92870	5705	30	06059	33.8732939	-117.8764029	Orange County
223694	Fee-for-Service	1063577138	1063577138	1	1	ARNAOUT, WALID S MD AMC	7/10/2012	174400000X	NA	Other	026	PHYSICIANS	53180	02	General Surgery	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
223697	Fee-for-Service	1518223031	1518223031	1	1	ANKLESARIA, ZAFIA MD	4/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	130115	41	Internal Medicine	0	In state provider	None	1401 SOUTH GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
223719	Fee-for-Service	1942750393	1942750393	1	1	AGUILAR, AMBER NP	5/28/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5311 HOPYARD RD	None	PLEASANTON	CA	94588	3307	01	06001	37.69896849	-121.9046448	Alameda County
223724	Fee-for-Service	1285667238	1285667238	1	1	ALHAMBRA AUDIOLOGY INC	5/1/2001	193400000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	41 N GARFIELD AVE	STE 101	ALHAMBRA	CA	91801	3556	19	06037	34.09590269	-118.1274015	Los Angeles County
223745	Fee-for-Service	1407074008	1407074008	1	1	ADDAMS, CECILIA B LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
223759	Fee-for-Service	1669922183	1669922183	1	1	A PRIME HOME HEALTH SERVICES	8/29/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	266 MOBIL AVE	STE 215	CAMARILLO	CA	93010	6309	56	06111	34.219179	-119.042954	Ventura County
223771	Fee-for-Service	1225044100	1225044100	1	1	ANSHUS, JOHN MD	4/30/1983	207P00000X	NA	Other	026	PHYSICIANS	46650	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18321 CLARK ST	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
223774	Fee-for-Service	1073212775	1073212775	1	1	APPLE URGENT CARE, INC	7/14/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	82013 DOCTOR CARREON BLV	STE G	INDIO	CA	92201	4832	33	06065	33.70738152	-116.233002	Riverside County
223782	Fee-for-Service	1770045924	1770045924	1	1	ATWAL, MONIQUE MD	7/10/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	179742	27	Psychiatry Neurology (D.O. only)	0	In state provider	None	1742 OREGON STREET	None	REDDING	CA	96001	1717	45	06089	40.5808265	-122.3932989	Shasta County
223784	Fee-for-Service	1013509546	1013509546	1	1	ALALIK CARE INC	1/19/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	11152 WOODLEY AVE	None	GRANADA HILLS	CA	91344	3806	19	06037	34.273494	-118.484672	Los Angeles County
223790	Fee-for-Service	1093934390	1093934390	1	1	ABDULLA, FARAH R MD	10/21/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	107186	07	Dermatology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
223810	Fee-for-Service	1952385544	1952385544	1	1	AZIMIAN, KIAN J MD	6/6/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	84315	None	None	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
223839	Fee-for-Service	1326328683	1326328683	1	1	ALLBRIGHT, SARAH R LMFT	3/27/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	53578	-	NOT APPLICABLE	0	In state provider	None	625 E MAIN STREET	None	SANTA PAULA	CA	93060	2608	56	06111	34.35196586	-119.0663619	Ventura County
223840	Fee-for-Service	1558736405	1558736405	1	1	ALALI, MUAYAD MD	5/2/2024	2080P0208X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	77	Infectious Disease	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
223908	Fee-for-Service	1588356836	1588356836	1	1	ASSISTED COMFORT HOME, INC.	7/5/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	23731 KILLION STREET	None	WOODLAND HILLS	CA	91367	5823	19	06037	34.17001849	-118.6446391	Los Angeles County
223926	Fee-for-Service	1023695145	1023695145	1	1	ASANA RECOVERY	7/11/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3073 MADISON AVE	None	COSTA MESA	CA	92626	2823	30	06059	33.68360759	-117.9004242	Orange County
223935	Fee-for-Service	1093350993	1093350993	1	1	ACCUMED INC	2/12/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1851 FLOWER ST	None	GLENDALE	CA	91201	0000	19	06037	34.16828824	-118.2987352	Los Angeles County
223939	Fee-for-Service	1528472800	1528472800	1	1	ABIDI, HIRA H MD	12/1/2022	208600000X	NA	General Surgery	026	PHYSICIANS	166893	None	None	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
223964	Fee-for-Service	1487375945	1487375945	1	1	ALISON BURKS CLINIC OF HEARI	1/25/2023	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	NG INC	1000 S HILL RD	STE 330	VENTURA	CA	93003	4455	56	06111	34.26767279	-119.2067069	Ventura County
223992	Fee-for-Service	1790339919	1790339919	1	1	A PLUS HEALTHCARE LLC	10/1/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5006 SUNRISE BLVD	SUITE 203	FAIR OAKS	CA	95628	4940	34	06067	38.656899	-121.2718365	Sacramento County
224015	Fee-for-Service	1295020709	1295020709	1	1	AVANESSIAN, EVLYN MD	9/21/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	127456	08	Family Practice	0	In state provider	None	7709 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2120	19	06037	34.25684465	-118.3003544	Los Angeles County
224022	Fee-for-Service	1720266075	1720266075	2	1	ADVANCED RADIATION ONCOLOGY	9/16/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	2707 E VALLEY BLVD	STE 109	WEST COVINA	CA	91792	3140	19	06037	34.00296323	-117.8868537	Los Angeles County
224049	Fee-for-Service	1316165582	1316165582	1	1	ADULT DAY HEALTH CARE	12/1/2003	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	OF FRESNO & CLOVIS	5757 N 1ST ST	None	FRESNO	CA	93710	6203	10	06019	36.821952	-119.772409	Fresno County
224062	Fee-for-Service	1073212775	1073212775	1	1	APPLE URGENT CARE, INC	7/14/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	82013 DOCTOR CARREON BLV	STE G	INDIO	CA	92201	4832	33	06065	33.70738152	-116.233002	Riverside County
224099	Fee-for-Service	1669653101	1669653101	1	1	ALI, NAYYER Z MD INC	7/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	69091	41	Internal Medicine	0	In state provider	None	701 E 28TH ST	STE 400	LONG BEACH	CA	90806	2778	19	06037	33.80803441	-118.1847137	Los Angeles County
224131	Fee-for-Service	1548878101	1548878101	1	1	ALLEVIATE HOSPICE INC	5/31/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8138 FOOTHILL BLVD	STE 210	SUNLAND	CA	91040	2900	19	06037	34.25963955	-118.310661	Los Angeles County
224156	Fee-for-Service	1396783379	1396783379	1	18	ASANA INTEGRATED MEDICAL GRO	10/13/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP PC	815 POLLARD RD	None	LOS GATOS	CA	95032	1438	43	06085	37.26214754	-121.9701986	Santa Clara County
224164	Fee-for-Service	1588879217	1588879217	1	1	ARORA, NEIHA MD	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99107	41	Internal Medicine	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
224199	Fee-for-Service	1144782673	1144782673	1	1	ALEXANDER, MAGIN MD	12/30/2024	207R00000X	NA	Other	026	PHYSICIANS	184829	41	Internal Medicine	0	In state provider	None	46690 MOHAVE DR	None	FREMONT	CA	94539	7001	01	06001	37.49166118	-121.9261313	Alameda County
224230	Fee-for-Service	1114381076	1114381076	1	1	AUDUONG, PRISCILLA MD	5/1/2019	390200000X	NA	Other	026	PHYSICIANS	153919	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
224286	Fee-for-Service	1598123416	1598123416	1	1	ALL IN ONE TRANSPORTATION AN	11/4/2022	347C00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	D INTERPRETATION INC.	22693 HESPERIAN BLVD	#145	HAYWARD	CA	94541	7044	01	06001	37.65681785	-122.1127952	Alameda County
224298	Fee-for-Service	1386175685	1386175685	1	1	ANGHA, ARIO MD	11/5/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	169354	None	None	0	In state provider	None	4050 BARRANCA PKWY	STE 200	IRVINE	CA	92604	1723	30	06059	33.68293726	-117.8067799	Orange County
224308	Fee-for-Service	1811993454	1811993454	1	1	AZAM, SYED FAROOG MD INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	67791	41	Internal Medicine	0	In state provider	INDUS MEDICAL ASSOC	73 345 HIGHWAY 111	STE 202	PALM DESERT	CA	92260	4215	33	06065	33.721101	-116.3648803	Riverside County
224311	Fee-for-Service	1720266075	1720266075	2	1	ADVANCED RADIATION ONCOLOGY	9/16/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	78	Neoplastic Diseases/Oncology	0	In state provider	None	2707 E VALLEY BLVD	STE 109	WEST COVINA	CA	91792	3140	19	06037	34.00296323	-117.8868537	Los Angeles County
224312	Fee-for-Service	1871682179	1871682179	1	1	ASSAF, SAMER S MD	7/1/2000	207R00000X	NA	Other	026	PHYSICIANS	68784	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
224351	Fee-for-Service	1073212775	1073212775	1	1	APPLE URGENT CARE, INC	7/14/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	82013 DOCTOR CARREON BLV	STE G	INDIO	CA	92201	4832	33	06065	33.70738152	-116.233002	Riverside County
224355	Fee-for-Service	1629369780	1629369780	1	1	ALVI, SEHAR MD	6/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141454	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
224362	Fee-for-Service	1942286257	1942286257	1	1	ANTOGNINI, JOSEPH F MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55662	02	General Surgery	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
224375	Fee-for-Service	1417262619	1417262619	1	1	ADVANCED PSYCHOLOGICAL ASSOC	1/28/2021	251S00000X	NA	Other	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	IATES & WELLNESS CENTER	10722 ARROW RTE	314-316	RANCHO CUCAMONGA	CA	91730	4811	36	06071	34.09917725	-117.5708877	San Bernardino County
224386	Fee-for-Service	1669653101	1669653101	1	1	ALI, NAYYER Z MD INC	7/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	69091	66	Emergency Medicine (Urgent Care)	0	In state provider	None	701 E 28TH ST	STE 400	LONG BEACH	CA	90806	2778	19	06037	33.80803441	-118.1847137	Los Angeles County
224412	Fee-for-Service	1861692444	1861692444	1	1	ANDAYA, CARL S LCSW	12/18/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
224414	Fee-for-Service	1568726594	1568726594	1	1	ADIAL, AJAY MD	2/14/2020	207RC0200X	NA	Other	026	PHYSICIANS	162404	41	Internal Medicine	0	In state provider	None	341 E MAIN ST	STE 100	SAN JACINTO	CA	92583	4205	33	06065	33.78391437	-116.9562698	Riverside County
224418	Fee-for-Service	1548878101	1548878101	1	1	ALLEVIATE HOSPICE INC	5/31/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8138 FOOTHILL BLVD	STE 210	SUNLAND	CA	91040	2900	19	06037	34.25963955	-118.310661	Los Angeles County
224421	Fee-for-Service	1164746038	1164746038	2	1	AVERY HOME HEALTH AGENCY INC	8/1/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	725 W TOWN & COUNTRY RD	SUITE 420	ORANGE	CA	92868	4703	30	06059	33.77669152	-117.8601975	Orange County
224438	Fee-for-Service	1265718837	1265718837	1	1	ARIZONA CONSULTANTS PLLC	6/13/2016	193400000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
224443	Fee-for-Service	1679510598	1679510598	1	1	ADVANTAGE PLUS MEDICAL	2/18/2004	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CENTER	18021 SKY PARK CIR	BLDG 68 STE G	IRVINE	CA	92614	6523	30	06059	33.68904995	-117.8542045	Orange County
224449	Fee-for-Service	1275198368	1275198368	1	1	ABERNATHY, LANT DPM	3/18/2024	213ES0131X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	210 CANAL ST	None	KING CITY	CA	93930	3432	27	06053	36.20731142	-121.1325532	Monterey County
224452	Fee-for-Service	1588879217	1588879217	1	1	ARORA, NEIHA MD	10/13/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99107	45	Nephrology (Renal-Kidney)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
224493	Fee-for-Service	1861489098	1861489098	1	1	AGARWAL, SUMAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	36050	08	Family Practice	0	In state provider	None	4646 BROCKTON AVE	STE 203	RIVERSIDE	CA	92506	0102	33	06065	33.9760171	-117.3860626	Riverside County
224504	Fee-for-Service	1417010604	1417010604	1	37	ABLELIGHT INC	2/11/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1917 CANTER WAY	None	BAKERSFIELD	CA	93309	4710	15	06029	35.33707557	-119.0562244	Kern County
224529	Fee-for-Service	1073685723	1073685723	1	1	AGHARKAR, UJWALA S MD	8/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	43536	36	Psychiatry	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
224551	Fee-for-Service	1629585856	1629585856	1	1	AMAZING GRACE OASIS, LLC	11/15/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	13842 LEMONGRASS WAY	None	HESPERIA	CA	92344	0042	36	06071	34.41166219	-117.3605498	San Bernardino County
224583	Fee-for-Service	1013731876	1013731876	1	1	ADLUM, LOGAN PT	1/7/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	12 UPPER RAGSDALE	None	MONTEREY	CA	93940	5730	27	06053	36.57482436	-121.8101797	Monterey County
224591	Fee-for-Service	1437621117	1437621117	1	1	ACHIEVE BRAIN AND SPINE, INC	8/8/2019	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	14	Neurological Surgery	0	In state provider	None	2811 WILSHIRE BLVD	STE 930	SANTA MONICA	CA	90403	4809	19	06037	34.03785224	-118.4752132	Los Angeles County
224621	Fee-for-Service	1104038256	1104038256	1	1	ABOULIAN, ARIN MD	6/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	98177	41	Internal Medicine	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
224623	Fee-for-Service	1669089165	1669089165	1	1	AGA ANGELS HOSPICE, INC.	3/8/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11791 SHERMAN WAY	UNIT A	NORTH HOLLYWOOD	CA	91605	3721	19	06037	34.20123751	-118.390248	Los Angeles County
224627	Fee-for-Service	1306245683	1306245683	1	1	ALESHINLOYE, MANDY O LCSW	11/14/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1255 W COLTON AVE	None	REDLANDS	CA	92374	2861	36	06071	34.06285254	-117.20178	San Bernardino County
224628	Fee-for-Service	1942858980	1942858980	1	1	ASUNCION, MICHAEL LMFT	6/10/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
224642	Fee-for-Service	1215256599	1215256599	1	1	ADHAM, SUSAN L MD	7/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108068	40	Pediatrics	0	In state provider	None	4053 LONE TREE WAY	SUITE 101	ANTIOCH	CA	94509	6200	07	06013	37.97569499	-121.800733	Contra Costa County
224645	Fee-for-Service	1710105408	1710105408	1	1	AXIS COMMUNITY HEALTH	3/1/1997	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	3311 PACIFIC AVE	None	LIVERMORE	CA	94550	7007	01	06001	37.67610149	-121.755159	Alameda County
224649	Fee-for-Service	1942286257	1942286257	1	1	ANTOGNINI, JOSEPH F MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	55662	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
224665	Fee-for-Service	1417262619	1417262619	1	1	ADVANCED PSYCHOLOGICAL ASSOC	10/22/2020	251S00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	IATES & WELLNESS CENTER	10722 ARROW RTE	314-316	RANCHO CUCAMONGA	CA	91730	4811	36	06071	34.09917725	-117.5708877	San Bernardino County
224707	Fee-for-Service	1740415686	1740415686	1	1	AHOUBIM, DANIEL MD	11/14/2017	2084N0400X	NA	Neurology	026	PHYSICIANS	144380	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
224740	Fee-for-Service	1871593384	1871593384	1	1	ABRAMS, EDWARD MD INC	2/1/1984	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	17797	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	16660 PARAMOUNT BLVD	STE 210	PARAMOUNT	CA	90723	5464	19	06037	33.882723	-118.1599535	Los Angeles County
224765	Fee-for-Service	1548278476	1548278476	1	1	ALTON MEMORIAL HOSP	7/27/2000	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1 MEMORIAL DR	None	ALTON	IL	62002	6755	00	None	38.89907683	-90.15981238	Madison County
224775	Fee-for-Service	1538780556	1538780556	1	1	ADIL, ABID NAWAZ KHAN MD	9/7/2023	207R00000X	NA	Other	026	PHYSICIANS	185310	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
224796	Fee-for-Service	1588169007	1588169007	1	1	AGUILAR, VERONICA E	7/13/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	167212	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
224865	Fee-for-Service	1588778674	1588778674	1	1	ABATE, MARK S MD	12/31/1992	207RH0003X	NA	Oncology	026	PHYSICIANS	55892	78	Neoplastic Diseases/Oncology	0	In state provider	None	215 PESETAS LN	None	SANTA BARBARA	CA	93110	1416	42	06083	34.44257521	-119.7584538	Santa Barbara County
224878	Fee-for-Service	1063413920	1063413920	1	1	AFSHAR, ARDAVAN MD	8/6/2004	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	70746	30	Radiology	0	In state provider	None	2020 IOWA AVE	STE 103	RIVERSIDE	CA	92507	2417	33	06065	33.992973	-117.3398145	Riverside County
224904	Fee-for-Service	1346354792	1346354792	1	1	AVINS, ANDREW L MD	6/30/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	52909	01	General Practice	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
224910	Fee-for-Service	1669089165	1669089165	1	1	AGA ANGELS HOSPICE, INC.	3/8/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11791 SHERMAN WAY	UNIT A	NORTH HOLLYWOOD	CA	91605	3721	19	06037	34.20123751	-118.390248	Los Angeles County
224952	Fee-for-Service	1093860314	1093860314	1	1	ALL CARE MEDICAL GRP INC	2/28/1986	261QR0200X	NA	Mammography/MRI Provider	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	PROFESSIONAL SVS MED GRP	2623 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2926	19	06037	33.98921547	-118.2242565	Los Angeles County
224953	Fee-for-Service	1417262619	1417262619	1	1	ADVANCED PSYCHOLOGICAL ASSOC	4/16/2021	251S00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	IATES & WELLNESS CENTER	10722 ARROW RTE	314-316	RANCHO CUCAMONGA	CA	91730	4811	36	06071	34.09917725	-117.5708877	San Bernardino County
224960	Fee-for-Service	1003274234	1003274234	1	1	ALVARADO, CYNTHIA V LMFT	2/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.9171603	-118.1288418	Los Angeles County
224975	Fee-for-Service	1386717726	1386717726	2	1	AIDS MEDICAL ENTERPRISES	12/6/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INC	12505 LAMBERT RD	None	WHITTIER	CA	90606	2709	19	06037	33.96534127	-118.0468218	Los Angeles County
225018	Fee-for-Service	1942306550	1942306550	1	1	A NOURIN MD INC	5/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	64870	41	Internal Medicine	0	In state provider	A NOURIN MD, INC	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
225037	Fee-for-Service	1235319385	1235319385	1	1	ABU ALNAAJ, HANAN MD	9/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128557	01	General Practice	0	In state provider	None	19341 BEAR VALLEY RD	STE 105	APPLE VALLEY	CA	92308	5152	36	06071	34.47101125	-117.2412548	San Bernardino County
225043	Fee-for-Service	1932234119	1932234119	1	1	ABAYON, VANESSA R LMFT	5/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 PULLMAN ST	None	LIVERMORE	CA	94551	9756	01	06001	37.70755227	-121.7149933	Alameda County
225055	Fee-for-Service	1548278476	1548278476	1	1	ALTON MEMORIAL HOSP	4/26/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1 MEMORIAL DR	None	ALTON	IL	62002	6755	00	None	38.89907683	-90.15981238	Madison County
225056	Fee-for-Service	1104121524	1104121524	1	1	AULAKH, KIMPREET K MD	10/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123076	41	Internal Medicine	0	In state provider	None	4770 W HERNDON AVE	None	FRESNO	CA	93722	8401	10	06019	36.83717984	-119.8778388	Fresno County
225066	Fee-for-Service	1215488135	1215488135	1	1	AARIEL HOSPICE INC	1/19/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5301 LAUREL CANYON BLVD	SUITE 201A	VALLEY VILLAGE	CA	91607	2736	19	06037	34.166907	-118.396546	Los Angeles County
225085	Fee-for-Service	1356451579	1356451579	2	1	AYYOUB, ZIYAD A MD	2/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53397	01	General Practice	0	In state provider	None	16660 PARAMOUNT BLVD	SUITE 203	PARAMOUNT	CA	90723	5458	19	06037	33.882723	-118.1599535	Los Angeles County
225103	Fee-for-Service	1588028377	1588028377	1	1	ARORA, RAJAN PREET S MD	9/2/2021	2084N0400X	NA	Neurology	026	PHYSICIANS	154192	None	None	0	In state provider	None	4440 BROCKTON AVE	STE 130	RIVERSIDE	CA	92501	4026	33	06065	33.97764104	-117.3838896	Riverside County
225123	Fee-for-Service	1285628099	1285628099	1	1	AXELROD, ROBERT C. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1615 DELAWARE ST	None	LONGVIEW	WA	98632	2367	00	None	46.1309207	-122.9408931	Cowlitz County
225164	Fee-for-Service	1922165323	1922165323	1	1	ALAMEDA COUNTY DBA	12/11/1990	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	HIGHLAND HOSP PHARMACY	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
225169	Fee-for-Service	1972621860	1972621860	1	1	ALLERGY ASTHMA CONSULTANTS	3/7/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	OF THE INLAND EMPIRE INC	375 TERRACINA BLVD	None	REDLANDS	CA	92373	3801	36	06071	34.03691371	-117.2040917	San Bernardino County
225178	Fee-for-Service	1750559431	1750559431	1	7	ALL STAR PHYSICAL THERAPY, I	3/26/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	1922 HACIENDA DR	None	VISTA	CA	92081	0000	37	06073	33.1855682	-117.2834788	San Diego County
225183	Fee-for-Service	1063808053	1063808053	1	1	ALLISON E WOOD	11/23/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	601 CHILDRENS LN	None	NORFOLK	VA	23507	1910	00	None	36.8619664	-76.30130371	Norfolk city
225200	Fee-for-Service	1811992183	1811992183	1	1	AKMAKJIAN, JACK H MD	10/31/1995	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	62470	20	Orthopedic Surgery	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
225218	Fee-for-Service	1083370423	1083370423	1	1	ANOTHER WAY LLC.	10/8/2024	251S00000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	None	780 W OLIVE AVENUE	105	MERCED	CA	95348	2437	24	06047	37.31916174	-120.4814268	Merced County
225220	Fee-for-Service	1336207232	1336207232	1	1	ARCOS, SYLVIA OD APC	5/29/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9265 TELEGRAPH RD	None	PICO RIVERA	CA	90660	5423	19	06037	33.9573988	-118.1046901	Los Angeles County
225222	Fee-for-Service	1467908251	1467908251	1	1	AKEL, IMAD MD	1/2/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	159901	None	None	0	In state provider	None	7950 CHERRY AVE STE 105	None	FONTANA	CA	92336	4023	36	06071	34.109667	-117.4887355	San Bernardino County
225242	Fee-for-Service	1417262619	1417262619	1	1	ADVANCED PSYCHOLOGICAL ASSOC	10/22/2020	251S00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	IATES & WELLNESS CENTER	10722 ARROW RTE	314-316	RANCHO CUCAMONGA	CA	91730	4811	36	06071	34.09917725	-117.5708877	San Bernardino County
225279	Fee-for-Service	1295055176	1295055176	1	1	ATIENZA, KATHLEEN G	1/28/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	30116 ELGENBRODT WAY	None	UNION CITY	CA	94587	1225	01	06001	37.60846354	-122.0715526	Alameda County
225286	Fee-for-Service	1326043894	1326043894	1	1	ADLER, JUDY R MD	2/28/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	56817	45	Nephrology (Renal-Kidney)	0	In state provider	None	306 WALNUT AVE	STE 38	SAN DIEGO	CA	92103	4936	37	06073	32.74148926	-117.1623773	San Diego County
225307	Fee-for-Service	1942306550	1942306550	1	1	A NOURIN MD INC	5/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	64870	66	Emergency Medicine (Urgent Care)	0	In state provider	A NOURIN MD, INC	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
225328	Fee-for-Service	1922077494	1922077494	1	1	ALEXANDER, CHRISTOPHER B MD	4/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	67863	20	Orthopedic Surgery	0	In state provider	None	341 MAGNOLIA AVE	SUITE 101	CORONA	CA	92879	3331	33	06065	33.85291987	-117.5664344	Riverside County
225355	Fee-for-Service	1215488135	1215488135	1	1	AARIEL HOSPICE INC	1/19/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5301 LAUREL CANYON BLVD	SUITE 201A	VALLEY VILLAGE	CA	91607	2736	19	06037	34.166907	-118.396546	Los Angeles County
225358	Fee-for-Service	1568661452	1568661452	1	1	AYYAR, SIVA MD	11/14/2007	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	93006	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
225364	Fee-for-Service	1760434005	1760434005	1	1	ALAEV, VICTORIA MD	5/14/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78360	40	Pediatrics	0	In state provider	None	12157 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	3204	19	06037	34.18669745	-118.3985415	Los Angeles County
225371	Fee-for-Service	1356451579	1356451579	2	1	AYYOUB, ZIYAD A MD	2/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53397	25	Physical Medicine and Rehabilitation	0	In state provider	None	16660 PARAMOUNT BLVD	SUITE 203	PARAMOUNT	CA	90723	5458	19	06037	33.882723	-118.1599535	Los Angeles County
225390	Fee-for-Service	1326058991	1326058991	1	1	ADAMS, MICHELLE D MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65621	30	Radiology	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
225394	Fee-for-Service	1275506859	1275506859	1	1	AGGARWAL, ATUL MD	8/1/1984	207RP1001X	NA	Pulmonology	026	PHYSICIANS	37225	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2925 SYCAMORE DR	STE 302B	SIMI VALLEY	CA	93065	1209	56	06111	34.288398	-118.7439175	Ventura County
225409	Fee-for-Service	1376311712	1376311712	1	1	ARTEMIS RX SOLUTIONS INC	3/24/2024	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7630 VINELAND AVE	STE 205	SUN VALLEY	CA	91352	4535	19	06037	34.209189	-118.3703025	Los Angeles County
225443	Fee-for-Service	1194351643	1194351643	1	1	AURORA HOSPICE CARE, INC	9/30/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6850 VAN NUYS BLVD	#322	VAN NUYS	CA	91405	4629	19	06037	34.195401	-118.4487235	Los Angeles County
225452	Fee-for-Service	1043775422	1043775422	1	1	ANGEL PALLIATIVE CARE AND	8/25/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	HOSPICE	100 PRODUCE AVE	SUITE H	S SAN FRANCISCO	CA	94080	6524	41	06081	37.64929311	-122.4079523	San Mateo County
225467	Fee-for-Service	1750559431	1750559431	1	7	ALL STAR PHYSICAL THERAPY, I	3/26/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	1922 HACIENDA DR	None	VISTA	CA	92081	0000	37	06073	33.1855682	-117.2834788	San Diego County
225474	Fee-for-Service	1558543280	1558543280	1	1	APELIAN, GARBIS M MD	12/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106296	08	Family Practice	0	In state provider	None	18546 ROSCOE BLVD	STE 312	NORTHRIDGE	CA	91324	4669	19	06037	34.22069869	-118.537684	Los Angeles County
225513	Fee-for-Service	1962184770	1962184770	1	1	ANDERSON, SHANICE PT	10/23/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	585 SATURN	STE A	SAN DIEGO	CA	92154	4721	37	06073	32.586336	-117.088506	San Diego County
225530	Fee-for-Service	1417262619	1417262619	1	1	ADVANCED PSYCHOLOGICAL ASSOC	3/27/2021	251S00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	IATES & WELLNESS CENTER	10722 ARROW RTE	314-316	RANCHO CUCAMONGA	CA	91730	4811	36	06071	34.09917725	-117.5708877	San Bernardino County
225574	Fee-for-Service	1326043894	1326043894	1	1	ADLER, JUDY R MD	2/28/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	56817	41	Internal Medicine	0	In state provider	None	306 WALNUT AVE	STE 38	SAN DIEGO	CA	92103	4936	37	06073	32.74148926	-117.1623773	San Diego County
225639	Fee-for-Service	1750559431	1750559431	1	6	ALL STAR PHYSICAL THERAPY, I	2/25/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	25136 HANCOCK AVE	STE A	MURRIETA	CA	92562	5944	33	06065	33.56788654	-117.1824198	Riverside County
225645	Fee-for-Service	1174789218	1174789218	1	1	AHN, KYLE S MD	8/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	112162	05	Anesthesiology	0	In state provider	None	101 THE CITY DR SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
225646	Fee-for-Service	1396783379	1396783379	1	6	ASANA INTEGRATED MEDICAL GRO	10/13/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP PC	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
225670	Fee-for-Service	1366943441	1366943441	1	1	ARAIZA FUENTES, PAOLA LCSW	11/22/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
225677	Fee-for-Service	1326058991	1326058991	1	1	ADAMS, MICHELLE D MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65621	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
225680	Fee-for-Service	1275506859	1275506859	1	1	AGGARWAL, ATUL MD	8/1/1984	207RP1001X	NA	Pulmonology	026	PHYSICIANS	37225	41	Internal Medicine	0	In state provider	None	2925 SYCAMORE DR	STE 302B	SIMI VALLEY	CA	93065	1209	56	06111	34.288398	-118.7439175	Ventura County
225705	Fee-for-Service	1184607236	1184607236	1	1	ALBERTSON, TIMOTHY MD	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37112	41	Internal Medicine	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
225716	Fee-for-Service	1790833226	1790833226	1	3	AL-SHAIKH, RAAD A MD INC	2/28/2013	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	63005	20	Orthopedic Surgery	0	In state provider	None	11720 EDUCATION ST	SUITE 5	AUBURN	CA	95602	8908	31	06061	38.94437237	-121.1019188	Placer County
225717	Fee-for-Service	1154743417	1154743417	1	1	ANDRE, DAPHNE D NP	6/20/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	140 CENTENNIAL WAY	None	TUSTIN	CA	92780	3711	30	06059	33.74496	-117.818857	Orange County
225719	Fee-for-Service	1528160033	1528160033	1	1	ANDERS, DANA R	12/26/2018	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	35900 BOB HOPE DR	SUITE 140	RANCHO MIRAGE	CA	92270	1767	33	06065	33.790311	-116.405864	Riverside County
225722	Fee-for-Service	1093091662	1093091662	1	3	AMERICAN HEARING AID CENTER	12/12/2011	237600000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	740 LOMAS SANTA FE DR	STE 110	SOLANA BEACH	CA	92075	1441	37	06073	32.9960581	-117.2579748	San Diego County
225732	Fee-for-Service	1194351643	1194351643	1	1	AURORA HOSPICE CARE, INC	9/30/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6850 VAN NUYS BLVD	#322	VAN NUYS	CA	91405	4629	19	06037	34.195401	-118.4487235	Los Angeles County
225739	Fee-for-Service	1750343729	1750343729	1	1	ALGAR, ROBERT C MD	9/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87212	13	Neurology (M.D. only)	0	In state provider	None	130 LA CASA VIA	STE 206	WALNUT CREEK	CA	94598	3032	07	06013	37.91175467	-122.0414101	Contra Costa County
225740	Fee-for-Service	1043775422	1043775422	1	1	ANGEL PALLIATIVE CARE AND	8/25/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE	100 PRODUCE AVE	SUITE H	S SAN FRANCISCO	CA	94080	6524	41	06081	37.64929311	-122.4079523	San Mateo County
225755	Fee-for-Service	1750559431	1750559431	1	7	ALL STAR PHYSICAL THERAPY, I	4/30/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	1922 HACIENDA DR	None	VISTA	CA	92081	0000	37	06073	33.1855682	-117.2834788	San Diego County
225775	Fee-for-Service	1225403850	1225403850	1	1	ADVANCED HEALING SOLUTIONS	1/1/2017	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INC	1430 3RD STREET	STE 3	RIVERSIDE	CA	92507	3457	33	06065	33.98298096	-117.3432357	Riverside County
225787	Fee-for-Service	1023439957	1023439957	1	1	ABC MEDICINE INC	3/17/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7626 E CHAPMAN AVE	STE C	ORANGE	CA	92869	8532	30	06059	33.79507903	-117.7717597	Orange County
225788	Fee-for-Service	1164414827	1164414827	1	1	ALI, KARRAR H DO	3/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	8953	66	Emergency Medicine (Urgent Care)	0	In state provider	None	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	37	06073	32.61822301	-117.0234938	San Diego County
225802	Fee-for-Service	1629275433	1629275433	1	1	ARANDA, ALDO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	14502 W MEEKER BLVD	None	SUN CITY WEST	AZ	85375	5282	00	None	33.660657	-112.3736175	Maricopa County
225851	Fee-for-Service	1366730004	1366730004	1	1	ALMAROSA, PAULINA I LCSW	6/28/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
225868	Fee-for-Service	1023440302	1023440302	1	1	ABUNDANT HOME HEALTH CARE	4/21/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	6314 VAN NUYS BLVD	SUITE 200	VAN NUYS	CA	91401	2625	19	06037	34.18518362	-118.4487146	Los Angeles County
225870	Fee-for-Service	1801848825	1801848825	1	1	ASWANI, MANOJ D MD	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	84319	41	Internal Medicine	0	In state provider	None	2230 LYNN RD	STE 200	THOUSAND OAKS	CA	91360	1900	56	06111	34.20894685	-118.885185	Ventura County
225882	Fee-for-Service	1225263692	1225263692	1	1	ANUMANDLA, ASHWINI MD	7/2/2018	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	145958	10	Gastroenterology (M.D. only)	0	In state provider	None	2545 W HAMMER LN	None	STOCKTON	CA	95209	2839	39	06077	38.0214303	-121.3461515	San Joaquin County
225901	Fee-for-Service	1447443809	1447443809	1	1	ALVORD, PAUL B MD	8/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	66670	89	Surgery-Traumatic	0	In state provider	None	200 W ARBOR DRIVE	8201	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
225910	Fee-for-Service	1215982970	1215982970	1	1	ALLEN, DERRICK R MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69840	66	Emergency Medicine (Urgent Care)	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
225912	Fee-for-Service	1154462422	1154462422	1	1	ASIAN HEALTH SVS	3/1/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	818 WEBSTER ST	None	OAKLAND	CA	94607	4220	01	06001	37.79946052	-122.2711864	Alameda County
225918	Fee-for-Service	1205161932	1205161932	1	1	ABDOLLAHI-FARD, ALIREZA MD	6/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110374	05	Anesthesiology	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
225928	Fee-for-Service	1750559431	1750559431	1	6	ALL STAR PHYSICAL THERAPY, I	4/30/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	25136 HANCOCK AVE	STE A	MURRIETA	CA	92562	5944	33	06065	33.56788654	-117.1824198	Riverside County
225929	Fee-for-Service	1144254590	1144254590	1	1	AGZARIAN, ANITA Y MD INC	1/31/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	36902	41	Internal Medicine	0	In state provider	None	#450,455,490,290,550,525	None	LOS ANGELES	CA	90095	0001	19	06037	0	0	None
225991	Fee-for-Service	1184607236	1184607236	1	1	ALBERTSON, TIMOTHY MD	6/30/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	37112	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2601 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2210	34	06067	38.551311	-121.454433	Sacramento County
226011	Fee-for-Service	1093091662	1093091662	1	3	AMERICAN HEARING AID CENTER	12/12/2011	237600000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	740 LOMAS SANTA FE DR	STE 110	SOLANA BEACH	CA	92075	1441	37	06073	32.9960581	-117.2579748	San Diego County
226021	Fee-for-Service	1750054557	1750054557	1	1	ANDERSON, LEAH	7/8/2024	390200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
226037	Fee-for-Service	1487846150	1487846150	1	1	ADVANCED MEDICAL CARE	1/28/2010	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	ABC DAY HEALTH CARE	417 ALPINE ST	None	LOS ANGELES	CA	90012	2305	19	06037	34.06253316	-118.2387887	Los Angeles County
226041	Fee-for-Service	1144331224	1144331224	1	1	AMIRHAMZEH, MEHRDAD MD INC	7/12/2002	193400000X	NA	Other	026	PHYSICIANS	86572	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1610 W YOSEMITE AVE	UNIT 3	MANTECA	CA	95337	5189	39	06077	37.79730746	-121.2429154	San Joaquin County
226052	Fee-for-Service	1003894643	1003894643	1	1	APRIA HEALTHCARE LLC	3/1/1998	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1526 E MINERAL KING AVE	None	VISALIA	CA	93292	6910	54	06107	36.327591	-119.2756815	Tulare County
226064	Fee-for-Service	1437256302	1437256302	1	1	AARTI R DESHPANDE M.D.	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	37624 SE FURY ST	STE 101	SNOQUALMIE	WA	98065	9680	00	None	47.53345032	-121.838463	King County
226066	Fee-for-Service	1124592589	1124592589	1	1	AMI, DENNIS ACE DE GUZMAN	3/1/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	248 1/2 S HOBARTY BLVD	None	LOS ANGELES	CA	90004	5208	19	06037	34.06983588	-118.3054635	Los Angeles County
226088	Fee-for-Service	1063415834	1063415834	1	1	ADVANCED DIABETIC SERVIC	11/18/2003	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	805 S CHURCH ST	STE 9	MURFREESBORO	TN	37130	4917	00	None	35.83782579	-86.39263305	Rutherford County
226113	Fee-for-Service	1083824429	1083824429	1	1	AVILA, ANDREA Y LCSW	9/28/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7130 N MILLBROOK AVE	SUITE 100	FRESNO	CA	93720	3347	10	06019	36.83832032	-119.7632391	Fresno County
226137	Fee-for-Service	1952367070	1952367070	1	1	AGAHI, MASSOUD H MD	7/9/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	75832	02	General Surgery	0	In state provider	None	8635 W 3RD ST	None	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
226146	Fee-for-Service	1558371567	1558371567	1	1	ALLISON, M CHRISTINE MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	7685	01	General Practice	0	In state provider	None	43839 15TH ST W	None	LANCASTER	CA	93534	4756	19	06037	34.678791	-118.156867	Los Angeles County
226149	Fee-for-Service	1780108951	1780108951	1	1	ANTELOPE VALLEY SPECIALTY SU	3/18/2022	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	RGICAL CENTER, LLC	655 W AVENUE Q	SUITE B	PALMDALE	CA	93551	3894	19	06037	34.58715647	-118.1417372	Los Angeles County
226215	Fee-for-Service	1750559431	1750559431	1	6	ALL STAR PHYSICAL THERAPY, I	11/10/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	25136 HANCOCK AVE	STE A	MURRIETA	CA	92562	5944	33	06065	33.56788654	-117.1824198	Riverside County
226219	Fee-for-Service	1972651925	1972651925	1	1	ARULAMPALAM, NARESHKUMAR	10/1/1995	2084P0800X	NA	Psychiatry	026	PHYSICIANS	56123	01	General Practice	0	In state provider	None	3360 FLAIR DR	None	EL MONTE	CA	91731	2833	19	06037	34.0688923	-118.0711425	Los Angeles County
226260	Fee-for-Service	1477116077	1477116077	1	1	ALETTY, KARAN MD	3/27/2024	390200000X	NA	Other	026	PHYSICIANS	181208	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
226278	Fee-for-Service	1346213246	1346213246	1	1	ABRAMS, GARY M MD	6/28/1995	2084N0400X	NA	Neurology	026	PHYSICIANS	81653	13	Neurology (M.D. only)	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
226304	Fee-for-Service	1992366678	1992366678	1	1	AVANTA HOME HEALTH SERVICES	5/18/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2915 BURBANK BLVD	UNIT B	BURBANK	CA	91505	2364	19	06037	34.17711924	-118.3430525	Los Angeles County
226313	Fee-for-Service	1265201693	1265201693	1	1	ABINALES, MIRELA CNP	2/6/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
226328	Fee-for-Service	1144331224	1144331224	1	1	AMIRHAMZEH, MEHRDAD MD INC	7/12/2002	193400000X	NA	Other	026	PHYSICIANS	86572	33	Thoracic Surgery	0	In state provider	None	1610 W YOSEMITE AVE	UNIT 3	MANTECA	CA	95337	5189	39	06077	37.79730746	-121.2429154	San Joaquin County
226356	Fee-for-Service	1851575765	1851575765	1	1	ALTAMED HEALTH SVS CORP	1/1/1999	251B00000X	NA	Other	073	AIDS WAIVER SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5427 WHITTIER BLVD	None	E LOS ANGELES	CA	90022	4101	19	06037	34.01966132	-118.1536008	Los Angeles County
226358	Fee-for-Service	1124592589	1124592589	1	1	AMI, DENNIS ACE DE GUZMAN	3/1/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	248 1/2 S HOBARTY BLVD	None	LOS ANGELES	CA	90004	5208	19	06037	34.06983588	-118.3054635	Los Angeles County
226391	Fee-for-Service	1568929669	1568929669	1	1	ARMSTRONG, JACQUELINE PT	3/1/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
226433	Fee-for-Service	1740244367	1740244367	1	1	AZAM, MUHAMMAD A	3/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	52314	08	Family Practice	0	In state provider	None	860 JAMACHA RD	STE 103	EL CAJON	CA	92019	3225	37	06073	32.78430676	-116.9279962	San Diego County
226438	Fee-for-Service	1699382937	1699382937	1	1	ALTADENA HOSPICE CARE INC	8/18/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	133 N ALTADENA DR	SUITE 385	PASADENA	CA	91107	7328	19	06037	34.14843	-118.0986385	Los Angeles County
226445	Fee-for-Service	1033475462	1033475462	1	1	ATMADJA, MELANIE A MD	8/20/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126543	40	Pediatrics	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
226461	Fee-for-Service	1811525405	1811525405	1	1	ALAM, MAHZA MD	10/16/2023	207R00000X	NA	Other	026	PHYSICIANS	182868	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
226489	Fee-for-Service	1598832511	1598832511	1	1	ALVAREZ, RUBEN E MD	12/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	76115	01	General Practice	0	In state provider	None	4747 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
226503	Fee-for-Service	1043479280	1043479280	1	1	ARAI, SCOTT G PSY	10/24/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	27133	-	NOT APPLICABLE	0	In state provider	None	10 N SAN PEDRO RD	SUITE 1015, 1018, 1019	SAN RAFAEL	CA	94903	4155	21	06041	37.99529182	-122.5300426	Marin County
226524	Fee-for-Service	1033882915	1033882915	1	1	AURORA NON-EMERGENCY MEDICAL	9/9/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2005 EYE ST	1	BAKERSFIELD	CA	93301	4451	15	06029	35.37746687	-119.0200576	Kern County
226552	Fee-for-Service	1295357184	1295357184	1	1	ALL HEART HOSPICE, INC	3/25/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	8953 WOODMAN AVE	STE 208	ARLETA	CA	91331	6457	19	06037	34.23249056	-118.4383491	Los Angeles County
226565	Fee-for-Service	1346213246	1346213246	1	1	ABRAMS, GARY M MD	6/28/1995	2084N0400X	NA	Neurology	026	PHYSICIANS	81653	25	Physical Medicine and Rehabilitation	0	In state provider	None	1600 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3010	38	06075	37.78475261	-122.43973	San Francisco County
226595	Fee-for-Service	1609817659	1609817659	1	1	ALNAJJAR, SAMER P MD	1/8/2019	208200000X	NA	General Surgery	026	PHYSICIANS	87758	24	Plastic Surgery	0	In state provider	None	1401 S GRAND AVE	None	LOS ANGELES	CA	90015	3010	19	06037	34.03719097	-118.2654105	Los Angeles County
226606	Fee-for-Service	1043636400	1043636400	1	1	ALZ MEDICAL RESOURCE NETWORK	5/12/2014	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	INC	4152 KATELLA AVE	#204	LOS ALAMITOS	CA	90720	6608	30	06059	33.80297352	-118.060506	Orange County
226607	Fee-for-Service	1780846881	1780846881	1	1	ANSARI, JULIA G MD	6/1/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	167513	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3131 BERGER AVE	None	SAN DIEGO	CA	92123	4233	37	06073	32.8019999	-117.1515447	San Diego County
226612	Fee-for-Service	1588876346	1588876346	1	1	AVALOS, SORAYA L LMFT	9/1/2016	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	86910	-	NOT APPLICABLE	0	In state provider	None	21545 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	2947	19	06037	34.413021	-118.514534	Los Angeles County
226623	Fee-for-Service	1467742544	1467742544	1	1	AIDS HEALTHCARE FOUNDATION	9/17/2012	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3500 E PACIFIC COAST HWY	None	LONG BEACH	CA	90804	1904	19	06037	33.78983447	-118.1510145	Los Angeles County
226635	Fee-for-Service	1245596402	1245596402	1	1	AJIBOYE, REMI M MD	6/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	130753	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
226654	Fee-for-Service	1639414139	1639414139	1	1	APLA HEALTH & WELLNESS	7/28/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1741 E 120TH ST	None	LOS ANGELES	CA	90059	3051	19	06037	33.92464326	-118.2427028	Los Angeles County
226661	Fee-for-Service	1275279648	1275279648	1	1	AMBASTHA, CHETAN G MD	5/2/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	190131	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
226669	Fee-for-Service	1013065911	1013065911	1	1	ADRIANO, FRANCESCA D MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81379	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
226674	Fee-for-Service	1831122316	1831122316	1	1	ATHENA MEDICAL CENTER FOR	2/28/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	40262	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	WOMEN INC	321 CHERRY LN	None	MANTECA	CA	95337	4355	39	06077	37.80173846	-121.231044	San Joaquin County
226697	Fee-for-Service	1659534626	1659534626	1	1	ANCONA, MICHAEL R DO	10/14/2019	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	5333 HOLLISTER AVE	STE 130	SANTA BARBARA	CA	93111	3317	42	06083	34.43491982	-119.8105484	Santa Barbara County
226728	Fee-for-Service	1699382937	1699382937	1	1	ALTADENA HOSPICE CARE INC	8/18/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	133 N ALTADENA DR	SUITE 385	PASADENA	CA	91107	7328	19	06037	34.14843	-118.0986385	Los Angeles County
226752	Fee-for-Service	1114079332	1114079332	1	1	APOSTOLAKOS, DIANE MD	1/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96394	01	General Practice	0	In state provider	None	1001 RIVERSIDE BVLD	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
226796	Fee-for-Service	1235302589	1235302589	1	1	ARTHUR, ARVIN MD INC	10/6/2008	193200000X	NA	Other	026	PHYSICIANS	37057	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3939 J ST	STE 300	SACRAMENTO	CA	95819	3631	34	06067	38.570211	-121.45374	Sacramento County
226841	Fee-for-Service	1295357184	1295357184	1	1	ALL HEART HOSPICE, INC	3/25/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	8953 WOODMAN AVE	STE 208	ARLETA	CA	91331	6457	19	06037	34.23249056	-118.4383491	Los Angeles County
226858	Fee-for-Service	1255301347	1255301347	1	1	ADOLFO, MARIA C MD	9/12/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	3186 S MARYLAND PARKWAY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
226902	Fee-for-Service	1508869280	1508869280	1	1	APPELBLATT, NANCY H MD	10/31/1982	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	49511	01	General Practice	0	In state provider	None	3810 J ST	None	SACRAMENTO	CA	95816	5521	34	06067	38.569743	-121.455378	Sacramento County
226912	Fee-for-Service	1316028640	1316028640	1	1	ANDERSON, SHEILA	11/1/2005	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ANDERSON'S MEDCARE&SUPPL	2721 OLIVE HWY	STE 2	OROVILLE	CA	95966	6115	04	06007	39.50452062	-121.5420592	Butte County
226914	Fee-for-Service	1225412000	1225412000	1	1	ABDELMALAK, EBRAM DPM	4/5/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	3503 LEXINGTON AVE	None	EL MONTE	CA	91731	2607	19	06037	34.072227	-118.039478	Los Angeles County
226945	Fee-for-Service	1639414139	1639414139	1	1	APLA HEALTH & WELLNESS	7/28/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1741 E 120TH ST	None	LOS ANGELES	CA	90059	3051	19	06037	33.92464326	-118.2427028	Los Angeles County
226950	Fee-for-Service	1861402950	1861402950	1	2	ADORADOR ENTERPRISES	3/12/2020	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	32819 YUCAIPA BLVD	SUITE 3	YUCAIPA	CA	92399	1944	36	06071	34.03378554	-117.0888075	San Bernardino County
226956	Fee-for-Service	1992990915	1992990915	1	1	ARREDONDO, ESTHER LMFT	9/6/2018	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	301 9TH ST	STE 200	REDLANDS	CA	92374	4497	36	06071	34.05825	-117.177229	San Bernardino County
226969	Fee-for-Service	1891711446	1891711446	1	1	ANDONE,ANDREEA L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12785 SW JENKINS ROAD	None	BEAVERTON	OR	97005	0000	00	None	45.49922579	-122.8084485	Washington County
226972	Fee-for-Service	1558448795	1558448795	1	1	ADVANCED GI CONSULTANTS	4/14/2005	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	72217	41	Internal Medicine	0	In state provider	MEDICAL GROUP INC	4314 W VICTORY BLVD	None	BURBANK	CA	91505	1334	19	06037	34.18483654	-118.3581315	Los Angeles County
226996	Fee-for-Service	1336493394	1336493394	1	1	AT HOME NURSING CARE INC	12/16/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	531 ENCINITAS BLVD	SUITE 120	ENCINITAS	CA	92024	3773	37	06073	33.04711796	-117.2797731	San Diego County
227062	Fee-for-Service	1043347248	1043347248	1	1	ALEXANDER, MICHAEL J MD	8/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	77195	14	Neurological Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
227069	Fee-for-Service	1154572089	1154572089	1	1	APEX ANESTHESIA MEDICAL	11/10/2008	193400000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	GROUP INC	531 W COLLEGE STREET	None	LOS ANGELES	CA	90012	2315	19	06037	34.0645892	-118.2391033	Los Angeles County
227071	Fee-for-Service	1902907835	1902907835	1	1	ADDIEGO, JOSEPH A DPM	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	INC	1510 S CENTRAL AVE	STE 120	GLENDALE	CA	91204	2576	19	06037	34.12709764	-118.2577911	Los Angeles County
227080	Fee-for-Service	1396783379	1396783379	1	10	ASANA INTEGRATED MEDICAL GRO	10/13/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP PC	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
227135	Fee-for-Service	1336797232	1336797232	1	1	AMERICAS BEST CARE	2/24/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	8937 DE SOTO AVE	STE 205	CANOGA PARK	CA	91304	8937	19	06037	34.23241304	-118.5885517	Los Angeles County
227210	Fee-for-Service	1396178067	1396178067	1	2	ATHENA MEDICAL GROUP OF THE	10/27/2021	No Taxonomy Provided	NA	None	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	CENTRAL COAST INC	515 ALAMEDA AVE	STE C	SALINAS	CA	93901	4024	27	06053	36.65997494	-121.6486999	Monterey County
227230	Fee-for-Service	1841228764	1841228764	1	3	ARCADIA RADIOLOGY	10/1/1982	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GRP A PROF CORP	438 W LAS TUNAS DRIVE	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
227260	Fee-for-Service	1558448795	1558448795	1	1	ADVANCED GI CONSULTANTS	4/14/2005	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	72217	10	Gastroenterology (M.D. only)	0	In state provider	MEDICAL GROUP INC	4314 W VICTORY BLVD	None	BURBANK	CA	91505	1334	19	06037	34.18483654	-118.3581315	Los Angeles County
227264	Fee-for-Service	1578551537	1578551537	1	1	ASI, WAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	710 FM 1960 RD W	None	HOUSTON	TX	77090	3402	00	None	30.020697	-95.4426555	Harris County
227336	Fee-for-Service	1093805103	1093805103	1	1	AHN, EDWARD J MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	38304	30	Radiology	0	In state provider	None	3545 WILSHIRE BLVD	STE 315	LOS ANGELES	CA	90010	2305	19	06037	34.0617575	-118.301985	Los Angeles County
227341	Fee-for-Service	1033871207	1033871207	1	1	APPLE, ALEXANDRA C PHD	10/18/2021	103G00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
227358	Fee-for-Service	1952621393	1952621393	1	1	ARUN D PATEL M.D. INC	11/20/2020	207R00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	907 W WILSHIRE AVE	None	FULLERTON	CA	92832	1635	30	06059	33.87222302	-117.9408154	Orange County
227369	Fee-for-Service	1790193738	1790193738	1	1	ARASOGHLI, MONA MD	11/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146764	41	Internal Medicine	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
227449	Fee-for-Service	1700996980	1700996980	1	1	ANGUIANO, FRANCISCO E MD	4/1/2003	174400000X	NA	Other	026	PHYSICIANS	61584	01	General Practice	0	In state provider	INC	765 MEDICAL CENTER CT	STE 209	CHULA VISTA	CA	91911	6600	37	06073	32.619069	-117.020835	San Diego County
227452	Fee-for-Service	1801804943	1801804943	1	1	ALEXANDER, RAYNA L MD	11/2/1983	207P00000X	NA	Other	026	PHYSICIANS	30469	40	Pediatrics	0	In state provider	A PROFESSIONAL CORP	211 YACHT CLUB WAY	STE 3	REDONDO BEACH	CA	90277	2050	19	06037	33.85190197	-118.3975041	Los Angeles County
227453	Fee-for-Service	1275084527	1275084527	1	1	AAAA HOME HEALTH CARE	9/2/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	9561 VAN NUYS BLVD	UNIT 3	PANORAMA CITY	CA	91402	1344	19	06037	34.24443836	-118.4502813	Los Angeles County
227468	Fee-for-Service	1396783379	1396783379	1	13	ASANA INTEGRATED MEDICAL GRO	10/13/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP PC	2101 WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	36	06071	34.13502	-117.2758635	San Bernardino County
227472	Fee-for-Service	1245372366	1245372366	1	1	ARELLANO, JERRY L MD	10/11/2010	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	112760	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
227483	Fee-for-Service	1912533571	1912533571	1	1	ATWOOD, THEODORE O LMFT	2/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
227486	Fee-for-Service	1508359423	1508359423	1	1	AHERN, JAMES K MD	6/3/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	164158	None	None	0	In state provider	None	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
227490	Fee-for-Service	1417035916	1417035916	1	1	AHMADY, AZIM M MD	1/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	95470	08	Family Practice	0	In state provider	None	3700 VACA VALLEY PKWY	None	VACAVILLE	CA	95688	9430	48	06095	38.39008977	-121.9378499	Solano County
227499	Fee-for-Service	1396178067	1396178067	1	2	ATHENA MEDICAL GROUP OF THE	11/28/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CENTRAL COAST INC	515 ALAMEDA AVE	STE C	SALINAS	CA	93901	4024	27	06053	36.65997494	-121.6486999	Monterey County
227509	Fee-for-Service	1487260022	1487260022	1	1	A PLACE TO HEAL	9/28/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	7868 S WESTERN AVE	None	LOS ANGELES	CA	90047	2727	19	06037	33.967647	-118.3089935	Los Angeles County
227522	Fee-for-Service	1063646776	1063646776	1	1	ARCE, ANA C LMFT	5/7/2015	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10722 ARROW ROUTE	STE 308	RANCHO CUCAMONGA	CA	91730	4811	36	06071	34.09917725	-117.5708877	San Bernardino County
227555	Fee-for-Service	1467630715	1467630715	2	1	ALLIANCE HEALTHCARE SRVS INC	10/29/2018	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	7777 MILLIKEN AVE	None	RANCHO CUCAMONGA	CA	91730	6780	36	06071	34.10843256	-117.5570865	San Bernardino County
227566	Fee-for-Service	1366721722	1366721722	1	1	ASLAM, MEHWISH MD	1/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130156	40	Pediatrics	0	In state provider	None	17450 MAIN STREET	None	HESPERIA	CA	92345	6298	36	06071	34.41871211	-117.2821748	San Bernardino County
227618	Fee-for-Service	1790495315	1790495315	1	1	ASKER, HEBATALLA	7/6/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1633 E 4TH ST	STE 218	SANTA ANA	CA	92701	5163	30	06059	33.7481375	-117.846441	Orange County
227622	Fee-for-Service	1487910774	1487910774	1	1	AMINI, ARYA MD	7/8/2017	2085R0001X	NA	Other	026	PHYSICIANS	148496	30	Radiology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
227642	Fee-for-Service	1932756764	1932756764	1	9	ALTAMED HEALTH SERVICES	1/31/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	195 NORTH WESTERN AVENUE	None	ANAHEIM	CA	92801	6040	30	06059	33.833394	-118.0049085	Orange County
227658	Fee-for-Service	1194771584	1194771584	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	220 E BONITA AVE	None	SAN DIMAS	CA	91773	3186	19	06037	34.10664849	-117.8034615	Los Angeles County
227668	Fee-for-Service	1568553709	1568553709	1	1	AKWAYENA,RAYMOUND MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 LOTHROP STREET	None	PITTSBURG	PA	15213	0000	00	None	40.44188737	-79.96079711	Allegheny County
227720	Fee-for-Service	1720080815	1720080815	1	1	AFSHINE, GHAEMI MD	8/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91320	08	Family Practice	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
227734	Fee-for-Service	1700996980	1700996980	1	1	ANGUIANO, FRANCISCO E MD	4/1/2003	174400000X	NA	Other	026	PHYSICIANS	61584	66	Emergency Medicine (Urgent Care)	0	In state provider	INC	765 MEDICAL CENTER CT	STE 209	CHULA VISTA	CA	91911	6600	37	06073	32.619069	-117.020835	San Diego County
227746	Fee-for-Service	1174900211	1174900211	1	1	ACHA, KENNETH T MD	6/29/2018	390200000X	NA	Other	026	PHYSICIANS	139604	08	Family Practice	0	In state provider	None	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	33	06065	33.83753681	-116.5424435	Riverside County
227758	Fee-for-Service	1780885574	1780885574	1	1	AHLUWALIA, HARDEEP S MD	7/22/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	86707	23	Peripheral Vascular Disease or Surgery (D.O. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
227759	Fee-for-Service	1992786016	1992786016	1	1	ALBANESE, CAROL V MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	74469	25	Physical Medicine and Rehabilitation	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
227762	Fee-for-Service	1245372366	1245372366	1	1	ARELLANO, JERRY L MD	10/11/2010	207RC0001X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	112760	01	General Practice	0	In state provider	None	2350 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3305	38	06075	37.78305866	-122.4421313	San Francisco County
227770	Fee-for-Service	1265538003	1265538003	1	1	AHMED, ZAHED U MD	10/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	89205	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
227860	Fee-for-Service	1881772648	1881772648	1	1	ASADULLA, ABUBAKR MD	8/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	69025	41	Internal Medicine	0	In state provider	None	27400 HESPERIAN BLVD	None	HAYWARD	CA	94545	4235	01	06001	37.63011596	-122.0960694	Alameda County
227906	Fee-for-Service	1659653269	1659653269	1	1	ANDREA K. P. SAHARI M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4500 SAND POINT WAY NE	STE 100	SEATTLE	WA	98105	3954	00	None	47.66165594	-122.2864502	King County
227930	Fee-for-Service	1932756764	1932756764	1	9	ALTAMED HEALTH SERVICES	1/31/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	195 NORTH WESTERN AVENUE	None	ANAHEIM	CA	92801	6040	30	06059	33.833394	-118.0049085	Orange County
227973	Fee-for-Service	1154340289	1154340289	1	1	AVERY, G JAMES II MD	4/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	38981	33	Thoracic Surgery	0	In state provider	None	2340 CLAY ST	None	SAN FRANCISCO	CA	94115	1932	38	06075	37.79101969	-122.43208	San Francisco County
227978	Fee-for-Service	1952357972	1952357972	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2000 E 17TH ST	None	SANTA ANA	CA	92706	8647	30	06059	33.75980651	-117.8382375	Orange County
227982	Fee-for-Service	1811289093	1811289093	1	1	AUSTIN, ANDREA L MD	8/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136904	66	Emergency Medicine (Urgent Care)	0	In state provider	None	435 H STREET	None	CHULA VISTA	CA	91910	4307	37	06073	32.63282707	-117.0829101	San Diego County
228004	Fee-for-Service	1841394913	1841394913	2	1	AFSHAR, HOSEIN T MD	11/18/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	35988	41	Internal Medicine	0	In state provider	None	1687 ERRINGER RD	STE 204	SIMI VALLEY	CA	93065	6510	56	06111	34.268886	-118.761426	Ventura County
228016	Fee-for-Service	1205908951	1205908951	1	1	ABSAR, NORMAN MD	10/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	51562	01	General Practice	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
228018	Fee-for-Service	1881406999	1881406999	1	1	ANTHONY FAM, M.D., A PROFESS	3/6/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	IONAL MEDICAL CORPORAT	654 S. ANZA ST	None	EL CAJON	CA	92020	6602	37	06073	32.788926	-116.948218	San Diego County
228024	Fee-for-Service	1700996980	1700996980	1	1	ANGUIANO, FRANCISCO E MD	4/1/2003	174400000X	NA	Other	026	PHYSICIANS	61584	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	INC	765 MEDICAL CENTER CT	STE 209	CHULA VISTA	CA	91911	6600	37	06073	32.619069	-117.020835	San Diego County
228054	Fee-for-Service	1710134465	1710134465	1	1	AHMADI, EBRAHIM MD PC	3/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	50313	08	Family Practice	0	In state provider	None	38143 MARTHA AVE	None	FREMONT	CA	94536	3800	01	06001	37.56020244	-121.9920388	Alameda County
228085	Fee-for-Service	1992331417	1992331417	1	1	ASANT HOME HEALTH CARE INC	7/13/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	7108 DE SOTO AVENUE	SUITE 200A	CANOGA PARK	CA	91303	3230	19	06037	34.1994564	-118.5884133	Los Angeles County
228112	Fee-for-Service	1699769182	1699769182	1	1	AG SEAL BEACH, LLC	10/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	3000 N GATE BLVD	None	SEAL BEACH	CA	90740	2535	30	06059	33.77328499	-118.0776064	Orange County
228139	Fee-for-Service	1992840490	1992840490	1	1	ALMASRI, EYAD MD	5/25/2010	207RP1001X	NA	Pulmonology	026	PHYSICIANS	111780	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6311 N FRESNO ST	STE 106	FRESNO	CA	93710	5290	10	06019	36.82866273	-119.7814168	Fresno County
228187	Fee-for-Service	1083321467	1083321467	1	1	ANAV TRANS INC	8/9/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	301 H STREET	STE. C	BAKERSFIELD	CA	93304	2956	15	06029	35.359119	-119.0213085	Kern County
228209	Fee-for-Service	1275199093	1275199093	1	1	ASTHANA, NIRAJ K MD	11/22/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	182462	36	Psychiatry	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
228221	Fee-for-Service	1649804386	1649804386	1	1	ANIEMEKA, IFEOMA C	2/13/2023	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	510 PLAZA DRIVE	STE 170	FOLSOM	CA	95630	4790	34	06067	38.65716	-121.1738175	Sacramento County
228268	Fee-for-Service	1700175874	1700175874	1	1	AL-HAKIM, RAMSEY MD	6/17/2021	2085R0204X	NA	Other	026	PHYSICIANS	123187	None	None	0	In state provider	None	150 W. WASHINGTON STREET	None	SAN DIEGO	CA	92103	2005	37	06073	32.74999225	-117.1647027	San Diego County
228285	Fee-for-Service	1821411281	1821411281	1	1	ALBURY, DENISE A MD INC	7/11/2016	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	74533	40	Pediatrics	0	In state provider	None	133 N PRAIRIE AVE	STE B	INGLEWOOD	CA	90301	4879	19	06037	33.963957	-118.3439985	Los Angeles County
228294	Fee-for-Service	1134569429	1134569429	1	1	ABOLHODA MD INC	1/11/2016	208G00000X	NA	General Surgery	026	PHYSICIANS	85458	02	General Surgery	0	In state provider	None	3801 KATELLA AVE	SUITE 207	LOS ALAMITOS	CA	90720	3382	30	06059	33.80318951	-118.066068	Orange County
228297	Fee-for-Service	1922180157	1922180157	1	1	ALEXANDER, ERIC P MD	10/15/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108071	25	Physical Medicine and Rehabilitation	0	In state provider	None	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
228298	Fee-for-Service	1861439135	1861439135	1	1	ALAAMA, ABDUL M MD	7/25/1973	No Taxonomy Provided	NA	None	026	PHYSICIANS	25455	None	None	0	In state provider	None	7957 PAINTER AVE	None	WHITTIER	CA	90602	2434	19	06037	33.96837047	-118.0327433	Los Angeles County
228310	Fee-for-Service	1821011834	1821011834	1	1	AFONIN, OLGA N MD	7/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	87838	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
228325	Fee-for-Service	1467806356	1467806356	1	1	ASGARI, MASOUD MD	7/23/2024	207ZP0102X	NA	Other	026	PHYSICIANS	151460	22	Pathology (M.D. only)	0	In state provider	None	4301 NORTHSTAR WAY	None	MODESTO	CA	95356	9535	50	06099	0	0	None
228331	Fee-for-Service	1932756764	1932756764	1	8	ALTAMED HEALTH SERVICES	1/31/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	320 SOUTH DANBROOK DRIVE	None	ANAHEIM	CA	92804	2715	30	06059	33.82779767	-118.0085481	Orange County
228345	Fee-for-Service	1821224205	1821224205	1	1	ASADI, ROSHANAK OD	11/17/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
228354	Fee-for-Service	1538152236	1538152236	1	1	AARON S. HAMMOND, D.O.	1/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3390 N CAMPBELL AVE	STE 110	TUCSON	AZ	85719	2380	00	None	32.26833	-110.94327	Pima County
228367	Fee-for-Service	1437747151	1437747151	1	1	AWESOMFIT, INC	10/14/2021	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	5331 PIRRONE RD	STE. / APT. #B	SALIDA	CA	95368	9089	50	06099	37.7166377	-121.0921217	Stanislaus County
228419	Fee-for-Service	1073723144	1073723144	1	3	AMIT MITTAL M.D.	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5171 W OLIVE AVE	None	GLENDALE	AZ	85302	4204	00	None	33.567093	-112.1719365	Maricopa County
228424	Fee-for-Service	1013275262	1013275262	1	1	AMENT, ANDREA E MD	10/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128145	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
228430	Fee-for-Service	1992840490	1992840490	1	1	ALMASRI, EYAD MD	5/25/2010	207RP1001X	NA	Pulmonology	026	PHYSICIANS	111780	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6311 N FRESNO ST	STE 106	FRESNO	CA	93710	5290	10	06019	36.82866273	-119.7814168	Fresno County
228443	Fee-for-Service	1982754792	1982754792	1	1	ADORADOR, ALEXIS LMFT	5/3/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	98, 112, 122, 140	HENDLEY ST	SANTA ROSA	CA	95404	5205	49	06097	0	0	None
228459	Fee-for-Service	1881739530	1881739530	1	1	ARAI, SALLY MD	9/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87299	68	Hematology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
228476	Fee-for-Service	1831123124	1831123124	1	1	ALAM, MOHAMMED J MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76152	05	Anesthesiology	0	In state provider	None	9212 MIRA ESTE CT	STE 204	SAN DIEGO	CA	92126	6337	37	06073	32.88927901	-117.1482338	San Diego County
228490	Fee-for-Service	1588141006	1588141006	1	1	AUSTIN, FRANCES M RCP	10/19/2018	2279P3900X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
228560	Fee-for-Service	1649581679	1649581679	1	1	ARAFAT, OMAR S MD	3/16/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105581	None	None	0	In state provider	None	10833 LE CONTE AVENUE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
228583	Fee-for-Service	1134569429	1134569429	1	1	ABOLHODA MD INC	1/11/2016	208G00000X	NA	General Surgery	026	PHYSICIANS	85458	33	Thoracic Surgery	0	In state provider	None	3801 KATELLA AVE	SUITE 207	LOS ALAMITOS	CA	90720	3382	30	06059	33.80318951	-118.066068	Orange County
228614	Fee-for-Service	1881318012	1881318012	1	1	ANCHORED CALIFORNIA LICENSED	1/3/2023	101YM0800X	NA	Other	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	None	419 GEORGIA ST	STE 11	VALLEJO	CA	94590	6046	48	06095	38.10106704	-122.2557858	Solano County
228617	Fee-for-Service	1932756764	1932756764	1	8	ALTAMED HEALTH SERVICES	1/31/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	320 SOUTH DANBROOK DRIVE	None	ANAHEIM	CA	92804	2715	30	06059	33.82779767	-118.0085481	Orange County
228619	Fee-for-Service	1275617995	1275617995	1	1	ALICE M LEE	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SWEDISH HOSPITAL MED	747 BROADWAY	None	SEATTLE	WA	98122	4307	00	None	47.608326	-122.3207985	King County
228658	Fee-for-Service	1285992420	1285992420	1	1	ARGHAMI, ELHAM MD	2/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144973	01	General Practice	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
228693	Fee-for-Service	1174988976	1174988976	1	1	ALBERTSONS LLC	7/6/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	6240 FOOTHILL BLVD	None	TUJUNGA	CA	91042	2724	19	06037	34.24130378	-118.2676478	Los Angeles County
228701	Fee-for-Service	1659407823	1659407823	1	1	ADAMS, NEAL H MD MPH	7/2/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	43003	None	None	0	In state provider	None	2373 COLORADO BOULEVARD	None	LOS ANGELES	CA	90041	1157	19	06037	34.13990611	-118.2182985	Los Angeles County
228715	Fee-for-Service	1992840490	1992840490	1	1	ALMASRI, EYAD MD	5/25/2010	207RP1001X	NA	Pulmonology	026	PHYSICIANS	111780	41	Internal Medicine	0	In state provider	None	6311 N FRESNO ST	STE 106	FRESNO	CA	93710	5290	10	06019	36.82866273	-119.7814168	Fresno County
228717	Fee-for-Service	1467901728	1467901728	1	1	AGUILAR, TRACY	7/1/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD	SUITE 290-8	LOS ANGELES	CA	90010	3530	19	06037	34.06177566	-118.320844	Los Angeles County
228729	Fee-for-Service	1134573124	1134573124	1	1	ADIBNAZARI, OMID MD	8/14/2019	207P00000X	NA	Other	026	PHYSICIANS	151524	66	Emergency Medicine (Urgent Care)	0	In state provider	None	13100 STUDEBAKER ROAD	None	NORWALK	CA	90650	2531	19	06037	33.912594	-118.099152	Los Angeles County
228747	Fee-for-Service	1881739530	1881739530	1	1	ARAI, SALLY MD	9/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87299	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
228756	Fee-for-Service	1669602132	1669602132	1	1	ANANIADES, KATERINA-ELENA C	1/10/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118992	08	Family Practice	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
228774	Fee-for-Service	1306194105	1306194105	1	1	AMH COMPREHENSIVE MEDICAL	2/1/2020	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CENTERS	711 NORTH ALVARADO ST	SUITE 101	LOS ANGELES	CA	90026	4016	19	06037	34.07424293	-118.2655575	Los Angeles County
228847	Fee-for-Service	1790202968	1790202968	1	2	APLA HEALTH AND WELLNESS	8/23/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	5901 W OLYMPIC BLVD	STE 310	LOS ANGELES	CA	90036	4664	19	06037	34.05764121	-118.3603115	Los Angeles County
228857	Fee-for-Service	1164086096	1164086096	1	1	ALL HOURS ADULT CARE, SPC	5/30/2019	No Taxonomy Provided	NA	None	093	CARE COORDINATOR AGENCIES (CCA)	-	-	NOT APPLICABLE	0	In state provider	None	11840 MAGNOLIA AVE	UNIT G	RIVERSIDE	CA	92503	4900	33	06065	33.89540021	-117.4902651	Riverside County
228871	Fee-for-Service	1134569429	1134569429	1	1	ABOLHODA MD INC	1/11/2016	208G00000X	NA	General Surgery	026	PHYSICIANS	85458	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	3801 KATELLA AVE	SUITE 207	LOS ALAMITOS	CA	90720	3382	30	06059	33.80318951	-118.066068	Orange County
228892	Fee-for-Service	1881688422	1881688422	1	1	AJIT, AMIRTHA MD	4/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	56179	41	Internal Medicine	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
228901	Fee-for-Service	1457394801	1457394801	1	1	AMIN, ALPESH N MD	8/23/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55162	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
228930	Fee-for-Service	1356603443	1356603443	1	1	ALCALA, CRISTIAN V LCSW	5/28/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
228966	Fee-for-Service	1346414612	1346414612	1	1	ALTAMED HEALTH SERVICES CORP	4/29/2008	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	6336 PASSONS BLVD	None	PICO RIVERA	CA	90660	3355	19	06037	33.98515856	-118.0862644	Los Angeles County
229052	Fee-for-Service	1528512514	1528512514	1	1	ANI, JORCYELIN LCSW	9/1/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2185 W GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75425686	-121.4567805	San Joaquin County
229062	Fee-for-Service	1306194105	1306194105	1	1	AMH COMPREHENSIVE MEDICAL	2/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CENTERS	711 NORTH ALVARADO ST	SUITE 101	LOS ANGELES	CA	90026	4016	19	06037	34.07424293	-118.2655575	Los Angeles County
229081	Fee-for-Service	1881897015	1881897015	1	1	AZHIBEKOV, TIMUR MD	10/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121856	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
229087	Fee-for-Service	1356697767	1356697767	1	1	ARCE, HOLLY-MARIE LP	12/4/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	01	06001	37.53384106	-121.9607241	Alameda County
229108	Fee-for-Service	1134261704	1134261704	1	1	ALLIED HEALTHCARE	6/23/2010	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PROFESSIONALS INC	869 LINDAWOOD ST	None	NEWBURY PARK	CA	91320	3633	56	06111	34.17935848	-118.9014883	Ventura County
229114	Fee-for-Service	1205270154	1205270154	1	1	ALLSTAR HEALTH PROVIDERS INC	12/19/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	8632 ARCHIBALD AVE	STE 201	RANCHO CUCAMONGA	CA	91730	7704	36	06071	34.09672027	-117.593499	San Bernardino County
229127	Fee-for-Service	1639382088	1639382088	1	1	ANDREWS, ROGER N MD INC	12/31/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	31944	34	Urology and Urological Surgery	0	In state provider	None	624 W DUARTE RD	STE 203	ARCADIA	CA	91007	9262	19	06037	34.12637452	-118.0527313	Los Angeles County
229135	Fee-for-Service	1790202968	1790202968	1	2	APLA HEALTH AND WELLNESS	1/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	AFFILIATED	5901 W OLYMPIC BLVD	STE 310	LOS ANGELES	CA	90036	4664	19	06037	34.05764121	-118.3603115	Los Angeles County
229177	Fee-for-Service	1639400260	1639400260	1	1	ASSUTA FAMILY MEDICAL GROUP	2/18/2010	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	APMC	12922 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	2924	19	06037	34.18665352	-118.414773	Los Angeles County
229252	Fee-for-Service	1346414612	1346414612	1	1	ALTAMED HEALTH SERVICES CORP	4/29/2008	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	6336 PASSONS BLVD	None	PICO RIVERA	CA	90660	3355	19	06037	33.98515856	-118.0862644	Los Angeles County
229253	Fee-for-Service	1952355851	1952355851	1	2	ADVANCED DIAGNOSTIC AND SURG	2/21/2024	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	ICAL CENTER, INC.	1668 S GARFIELD AVE	SUITE 100	ALHAMBRA	CA	91801	5474	19	06037	34.07553674	-118.1229866	Los Angeles County
229276	Fee-for-Service	1205914926	1205914926	1	1	ALDER, DOUGLAS M MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	73847	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
229283	Fee-for-Service	1053437640	1053437640	1	1	ARREDONDO, ALEJANDRO OD	2/25/2005	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	OPTOMETRIC CORP	4349 E SLAUSON AVE	STE A	MAYWOOD	CA	90270	2837	19	06037	33.98747885	-118.1883211	Los Angeles County
229292	Fee-for-Service	1508156423	1508156423	1	1	ADVENTIST HEALTH PHYSICIANS	2/6/2019	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	821 SAINT HELENA HWY S	None	SAINT HELENA	CA	94574	2266	28	06055	38.48731402	-122.448269	Napa County
229308	Fee-for-Service	1063482891	1063482891	1	1	ARNER, MARGARET	5/2/1984	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	36801	08	Family Practice	0	In state provider	None	1245 S MAIN ST	None	WILLITS	CA	95490	4305	23	06045	39.39914622	-123.3495915	Mendocino County
229338	Fee-for-Service	1295757516	1295757516	1	1	ANDERSON, BRAD S. MD	4/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	0000	00	None	44.08199228	-123.0283538	Lane County
229343	Fee-for-Service	1609539584	1609539584	1	1	AZA HOME HEALTH CARE INC	10/29/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	15206 VENTURA BLVD	SUITE 204	SHERMAN OAKS	CA	91403	5365	19	06037	34.15345738	-118.4641805	Los Angeles County
229348	Fee-for-Service	1306194105	1306194105	1	1	AMH COMPREHENSIVE MEDICAL	2/1/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CENTERS	711 NORTH ALVARADO ST	SUITE 101	LOS ANGELES	CA	90026	4016	19	06037	34.07424293	-118.2655575	Los Angeles County
229412	Fee-for-Service	1285678748	1285678748	1	1	ANDREW ATIEMO M.D.	8/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2000 S THOMPSON ST	None	FLAGSTAFF	AZ	86001	8759	00	None	35.184573	-111.674529	Coconino County
229456	Fee-for-Service	1871948521	1871948521	1	1	ANKER, THOMAS P DO MD	2/9/2018	163WG0000X	NA	Other	026	PHYSICIANS	15785	01	General Practice	0	In state provider	None	1524 MCHENRY AVE	SUITE 370	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
229457	Fee-for-Service	1528361540	1528361540	1	2	AGARWAL, ARUNIMA B MD	3/1/2017	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	121134	40	Pediatrics	0	In state provider	None	200 S WELLS ROAD	SUITE 100	VENTURA	CA	93004	1378	56	06111	34.29321532	-119.1597424	Ventura County
229465	Fee-for-Service	1639400260	1639400260	1	1	ASSUTA FAMILY MEDICAL GROUP	2/18/2010	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	34	Urology and Urological Surgery	0	In state provider	APMC	12922 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	2924	19	06037	34.18665352	-118.414773	Los Angeles County
229471	Fee-for-Service	1164593133	1164593133	1	1	ABROLAT, MARLA L MD	1/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	63833	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
229546	Fee-for-Service	1245480763	1245480763	1	1	ALICE, PATRICIA LCSW	8/23/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15580 POHEZ ROAD	None	APPLE VALLEY	CA	92307	4662	36	06071	34.53495577	-117.2597838	San Bernardino County
229570	Fee-for-Service	1467818419	1467818419	1	1	ART OF HEALING HOME HEALTH	7/30/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	6850 VAN NUYS BLVD	SUITE 303	VAN NUYS	CA	91405	4634	19	06037	34.195401	-118.4487235	Los Angeles County
229595	Fee-for-Service	1831789213	1831789213	1	1	AMPARO, LOUIE J CRNA	2/5/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	207 W LEGION	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
229597	Fee-for-Service	1629541362	1629541362	1	1	ASNER LUCKERMAN, KATIE LMFT	11/2/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23822 VALENCIA BLVD	207	VALENCIA	CA	91355	5302	19	06037	34.41372708	-118.5513626	Los Angeles County
229666	Fee-for-Service	1558363986	1558363986	1	1	ASPIRUS WAUSAU HOSPITAL, INC	6/21/2023	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	333 PINE RIDGE BLVD	None	WAUSAU	WI	54401	4120	00	None	44.966367	-89.667756	Marathon County
229691	Fee-for-Service	1295165231	1295165231	1	1	ANDERSON, MICHELLE D	8/8/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9333 E ROSECRANS AVE	None	LOS ANGELES	CA	90706	2141	19	06037	33.90413858	-118.1346616	Los Angeles
229739	Fee-for-Service	1922362425	1922362425	1	1	AMERI, ALLEN MD	9/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139594	77	Infectious Disease	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
229751	Fee-for-Service	1639400260	1639400260	1	1	ASSUTA FAMILY MEDICAL GROUP	2/18/2010	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	APMC	12922 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	2924	19	06037	34.18665352	-118.414773	Los Angeles County
229798	Fee-for-Service	1497760177	1497760177	1	1	ALEKSANDRA BASHEER	11/18/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 S POTOMAC ST	None	AURORA	CO	80012	5411	00	None	39.689343	-104.832198	Arapahoe County
229823	Fee-for-Service	1114523958	1114523958	1	1	AVILA, ALESSANDRO MD	8/20/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	19	06037	34.27684353	-118.4684024	Los Angeles County
229828	Fee-for-Service	1093238164	1093238164	1	1	AGUILAR, KRYSTAL LCSW	2/5/2024	363LP0808X	NA	Nurse Practitioner	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 MUIR RD	None	MARTINEZ	CA	94553	4614	07	06013	37.99430233	-122.1107194	Contra Costa County
229843	Fee-for-Service	1457992265	1457992265	1	1	ALL DAY HOSPICE CARE INC	12/23/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6742 VAN NUYS BLVD	STE 204	VAN NUYS	CA	91405	4611	19	06037	34.19343344	-118.4487213	Los Angeles County
229847	Fee-for-Service	1821604265	1821604265	1	1	ARVIA DIAGNOSTICS, INC.	2/21/2021	293D00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	356 E OLIVE AVE	108	BURBANK	CA	91502	1261	19	06037	34.18278666	-118.3066979	Los Angeles County
229876	Fee-for-Service	1073805248	1073805248	1	1	ADMANI, SHEHLA MD	8/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	122465	01	General Practice	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
229901	Fee-for-Service	1538470778	1538470778	1	1	ABAUNZA, MIRIAM MD	6/24/2019	208600000X	NA	General Surgery	026	PHYSICIANS	161267	01	General Practice	0	In state provider	None	12260 FOOTHILL BLVD	None	SYLMAR	CA	91342	6001	19	06037	34.28200485	-118.4030797	Los Angeles County
229903	Fee-for-Service	1902008642	1902008642	1	2	ADVANCED MEMORIAL	9/27/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	32743	30	Radiology	0	In state provider	IMAGING GROUP, AMC	301 W BASTANCHURY RD	SUITE 130	FULLERTON	CA	92835	3423	30	06059	33.89397383	-117.9316737	Orange County
229918	Fee-for-Service	1700025780	1700025780	1	1	ABYE, MINALESHOA H MD	10/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	105237	40	Pediatrics	0	In state provider	None	2151 WEST GRANT LINE RD	None	TRACY	CA	95377	7309	39	06077	37.75424753	-121.455621	San Joaquin County
229943	Fee-for-Service	1043282841	1043282841	1	1	AMERIPATH NEW YORK LLC	11/28/2018	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	100 MIDLAND AVE	None	PORT CHESTER	NY	10573	4943	00	None	40.99419	-73.6688295	Westchester County
229950	Fee-for-Service	1558363986	1558363986	1	1	ASPIRUS WAUSAU HOSPITAL, INC	6/21/2023	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	333 PINE RIDGE BLVD	None	WAUSAU	WI	54401	4120	00	None	44.966367	-89.667756	Marathon County
229952	Fee-for-Service	1790833119	1790833119	1	1	ALVAREZ-MARTINEZ,	3/26/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	93797	08	Family Practice	0	In state provider	LILIANA MD	3946 NORWOOD AVE	None	SACRAMENTO	CA	95838	3300	34	06067	38.639952	-121.456359	Sacramento County
229957	Fee-for-Service	1417010604	1417010604	1	2	ABLELIGHT INC	1/28/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	COMMUNITIES INC	24472 FERROCARRIL	None	MISSION VIEJO	CA	92691	4027	30	06059	33.60744454	-117.6761457	Orange County
229967	Fee-for-Service	1720147689	1720147689	1	1	ALPHA HEALTHCARE MANAGEMENT	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED	373 VAN NESS AVENUE	SUITE 260	TORRANCE	CA	90501	6244	19	06037	33.844536	-118.3219785	Los Angeles County
229977	Fee-for-Service	1194860460	1194860460	1	1	AWATANI, SHEFALI MD	2/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	85464	41	Internal Medicine	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
229998	Fee-for-Service	1689781965	1689781965	1	1	ADAMS, CAMERON R MD	12/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	82192	13	Neurology (M.D. only)	0	In state provider	TOWER NEUROLOGICAL SERV	8631 W 3RD ST	STE 1020 E	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
230017	Fee-for-Service	1790167054	1790167054	1	1	AZIZ, HOSSEIN DO	4/2/2025	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	15268	20	Orthopedic Surgery	0	In state provider	None	3525 LOMA VISTA ROAD	SUITE A	VENTURA	CA	93003	3165	56	06111	34.27680789	-119.2480851	Ventura County
230026	Fee-for-Service	1922362425	1922362425	1	1	AMERI, ALLEN MD	9/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139594	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
230048	Fee-for-Service	1952489528	1952489528	1	1	AKINS, PAUL T MD	6/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	83907	13	Neurology (M.D. only)	0	In state provider	None	2825 J ST	STE 435	SACRAMENTO	CA	95816	4300	34	06067	38.573757	-121.468248	Sacramento County
230053	Fee-for-Service	1780976654	1780976654	1	1	ANVARI, EIMAN N DO	7/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14515	30	Radiology	0	In state provider	None	200 WEST ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
230062	Fee-for-Service	1548362312	1548362312	1	1	ALUZRI, GHADA MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	48738	05	Anesthesiology	0	In state provider	None	23201 LAKE CENTER DR	STE 214	LAKE FOREST	CA	92630	6808	30	06059	33.6255281	-117.7160257	Orange County
230064	Fee-for-Service	1528514247	1528514247	1	1	ABELLA AYALA, FRANK MD	7/13/2022	207WX0109X	NA	Ophthalmology	026	PHYSICIANS	177276	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
230082	Fee-for-Service	1750356176	1750356176	1	1	ARIATHURAI, SUNDERA V MD	7/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	33601	30	Radiology	0	In state provider	None	720 E COLORADO STREET	None	GLENDALE	CA	91205	1712	19	06037	34.14263851	-118.245897	Los Angeles County
230097	Fee-for-Service	1326467317	1326467317	1	1	ADAIR, JOHN MD	3/14/2024	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	192345	None	None	0	In state provider	None	1600 N ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
230130	Fee-for-Service	1457992265	1457992265	1	1	ALL DAY HOSPICE CARE INC	12/23/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6742 VAN NUYS BLVD	STE 204	VAN NUYS	CA	91405	4611	19	06037	34.19343344	-118.4487213	Los Angeles County
230144	Fee-for-Service	1679000103	1679000103	1	1	AXE, DAVID J MD	9/9/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
230169	Fee-for-Service	1538274709	1538274709	1	1	ALLSING, STEVEN R MD	7/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	84903	20	Orthopedic Surgery	0	In state provider	None	5565 GROSSMONT CENTER DR	# 3-154	LA MESA	CA	91942	3020	37	06073	32.77978322	-117.0094766	San Diego County
230183	Fee-for-Service	1578091567	1578091567	1	1	ANJORIN, FATIMAH CCC-SLP	3/19/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8550 BALBOA BLVD	SUITE 242	NORTHRIDGE	CA	91325	3593	19	06037	34.225713	-118.5026045	Los Angeles County
230205	Fee-for-Service	1235452335	1235452335	1	1	ARTISAN FOOT AND ANKLE PODIA	10/7/2022	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	SPECIALIST, INC	23141 MOULTON PKWY	STE 109	LAGUNA HILLS	CA	92653	1241	30	06059	33.62613379	-117.7305831	Orange County
230222	Fee-for-Service	1568526689	1568526689	1	1	ABBES, EDGAR A DPM	7/1/1991	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	16415 COLORADO AVE	STE 112	PARAMOUNT	CA	90723	5051	19	06037	33.8853075	-118.1614695	Los Angeles County
230254	Fee-for-Service	1720147689	1720147689	1	1	ALPHA HEALTHCARE MANAGEMENT	10/1/2009	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED	373 VAN NESS AVENUE	SUITE 260	TORRANCE	CA	90501	6244	19	06037	33.844536	-118.3219785	Los Angeles County
230267	Fee-for-Service	1609194950	1609194950	1	1	ANKRAH, BELINDA CNP	6/18/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
230326	Fee-for-Service	1750559431	1750559431	1	11	ALL STAR PHYSICAL THERAPY, I	4/30/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	16008 KAMANA RD.,	SUITE 200	APPLE VALLEY	CA	92307	0000	36	06071	34.54191149	-117.2725046	San Bernardino County
230355	Fee-for-Service	1013955442	1013955442	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	23850 W COPPER HILL RD	None	VALENCIA	CA	91354	1701	19	06037	34.46315853	-118.5566175	Los Angeles County
230372	Fee-for-Service	1518296110	1518296110	1	1	ANDREWS, SALLY J	5/20/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
230396	Fee-for-Service	1356696975	1356696975	1	1	AMII, KRISTINE N	1/11/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
230398	Fee-for-Service	1194705962	1194705962	1	1	ARKO, FRANK R MD	7/28/2008	208600000X	NA	General Surgery	026	PHYSICIANS	39227	02	General Surgery	0	In state provider	None	326 W HOBSON WY	None	BLYTHE	CA	92225	1640	33	06065	33.6101727	-114.6001127	Riverside County
230423	Fee-for-Service	1134374432	1134374432	1	1	AYERS, JERRY D MD INC	8/20/2012	207QA0401X	NA	Adult Primary Care	026	PHYSICIANS	42793	08	Family Practice	0	In state provider	None	2121 5TH AVE	STE 105	SAN DIEGO	CA	92101	2139	37	06073	32.727447	-117.160241	San Diego County
230465	Fee-for-Service	1922528694	1922528694	1	1	ASIAN & PACIFIC ISLANDER	8/2/2017	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1800 MARKET STREET	SUITE 401	SAN FRANCISCO	CA	94102	6227	38	06075	37.77161808	-122.4238295	San Francisco County
230478	Fee-for-Service	1003261454	1003261454	1	1	ASHLEY, JACQUELINE S LCSW	10/2/2018	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7140 INDIANA AVE	None	RIVERSIDE	CA	92504	4544	33	06065	33.93890182	-117.3977958	Riverside County
230492	Fee-for-Service	1235452335	1235452335	1	1	ARTISAN FOOT AND ANKLE PODIA	8/29/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	SPECIALIST, INC	23141 MOULTON PKWY	STE 109	LAGUNA HILLS	CA	92653	1241	30	06059	33.62613379	-117.7305831	Orange County
230503	Fee-for-Service	1033564026	1033564026	1	1	AYSHA AGARWAL MD	2/23/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3330 N 2ND ST	STE 300	PHOENIX	AZ	85012	2369	00	None	33.486606	-112.071654	Maricopa County
230519	Fee-for-Service	1003891482	1003891482	1	1	AUSTIN, KATHERINE C MD	2/28/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	176875	None	None	0	In state provider	D	1000 VALE TERRACE DR.	None	VISTA	CA	92084	5218	37	06073	33.20904502	-117.2286439	San Diego County
230559	Fee-for-Service	1922022532	1922022532	1	1	ALLEGIANCE HOME HEALTH INC	7/18/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	801 S GARFIELD AVE	SUITE 238	ALHAMBRA	CA	91801	4483	19	06037	34.087077	-118.123086	Los Angeles County
230578	Fee-for-Service	1578852877	1578852877	1	1	ANTUNEZ, FRANCISCO J MD	7/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129413	66	Emergency Medicine (Urgent Care)	0	In state provider	None	333 MERCY AVE	None	MERCED	CA	95340	8319	24	06047	37.33875148	-120.467457	Merced County
230590	Fee-for-Service	1629030515	1629030515	1	1	ADLER, FREDERICK W MD	12/1/1994	207P00000X	NA	Other	026	PHYSICIANS	50673	01	General Practice	0	In state provider	None	1733 CENTRAL AVE	None	MCKINLEYVILLE	CA	95519	3601	12	06023	40.93684932	-124.1008968	Humboldt County
230614	Fee-for-Service	1750559431	1750559431	1	11	ALL STAR PHYSICAL THERAPY, I	11/10/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	16008 KAMANA RD.,	SUITE 200	APPLE VALLEY	CA	92307	0000	36	06071	34.54191149	-117.2725046	San Bernardino County
230619	Fee-for-Service	1568525954	1568525954	1	1	ACOLATSE, JULIET D PHD	6/20/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1201 N SUTTER ST	None	STOCKTON	CA	95202	1506	39	06077	37.96541565	-121.2891842	San Joaquin County
230620	Fee-for-Service	1447319231	1447319231	1	1	ASSOCIATED REHABILITATION PR	12/18/2019	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	8400 FAIR OAKS BLVD	None	CARMICHAEL	CA	95608	2502	34	06067	38.636055	-121.306491	Sacramento County
230630	Fee-for-Service	1346311149	1346311149	1	1	ARCHIBALD, GERI	5/12/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	41	06081	37.53039072	-122.2987772	San Mateo County
230640	Fee-for-Service	1316226996	1316226996	1	1	AMBER JOHNSON	9/27/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	323 SW 10TH ST	None	MADISON	SD	57042	3200	00	None	43.99302789	-97.11819925	Lake County
230642	Fee-for-Service	1952333635	1952333635	1	1	AMPLA HEALTH	9/1/1992	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MEDICAL & DENTAL	2800 LINCOLN BLVD	None	OROVILLE	CA	95966	5961	04	06007	39.5019672	-121.5515919	Butte County
230647	Fee-for-Service	1306194105	1306194105	1	2	AMH COMPREHENSIVE MEDICAL	2/1/2020	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6017 ATLANTIC BLVD	None	MAYWOOD	CA	90270	3118	19	06037	33.98469611	-118.1859858	Los Angeles County
230660	Fee-for-Service	1073642682	1073642682	1	1	ASIAN PACIFIC HEALTH	12/11/2024	261QC1500X	NA	Other	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CARE VENTURE, INC	1530 HILLHURST AVE	STE 200	LOS ANGELES	CA	90027	5516	19	06037	34.098921	-118.287374	Los Angeles County
230711	Fee-for-Service	1134374432	1134374432	1	1	AYERS, JERRY D MD INC	8/20/2012	207QA0401X	NA	Adult Primary Care	026	PHYSICIANS	42793	01	General Practice	0	In state provider	None	2121 5TH AVE	STE 105	SAN DIEGO	CA	92101	2139	37	06073	32.727447	-117.160241	San Diego County
230717	Fee-for-Service	1588061345	1588061345	1	1	ATLAS PSYCHOLOGICAL FAMILY	12/26/2018	No Taxonomy Provided	NA	None	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	COUNSELING WELLNESS	1513 E CHAPMAN AVE	None	FULLERTON	CA	92831	4013	30	06059	33.8741613	-117.9005017	Orange County
230728	Fee-for-Service	1649348624	1649348624	1	1	ADDISON, ELISA LMFT	7/10/2020	171M00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
230751	Fee-for-Service	1922528694	1922528694	1	1	ASIAN & PACIFIC ISLANDER	8/2/2017	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	1800 MARKET STREET	SUITE 401	SAN FRANCISCO	CA	94102	6227	38	06075	37.77161808	-122.4238295	San Francisco County
230754	Fee-for-Service	1942506605	1942506605	1	1	ALTURA CENTERS FOR HEALTH	7/6/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1203 N CHERRY STREET	None	TULARE	CA	93274	2233	54	06107	36.224964	-119.336946	Tulare County
230795	Fee-for-Service	1003387473	1003387473	1	1	ARGENTE, MELISSA D RCP	4/9/2019	227900000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
230873	Fee-for-Service	1194309542	1194309542	1	1	ACTIVE SPORTS REHAB PHYSICAL	9/24/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	THERAPY	6850 LINCOLN AVE	STE 205	BUENA PARK	CA	90620	4180	30	06059	33.8317925	-118.0136745	Orange County
230879	Fee-for-Service	1629030515	1629030515	1	1	ADLER, FREDERICK W MD	12/1/1994	207P00000X	NA	Other	026	PHYSICIANS	50673	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1733 CENTRAL AVE	None	MCKINLEYVILLE	CA	95519	3601	12	06023	40.93684932	-124.1008968	Humboldt County
230882	Fee-for-Service	1659442614	1659442614	1	1	ACEVEDO, MAURICIO MD	4/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	56107	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
230887	Fee-for-Service	1437100948	1437100948	1	1	AKTAY, RECAI MD	6/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	52997	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
230901	Fee-for-Service	1750559431	1750559431	1	11	ALL STAR PHYSICAL THERAPY, I	3/26/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	16008 KAMANA RD.,	SUITE 200	APPLE VALLEY	CA	92307	0000	36	06071	34.54191149	-117.2725046	San Bernardino County
230929	Fee-for-Service	1952333635	1952333635	1	1	AMPLA HEALTH	7/1/1994	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	MEDICAL & DENTAL	2800 LINCOLN BLVD	None	OROVILLE	CA	95966	5961	04	06007	39.5019672	-121.5515919	Butte County
230932	Fee-for-Service	1548249709	1548249709	1	1	ANCHORDOGVY, ROSALIE A	10/1/1998	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	24250 STRING CREEK RD	None	WILLITS	CA	95490	9244	23	06045	39.45116792	-123.3149532	Mendocino County
230937	Fee-for-Service	1306194105	1306194105	1	2	AMH COMPREHENSIVE MEDICAL	2/1/2020	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	6017 ATLANTIC BLVD	None	MAYWOOD	CA	90270	3118	19	06037	33.98469611	-118.1859858	Los Angeles County
230967	Fee-for-Service	1760644678	1760644678	1	1	ABRA, GRAHAM E MD	3/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	102026	08	Family Practice	0	In state provider	None	4647 ZION AVENUE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
231015	Fee-for-Service	1013105212	1013105212	1	1	ASHRAF, MOHAMMAD MD INC	7/27/1980	207R00000X	NA	Other	026	PHYSICIANS	35686	41	Internal Medicine	0	In state provider	None	1260 E ALMOND AVE	None	MADERA	CA	93637	6500	20	06039	36.9453747	-120.0454403	Madera County
231027	Fee-for-Service	1841670841	1841670841	1	1	AL-LOUZI, OMAR	7/8/2021	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	170549	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
231042	Fee-for-Service	1942506605	1942506605	1	1	ALTURA CENTERS FOR HEALTH	7/6/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1203 N CHERRY STREET	None	TULARE	CA	93274	2233	54	06107	36.224964	-119.336946	Tulare County
231157	Fee-for-Service	1639453905	1639453905	1	1	ATTIA, REHAM A Y MD	6/1/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	118047	01	General Practice	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
231165	Fee-for-Service	1457442931	1457442931	1	1	ABOUZAMZAM, ASHRAF A MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65819	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
231166	Fee-for-Service	1629030515	1629030515	1	1	ADLER, FREDERICK W MD	12/1/1994	207P00000X	NA	Other	026	PHYSICIANS	50673	08	Family Practice	0	In state provider	None	1733 CENTRAL AVE	None	MCKINLEYVILLE	CA	95519	3601	12	06023	40.93684932	-124.1008968	Humboldt County
231167	Fee-for-Service	1659442614	1659442614	1	1	ACEVEDO, MAURICIO MD	4/30/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	56107	41	Internal Medicine	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
231185	Fee-for-Service	1730361569	1730361569	1	1	ARC OF SAN DIEGO	1/23/1994	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	9075 CREEKFORD DR	None	LAKESIDE	CA	92040	3703	37	06073	32.84174157	-116.9355899	San Diego County
231214	Fee-for-Service	1194288159	1194288159	1	1	AMA HOSPICE, INC	3/25/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14553 DELANO ST	STE 314	VAN NUYS	CA	91411	2820	19	06037	34.18266949	-118.450629	Los Angeles County
231218	Fee-for-Service	1952333635	1952333635	1	1	AMPLA HEALTH	3/25/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	MEDICAL & DENTAL	2800 LINCOLN BLVD	None	OROVILLE	CA	95966	5961	04	06007	39.5019672	-121.5515919	Butte County
231240	Fee-for-Service	1922327402	1922327402	1	1	ARIMIE, RALUCA MEDICAL	9/15/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	54502	06	Cardiovascular Disease (M.D. only)	0	In state provider	CORPORATION	7325 MEDICAL CENTER DR	STE 306	WEST HILLS	CA	91307	4116	19	06037	34.20369349	-118.629837	Los Angeles County
231304	Fee-for-Service	1013105212	1013105212	1	1	ASHRAF, MOHAMMAD MD INC	7/27/1980	207R00000X	NA	Other	026	PHYSICIANS	35686	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1260 E ALMOND AVE	None	MADERA	CA	93637	6500	20	06039	36.9453747	-120.0454403	Madera County
231312	Fee-for-Service	1629539887	1629539887	1	1	ADAMS, STERLING G DO	7/27/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	19443	None	None	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
231324	Fee-for-Service	1851636625	1851636625	1	1	ALLIANCE REHAB INC	8/13/2018	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	9555 WARNER AVE	SUITE A	FOUNTAIN VALLEY	CA	92708	2827	30	06059	33.71617072	-117.9626877	Orange County
231328	Fee-for-Service	1053990549	1053990549	1	1	AQEEL, FADI DPM	7/17/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1334 W COVINA BLVD 105	None	SAN DIMAS	CA	91773	3211	19	06037	34.097067	-117.833751	Los Angeles County
231361	Fee-for-Service	1164584041	1164584041	1	2	ALLIANCE HEALTHCARE SERVICES	10/3/2019	261QR0208X	NA	Mammography Provider	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	INC	2330 BUHNE ST	None	EUREKA	CA	95501	3237	12	06023	40.78589338	-124.1424621	Humboldt County
231363	Fee-for-Service	1710284963	1710284963	1	1	ADVENTIST HEALTH PHYSICIANS	3/30/2011	2084P0800X	NA	Psychiatry	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	913 WASHINGTON ST	None	CALISTOGA	CA	94515	1433	28	06055	38.57812737	-122.5772111	Napa County
231376	Fee-for-Service	1730119553	1730119553	1	8	AFFILIATED PATHOLOGISTS MEDI	11/28/1990	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	24451 HEALTH CENTER DR	None	LAGUNA HILLS	CA	92653	3689	30	06059	33.60848903	-117.7079742	Orange County
231381	Fee-for-Service	1497003339	1497003339	1	1	ARIZONA PHYSICIAN SERVICES	11/19/2013	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	LLC	101 CIVIC CENTER LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
231419	Fee-for-Service	1902133093	1902133093	1	1	AMIRIKIA, KATHRYN C MD INC	11/18/2009	208600000X	NA	General Surgery	026	PHYSICIANS	86919	02	General Surgery	0	In state provider	None	7501 HOSPITAL DR	STE 305	SACRAMENTO	CA	95823	5405	34	06067	38.464776	-121.416912	Sacramento County
231441	Fee-for-Service	1841491644	1841491644	1	1	ALAMEDA COUNTY MED CTR	7/1/1998	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	NEWARK HEALTH CENTER	6955 FOOTHILL BLVD	STE 200	OAKLAND	CA	94605	2426	01	06001	37.76924146	-122.1732586	Alameda County
231448	Fee-for-Service	1689715070	1689715070	1	1	ARMINE NAZARYAN MD MEDICAL	8/27/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	85687	01	General Practice	0	In state provider	CLINIC INC APC	221 S GLENDALE AVE	None	GLENDALE	CA	91205	1713	19	06037	34.14369184	-118.2485831	Los Angeles County
231455	Fee-for-Service	1457442931	1457442931	1	1	ABOUZAMZAM, ASHRAF A MD	1/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65819	05	Anesthesiology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
231469	Fee-for-Service	1184391070	1184391070	1	1	ACCURO HOMES	7/5/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	6764 BLACK FOREST DRIVE	None	EASTVALE	CA	92880	3922	33	06065	33.96554816	-117.571826	Riverside County
231484	Fee-for-Service	1689832966	1689832966	1	1	AKMAL, YASIR M MD	7/21/2009	208600000X	NA	General Surgery	026	PHYSICIANS	106981	02	General Surgery	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
231496	Fee-for-Service	1245604925	1245604925	1	1	AVALON VILLA HEALTH CARE LLC	9/4/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	12029 AVALON BLVD	None	LOS ANGELES	CA	90061	2838	19	06037	33.922818	-118.2652565	Los Angeles County
231504	Fee-for-Service	1194288159	1194288159	1	1	AMA HOSPICE, INC	3/25/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14553 DELANO ST	STE 314	VAN NUYS	CA	91411	2820	19	06037	34.18266949	-118.450629	Los Angeles County
231505	Fee-for-Service	1952333635	1952333635	1	1	AMPLA HEALTH	9/1/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MEDICAL & DENTAL	2800 LINCOLN BLVD	None	OROVILLE	CA	95966	5961	04	06007	39.5019672	-121.5515919	Butte County
231515	Fee-for-Service	1487929139	1487929139	1	1	ALLEN, KRISTIN K MD	5/11/2012	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
231526	Fee-for-Service	1740324508	1740324508	1	1	AMERICAN HEARING AND	7/30/2007	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	BALANCE	6229 W 87TH ST	None	LOS ANGELES	CA	90045	3901	19	06037	33.95860798	-118.3941238	Los Angeles County
231581	Fee-for-Service	1851446132	1851446132	1	1	ADOLESCENT AND CHILDRENS	12/1/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	ORTHOPEDIC SURGEONS INC	5353 BALBOA BLVD	STE 202	ENCINO	CA	91316	2889	19	06037	34.169067	-118.501128	Los Angeles County
231592	Fee-for-Service	1043352586	1043352586	2	1	ALPHA CLINICAL LABORATORY, I	3/19/2021	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	NC.	3021 N. SAN FERNANDO BLV	SUITE C	BURBANK	CA	91504	4709	19	06037	34.20186711	-118.3437848	Los Angeles County
231599	Fee-for-Service	1871798470	1871798470	1	1	ARNAOUT, RIMA MD	5/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106942	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
231612	Fee-for-Service	1033455787	1033455787	1	1	ADVANCED TRANSIT LLC	7/30/2018	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	180 PROMENADE CIRCLE	STE 300	SACRAMENTO	CA	95834	2952	34	06067	38.636649	-121.49838	Sacramento County
231662	Fee-for-Service	1154369049	1154369049	2	2	ALLIED MEDICAL SUPPLY, INC	2/6/2024	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	170 EL CAMINO REAL	101	TUSTIN	CA	92780	3658	30	06059	33.744573	-117.823696	Orange County
231677	Fee-for-Service	1043606130	1043606130	1	1	AGUSTIN, GLENDA MD	10/12/2022	207R00000X	NA	Other	026	PHYSICIANS	176195	None	None	0	In state provider	None	1420 RIVER PARK DR	STE 120	SACRAMENTO	CA	95815	4506	34	06067	38.597571	-121.4392905	Sacramento County
231678	Fee-for-Service	1942624101	1942624101	1	1	A NEW DAY HOSPICE CARE	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	495 E RINCON ST	SUITE 100	CORONA	CA	92879	1306	33	06065	33.88626226	-117.5607759	Riverside County
231705	Fee-for-Service	1902133093	1902133093	1	1	AMIRIKIA, KATHRYN C MD INC	11/18/2009	208600000X	NA	General Surgery	026	PHYSICIANS	86919	78	Neoplastic Diseases/Oncology	0	In state provider	None	7501 HOSPITAL DR	STE 305	SACRAMENTO	CA	95823	5405	34	06067	38.464776	-121.416912	Sacramento County
231737	Fee-for-Service	1396909537	1396909537	1	1	ALHAZMI, ALAA A MD	6/9/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107738	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
231766	Fee-for-Service	1225492457	1225492457	1	1	ALBERTO, FABIAN MD	10/11/2022	208600000X	NA	General Surgery	026	PHYSICIANS	181948	None	None	0	In state provider	None	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	34	06067	38.571084	-121.471074	Sacramento County
231776	Fee-for-Service	1689832966	1689832966	1	1	AKMAL, YASIR M MD	7/21/2009	208600000X	NA	General Surgery	026	PHYSICIANS	106981	78	Neoplastic Diseases/Oncology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
231777	Fee-for-Service	1306031240	1306031240	1	1	AMEZCUA, LILYANA MD	11/20/2007	2084P0800X	NA	Psychiatry	026	PHYSICIANS	86709	36	Psychiatry	0	In state provider	None	1520 SAN PABLO ST	STE 3000	LOS ANGELES	CA	90033	5315	19	06037	34.06269295	-118.2030006	Los Angeles County
231785	Fee-for-Service	1689706418	1689706418	1	1	ALCANTAR, CRISTINA LMFT	7/6/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	200 N BROADWAY	SUITE D	TURLOCK	CA	95380	4755	50	06099	37.49472973	-120.8495129	Stanislaus County
231791	Fee-for-Service	1356693436	1356693436	1	1	ATLANTIC MEDICAL, LLC	5/23/2024	3336C0003X	NA	Pharmacies	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	915 FERNCLIFF COVE	SUITE 1A	SOUTHAVEN	MS	38671	2420	00	None	34.98864252	-90.005877	DeSoto County
231808	Fee-for-Service	1508114505	1508114505	2	1	ABBEY ROAD VILLA LLC	10/21/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	14132 HUBBARD STREET	None	SYLMAR	CA	91342	4712	19	06037	34.29801426	-118.4408207	Los Angeles County
231855	Fee-for-Service	1740209295	1740209295	1	1	AVULA, VENKATESWARA R	6/30/1990	207RH0003X	NA	Oncology	026	PHYSICIANS	50020	68	Hematology	0	In state provider	None	4134 E CLINTON AVE	None	FRESNO	CA	93703	2520	10	06019	36.77229255	-119.754909	Fresno County
231871	Fee-for-Service	1851446132	1851446132	1	1	ADOLESCENT AND CHILDRENS	9/1/2005	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	ORTHOPEDIC SURGEONS INC	5353 BALBOA BLVD	STE 202	ENCINO	CA	91316	2889	19	06037	34.169067	-118.501128	Los Angeles County
231875	Fee-for-Service	1114430139	1114430139	1	1	AVB & LV CORPORATION	11/21/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	18340 VENTURA BLVD	STE 220	TARZANA	CA	91356	4269	19	06037	34.16710415	-118.5320031	Los Angeles County
231876	Fee-for-Service	1790826923	1790826923	1	1	AL-AHMAD, AMIN MD	7/10/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82897	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
231879	Fee-for-Service	1700070273	1700070273	1	1	AGGARWAL, PIYUSH MD	2/4/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	157104	01	General Practice	0	In state provider	None	1479 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	2986	07	06013	37.91301169	-122.0438513	Contra Costa County
231886	Fee-for-Service	1871798470	1871798470	1	1	ARNAOUT, RIMA MD	5/31/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106942	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
231901	Fee-for-Service	1396069217	1396069217	1	1	AAA MEDICAL SOLUTIONS INC	3/15/2011	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	2	Out of state provider	INCORPORATED	412 S KING AVENUE	STE 100	MIDDLETON	ID	83644	5294	00	None	43.701858	-116.615682	Canyon County
231911	Fee-for-Service	1265434096	1265434096	1	1	AUSTIN, DAVID MD	1/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	92271	40	Pediatrics	0	In state provider	None	2067 W VISTA WAY	STE 180	VISTA	CA	92083	6033	37	06073	33.18505594	-117.285958	San Diego County
231912	Fee-for-Service	1306042684	1306042684	1	1	ATWAL, PARAMJEET K MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120307	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
231964	Fee-for-Service	1942624101	1942624101	1	1	A NEW DAY HOSPICE CARE	4/18/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	495 E RINCON ST	SUITE 100	CORONA	CA	92879	1306	33	06065	33.88626226	-117.5607759	Riverside County
231971	Fee-for-Service	1578871406	1578871406	1	1	ALPHA MEDICAL PHARMACY INC	5/6/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1418 S SAN GABRIEL BLVD	SUITE A	SAN GABRIEL	CA	91776	4605	19	06037	34.082541	-118.090754	Los Angeles County
231973	Fee-for-Service	1366981581	1366981581	1	1	ALI GOLSHAN MD INC	1/17/2024	2085R0204X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	4281 KATELLA AVE	120	LOS ALAMITOS	CA	90720	3500	30	06059	33.80315853	-118.058328	Orange County
231987	Fee-for-Service	1245498583	1245498583	1	1	AMANDA EGAN NP	5/26/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4125 BRIARGATE PKWY	None	COLORADO SPGS	CO	80920	7804	00	None	38.96575196	-104.7533195	El Paso County
231990	Fee-for-Service	1679598908	1679598908	1	1	ADRIAN, KAREN LMFT	10/4/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
232065	Fee-for-Service	1306031240	1306031240	1	1	AMEZCUA, LILYANA MD	11/20/2007	2084P0800X	NA	Psychiatry	026	PHYSICIANS	86709	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	STE 3000	LOS ANGELES	CA	90033	5315	19	06037	34.06269295	-118.2030006	Los Angeles County
232089	Fee-for-Service	1841229010	1841229010	1	1	ASANDRA, CHRISTOPHER F MD	3/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	130701	66	Emergency Medicine (Urgent Care)	0	In state provider	None	420 34TH ST	None	BAKERSFIELD	CA	93301	2237	15	06029	35.39052148	-119.0070765	Kern County
232104	Fee-for-Service	1376056002	1376056002	1	7	AFFORDABLE SENIOR HOUSING FO	9/27/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1353 OAK HILL DRIVE	None	ESCONDIDO	CA	92027	3604	37	06073	33.12529181	-117.0602397	San Diego County
232111	Fee-for-Service	1467955286	1467955286	1	1	ALAM, ASIM MD	1/3/2022	207R00000X	NA	Other	026	PHYSICIANS	164606	None	None	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
232113	Fee-for-Service	1649249954	1649249954	1	1	ANDERSON, STEPHANIE S MD	7/11/2017	207R00000X	NA	Other	026	PHYSICIANS	68009	41	Internal Medicine	0	In state provider	None	650 5TH STREET	STE 502	SAN FRANCISCO	CA	94107	1536	38	06075	37.77575268	-122.3977845	San Francisco County
232140	Fee-for-Service	1841889565	1841889565	1	1	ALICE WAITHIRA KARANJA	4/13/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	10 PINE COURT	None	INGLEWOOD	CA	90302	2930	19	06037	33.96948254	-118.3624988	Los Angeles County
232144	Fee-for-Service	1740209295	1740209295	1	1	AVULA, VENKATESWARA R	6/30/1990	207RH0003X	NA	Oncology	026	PHYSICIANS	50020	78	Neoplastic Diseases/Oncology	0	In state provider	None	4134 E CLINTON AVE	None	FRESNO	CA	93703	2520	10	06019	36.77229255	-119.754909	Fresno County
232145	Fee-for-Service	1669501524	1669501524	1	1	AKAMATSU, JOHN A OD INC	5/1/1996	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	237 N BRAND BLVD	None	GLENDALE	CA	91203	2609	19	06037	34.14947165	-118.2551114	Los Angeles County
232153	Fee-for-Service	1386841476	1386841476	1	1	ALLIANCE MEDICAL CENTER	7/1/1994	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	49	06097	38.62729851	-122.8637785	Sonoma County
232156	Fee-for-Service	1851446132	1851446132	1	1	ADOLESCENT AND CHILDRENS	12/1/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	ORTHOPEDIC SURGEONS INC	5353 BALBOA BLVD	STE 202	ENCINO	CA	91316	2889	19	06037	34.169067	-118.501128	Los Angeles County
232171	Fee-for-Service	1417010604	1417010604	1	19	ABLELIGHT INC	6/2/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	25552 CHARLEMAGNE ROAD	None	LAGUNA HILLS	CA	92653	5068	30	06059	33.59693129	-117.6840065	Orange County
232197	Fee-for-Service	1619106176	1619106176	1	1	ANDERS, MARIA A DO	11/12/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12920	41	Internal Medicine	0	In state provider	None	2615 CHESTER AVE	None	BAKERSFIELD	CA	93301	2014	15	06029	35.38333823	-119.0188872	Kern County
232202	Fee-for-Service	1306042684	1306042684	1	1	ATWAL, PARAMJEET K MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120307	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
232251	Fee-for-Service	1396783379	1396783379	1	15	ASANA INTEGRATED MEDICAL GRO	10/13/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP PC	768 MOUNTAIN RANCH RD	None	SAN ANDREAS	CA	95249	9707	05	06009	38.19058212	-120.6709481	Calaveras County
232258	Fee-for-Service	1114505781	1114505781	1	1	AHMED-KHAN, MOHAMMAD A MD	1/16/2025	207R00000X	NA	Other	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	10880 WILSHIRE BLVD	1101	LOS ANGELES	CA	90024	4112	19	06037	34.05897499	-118.4431123	Los Angeles County
232294	Fee-for-Service	1417010604	1417010604	1	17	ABLELIGHT INC	2/11/2010	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1696 SO HELM AVE	None	FRESNO	CA	93727	5111	10	06019	36.725958	-119.722407	Fresno County
232328	Fee-for-Service	1780771154	1780771154	1	1	AUYEUNG, TERESA H MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	50267	08	Family Practice	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
232335	Fee-for-Service	1952562753	1952562753	2	1	ASHLIE TRONNES MD	11/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9701 SW BARNES RD	STE 229	PORTLAND	OR	97225	6689	00	None	45.51056669	-122.7766223	Washington County
232360	Fee-for-Service	1083005458	1083005458	1	1	AMMEN, MAGENA C LMFT	2/6/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	250 W FIRST ST	STE 346	CLAREMONT	CA	91711	4742	19	06037	34.09450024	-117.7183344	Los Angeles County
232376	Fee-for-Service	1538521224	1538521224	1	1	ASHLAND, SARAH DO	7/13/2022	2080P0203X	NA	Other	026	PHYSICIANS	19007	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
232390	Fee-for-Service	1417969973	1417969973	1	1	ASSAF, PIERRE B MD	8/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	36989	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
232425	Fee-for-Service	1568428134	1568428134	1	1	AL-SAYED, MOHAMAD Y MD	4/28/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	74158	41	Internal Medicine	0	In state provider	None	1500 DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
232427	Fee-for-Service	1841889565	1841889565	1	1	ALICE WAITHIRA KARANJA	4/13/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	10 PINE COURT	None	INGLEWOOD	CA	90302	2930	19	06037	33.96948254	-118.3624988	Los Angeles County
232431	Fee-for-Service	1740209295	1740209295	1	1	AVULA, VENKATESWARA R	6/30/1990	207RH0003X	NA	Oncology	026	PHYSICIANS	50020	41	Internal Medicine	0	In state provider	None	4134 E CLINTON AVE	None	FRESNO	CA	93703	2520	10	06019	36.77229255	-119.754909	Fresno County
232457	Fee-for-Service	1760851968	1760851968	1	1	ALLISON, DANIEL C MD FACS	10/19/2015	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	87437	20	Orthopedic Surgery	0	In state provider	AMC	444 S SAN VICENTE BLVD	SUITE 703	LOS ANGELES	CA	90048	4174	19	06037	34.06999878	-118.3755119	Los Angeles County
232459	Fee-for-Service	1114246287	1114246287	1	1	AWREY, JULIANNE M MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	117759	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
232487	Fee-for-Service	1134120124	1134120124	1	1	ABBASI MEDICAL CORP	3/12/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	15644 POMERADO RD	STE 202	POWAY	CA	92064	2434	37	06073	32.99717879	-117.0579379	San Diego County
232504	Fee-for-Service	1740863588	1740863588	1	1	ALERACARE MEDICAL GROUP OF C	5/9/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ALIFORNIA	2650 JONES WAY	STE 30	SIMI VALLEY	CA	93065	1221	56	06111	34.28861251	-118.745991	Ventura County
232567	Fee-for-Service	1366277311	1366277311	1	1	ANDRADES, JAHLON DOULA	11/4/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	01	06001	0	0	None
232568	Fee-for-Service	1396783379	1396783379	1	12	ASANA INTEGRATED MEDICAL GRO	10/13/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP PC	2309 ANTONIO AVE	None	CAMARILLO	CA	93010	1414	56	06111	34.24435917	-119.0191975	Ventura County
232582	Fee-for-Service	1588676811	1588676811	1	1	ADILI-KHAMS, BABEK MD	1/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	53927	None	None	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	0070	36	06071	34.26577765	-117.1695461	San Bernardino County
232588	Fee-for-Service	1609292770	1609292770	1	2	AFKHAMI, HASTI LMFT	8/24/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
232602	Fee-for-Service	1447265814	1447265814	1	1	AUBRY, WADE M MD	1/31/1997	207RE0101X	NA	Endocrinology	026	PHYSICIANS	37637	41	Internal Medicine	0	In state provider	None	909 HYDE ST	STE 125	SAN FRANCISCO	CA	94109	4832	38	06075	37.78939387	-122.4170945	San Francisco County
232610	Fee-for-Service	1689274565	1689274565	1	1	AHPC PALM DESERT INC	8/12/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	777 E TAHQUITZ CANYON WY	STE 200-099	PALM SPRINGS	CA	92262	6784	33	06065	33.82304055	-116.540676	Riverside County
232622	Fee-for-Service	1760506927	1760506927	1	1	ARLIEN, DANA M MD	5/27/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	36	Psychiatry	1	Border provider	None	1240 EAST 9TH STREET	None	RENO	NV	89512	2964	00	None	39.53846574	-119.7974202	Washoe County
232629	Fee-for-Service	1437263845	1437263845	1	1	ADATTO, ISAAC J MD	12/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	60245	41	Internal Medicine	0	In state provider	None	16030 VENTURA BLVD	STE 680	ENCINO	CA	91436	4443	19	06037	34.15615339	-118.4824038	Los Angeles County
232681	Fee-for-Service	1417969973	1417969973	1	1	ASSAF, PIERRE B MD	8/31/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	36989	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
232713	Fee-for-Service	1366718033	1366718033	1	1	ARTHUR, KATHERINE R MD	11/14/2018	207L00000X	NA	Other	026	PHYSICIANS	154198	05	Anesthesiology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
232729	Fee-for-Service	1053347344	1053347344	1	1	ACCURATE HEALTHCARE, INC	10/29/2018	332BP3500X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	493 CAVE ROAD	None	NASHVILLE	TN	37210	2301	00	None	36.16195568	-86.71907026	Davidson County
232771	Fee-for-Service	1023249422	1023249422	1	1	ARORA, MILI MD	7/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119994	41	Internal Medicine	0	In state provider	None	4501 X ST	None	SACRAMENTO	CA	95817	2229	34	06067	38.553822	-121.452822	Sacramento County
232775	Fee-for-Service	1134120124	1134120124	1	1	ABBASI MEDICAL CORP	3/12/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	38	Geriatrics	0	In state provider	None	15644 POMERADO RD	STE 202	POWAY	CA	92064	2434	37	06073	32.99717879	-117.0579379	San Diego County
232804	Fee-for-Service	1780154559	1780154559	1	1	ANGELES HOME HEALTH CARE	4/28/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	816 N HOLLYWOOD WAY	UNIT 3	BURBANK	CA	91505	2832	19	06037	34.16503922	-118.3455811	Los Angeles County
232806	Fee-for-Service	1982205738	1982205738	1	1	ASM FAMILY FOUNDATION	6/16/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	120 CORNING AVE	None	MILPITAS	CA	95035	5225	43	06085	37.42445526	-121.9078558	Santa Clara County
232811	Fee-for-Service	1366265803	1366265803	1	1	ALCANTARA, ERIC OT	11/15/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	5350 OLIVE ST	None	MONTCLAIR	CA	91763	1639	36	06071	34.09054746	-117.6886395	San Bernardino County
232867	Fee-for-Service	1649378894	1649378894	2	1	ADVANCED INSTITUTE FOR	3/3/2016	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	41738	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	OBSTETRICS GYNECOLOGY	18411 CLARK STREET	SUITE 103	TARZANA	CA	91356	3527	19	06037	34.16981538	-118.5337442	Los Angeles County
232893	Fee-for-Service	1427168608	1427168608	1	1	AREGOOD III, JOHN M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1015 NW 22ND AVE	None	PORTLAND	OR	97210	0000	00	None	45.53024175	-122.6966202	Multnomah County
232897	Fee-for-Service	1689274565	1689274565	1	1	AHPC PALM DESERT INC	8/12/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	777 E TAHQUITZ CANYON WY	STE 200-099	PALM SPRINGS	CA	92262	6784	33	06065	33.82304055	-116.540676	Riverside County
232905	Fee-for-Service	1699198713	1699198713	1	1	ADVENT PHYSICAL THERAPY	9/21/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	GROUP PC	737 PEARL ST	STE 108	LA JOLLA	CA	92037	5063	37	06073	32.83984428	-117.2752583	San Diego County
232935	Fee-for-Service	1912218199	1912218199	1	1	A'COURT, ALISON M-K MD	7/14/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121035	05	Anesthesiology	0	In state provider	None	11234 ANDERSONE ST	None	SAN BERNARDINO	CA	92354	3450	36	06071	34.049547	-117.264078	San Bernardino
232970	Fee-for-Service	1174937346	1174937346	1	1	ALHANKAWI, DHUHA MD	9/1/2021	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	152114	None	None	0	In state provider	None	5555 GROSSMONT CENTER	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
232983	Fee-for-Service	1437445632	1437445632	1	1	AHRONOWITZ, IRIS Z MD	6/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	123269	None	None	0	In state provider	None	1701 E CESAR E CHAVEZ	SUITE 510	LOS ANGELES	CA	90033	2488	19	06037	34.05112725	-118.2173921	Los Angeles County
232990	Fee-for-Service	1376862938	1376862938	1	1	ABDI-MORADI, SOHAIL R MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142608	None	None	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
233046	Fee-for-Service	1881857118	1881857118	1	1	ATAI, SOLIMAN S MD	8/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	113224	66	Emergency Medicine (Urgent Care)	0	In state provider	None	500 WEST HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
233063	Fee-for-Service	1134120124	1134120124	1	1	ABBASI MEDICAL CORP	3/12/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	15644 POMERADO RD	STE 202	POWAY	CA	92064	2434	37	06073	32.99717879	-117.0579379	San Diego County
233081	Fee-for-Service	1801664198	1801664198	1	1	A5 TRANSPORTATION LLC	1/29/2024	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	7225 DEERING AVE	None	CANOGA PARK	CA	91303	1502	19	06037	34.20176412	-118.5966602	Los Angeles County
233150	Fee-for-Service	1285659284	1285659284	1	1	ARELLO, JESSE MD	7/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	75220	08	Family Practice	0	In state provider	None	575 PRICE ST	STE 101	PISMO BEACH	CA	93449	2553	40	06079	35.14080956	-120.6390342	San Luis Obispo County
233247	Fee-for-Service	1831742261	1831742261	1	1	ANTZOULATOS, JENNIFER LCSW	8/17/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3625 E THOUSAND OAKS BLV	STE 128	WESTLAKE VILLAGE	CA	91362	4045	19	06037	34.16480359	-118.8299997	Ventura County
233259	Fee-for-Service	1447790696	1447790696	1	1	AFEK, ADI V CNM	1/21/2022	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
233284	Fee-for-Service	1609823459	1609823459	1	1	ADEY, DEBORAH B MD	10/1/1996	207RN0300X	NA	Nephrology	026	PHYSICIANS	82086	45	Nephrology (Renal-Kidney)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
233285	Fee-for-Service	1407163934	1407163934	1	1	ABDIJADID, SARA MD	6/2/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	12327	36	Psychiatry	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
233293	Fee-for-Service	1942369152	1942369152	1	1	ALEXAKIS, PETER G MD	6/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	18145	20	Orthopedic Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
233295	Fee-for-Service	1336108885	1336108885	1	1	ABE, ANGELA M OD	2/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
233302	Fee-for-Service	1407050669	1407050669	1	1	AFHSAR, KAMYAR DO	6/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8875	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
233312	Fee-for-Service	1144300229	1144300229	1	1	AVERY, ANDREA D MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	43346	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
233317	Fee-for-Service	1750878724	1750878724	1	1	ANDRUSAITIS, JESSICA G MD	1/14/2020	261QE0002X	NA	Other	026	PHYSICIANS	164703	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
233320	Fee-for-Service	1467489203	1467489203	1	1	ANDERSON, JENNIFER L MD	10/31/2007	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	75325	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3309 RENNER DRIVE	None	FORTUNA	CA	95540	3119	12	06023	40.58239969	-124.1358904	Humboldt County
233331	Fee-for-Service	1548417736	1548417736	1	1	ALHAMBRA OTOMETRY APC	3/2/2012	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1239 E VALLEY BLVD	None	ALHAMBRA	CA	91801	5235	19	06037	34.07926357	-118.1108064	Los Angeles County
233336	Fee-for-Service	1851473177	1851473177	1	1	ABRAMSON, KEEVAN MD	6/25/1994	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	19197	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	850 SEQUOIA CIR	None	FORT BRAGG	CA	95437	5490	23	06045	39.4304969	-123.8020209	Mendocino County
233340	Fee-for-Service	1700319019	1700319019	1	1	ADLER, ELIZABETH MD	8/28/2020	208M00000X	NA	Other	026	PHYSICIANS	159283	41	Internal Medicine	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
233343	Fee-for-Service	1871179366	1871179366	1	1	ANDERSON, LAUREN N OD	2/27/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
233351	Fee-for-Service	1184007478	1184007478	1	1	ANTONIOS, JOSEPH K MD	10/1/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	145434	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
233364	Fee-for-Service	1184251258	1184251258	1	1	ARDALAN, AUSTIN MD	9/15/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
233383	Fee-for-Service	1780362616	1780362616	1	1	ADVENTIST HEALTH PHYSICIANS	2/2/2024	261QU0200X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	23 N MAIN ST	101	ANGELS CAMP	CA	95222	8001	05	06009	38.08274503	-120.5591725	Calaveras County
233412	Fee-for-Service	1922179811	1922179811	1	1	ALLEYNE, CLAUDIA M MD	5/28/2002	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	60473	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
233423	Fee-for-Service	1487049888	1487049888	1	1	ANYANWU, JOY C MD	3/29/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	155855	08	Family Practice	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
233433	Fee-for-Service	1164713871	1164713871	1	1	ARNALDO, CHRISTINE L MD	5/27/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125241	40	Pediatrics	0	In state provider	None	18210 YORBA LINDA BLVD	STE 404	YORBA LINDA	CA	92886	4060	30	06059	33.8883981	-117.8154098	Orange County
233501	Fee-for-Service	1619973591	1619973591	1	1	ALVARADO EYE ASSOCIATES	5/1/1996	207W00000X	NA	Ophthalmology	022	PHYSICIANS GROUP	-	18	Ophthalmology	0	In state provider	MEDICAL CLINIC INC	7877 PARKWAY DRIVE	SUITE 100	LA MESA	CA	91942	2000	37	06073	32.77448693	-117.02783	San Diego County
233509	Fee-for-Service	1902038284	1902038284	1	1	ADIARTE, ERIC G MD	10/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	125682	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
233561	Fee-for-Service	1073723144	1073723144	1	2	AMIT MITTAL M.D.	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	251 N ESTRELLA PKWY	None	GOODYEAR	AZ	85338	9334	00	None	33.449436	-112.3919055	Maricopa County
233589	Fee-for-Service	1407050669	1407050669	1	1	AFHSAR, KAMYAR DO	6/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	8875	41	Internal Medicine	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
233591	Fee-for-Service	1215085287	1215085287	1	1	AZIZ-BUTLER, NASHWA MD	12/1/1997	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	60248	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
233600	Fee-for-Service	1619471091	1619471091	1	1	AMINZAI, SUSAN MD	7/27/2023	207R00000X	NA	Other	026	PHYSICIANS	173244	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
233642	Fee-for-Service	1114218252	1114218252	1	1	ABREU, JESSICA NP	9/30/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15260 VENTURA BLVD	1200	SHERMAN OAKS	CA	91403	5307	19	06037	34.15370926	-118.4656644	Los Angeles County
233646	Fee-for-Service	1841429461	1841429461	1	1	ANAFI, EDWARD MD	12/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	155560	41	Internal Medicine	0	In state provider	None	1100 LAS TABLAS RD	None	TEMPLETON	CA	93465	9704	40	06079	35.55442648	-120.719754	San Luis Obispo County
233671	Fee-for-Service	1902374242	1902374242	1	1	ATENA HOSPICE INC	5/19/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	15450 VENTURA BLVD	SUITE 200	SHERMAN OAKS	CA	91403	3000	19	06037	34.15447117	-118.4703094	Los Angeles County
233698	Fee-for-Service	1922179811	1922179811	1	1	ALLEYNE, CLAUDIA M MD	5/28/2002	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	60473	40	Pediatrics	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
233746	Fee-for-Service	1619970068	1619970068	1	1	ALLENDE, JORGE A MD	3/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	50896	66	Emergency Medicine (Urgent Care)	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
233757	Fee-for-Service	1316138126	1316138126	1	1	AHN, CHRISTOPHER M MD	1/20/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
233763	Fee-for-Service	1689643611	1689643611	1	1	AIKIN, BRENT A DO	9/12/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14887	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
233785	Fee-for-Service	1952830978	1952830978	1	1	ANGELES, DANIEL A MD	9/29/2020	207P00000X	NA	Other	026	PHYSICIANS	169535	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
233823	Fee-for-Service	1265696975	1265696975	1	1	ALOSH, HUMAM MD	11/13/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	111581	40	Pediatrics	0	In state provider	None	201 E LAKEVIEW AVE	None	WOODLAKE	CA	93286	1301	54	06107	36.4172997	-119.0975768	Tulare County
233832	Fee-for-Service	1093960387	1093960387	1	1	AHMADPOUR & PEDARSANI MD INC	5/14/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3300 E SOUTH STREET	SUITE 303	LONG BEACH	CA	90805	4549	19	06037	33.86018093	-118.1537163	Los Angeles County
233840	Fee-for-Service	1275517880	1275517880	1	1	ALESNA, DANILO MD	10/20/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	170272	40	Pediatrics	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
233873	Fee-for-Service	1033247440	1033247440	2	1	ABILITY PATHWAYS	6/19/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED	5283 EAGLE DALE AVE	None	EAGLEROCK	CA	90041	1013	36	06071	34.14512678	-118.2281192	Los Angeles County
233878	Fee-for-Service	1295775062	1295775062	1	1	ALCH, MICHAEL D MD	3/1/1999	207P00000X	NA	Other	026	PHYSICIANS	21010	01	General Practice	0	In state provider	FRESNO COMM HOSP	FRESNO AND R STREETS	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
233901	Fee-for-Service	1548319965	1548319965	1	1	ALKASSPOOLES, SALAM F MD	7/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	81802	41	Internal Medicine	0	In state provider	None	11633 SAN VICENTE BLVD	STE 314	LOS ANGELES	CA	90049	6514	19	06037	34.05402447	-118.4632335	Los Angeles County
233920	Fee-for-Service	1497231310	1497231310	1	1	ALL AMERICA ENTERPRISES, INC	11/25/2019	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1124 E ELMWOOD AVE	None	BURBANK	CA	91501	1614	19	06037	34.18838386	-118.2884904	Los Angeles County
233924	Fee-for-Service	1104011451	1104011451	1	1	AMICK, JAN M LCSW	4/30/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	82148	-	NOT APPLICABLE	0	In state provider	None	5 MAREBLU	STE 100, 200, 250	ALISO VIEJO	CA	92656	3014	30	06059	33.57250566	-117.7027366	Orange County
233958	Fee-for-Service	1902374242	1902374242	1	1	ATENA HOSPICE INC	5/19/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	15450 VENTURA BLVD	SUITE 200	SHERMAN OAKS	CA	91403	3000	19	06037	34.15447117	-118.4703094	Los Angeles County
234006	Fee-for-Service	1134142524	1134142524	2	1	AFATO MEDICAL CORP	8/8/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	REGENCY URGENT CARE MED	1429 COLUSA HWY	STE B	YUBA CITY	CA	95993	9092	51	06101	39.14182148	-121.6388115	Sutter County
234017	Fee-for-Service	1679554612	1679554612	1	1	AARON DOUGLAS BOSSLER	9/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
234071	Fee-for-Service	1659703288	1659703288	1	1	AGGARWAL, ANUJ K MD	6/19/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	131908	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
234079	Fee-for-Service	1205412897	1205412897	1	1	ALVARADO, EDUARDO MD	7/12/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	191962	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
234082	Fee-for-Service	1558691451	1558691451	1	1	ASHTARI, MOZGHAN MD	7/14/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111582	41	Internal Medicine	0	In state provider	None	1400 EAST CHURCH STREET	None	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
234105	Fee-for-Service	1790394591	1790394591	1	1	ANDERSON, MADELINE C CNM	9/8/2023	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
234122	Fee-for-Service	1780881763	1780881763	1	1	AMBE, SHAMA MD	6/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138233	40	Pediatrics	0	In state provider	None	1300 W 7TH STREET	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
234128	Fee-for-Service	1912485707	1912485707	1	1	A PLUS CARE LLC	12/3/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11601 WILSHIRE BLVD	OFFICE 561	LOS ANGELES	CA	90025	1741	19	06037	34.05052592	-118.4595943	Los Angeles County
234154	Fee-for-Service	1235452335	1235452335	1	2	ARTISAN FOOT AND ANKLE PODIA	8/29/2017	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	SPECIALIST, INC	26800 CROWN VALLEY PKWY	STE 420	MISSION VIEJO	CA	92691	8038	30	06059	33.56286021	-117.6673449	Orange County
234173	Fee-for-Service	1316326382	1316326382	1	1	AHMED, AISHA DPM	2/12/2020	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	345 F STREET	STE 100	CHULA VISTA	CA	91910	2632	37	06073	32.64088085	-117.081699	San Diego County
234190	Fee-for-Service	1548319965	1548319965	1	1	ALKASSPOOLES, SALAM F MD	7/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	81802	77	Infectious Disease	0	In state provider	None	11633 SAN VICENTE BLVD	STE 314	LOS ANGELES	CA	90049	6514	19	06037	34.05402447	-118.4632335	Los Angeles County
234213	Fee-for-Service	1679080949	1679080949	1	1	AKHAVAN, SHIVA	3/5/2018	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	18643 BROOKHURST ST	STE 1D	FOUNTAIN VALLEY	CA	92708	6709	30	06059	33.69222046	-117.9543117	Orange County
234226	Fee-for-Service	1457396442	1457396442	1	1	ABRAHAM, RICHARD MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1460 G STREET	None	SPRINGFIELD	OR	97477	4112	00	None	44.0524395	-123.0035985	Lane County
234237	Fee-for-Service	1366761850	1366761850	1	1	AUSTIN'S PHARMACY, INC	11/19/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1345 W HOBSON WAY	None	BLYTHE	CA	92225	1425	33	06065	33.6101917	-114.6123313	Riverside County
234246	Fee-for-Service	1356017321	1356017321	1	1	AZIZ AWAD AWADALLA, MARINAEM	11/15/2021	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	AD OD	555 N 13TH AVE	None	UPLAND	CA	91786	4904	36	06071	34.10042233	-117.6335451	San Bernardino County
234252	Fee-for-Service	1467585216	1467585216	1	1	AJAR, AMIR H MD	8/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114730	04	Otology, Laryngology, Rhinology	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
234258	Fee-for-Service	1558925735	1558925735	1	1	AURA MEDICAL GROUP INC	8/28/2020	207RH0002X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	960 EAST GREEN STREET	L7	PASADENA	CA	91106	2401	19	06037	34.14451994	-118.1301695	Los Angeles County
234276	Fee-for-Service	1942704341	1942704341	1	1	ANDERSON, KEMP M MD	12/3/2021	208600000X	NA	General Surgery	026	PHYSICIANS	164982	None	None	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
234280	Fee-for-Service	1992001804	1992001804	1	1	AILES, DEREK A MD	7/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	122736	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1425 S MAIN STREET	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
234338	Fee-for-Service	1679717920	1679717920	1	1	ALVARADO, ONEIDA G LMFT	10/23/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
234341	Fee-for-Service	1457596371	1457596371	1	4	ALLSAFE MEDICAL GROUP INC.	10/12/2022	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3501 HARBOR BLVD	200	SANTA ANA	CA	92704	6919	30	06059	33.69981147	-117.9194272	Orange County
234375	Fee-for-Service	1952670341	1952670341	1	2	ANNETTE A CORONEL-PEREY MD I	7/28/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	55253	40	Pediatrics	0	In state provider	INC	4455 W 117TH ST	STE 406	HAWTHORNE	CA	90250	2240	19	06037	33.92825048	-118.3539285	Los Angeles County
234415	Fee-for-Service	1992722359	1992722359	1	1	ATALA, MARINA M MD	8/5/2008	208M00000X	NA	Other	026	PHYSICIANS	104889	41	Internal Medicine	0	In state provider	None	180 ROWLAND WAY	None	NOVATO	CA	94945	5009	21	06041	38.09825699	-122.5598561	Marin County
234426	Fee-for-Service	1770537458	1770537458	1	1	ALISO VIEJO FAMILY MEDICINE	5/21/2017	193400000X	NA	Other	026	PHYSICIANS	8730	01	General Practice	0	In state provider	PROFESSIONAL CORP	24801 ALICIA PKWY	STE C	LAGUNA HILLS	CA	92653	4654	30	06059	33.60186269	-117.6914168	Orange County
234441	Fee-for-Service	1235452335	1235452335	1	2	ARTISAN FOOT AND ANKLE PODIA	10/7/2022	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	SPECIALIST, INC	26800 CROWN VALLEY PKWY	STE 420	MISSION VIEJO	CA	92691	8038	30	06059	33.56286021	-117.6673449	Orange County
234455	Fee-for-Service	1801848981	1801848981	1	1	ALEKSANDR SHESTAK	7/1/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 OCEAN PKWY	None	BROOKLYN	NY	11235	7745	00	None	40.586031	-73.9657305	Kings County
234462	Fee-for-Service	1538689021	1538689021	1	1	ADJAMIAN, NORAIR DO	8/16/2023	2086S0127X	NA	General Surgery	026	PHYSICIANS	16539	None	None	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
234479	Fee-for-Service	1265724389	1265724389	1	1	ALY, OMAR MD	1/2/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	137320	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
234491	Fee-for-Service	1649983651	1649983651	1	1	ANTELOPE VALLEY HISTOLOGY LL	12/6/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	C	44920 VALLEY CENTRAL WAY	STE 107	LANCASTER	CA	93536	7260	19	06037	34.6984201	-118.1735581	Los Angeles County
234514	Fee-for-Service	1679936439	1679936439	1	1	ALWASH, MUSTAFA MD	12/27/2019	208M00000X	NA	Other	026	PHYSICIANS	160516	None	None	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
234543	Fee-for-Service	1184787434	1184787434	1	1	APPLETON-SKUBAL, LOUISE LCSW	3/16/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
234547	Fee-for-Service	1558925735	1558925735	1	1	AURA MEDICAL GROUP INC	8/28/2020	207RH0002X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	960 EAST GREEN STREET	L7	PASADENA	CA	91106	2401	19	06037	34.14451994	-118.1301695	Los Angeles County
234554	Fee-for-Service	1336538495	1336538495	1	1	ASSISTED HOME RECOVERY, INC	4/1/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	3731 WILSHIRE BLVD	SUITE 516	LOS ANGELES	CA	90010	2827	19	06037	34.06173792	-118.3074483	Los Angeles County
234562	Fee-for-Service	1114246154	1114246154	1	1	AGBAI, OMA N MD	8/10/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121135	07	Dermatology	0	In state provider	None	3301 C STREET	None	SACRAMENTO	CA	95816	3300	34	06067	38.579877	-121.456143	Sacramento County
234572	Fee-for-Service	1083602791	1083602791	1	2	AMERICAN MEDICAL PROSTHETIC	7/17/2019	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	& ORTHOTICS, INC.	4955 VAN NUYS BOULEVARD	SUITE 514	SHERMAN OAKS	CA	91403	1831	19	06037	34.160805	-118.4487295	Los Angeles County
234576	Fee-for-Service	1356536130	1356536130	1	1	ABDALKHANI, ARMAN MD	8/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95709	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
234593	Fee-for-Service	1598318933	1598318933	1	1	ALVARADO, ERICA M	8/20/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	11923 STEEPLECHASE DR	None	MORENO VALLEY	CA	92555	1751	33	06065	33.94779272	-117.2064603	Riverside County
234619	Fee-for-Service	1649238379	1649238379	1	1	AMINIAN, A M MD	4/30/1985	207K00000X	NA	Other	026	PHYSICIANS	40672	None	None	0	In state provider	None	7375 N FRESNO ST	None	FRESNO	CA	93720	2478	10	06019	36.844218	-119.7838975	Fresno County
234626	Fee-for-Service	1811593114	1811593114	1	1	ARROWHEAD HOME INC	2/11/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	639 S GLENWOOD PLACE	UNIT 118	BURBANK	CA	91506	2819	19	06037	34.16551979	-118.3138484	Los Angeles County
234629	Fee-for-Service	1568581759	1568581759	1	1	AHN, SANG-HOON MD	8/21/2008	207RH0003X	NA	Oncology	026	PHYSICIANS	95562	78	Neoplastic Diseases/Oncology	0	In state provider	None	11180 WARNER AVE	SUITE 365	FOUNTAIN VALLEY	CA	92708	7501	30	06059	33.71632048	-117.9334575	Orange County
234652	Fee-for-Service	1801865498	1801865498	1	1	AYERS, LARRY N MD	1/1/1982	207RP1001X	NA	Pulmonology	026	PHYSICIANS	28720	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1662 E MAIN ST	STE 319	EL CAJON	CA	92021	5209	37	06073	32.81045723	-116.9198877	San Diego County
234654	Fee-for-Service	1912938499	1912938499	1	1	ALBO, MICHAEL MD	6/30/1994	208800000X	NA	Other	026	PHYSICIANS	81920	34	Urology and Urological Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
234674	Fee-for-Service	1699298224	1699298224	1	1	ASSAR, SIAVASH OD	2/28/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	01	06001	37.79926205	-122.2314248	Alameda County
234711	Fee-for-Service	1750559431	1750559431	1	3	ALL STAR PHYSICAL THERAPY, I	3/26/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	29798 HAUN	201	MENIFEE	CA	92586	6541	33	06065	33.68787713	-117.1748638	Riverside County
234773	Fee-for-Service	1043088172	1043088172	1	1	ALVARADO GRAJEDA, JORGE LMF	9/9/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	T	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
234780	Fee-for-Service	1629207287	1629207287	1	1	ABC HOME HEALTH CARE LLC	6/4/2012	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5090 SHOREHAM PL	SUITE 109	SAN DIEGO	CA	92122	5935	37	06073	32.85270901	-117.1853975	San Diego County
234846	Fee-for-Service	1386087864	1386087864	1	1	ABDUL-HAQQ, RYAN A MD	2/25/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	154965	02	General Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
234860	Fee-for-Service	1548645302	1548645302	1	1	AFFECTIVE HOSPICE CARE INC	12/26/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	5050 PALO VERDE STREET	SUITE 208	MONTCLAIR	CA	91763	2334	36	06071	34.08145549	-117.69516	San Bernardino County
234882	Fee-for-Service	1598318933	1598318933	1	1	ALVARADO, ERICA M	8/20/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	11923 STEEPLECHASE DR	None	MORENO VALLEY	CA	92555	1751	33	06065	33.94779272	-117.2064603	Riverside County
234914	Fee-for-Service	1639427511	1639427511	1	1	ALCANTARA, DARCY PHD	1/19/2022	103TC2200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
234915	Fee-for-Service	1568581759	1568581759	1	1	AHN, SANG-HOON MD	8/21/2008	207RH0003X	NA	Oncology	026	PHYSICIANS	95562	68	Hematology	0	In state provider	None	11180 WARNER AVE	SUITE 365	FOUNTAIN VALLEY	CA	92708	7501	30	06059	33.71632048	-117.9334575	Orange County
234939	Fee-for-Service	1801865498	1801865498	1	1	AYERS, LARRY N MD	1/1/1982	207RP1001X	NA	Pulmonology	026	PHYSICIANS	28720	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1662 E MAIN ST	STE 319	EL CAJON	CA	92021	5209	37	06073	32.81045723	-116.9198877	San Diego County
234942	Fee-for-Service	1558960161	1558960161	1	1	ANTELOPE VALLEY OUTPATIENT I	6/4/2021	2085R0202X	NA	Mammography/MRI Provider	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	MAGING CENTER, LLC	38209 47TH ST E	STE D	PALMDALE	CA	93552	3113	19	06037	34.576173	-118.045189	Los Angeles County
234945	Fee-for-Service	1962409573	1962409573	1	1	ARCHER, JULIE A MD	8/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	68085	41	Internal Medicine	0	In state provider	None	1645 ESPLANADE	STE 1	CHICO	CA	95926	3312	04	06007	39.74374167	-121.8502328	Butte County
234976	Fee-for-Service	1396061164	1396061164	1	1	ASHER, CHRISTOPHER MD	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	119075	05	Anesthesiology	0	In state provider	None	1 HOAG DRIVE	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
235003	Fee-for-Service	1750559431	1750559431	1	3	ALL STAR PHYSICAL THERAPY, I	4/30/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	29798 HAUN	201	MENIFEE	CA	92586	6541	33	06065	33.68787713	-117.1748638	Riverside County
235040	Fee-for-Service	1982967345	1982967345	1	1	AUNG, MYA M MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132716	41	Internal Medicine	0	In state provider	None	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
235048	Fee-for-Service	1356515506	1356515506	1	1	ALTAMED HEALTH SERVICES CORP	4/24/2008	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	ALTAMED EL MONTE ADHC	10412-10420 VALLEY BLVD	None	EL MONTE	CA	91731	2402	19	06037	34.07647884	-118.0458956	Los Angeles County
235070	Fee-for-Service	1235152455	1235152455	1	1	ADELSON, LEONARD J MD	6/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	36798	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	12626 RIVERSIDE DR	STE 404	NORTH HOLLYWOOD	CA	91607	3456	19	06037	34.15758449	-118.408131	Los Angeles County
235077	Fee-for-Service	1770785859	1770785859	1	1	ALJAYEH, MOHSEN A MD	6/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	136655	41	Internal Medicine	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
235118	Fee-for-Service	1689847220	1689847220	1	1	ALBORZI, FARZIN MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100788	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
235133	Fee-for-Service	1740609288	1740609288	1	1	ARREDONDO, ANTHONY R DO	1/1/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
235147	Fee-for-Service	1548645302	1548645302	1	1	AFFECTIVE HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	5050 PALO VERDE STREET	SUITE 208	MONTCLAIR	CA	91763	2334	36	06071	34.08145549	-117.69516	San Bernardino County
235151	Fee-for-Service	1598924847	1598924847	1	1	APRECIO, RAYDOLFO A JR CRNA	2/23/2009	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
235170	Fee-for-Service	1104953538	1104953538	1	1	ASSAFI, HEFTSI LMFT	3/9/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13201 SAN PABLO AVE	STE 316	SAN PABLO	CA	94806	3965	07	06013	37.95165516	-122.3328786	Contra Costa County
235178	Fee-for-Service	1619062346	1619062346	1	1	ABBASI, TAHIRA MD	3/12/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	90215	01	General Practice	0	In state provider	None	15644 POMERADO RD	STE 202	POWAY	CA	92064	2434	37	06073	32.99717879	-117.0579379	San Diego County
235191	Fee-for-Service	1487621918	1487621918	1	1	ABRAHAMS, BARBARA B MD	11/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	06	Cardiovascular Disease (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
235196	Fee-for-Service	1760559587	1760559587	1	1	ALEXANDER, JULIE LOUISE	6/30/1994	2085B0100X	NA	MRI Provider	026	PHYSICIANS	69277	30	Radiology	0	In state provider	None	1000 S FREMONT AVE	None	ALHAMBRA	CA	91803	8800	19	06037	34.081452	-118.1518515	Los Angeles County
235288	Fee-for-Service	1750559431	1750559431	1	3	ALL STAR PHYSICAL THERAPY, I	11/10/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	29798 HAUN	201	MENIFEE	CA	92586	6541	33	06065	33.68787713	-117.1748638	Riverside County
235315	Fee-for-Service	1558995654	1558995654	1	1	A CHOICE HOSPICE CORP	5/24/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6621 VAN NUYS BLVD	UNIT 102	VAN NUYS	CA	91405	4673	19	06037	34.19138471	-118.4487668	Los Angeles County
235337	Fee-for-Service	1356515506	1356515506	1	1	ALTAMED HEALTH SERVICES CORP	4/24/2008	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	ALTAMED EL MONTE ADHC	10412-10420 VALLEY BLVD	None	EL MONTE	CA	91731	2402	19	06037	34.07647884	-118.0458956	Los Angeles County
235340	Fee-for-Service	1295916021	1295916021	2	1	ALLAN D SINGER MD INC AND	3/21/2016	193400000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	DEAN T CHIANG MD INC A	3440 LOMITA BLVD	SUITE 228	TORRANCE	CA	90505	4870	19	06037	33.81328127	-118.3452927	Los Angeles County
235357	Fee-for-Service	1710320593	1710320593	1	1	AYAT, JOSEPH H MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1707 W CHARLESTON BLVD	SUITE 230	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
235360	Fee-for-Service	1083015978	1083015978	1	1	ALTOMARE, CLAUDIA B CRNA	12/19/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
235363	Fee-for-Service	1235152455	1235152455	1	1	ADELSON, LEONARD J MD	6/30/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	36798	41	Internal Medicine	0	In state provider	None	12626 RIVERSIDE DR	STE 404	NORTH HOLLYWOOD	CA	91607	3456	19	06037	34.15758449	-118.408131	Los Angeles County
235366	Fee-for-Service	1912339474	1912339474	1	1	ALEXANDER PROSTHETICS & ORTH	6/11/2019	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	OTICS, INC	660 E REGENT ST	None	INGLEWOOD	CA	90301	1415	19	06037	33.96448548	-118.344402	Los Angeles County
235370	Fee-for-Service	1861598435	1861598435	1	1	ATIENZA, ROLANDO R MD	3/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	79796	08	Family Practice	0	In state provider	None	1900 MOWRY AVE	STE 309	FREMONT	CA	94538	1722	01	06001	37.55862396	-121.9799952	Alameda County
235448	Fee-for-Service	1518246719	1518246719	1	1	A TO Z HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1202 MONTE VISTA AVE	SUITE 4	UPLAND	CA	91786	8209	36	06071	34.10834793	-117.6982408	San Bernardino County
235454	Fee-for-Service	1457540460	1457540460	1	1	AMAR MEDICAL GROUP INC	4/28/2009	193400000X	NA	Other	026	PHYSICIANS	23964	08	Family Practice	0	In state provider	None	23341 GOLDEN SPRINGS RD	STE 220	DIAMOND BAR	CA	91765	2054	19	06037	34.01718502	-117.8110721	Los Angeles County
235468	Fee-for-Service	1588208946	1588208946	1	1	AL-HASSAN, NOOR S OD	2/15/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
235494	Fee-for-Service	1811235450	1811235450	1	2	AMS NEUROLOGY	7/20/2022	2084N0400X	NA	Neurology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	960 E GREEN ST	STE L11	PASADENA	CA	91106	2412	19	06037	34.14451994	-118.1301695	Los Angeles County
235495	Fee-for-Service	1366647133	1366647133	1	1	ANGELES, ANGIE E LCSW	2/8/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3400 DELTA FAIR BLVD	None	ANTIOCH	CA	94509	4004	07	06013	38.00403417	-121.8422798	Contra Costa County
235523	Fee-for-Service	1912456583	1912456583	1	1	ARANCIBIA, RUBEN	3/4/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	302 W 5TH ST STE 308	None	SAN PEDRO	CA	90731	2750	19	06037	33.73971572	-118.284045	Los Angeles County
235568	Fee-for-Service	1003857046	1003857046	1	1	ARIZONA CVS STORES LLC	12/11/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	1	Border provider	None	2800 S 4TH AVE	None	YUMA	AZ	85364	8110	00	None	32.676165	-114.625494	Yuma County
235582	Fee-for-Service	1093043846	1093043846	1	1	ACEVEDO, JARED L	8/13/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4201 W CHAPMAN AVE	None	ORANGE	CA	92868	1505	30	06059	33.78900343	-117.8985235	Orange County
235595	Fee-for-Service	1457196040	1457196040	1	1	AGUILAR, KAELA C PT	8/16/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2051 STATHAM BLVD	None	OXNARD	CA	93033	3901	56	06111	34.17967669	-119.1655477	Ventura County
235603	Fee-for-Service	1558995654	1558995654	1	1	A CHOICE HOSPICE CORP	5/24/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6621 VAN NUYS BLVD	UNIT 102	VAN NUYS	CA	91405	4673	19	06037	34.19138471	-118.4487668	Los Angeles County
235614	Fee-for-Service	1326145079	1326145079	1	1	ARANAS, MARIA T DO	6/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	8507	41	Internal Medicine	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
235624	Fee-for-Service	1356515506	1356515506	1	1	ALTAMED HEALTH SERVICES CORP	4/24/2008	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	ALTAMED EL MONTE ADHC	10412-10420 VALLEY BLVD	None	EL MONTE	CA	91731	2402	19	06037	34.07647884	-118.0458956	Los Angeles County
235631	Fee-for-Service	1568732683	1568732683	1	1	ANNAND, STACEY D LMFT	9/14/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	98137	-	NOT APPLICABLE	0	In state provider	None	4990 WILLIAMS AVE	None	LA MESA	CA	91942	7409	37	06073	32.76933362	-117.0371085	San Diego County
235706	Fee-for-Service	1396783379	1396783379	1	2	ASANA INTEGRATED MEDICAL GRO	2/9/2010	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP PC	1805 MEDICAL CENTER DRIV	None	SAN BERNARDINO	CA	92411	1217	36	06071	34.131303	-117.3225325	San Bernardino County
235719	Fee-for-Service	1275907073	1275907073	1	1	ALVAREZ, EVANGELINE C LCSW	5/22/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14500 ROSCOE BLVD	STE 400	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
235730	Fee-for-Service	1235796095	1235796095	1	1	ANTONIEWICZ, JILLIANA C	4/16/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	43585 MONTEREY AVE	SUITE 1	PALM DESERT	CA	92260	9342	33	06065	33.731946	-116.3912695	Riverside County
235738	Fee-for-Service	1518246719	1518246719	1	1	A TO Z HOSPICE CARE INC	10/7/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1202 MONTE VISTA AVE	SUITE 4	UPLAND	CA	91786	8209	36	06071	34.10834793	-117.6982408	San Bernardino County
235740	Fee-for-Service	1457540460	1457540460	1	1	AMAR MEDICAL GROUP INC	4/28/2009	193400000X	NA	Other	026	PHYSICIANS	23964	22	Pathology (M.D. only)	0	In state provider	None	23341 GOLDEN SPRINGS RD	STE 220	DIAMOND BAR	CA	91765	2054	19	06037	34.01718502	-117.8110721	Los Angeles County
235757	Fee-for-Service	1689233546	1689233546	1	1	ALCORN, MARIA LCSW	8/14/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD	STE 230	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
235781	Fee-for-Service	1811235450	1811235450	1	2	AMS NEUROLOGY	7/20/2022	2084N0400X	NA	Neurology	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	960 E GREEN ST	STE L11	PASADENA	CA	91106	2412	19	06037	34.14451994	-118.1301695	Los Angeles County
235795	Fee-for-Service	1851963763	1851963763	1	1	AMANDA ANN BLANTON	7/20/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	26208 EDGEMONT DR	None	HIGHLAND	CA	92346	1600	36	06071	34.14991159	-117.2326174	San Bernardino County
235877	Fee-for-Service	1528178837	1528178837	1	1	AFRA, ROBERT MD	11/17/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	96247	20	Orthopedic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
235917	Fee-for-Service	1013970169	1013970169	1	1	AHUJA, GURPREET S MD	5/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	54475	04	Otology, Laryngology, Rhinology	0	In state provider	None	1201 W LA VETA AVE	STE 604	ORANGE	CA	92868	4211	30	06059	33.78034779	-117.8655767	Orange County
235946	Fee-for-Service	1952544868	1952544868	1	1	ARORA, JORDAN A MD	5/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	125946	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	555 CASTRO ST	None	MOUNTAIN VIEW	CA	94041	2009	43	06085	37.38946454	-122.0815711	Santa Clara County
235953	Fee-for-Service	1457489965	1457489965	2	1	ABILITY PATHWAYS	6/19/2017	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED	8141 TROOST AVE	None	N HOLLYWOOD	CA	91605	1627	19	06037	34.21896116	-118.3863411	Los Angeles County
235956	Fee-for-Service	1396260113	1396260113	1	1	AUBURN PHARMACY SERVICES INC	6/15/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5020 ELLINGHOUSE DR	STE. E	COOL	CA	95614	9569	09	06017	38.88643939	-121.0137037	El Dorado County
235965	Fee-for-Service	1073787644	1073787644	1	1	ADACKAPARA, CHERYL A MD	10/3/2019	207ZP0102X	NA	Other	026	PHYSICIANS	151095	22	Pathology (M.D. only)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
235980	Fee-for-Service	1801088794	1801088794	1	1	ARPAN WAGHRAY MD	7/8/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	751 NE BLAKELY DR	STE 4020	ISSAQUAH	WA	98029	6201	00	None	47.53652154	-122.0220045	King County
235992	Fee-for-Service	1427064195	1427064195	1	1	AUSUBEL,KALMAN MD	6/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	111E 210TH ST	None	BRONX	NY	10469	0000	00	None	40.879872	-73.8798975	Bronx County
235994	Fee-for-Service	1396783379	1396783379	1	2	ASANA INTEGRATED MEDICAL GRO	2/9/2010	193200000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	UP PC	1805 MEDICAL CENTER DRIV	None	SAN BERNARDINO	CA	92411	1217	36	06071	34.131303	-117.3225325	San Bernardino County
235999	Fee-for-Service	1437374303	1437374303	1	1	ABRAM, NICHOLAS J MD	3/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114119	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2131 WEST 3RD ST	None	LOS ANGELES	CA	90057	1901	19	06037	34.06324759	-118.2737045	Los Angeles County
236003	Fee-for-Service	1770899585	1770899585	1	1	AREVIAN, ARMEN C MD	7/15/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	121354	36	Psychiatry	0	In state provider	None	121 S LONG BEACH BLVD	None	COMPTON	CA	90221	3423	19	06037	33.89475493	-118.2080292	Los Angeles County
236004	Fee-for-Service	1093464455	1093464455	1	1	ARNOLD, ALEXANDRA	10/25/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	1212 S MAIN ST	None	SALINAS	CA	93901	2260	27	06053	36.65759539	-121.6594973	Monterey County
236015	Fee-for-Service	1790078228	1790078228	1	1	AHANKOOB, NONA MD	1/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126281	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
236033	Fee-for-Service	1427324987	1427324987	1	1	AKYOL, JANET E LMFT	4/11/2016	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	572 DUNHOLME WAY	None	SUNNYVALE	CA	94087	3300	43	06085	37.34482247	-122.0283135	Santa Clara County
236064	Fee-for-Service	1750559431	1750559431	1	8	ALL STAR PHYSICAL THERAPY, I	11/10/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	32246 CLINTON KEITH	STE 103	WILDOMAR	CA	92595	7320	33	06065	33.59200657	-117.2501269	Riverside County
236083	Fee-for-Service	1851963763	1851963763	1	1	AMANDA ANN BLANTON	7/20/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	26208 EDGEMONT DR	None	HIGHLAND	CA	92346	1600	36	06071	34.14991159	-117.2326174	San Bernardino County
236123	Fee-for-Service	1740781681	1740781681	1	1	AVILES, MARILYN P OT	2/20/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	911 BERN CT	STE 140	SAN JOSE	CA	95112	1242	43	06085	37.37594797	-121.8941096	Santa Clara County
236143	Fee-for-Service	1811428469	1811428469	1	1	ALZUPHAR, KIMBERLY M MD	6/29/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	185372	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
236144	Fee-for-Service	1295032290	1295032290	1	1	ADDIS, KATHERINE M PT	12/2/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	11750 SORRENTO VALLEY	STE 130	SAN DIEGO	CA	92121	1019	37	06073	32.91461387	-117.2343576	San Diego County
236153	Fee-for-Service	1780215699	1780215699	1	1	ANGELES, KATHERINE R CNP	2/16/2021	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
236178	Fee-for-Service	1659386175	1659386175	1	1	ANOMADARSHI BARUA	5/18/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 OCEAN PKWY	None	BROOKLYN	NY	11235	7745	00	None	40.586031	-73.9657305	Kings County
236179	Fee-for-Service	1518596584	1518596584	1	1	ALJIDUI, ALI MD	7/16/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	182075	08	Family Practice	0	In state provider	None	514 N. PROSPECT AVE	None	REDONDO BEACH	CA	90277	3036	19	06037	33.85253987	-118.3796668	Los Angeles County
236199	Fee-for-Service	1992241772	1992241772	1	1	A PLUS MORE MEDTRANSPORT INC	2/9/2017	343900000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	STE 200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
236207	Fee-for-Service	1013970169	1013970169	1	1	AHUJA, GURPREET S MD	5/8/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	54475	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	1201 W LA VETA AVE	STE 604	ORANGE	CA	92868	4211	30	06059	33.78034779	-117.8655767	Orange County
236215	Fee-for-Service	1396178067	1396178067	1	4	ATHENA MEDICAL GROUP OF THE	3/1/2017	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	CENTRAL COAST INC	1332 NATIVIDAD RD	STE B	SALINAS	CA	93906	3133	27	06053	36.69909137	-121.635247	Monterey County
236218	Fee-for-Service	1306896568	1306896568	1	1	ANGELOTTI, TIMOTHY P MD	3/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	85123	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
236223	Fee-for-Service	1205601283	1205601283	1	1	ANOLIN, ALLAN PT	4/12/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25381 RAILROAD CANYON RD	1101 AND 1102	LAKE ELSINORE	CA	92532	2705	33	06065	33.66885662	-117.2636558	Riverside County
236243	Fee-for-Service	1639289739	1639289739	1	1	AHLUWALIA, MOHINDER PS MD	7/1/1982	207R00000X	NA	Other	026	PHYSICIANS	38421	41	Internal Medicine	0	In state provider	None	15982 QUANTICO RD	STE A	APPLE VALLEY	CA	92307	1382	36	06071	34.54150582	-117.2707656	San Bernardino County
236260	Fee-for-Service	1841211851	1841211851	1	1	AYYAGARI, SUNIL MD	6/29/2023	207R00000X	NA	Other	026	PHYSICIANS	178895	None	None	0	In state provider	None	ONE MEDICAL PLAZA DR	None	ROSEVILLE	CA	95661	3037	31	06061	38.76553806	-121.2497067	Placer County
236281	Fee-for-Service	1750512489	1750512489	1	1	AHDOOT, JONATHAN MD INC	8/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	44025	None	None	0	In state provider	None	15775 LAGUNA CANYON RD	STE 290	IRVINE	CA	92618	7705	30	06059	33.6663745	-117.760682	Orange County
236314	Fee-for-Service	1417928011	1417928011	1	1	ASKIN, JERALD M DPM	1/1/1979	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	9604 ARTESIA BLVD	SUITE 201	BELLFLOWER	CA	90706	6699	19	06037	33.87472842	-118.1288599	Los Angeles County
236325	Fee-for-Service	1144212549	1144212549	1	1	ANTHONY SCOTT JORDAN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12080 W MCMILLAN RD	None	BOISE	ID	83713	2462	00	None	43.64851946	-116.332911	Ada County
236335	Fee-for-Service	1467059634	1467059634	1	1	ARROUES, KARLY J PT	8/17/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	137 S LAS POSAS RD	STE 254	SAN MARCOS	CA	92078	2475	37	06073	33.14138594	-117.1924065	San Diego County
236355	Fee-for-Service	1750559431	1750559431	1	8	ALL STAR PHYSICAL THERAPY, I	3/26/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	32246 CLINTON KEITH	STE 103	WILDOMAR	CA	92595	7320	33	06065	33.59200657	-117.2501269	Riverside County
236356	Fee-for-Service	1386781953	1386781953	1	2	ADDICTION RESEARCH AND TREAT	10/11/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1235 E STREET	None	FRESNO	CA	93706	2024	10	06019	36.73272329	-119.7993386	Fresno County
236359	Fee-for-Service	1861569741	1861569741	1	1	AHN, CHAEWOO MD	1/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	67557	01	General Practice	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
236397	Fee-for-Service	1811280548	1811280548	1	1	ASRAT, KIBROM G DPM APC	7/30/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	13132 STUDEBAKER RD	STE 6	NORWALK	CA	90650	2561	19	06037	33.911874	-118.099151	Los Angeles County
236442	Fee-for-Service	1629627120	1629627120	1	1	ANYAH, EMILIA NP	7/20/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
236449	Fee-for-Service	1831301647	1831301647	1	1	ALI, MIR W MD	8/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	81819	33	Thoracic Surgery	0	In state provider	None	401 E HIGHLAND AVE	STE 450A	SAN BERNARDINO	CA	92404	3836	36	06071	34.1358627	-117.2757778	San Bernardino County
236504	Fee-for-Service	1124547260	1124547260	1	1	AMATO, CHRISTOPHER M PT	10/10/2017	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2700 N MAIN ST	STE 340	SANTA ANA	CA	92705	6634	30	06059	33.7737545	-117.8687284	Orange County
236519	Fee-for-Service	1558586057	1558586057	1	1	AMY MCENTAFFER MD	1/20/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5950 UNIVERSITY AVE	STE 205	WDM	IA	50266	8231	00	None	41.598693	-93.792393	Dallas County
236521	Fee-for-Service	1508928607	1508928607	1	1	AHMED, NABIL M MD	8/16/2020	2080P0207X	NA	Hematology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	6621 FANNIN STREET	None	HOUSTON	TX	77030	2303	00	None	29.70724683	-95.4026169	Harris County
236522	Fee-for-Service	1588790232	1588790232	1	1	ATTENELLO, FRANK J JR MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	42643	01	General Practice	0	In state provider	None	1201 E BIXBY RD	None	LONG BEACH	CA	90807	4221	19	06037	33.82673052	-118.1760072	Los Angeles County
236549	Fee-for-Service	1932756764	1932756764	1	3	ALTAMED HEALTH SERVICES	6/19/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3601 WEST SUNFLOWER AVE	SUITE 100	SANTA ANA	CA	92704	7916	30	06059	33.69568151	-117.918072	Orange County
236582	Fee-for-Service	1992330690	1992330690	1	2	AFFORDABLE URGENT CARE, INC	8/1/2023	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	21300 SHERMAN WAY STE 3	None	CANOGA PARK	CA	91303	3672	19	06037	34.20095853	-118.5957675	Los Angeles County
236587	Fee-for-Service	1427181064	1427181064	1	1	ALFARO, MARIA G LMFT	11/5/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6931 VAN NUYS BLVD	SUITE 329	VAN NUYS	CA	91405	3999	19	06037	34.19649	-118.448787	Los Angeles County
236604	Fee-for-Service	1275598500	1275598500	1	2	ALWAYS STAY HOME NURSING	2/5/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11633 HAWTHORNE BLVD	STE 220	HAWTHORNE	CA	90250	2369	19	06037	33.928488	-118.3527475	Los Angeles County
236641	Fee-for-Service	1750559431	1750559431	1	8	ALL STAR PHYSICAL THERAPY, I	4/30/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	32246 CLINTON KEITH	STE 103	WILDOMAR	CA	92595	7320	33	06065	33.59200657	-117.2501269	Riverside County
236642	Fee-for-Service	1396973285	1396973285	1	1	AYSON, ENZO G	8/29/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
236644	Fee-for-Service	1750559431	1750559431	1	1	ALL STAR PHYSICAL THERAPY, I	2/19/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	425 DIAMOND DR.,	101	LAKE ELSINORE	CA	92530	0000	33	06065	33.65802263	-117.3002985	Riverside County
236686	Fee-for-Service	1447487830	1447487830	1	1	ADAMS, WILLIAM C DPM	7/20/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
236703	Fee-for-Service	1639170764	1639170764	1	1	AMARNAUTH SINGH	9/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5859 W TALAVI BLVD	STE 100	GLENDALE	AZ	85306	1870	00	None	33.635232	-112.184793	Maricopa County
236728	Fee-for-Service	1538559760	1538559760	1	2	ANDREWS, RANDY LCSW	10/9/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	415 KNOLLCREST DR	STE 101	REDDING	CA	96002	0181	45	06089	40.57267376	-122.3643496	Shasta County
236832	Fee-for-Service	1871905257	1871905257	1	1	AFRIDI, FARAZ MD	9/1/2021	207RP1001X	NA	Pulmonology	026	PHYSICIANS	148981	None	None	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 230	RIVERSIDE	CA	92505	3312	33	06065	33.90290859	-117.4941562	Riverside County
236833	Fee-for-Service	1336162981	1336162981	1	1	ATKINSON, JAMES B MD	7/1/1996	208600000X	NA	General Surgery	026	PHYSICIANS	34794	02	General Surgery	0	In state provider	None	100 MEDICAL PLAZA	STE 755	LOS ANGELES	CA	90024	0000	19	06037	34.06544724	-118.4459249	Los Angeles County
236838	Fee-for-Service	1932756764	1932756764	1	3	ALTAMED HEALTH SERVICES	6/19/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3601 WEST SUNFLOWER AVE	SUITE 100	SANTA ANA	CA	92704	7916	30	06059	33.69568151	-117.918072	Orange County
236839	Fee-for-Service	1184958977	1184958977	1	1	AFSHAR, POUYA	11/24/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107069	None	None	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
236857	Fee-for-Service	1164528105	1164528105	1	1	AWAD, YOUSSEF B MD	10/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52194	41	Internal Medicine	0	In state provider	None	3440 ATLANTIC AVE	STE 3	LONG BEACH	CA	90807	4568	19	06037	33.81966	-118.1849935	Los Angeles County
236905	Fee-for-Service	1629564026	1629564026	1	1	AMERICAN RIVER HOSPICE	6/20/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	SERVICES	1451 RIVER PARK DR	SUITE 241	SACRAMENTO	CA	95815	4514	34	06067	38.598651	-121.439673	Sacramento County
236931	Fee-for-Service	1750559431	1750559431	1	1	ALL STAR PHYSICAL THERAPY, I	2/19/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	425 DIAMOND DR.,	101	LAKE ELSINORE	CA	92530	0000	33	06065	33.65802263	-117.3002985	Riverside County
236954	Fee-for-Service	1184803843	1184803843	1	1	ABOOD, FERIA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2559 MEDICAL DR	STE C	ALAMOGORDO	NM	88310	8704	00	None	32.92356592	-105.9331168	Otero County
236974	Fee-for-Service	1316080807	1316080807	1	1	ANKENEY, LINDA A MFT	2/22/2016	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1380 LEAD HILL BLVD	SUITE 160	ROSEVILLE	CA	95661	2998	31	06061	38.74953449	-121.2601832	Placer County
237025	Fee-for-Service	1932756764	1932756764	1	7	ALTAMED HEALTH SERVICES	4/24/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1829 N CAMBRIDGE STREET	None	ORANGE	CA	92865	4409	30	06059	33.81808587	-117.8441416	Orange County
237026	Fee-for-Service	1942398482	1942398482	1	1	ARTEAGA, ALBERT H MD	6/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	38206	40	Pediatrics	0	In state provider	None	565 N MOUNT VERNON AVE	None	SAN BERNARDINO	CA	92411	2661	36	06071	34.109406	-117.313813	San Bernardino County
237030	Fee-for-Service	1528726809	1528726809	1	1	ACCESS CARE ANESTHESIA OF CA	8/24/2023	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	LIFORNIA PC	16506 LAKEWOOD BLVD	SUITE 200	BELLFLOWER	CA	90706	5164	19	06037	33.88470916	-118.1424401	Los Angeles County
237041	Fee-for-Service	1225687783	1225687783	1	1	ASSURED INDEPENDENCE LLC	2/10/2022	No Taxonomy Provided	NA	None	068	HCBC BENEFIT PROVIDER	-	-	NOT APPLICABLE	2	Out of state provider	None	3125 COLBY AVE	SUITE B	EVERET	WA	98201	0000	00	None	47.97549045	-122.2084679	Snohomish County
237053	Fee-for-Service	1457596371	1457596371	1	8	ALLSAFE MEDICAL GROUP INC.	6/3/2024	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2617 E CHAPMAN AVE	312	ORANGE	CA	92869	3226	30	06059	33.7878445	-117.8254845	Orange County
237101	Fee-for-Service	1750490363	1750490363	1	1	ASIAN AMERICANS FOR COMM	11/25/2005	261Q00000X	NA	Other	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INVOLVEMENT SANTA CLARA	2400 MOORPARK AVE	STE 319	SAN JOSE	CA	95128	2680	43	06085	37.3160785	-121.937121	Santa Clara County
237114	Fee-for-Service	1336162981	1336162981	1	1	ATKINSON, JAMES B MD	7/1/1996	208600000X	NA	General Surgery	026	PHYSICIANS	34794	85	Surgery-Pediatric	0	In state provider	None	100 MEDICAL PLAZA	STE 755	LOS ANGELES	CA	90024	0000	19	06037	34.06544724	-118.4459249	Los Angeles County
237115	Fee-for-Service	1114125846	1114125846	1	1	ARNUSH, MARC E MD	9/16/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	90486	01	General Practice	0	In state provider	None	9601 S SEPULVEDA BLVD	None	LOS ANGELES	CA	90045	5203	19	06037	33.948297	-118.3963665	Los Angeles County
237119	Fee-for-Service	1700896727	1700896727	1	1	ARYAFAR, PARASTOO NP	4/21/2014	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	47923 OASIS ST	None	INDIO	CA	92201	6950	33	06065	33.70080223	-116.2209518	Riverside County
237120	Fee-for-Service	1184496283	1184496283	1	1	A-1 ASCENDED SENIOR CARE INC	12/6/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	16444 GERMAIN ST	None	GRANADA HILLS	CA	91344	6712	19	06037	34.26193772	-118.4907874	Los Angeles County
237128	Fee-for-Service	1780079780	1780079780	1	1	APPELL, LAUREN E MD	5/2/2023	2080P0207X	NA	Hematology	026	PHYSICIANS	-	None	None	2	Out of state provider	None	1 CHILDREN'S WAY	SLOT 653	LITTLE ROCK	AR	72202	3500	00	None	34.742745	-92.2927905	Pulaski County
237182	Fee-for-Service	1609826510	1609826510	1	1	ANDREA H. AN, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	655 S DOBSON RD	STE 103	CHANDLER	AZ	85224	5668	00	None	33.294555	-111.875382	Maricopa County
237196	Fee-for-Service	1629564026	1629564026	1	1	AMERICAN RIVER HOSPICE	6/20/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	SERVICES	1451 RIVER PARK DR	SUITE 241	SACRAMENTO	CA	95815	4514	34	06067	38.598651	-121.439673	Sacramento County
237219	Fee-for-Service	1750559431	1750559431	1	1	ALL STAR PHYSICAL THERAPY, I	4/30/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	425 DIAMOND DR.,	101	LAKE ELSINORE	CA	92530	0000	33	06065	33.65802263	-117.3002985	Riverside County
237226	Fee-for-Service	1720040504	1720040504	1	1	ALDERETE, EDWARD C MD	8/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	30551	40	Pediatrics	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93456	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
237273	Fee-for-Service	1346328820	1346328820	1	1	ALEXANDER, JASON Q MD	8/25/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	72072	01	General Practice	0	In state provider	None	1510 SAN PABLO ST	STE 514	LOS ANGELES	CA	90033	5324	19	06037	34.06287152	-118.2029433	Los Angeles County
237294	Fee-for-Service	1972537173	1972537173	1	1	AMERICAN MEDICAL RESPONSE	12/10/1997	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	WEST	10 VICTOR SQUARE	None	SCOTTS VALLEY	CA	95066	3562	44	06087	37.05998332	-122.0067604	Santa Cruz County
237295	Fee-for-Service	1518018746	1518018746	1	1	ALVES, DANIEL MD	10/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64574	47	Miscellaneous	0	In state provider	None	25455 BARTON RD	STE 106A	LOMA LINDA	CA	92354	3129	36	06071	34.04805253	-117.249534	San Bernardino County
237314	Fee-for-Service	1932756764	1932756764	1	7	ALTAMED HEALTH SERVICES	4/24/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	1829 N CAMBRIDGE STREET	None	ORANGE	CA	92865	4409	30	06059	33.81808587	-117.8441416	Orange County
237316	Fee-for-Service	1528726809	1528726809	1	1	ACCESS CARE ANESTHESIA OF CA	8/24/2023	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	LIFORNIA PC	16506 LAKEWOOD BLVD	SUITE 200	BELLFLOWER	CA	90706	5164	19	06037	33.88470916	-118.1424401	Los Angeles County
237389	Fee-for-Service	1750490363	1750490363	1	1	ASIAN AMERICANS FOR COMM	12/15/2021	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	INVOLVEMENT SANTA CLARA	2400 MOORPARK AVE	STE 319	SAN JOSE	CA	95128	2680	43	06085	37.3160785	-121.937121	Santa Clara County
237399	Fee-for-Service	1548557903	1548557903	1	1	ABBOTT, RACHEL A MD	4/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	122734	01	General Practice	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
237424	Fee-for-Service	1194341610	1194341610	1	1	ADVANCE SOLUTIONS USA MEDICA	2/16/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	L SUPPLY LLC	312 E BASE LINE ST	None	SAN BERNARDINO	CA	92410	3905	36	06071	34.1213883	-117.2786412	San Bernardino County
237429	Fee-for-Service	1710151840	1710151840	1	1	AFARIAN, HAGOP M MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	92959	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2755 HERNDON AVENUE	None	CLOVIS	CA	93611	6800	10	06019	36.83745149	-119.6604315	Fresno County
237437	Fee-for-Service	1598390429	1598390429	1	1	ALL HOPE HOSPICE LLC	11/19/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	27001 CALAROGA AVENUE	SUITE 3B	HAYWARD	CA	94545	4345	01	06001	37.63388965	-122.0898396	Alameda County
237438	Fee-for-Service	1215193495	1215193495	1	1	AMAYA, KEVIN E DO	8/22/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	10917	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
237456	Fee-for-Service	1518385699	1518385699	1	1	AGGARWAL, ISHITA MD	10/7/2020	207RR0500X	NA	Other	026	PHYSICIANS	138573	83	Rheumatology	0	In state provider	None	2100 WEBSTER ST	STE 112	SAN FRANCISCO	CA	94115	2374	38	06075	37.7904826	-122.4324477	San Francisco County
237484	Fee-for-Service	1134126329	1134126329	1	1	ASHOKKUMAR, SRINIVASA K	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	42227	41	Internal Medicine	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65911769	-121.6448024	Monterey County
237509	Fee-for-Service	1720040504	1720040504	1	1	ALDERETE, EDWARD C MD	8/23/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	30551	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1400 E CHURCH ST	None	SANTA MARIA	CA	93456	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
237575	Fee-for-Service	1861438889	1861438889	1	1	ABRANTES, MARIA A S MD	10/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	71928	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
237582	Fee-for-Service	1740804715	1740804715	1	1	ADEL EL-BIALY MD INC	10/12/2021	2471C1101X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	23928 LYONS AVE	201	NEWHALL	CA	91321	2454	19	06037	34.37895689	-118.5532505	Los Angeles County
237602	Fee-for-Service	1912904806	1912904806	1	1	ANASTASSIOU, PETER T	7/9/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	43203	None	None	0	In state provider	None	2100 WEBSTER ST	STE 411	SAN FRANCISCO	CA	94115	2379	38	06075	37.7904826	-122.4324477	San Francisco County
237606	Fee-for-Service	1528726809	1528726809	1	1	ACCESS CARE ANESTHESIA OF CA	8/24/2023	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	LIFORNIA PC	16506 LAKEWOOD BLVD	SUITE 200	BELLFLOWER	CA	90706	5164	19	06037	33.88470916	-118.1424401	Los Angeles County
237607	Fee-for-Service	1376566190	1376566190	1	1	ALIPOUR, ZARI PSYD	4/26/2016	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
237618	Fee-for-Service	1881126530	1881126530	1	1	ALLEN, JUSTIN	6/19/2024	207P00000X	NA	Other	026	PHYSICIANS	170421	66	Emergency Medicine (Urgent Care)	0	In state provider	None	914 PINE STREET	None	MOUNT SHASTA	CA	96067	2143	47	06093	41.31798759	-122.3218165	Siskiyou County
237625	Fee-for-Service	1164992046	1164992046	1	1	ALIBAYAN, HAZEL C RCP	12/30/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	01	06001	37.706364	-122.165163	Alameda County
237661	Fee-for-Service	1407476468	1407476468	1	1	ANUGU, GAUTAM MD	10/13/2023	207R00000X	NA	Other	026	PHYSICIANS	187403	None	None	0	In state provider	None	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
237677	Fee-for-Service	1750490363	1750490363	1	1	ASIAN AMERICANS FOR COMM	11/25/2005	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INVOLVEMENT SANTA CLARA	2400 MOORPARK AVE	STE 319	SAN JOSE	CA	95128	2680	43	06085	37.3160785	-121.937121	Santa Clara County
237680	Fee-for-Service	1588053177	1588053177	1	1	A BETTER SOLUTION IN HOME	7/8/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CARE, INC	8929 COMPLEX DRIVE	None	SAN DIEGO	CA	92123	1454	37	06073	32.82996636	-117.1337181	San Diego County
237724	Fee-for-Service	1598390429	1598390429	1	1	ALL HOPE HOSPICE LLC	11/19/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	27001 CALAROGA AVENUE	SUITE 3B	HAYWARD	CA	94545	4345	01	06001	37.63388965	-122.0898396	Alameda County
237728	Fee-for-Service	1386073880	1386073880	1	1	ACOSTA, MARIA E LMFT	2/5/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
237772	Fee-for-Service	1134126329	1134126329	1	1	ASHOKKUMAR, SRINIVASA K	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	42227	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1033 LOS PALOS DR	None	SALINAS	CA	93901	3916	27	06053	36.65911769	-121.6448024	Monterey County
237789	Fee-for-Service	1659422475	1659422475	1	1	AZER, MAHER A A MD INC	4/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	45	Nephrology (Renal-Kidney)	0	In state provider	None	3810 KATELLA AVE	None	LOS ALAMITOS	CA	90720	3302	30	06059	33.80299148	-118.0666755	Orange County
237791	Fee-for-Service	1326441239	1326441239	1	1	ANZA HEALTHCARE INC	12/1/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	654 SOUTH ANZA STREET	None	EL CAJON	CA	92020	6602	37	06073	32.788926	-116.948218	San Diego County
237798	Fee-for-Service	1346414513	1346414513	1	1	ALTAMED HEALTH SERVICES	4/30/2008	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	12130 PARAMOUNT BLVD	None	DOWNEY	CA	90242	2339	19	06037	33.93100421	-118.1466676	Los Angeles County
237811	Fee-for-Service	1922339092	1922339092	1	1	ADVANCED MEDICAL AND URGENT	12/28/2018	261Q00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER, INC.	974 W FOOTHILL BLVD	None	UPLAND	CA	91786	3728	36	06071	34.106562	-117.6651435	San Bernardino County
237820	Fee-for-Service	1770538027	1770538027	1	1	ARORA, LOKESH C MD	8/20/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	60272	30	Radiology	0	In state provider	None	18012 SKY PARK CIR	STE 100	IRVINE	CA	92614	6429	30	06059	33.68788858	-117.8562743	Orange County
237834	Fee-for-Service	1649328519	1649328519	1	1	AZIZOLLAHI, FARID MD	3/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	83353	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
237837	Fee-for-Service	1235523473	1235523473	1	1	ALLEN-SHARPLEY, MICHELLE MD	12/15/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	147842	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
237858	Fee-for-Service	1861438889	1861438889	1	1	ABRANTES, MARIA A S MD	10/14/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	71928	40	Pediatrics	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
237880	Fee-for-Service	1750668554	1750668554	1	1	ACE MEDICAL	12/19/2011	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	TRANSPORTATION, LLC.	1256 W BROOKS STREET	SUITE H	ONTARIO	CA	91762	3663	36	06071	34.062102	-117.674334	San Bernardino County
237922	Fee-for-Service	1326354838	1326354838	1	1	ALTIVEROS, ANDREW MARCOS I M	3/24/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	174205	None	None	0	In state provider	D	7601 HOSPITAL DR	100 A	SACRAMENTO	CA	95823	5408	34	06067	38.464794	-121.415571	Sacramento County
237934	Fee-for-Service	1073254587	1073254587	1	1	ANDREW M FOX MD INC A PROFES	1/17/2023	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SIONAL MEDICAL CORPORATI	4849 VAN NUYS BLVD	STE 203	SHERMAN OAKS	CA	91403	2122	19	06037	34.159113	-118.4487465	Los Angeles County
237951	Fee-for-Service	1922338987	1922338987	1	1	ALLISON-HUNT, KRISTINE D	3/15/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
237974	Fee-for-Service	1114175189	1114175189	1	1	AGARWALA, RICHA V LCSW	12/18/2018	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3808 RIVERSIDE DR	SUITE 500	BURBANK	CA	91505	5301	19	06037	34.15252315	-118.3412174	Los Angeles County
237994	Fee-for-Service	1720607997	1720607997	1	1	ALTAMED HEALTH SERVICES CORP	8/13/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8627 ATLANTIC AVENUE	ROOM 100	SOUTH GATE	CA	90280	3501	19	06037	33.95462085	-118.1838426	Los Angeles County
238009	Fee-for-Service	1326042870	1326042870	1	1	ABBVIE ENDOCRINOLOGY INC	8/17/2015	332B00000X	NA	Other	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	1 N WAUKEGAN RD	AP5-NE	NORTH CHICAGO	IL	60064	1802	00	None	42.302106	-87.89157	Lake County
238029	Fee-for-Service	1629383997	1629383997	1	1	AHMADI, SHAHRYAR MD	2/22/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	146477	None	None	0	In state provider	None	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	15	06029	35.640783	-117.6698475	Kern County
238053	Fee-for-Service	1285273490	1285273490	2	1	ADKINS, SIMONE LMFT	1/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	333 1ST ST	SUITE 2	BENICIA	CA	94510	3258	48	06095	38.04715766	-122.1604997	Solano County
238086	Fee-for-Service	1346414513	1346414513	1	1	ALTAMED HEALTH SERVICES	4/30/2008	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	12130 PARAMOUNT BLVD	None	DOWNEY	CA	90242	2339	19	06037	33.93100421	-118.1466676	Los Angeles County
238098	Fee-for-Service	1922339092	1922339092	1	1	ADVANCED MEDICAL AND URGENT	12/28/2018	261Q00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CARE CENTER, INC.	974 W FOOTHILL BLVD	None	UPLAND	CA	91786	3728	36	06071	34.106562	-117.6651435	San Bernardino County
238104	Fee-for-Service	1881795896	1881795896	1	1	AIDS PROJECT OF EAST BAY	8/14/2002	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1320 WEBSTER ST	STE 2	OAKLAND	CA	94612	3204	01	06001	37.80282669	-122.2690561	Alameda County
238109	Fee-for-Service	1033398268	1033398268	1	1	ASISH K. DAS, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAM JACKSON PARK	None	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
238177	Fee-for-Service	1659697092	1659697092	1	1	ATHWAL, PARDEEP MD	8/1/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	144278	30	Radiology	0	In state provider	None	501 PETALUMA AVE	None	SEBASTOPOL	CA	95472	9917	49	06097	38.39674221	-122.8201502	Sonoma County
238226	Fee-for-Service	1952639536	1952639536	1	1	ALLAN, REBECCA S	9/30/1994	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 S SANTA CRUZ AVE	STE 100	LOS GATOS	CA	95030	6743	43	06085	37.22004633	-121.9856938	Santa Clara County
238229	Fee-for-Service	1871570341	1871570341	1	1	AMUKELE, SAMUEL A MD	4/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	97898	34	Urology and Urological Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
238238	Fee-for-Service	1164438438	1164438438	2	1	ADVANTACARE HEALTH, INC	2/6/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	5 MANDEVILLE CT	STE 400	MONTEREY	CA	93940	5745	27	06053	36.57541006	-121.8125248	Monterey County
238255	Fee-for-Service	1275714982	1275714982	1	1	AL-KOURAINY, KOUSAY A MD	3/29/1995	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	480 4TH AVE	STE 409	CHULA VISTA	CA	91910	4413	37	06073	32.63411298	-117.0816772	San Diego County
238277	Fee-for-Service	1881911477	1881911477	1	1	ANDERSON, D. GORDON MD INC	4/29/2010	208200000X	NA	General Surgery	026	PHYSICIANS	20223	24	Plastic Surgery	0	In state provider	None	1130 COFFEE ROAD	SUITE 5B	MODESTO	CA	95355	4228	50	06099	37.65884948	-120.9755938	Stanislaus County
238284	Fee-for-Service	1912465915	1912465915	1	1	ADVENTIST HEALTH PHYSICIANS	7/31/2019	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	111 RALEY BLVD	STE 240	CHICO	CA	95928	8351	04	06007	39.71601447	-121.790817	Butte County
238304	Fee-for-Service	1477539310	1477539310	1	1	AMIRSHEYBANI, HAMID R MD	2/8/2015	208200000X	NA	General Surgery	026	PHYSICIANS	74344	24	Plastic Surgery	0	In state provider	None	1130 COFFEE RD	STE 5B	MODESTO	CA	95355	4228	50	06099	37.65884948	-120.9755938	Stanislaus County
238319	Fee-for-Service	1366272718	1366272718	1	1	ALONZO AVILA, JESSICA L LCSW	8/5/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
238321	Fee-for-Service	1679062707	1679062707	1	1	ALLINSON, FRANCIS MD	10/31/2024	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	167388	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
238323	Fee-for-Service	1902537855	1902537855	1	1	AMERICAN ROSE HEALTHCARE	9/3/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	GROUP INC	1475 N BROADWAY	STE 335	WALNUT CREEK	CA	94596	4672	07	06013	37.90047617	-122.0602361	Contra Costa County
238327	Fee-for-Service	1659535318	1659535318	1	1	AQIL, MOHAMMAD W DO	12/8/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	10212	08	Family Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
238341	Fee-for-Service	1184753923	1184753923	1	2	ARTENOS, JOHN A MD INC	12/30/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	73956	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1505 WILSON TER	STE 160	GLENDALE	CA	91206	4077	19	06037	34.14960934	-118.2313491	Los Angeles County
238376	Fee-for-Service	1346414513	1346414513	1	1	ALTAMED HEALTH SERVICES	4/30/2008	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	12130 PARAMOUNT BLVD	None	DOWNEY	CA	90242	2339	19	06037	33.93100421	-118.1466676	Los Angeles County
238379	Fee-for-Service	1033312988	1033312988	1	1	ARRINGTON, JERRICA LMFT	7/27/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4949 BUCKLEY WAY	113	BAKERSFIELD	CA	93309	4842	15	06029	35.33866564	-119.0541714	Kern County
238381	Fee-for-Service	1437170982	1437170982	1	1	ABRAMS, ROBERT A DPM	5/1/1975	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	910 S SUNSET AVE	STE 7	WEST COVINA	CA	91790	3409	19	06037	34.064247	-117.9429166	Los Angeles County
238383	Fee-for-Service	1649980699	1649980699	1	1	ARVA MEDTRANS LLC	7/13/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1900 VICTORY BLVD	None	GLENDALE	CA	91201	2532	19	06037	34.16395949	-118.3041978	Los Angeles County
238395	Fee-for-Service	1518972330	1518972330	1	1	ATTAR-SEYEDI, MARYAM MD	9/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	52547	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
238401	Fee-for-Service	1346276573	1346276573	1	1	ABBOTT, RICHARD L MD	8/3/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	26890	18	Ophthalmology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
238452	Fee-for-Service	1922838671	1922838671	1	1	AL-SAADI, TARIQ D MD	11/3/2024	207T00000X	NA	General Surgery	026	PHYSICIANS	None	14	Neurological Surgery	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
238481	Fee-for-Service	1477653574	1477653574	1	1	AMADOR EMERGENCY PHYSICI	2/28/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP INC	1100 BUTTE ST	None	REDDING	CA	96001	0852	45	06089	40.5853603	-122.3869865	Shasta County
238516	Fee-for-Service	1760414502	1760414502	1	1	ADLER MILES FM	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	16859	41	Internal Medicine	0	In state provider	A PROFESSIONAL CORP	13847 E 14TH ST	RM 2	SAN LEANDRO	CA	94578	2632	01	06001	37.71457844	-122.1418551	Alameda County
238585	Fee-for-Service	1578986220	1578986220	2	1	ACCESS MEDICAL, INC.	8/4/2023	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1525 W. CHAPMAN AVE.	STE. B	ORANGE	CA	92868	2746	30	06059	33.7879245	-117.8693325	Orange County
238610	Fee-for-Service	1053162487	1053162487	1	1	ALBANY CITY UNIFIED	7/1/2024	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	1216 SOLANO AVE	None	ALABANY	CA	94706	1725	01	06001	37.89041965	-122.2957657	Alameda County
238643	Fee-for-Service	1053674283	1053674283	1	1	AZIM, SHABRINA PSYD	9/11/2020	101YM0800X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
238659	Fee-for-Service	1790829182	1790829182	1	1	AZAMIAN, BOBAK R MD	7/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119910	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
238672	Fee-for-Service	1922525112	1922525112	1	1	ADAMS, HOLLIS S LMFT	11/30/2021	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	591 CAMINO DE LA REINA	802	SAN DIEGO	CA	92108	3102	37	06073	32.76632791	-117.1616245	San Diego County
238731	Fee-for-Service	1225011034	1225011034	1	1	AMADEO, ALESSANDRA M MD	2/23/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	52834	78	Neoplastic Diseases/Oncology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
238753	Fee-for-Service	1750490363	1750490363	1	4	ASIAN AMERICANS FOR COMM	8/22/2024	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	266 NORTH JACKSON AVENUE	SUITE 4	SAN JOSE	CA	95116	1606	43	06085	37.36445516	-121.8492308	Santa Clara County
238805	Fee-for-Service	1396783379	1396783379	1	9	ASANA INTEGRATED MEDICAL GRO	10/13/2022	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	UP PC	1555 SOQUEL DR	None	SANTA CRUZ	CA	95065	1705	44	06087	36.98863619	-121.9830754	Santa Cruz County
238807	Fee-for-Service	1053428078	1053428078	1	1	ALEXANDER, LIZA H	2/8/2015	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	2700 N BELLFLOWER BLVD	STE 312	LONG BEACH	CA	90815	1145	19	06037	33.805692	-118.1251805	Los Angeles County
238810	Fee-for-Service	1164479119	1164479119	1	1	ANZIVINO, MICHAEL J MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	71519	41	Internal Medicine	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
238823	Fee-for-Service	1871671156	1871671156	1	1	ALEXANDER, VICTOR MD	3/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53788	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
238878	Fee-for-Service	1255767216	1255767216	1	1	AZIZ, ADEL MD INC	12/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	74346	05	Anesthesiology	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
238901	Fee-for-Service	1538462023	1538462023	1	1	AFFINITY PERS CARE AGEN	4/5/2011	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	18341 SHERMAN WAY	SUITE 204	RESEDA	CA	91335	4437	19	06037	34.20120746	-118.533105	Los Angeles County
238920	Fee-for-Service	1356481360	1356481360	1	1	A WOMAN FOR WOMEN MEDICAL	6/30/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	34831	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	GROUP INC	9460 NO NAME UNO	STE 245	GILROY	CA	95020	3538	43	06085	37.037781	-121.570965	Santa Clara County
238960	Fee-for-Service	1558306266	1558306266	2	2	AMG, A PROFESSIONAL MEDICAL	5/20/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	CORPORATION	925 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4442	19	06037	34.08499473	-118.1230937	Los Angeles County
238997	Fee-for-Service	1376621458	1376621458	1	1	ARROYO ANTHONY J MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71372	41	Internal Medicine	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
239017	Fee-for-Service	1225011034	1225011034	1	1	AMADEO, ALESSANDRA M MD	2/23/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	52834	30	Radiology	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	1901	19	06037	34.05358988	-118.2661119	Los Angeles County
239025	Fee-for-Service	1356419261	1356419261	1	1	AHMED, SURAIYA PT	7/1/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	7365 CARNELIAN ST	SUITE 124	RANCHO CUCAMONGA	CA	91730	1158	36	06071	34.12038413	-117.6160525	San Bernardino County
239038	Fee-for-Service	1750490363	1750490363	1	4	ASIAN AMERICANS FOR COMM	8/22/2024	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT CLINIC	266 NORTH JACKSON AVENUE	SUITE 4	SAN JOSE	CA	95116	1606	43	06085	37.36445516	-121.8492308	Santa Clara County
239047	Fee-for-Service	1407145931	1407145931	1	1	ALMAZAN, TIMOTHY H MD	10/6/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	125941	07	Dermatology	0	In state provider	None	11900 SOUTH ST STE 118	SUITE 118	CERRITOS	CA	90703	6800	19	06037	33.85841261	-118.07847	Los Angeles County
239098	Fee-for-Service	1164479119	1164479119	1	1	ANZIVINO, MICHAEL J MD	5/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	71519	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3565 DEL AMO BLVD	None	TORRANCE	CA	90503	1637	19	06037	33.84861872	-118.3488958	Los Angeles County
239132	Fee-for-Service	1316937121	1316937121	1	1	ADVENTIST HEALTH CLEARLAKE	7/1/1997	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	15230 LAKESHORE DR	None	CLEARLAKE	CA	95422	8107	17	06033	38.95005226	-122.6264492	Lake County
239153	Fee-for-Service	1356554802	1356554802	2	1	ABDIAN, LOGHMAN MD	4/27/2006	261Q00000X	NA	Other	026	PHYSICIANS	46128	01	General Practice	0	In state provider	None	1107 S ALVARADO ST	STE 102	LOS ANGELES	CA	90006	0408	19	06037	34.04997092	-118.2810099	Los Angeles County
239154	Fee-for-Service	1427443969	1427443969	1	1	ALL CONCIERGE HOMEHEALTH INC	12/10/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2125 S EL CAMINO REAL	SUITE 104	OCEANSIDE	CA	92054	6249	37	06073	33.18895278	-117.3283467	San Diego County
239194	Fee-for-Service	1770953895	1770953895	1	1	A CARE HOME HEALTH INC	9/17/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	709 BREA CANYON RD	SUITE 3	WALNUT	CA	91789	3041	19	06037	34.0052163	-117.8466001	Los Angeles County
239197	Fee-for-Service	1861452765	1861452765	1	1	ACTON, JOSEPH H MD	12/22/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	101 CIVIC CENTER LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
239208	Fee-for-Service	1811339138	1811339138	1	1	A ONE HOSPICE PROVIDERS INC	8/29/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4110 EDISON AVE	STE 205	CHINO	CA	91710	8409	36	06071	33.99723746	-117.7140555	San Bernardino County
239248	Fee-for-Service	1558306266	1558306266	2	2	AMG, A PROFESSIONAL MEDICAL	5/20/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	CORPORATION	925 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4442	19	06037	34.08499473	-118.1230937	Los Angeles County
239249	Fee-for-Service	1902352818	1902352818	1	1	ABELLANOSA, FRAN CYREM O PT	8/9/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
239261	Fee-for-Service	1568169266	1568169266	1	1	AMERI LABPRO INC	12/12/2023	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	3555 VOYAGER ST	104D	TORRANCE	CA	90503	1675	19	06037	33.85272545	-118.350225	Los Angeles County
239297	Fee-for-Service	1225520885	1225520885	1	1	AVITA FAMILY THERAPY AND	10/8/2019	106H00000X	NA	Mental Health Outpatient Services	104	LICENSED PROFESSIONAL CLINICAL COUNSELOR - GROUP	-	-	NOT APPLICABLE	0	In state provider	WELLNESS CENTER	9666 BUSINESSPARK AVENUE	SUITE 207	SAN DIEGO	CA	92131	1646	37	06073	32.89839401	-117.1124102	San Diego County
239310	Fee-for-Service	1194093393	1194093393	1	1	ANAIT GRIGORYAN	1/31/2000	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4448 EAGLE ROCK BLVD	#A	LOS ANGELES	CA	90041	3512	19	06037	34.12550387	-118.2193928	Los Angeles County
239346	Fee-for-Service	1356510101	1356510101	1	1	ALEXANDER, SAMYRA LMFT	9/22/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
239350	Fee-for-Service	1487987772	1487987772	1	1	ALGD LLC	10/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	350 DE SOTO DR	None	LOS GATOS	CA	95032	2402	43	06085	37.24527764	-121.9469741	Santa Clara County
239374	Fee-for-Service	1629001466	1629001466	1	1	ANAKA, RICK A MD	1/16/2008	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	68810	40	Pediatrics	0	In state provider	None	1840 SIERRA GARDENS	None	ROSEVILLE	CA	95678	2912	31	06061	38.74730831	-121.2613758	Placer County
239418	Fee-for-Service	1760094015	1760094015	1	1	ABDELGAWAD, HADIA H CRNA	3/20/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
239422	Fee-for-Service	1316937121	1316937121	1	1	ADVENTIST HEALTH CLEARLAKE	7/1/1997	261QR1300X	NA	Rural Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	15230 LAKESHORE DR	None	CLEARLAKE	CA	95422	8107	17	06033	38.95005226	-122.6264492	Lake County
239426	Fee-for-Service	1639519986	1639519986	1	1	ASCC LLC	6/25/2013	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	5320 CARRINGTON CIRCLE	None	STOCKTON	CA	95210	3515	39	06077	38.00512188	-121.2937141	San Joaquin County
239459	Fee-for-Service	1376315291	1376315291	1	1	APPLE VALLEY RETIREMENT INC	11/1/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	12994 RINCON ROAD	None	APPLE VALLEY	CA	92308	6284	36	06071	34.48754217	-117.2244359	San Bernardino County
239496	Fee-for-Service	1811339138	1811339138	1	1	A ONE HOSPICE PROVIDERS INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4110 EDISON AVE	STE 205	CHINO	CA	91710	8409	36	06071	33.99723746	-117.7140555	San Bernardino County
239509	Fee-for-Service	1528014529	1528014529	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4541 CAMPUS DR	None	IRVINE	CA	92612	2621	30	06059	33.64879496	-117.8309544	Orange County
239536	Fee-for-Service	1558306266	1558306266	2	2	AMG, A PROFESSIONAL MEDICAL	5/20/2020	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	925 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4442	19	06037	34.08499473	-118.1230937	Los Angeles County
239537	Fee-for-Service	1306069737	1306069737	1	1	ADVANCED HOME HEALTH INC	2/12/2008	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4354 AUBURN BLVD	SUITE 300	SACRAMENTO	CA	95841	4107	34	06067	38.645883	-121.362228	Sacramento County
239584	Fee-for-Service	1225520885	1225520885	1	1	AVITA FAMILY THERAPY AND	11/5/2018	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	WELLNESS CENTER	9666 BUSINESSPARK AVENUE	SUITE 207	SAN DIEGO	CA	92131	1646	37	06073	32.89839401	-117.1124102	San Diego County
239601	Fee-for-Service	1932697190	1932697190	1	1	AHMADIEH, KIAN	7/18/2023	208800000X	NA	Other	026	PHYSICIANS	187142	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
239608	Fee-for-Service	1356630859	1356630859	1	1	ADVANCED SLEEP MEDICINE SRVS	7/3/2018	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	435 ARDEN AVE	SUITE 440	GLENDALE	CA	91203	4063	19	06037	34.15848148	-118.2628845	Los Angeles County
239636	Fee-for-Service	1225251135	1225251135	1	1	ANDERSEN, ERIN L NP	6/5/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
239650	Fee-for-Service	1750490363	1750490363	1	3	ASIAN AMERICANS FOR COMM	12/1/2022	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	266 NORTH JACKSON AVE	SUITE 1	SAN JOSE	CA	95116	1606	43	06085	37.36445516	-121.8492308	Santa Clara County
239691	Fee-for-Service	1578843371	1578843371	1	1	AVERY, NOHEAAUMOE P NP	4/1/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3737 MARTIN LUTHER KING	SUITE 605B	LYNWOOD	CA	90262	3543	19	06037	33.92872742	-118.2006921	Los Angeles County
239707	Fee-for-Service	1316937121	1316937121	1	1	ADVENTIST HEALTH CLEARLAKE	1/31/2011	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL INC	15230 LAKESHORE DR	None	CLEARLAKE	CA	95422	8107	17	06033	38.95005226	-122.6264492	Lake County
239732	Fee-for-Service	1053775502	1053775502	1	1	ADVANCED ARTIFICIAL EYES	7/28/2023	156FX1700X	NA	Other	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	18455 BURBANK BLVD	SUITE 202	TARZANA	CA	91356	2802	19	06037	34.17237215	-118.5354469	Los Angeles County
239741	Fee-for-Service	1558758607	1558758607	1	1	ADENIKINJU, OMOSALEWA MD	2/1/2024	2085R0204X	NA	Other	026	PHYSICIANS	184247	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
239753	Fee-for-Service	1942550363	1942550363	1	1	ABEYSEKERA, SHENALI MD	2/6/2020	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	156120	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
239779	Fee-for-Service	1326089053	1326089053	1	1	ALSALIHI, HEDEAL A MD	7/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	99102	41	Internal Medicine	0	In state provider	None	101 E NOBLE AVE	None	VISALIA	CA	93277	2717	54	06107	36.326115	-119.29203	Tulare County
239804	Fee-for-Service	1336638691	1336638691	1	1	AGARWAL, ANAND MD	8/19/2021	207R00000X	NA	Other	026	PHYSICIANS	173575	None	None	0	In state provider	None	2823 FRESNO STREET	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
239823	Fee-for-Service	1558306266	1558306266	2	2	AMG, A PROFESSIONAL MEDICAL	5/20/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CORPORATION	925 S GARFIELD AVE	None	ALHAMBRA	CA	91801	4442	19	06037	34.08499473	-118.1230937	Los Angeles County
239826	Fee-for-Service	1588892673	1588892673	1	1	ASHLEY, MATTHEW J MD	6/3/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115477	13	Neurology (M.D. only)	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
239849	Fee-for-Service	1366627812	1366627812	2	1	ALLEN, AMY A LMFT	5/25/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5124 BIXLER AVE	None	LAKEWOOD	CA	90712	2211	19	06037	33.8509895	-118.1521806	Los Angeles County
239854	Fee-for-Service	1588309330	1588309330	1	1	ANDREW BABAYAN, OD, APC.	6/30/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	12000 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	3319	19	06037	34.18665451	-118.394541	Los Angeles County
239865	Fee-for-Service	1609822600	1609822600	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	927 S CHINA LAKE BLVD	None	RIDGECREST	CA	93555	6315	15	06029	35.60444344	-117.6740966	Kern County
239868	Fee-for-Service	1427418383	1427418383	1	1	ALL VALLEY CONGREGATE LIVING	7/18/2019	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	17404 HORACE ST	None	GRANADA HILLS	CA	91344	4719	19	06037	34.26965463	-118.5133906	Los Angeles County
239871	Fee-for-Service	1508844796	1508844796	1	1	ALLEN, GEORGIA C DO	6/23/2009	207R00000X	NA	Other	026	PHYSICIANS	6109	41	Internal Medicine	0	In state provider	None	7200 PARKWAY DR	STE 113	LA MESA	CA	91942	1534	37	06073	32.77297454	-117.0419524	San Diego County
239884	Fee-for-Service	1497831903	1497831903	1	1	ANNAMALAI, AKILA MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69842	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
239892	Fee-for-Service	1447298955	1447298955	1	1	ADROUNY, ADOUR MD	2/8/2015	207RH0003X	NA	Oncology	026	PHYSICIANS	34013	None	None	0	In state provider	None	700 W PARR AVE	STE B	LOS GATOS	CA	95032	1416	43	06085	37.26403	-121.9683443	Santa Clara County
239899	Fee-for-Service	1134213192	1134213192	1	1	ALLEN, PETER W MD	2/28/1990	207L00000X	NA	Other	026	PHYSICIANS	64470	None	None	0	In state provider	None	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	21	06041	37.9469952	-122.5373892	Marin County
239921	Fee-for-Service	1194868760	1194868760	1	2	ALFRED J COPPOLA JR MD INC	11/17/2022	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	None	None	0	In state provider	None	400 OLD RIVER RD	None	BAKERSFIELD	CA	93311	9781	15	06029	35.351487	-119.1143025	Kern County
239940	Fee-for-Service	1750490363	1750490363	1	3	ASIAN AMERICANS FOR COMM	12/1/2022	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	266 NORTH JACKSON AVE	SUITE 1	SAN JOSE	CA	95116	1606	43	06085	37.36445516	-121.8492308	Santa Clara County
239946	Fee-for-Service	1417305624	1417305624	1	1	AKELLA, PYDI M MD	8/31/2020	208M00000X	NA	Other	026	PHYSICIANS	161756	41	Internal Medicine	0	In state provider	None	2425 SAMARITAN	None	SAN JOSE	CA	95124	3908	43	06085	37.25111017	-121.9465891	Santa Clara County
239957	Fee-for-Service	1649205576	1649205576	1	1	ARDEHALI, ABBAS MD	9/30/1991	208G00000X	NA	General Surgery	026	PHYSICIANS	62746	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
239965	Fee-for-Service	1407344948	1407344948	1	1	ALIDOOST, MARJAN MD	8/24/2023	207RR0500X	NA	Other	026	PHYSICIANS	174046	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
239997	Fee-for-Service	1497985857	1497985857	1	1	ARGO, JEREMY S LCSW	4/16/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	1200 NORTH MAIN ST	STE 100B, 301, 500	SANTA ANA	CA	92701	3640	30	06059	33.755175	-117.8676195	Orange County
240032	Fee-for-Service	1467460402	1467460402	2	1	AIZENSTEIN, ROBERT I	8/9/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	139350	None	None	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
240040	Fee-for-Service	1245399831	1245399831	1	1	AUNG, KYI MD	11/30/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	72351	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS STREET	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
240072	Fee-for-Service	1619050846	1619050846	1	1	ANESTHESIA SPECIALISTS	3/30/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	MEDICAL GROUP INC	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	50	06099	37.66508443	-120.9962589	Stanislaus County
240078	Fee-for-Service	1659398204	1659398204	1	1	ALPHA ORTHO APPL CO INC	7/1/2005	224P00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ALPHA ORTHO APPL CO INC	5940 E WASHINGTON BLVD	None	COMMERCE	CA	90040	2413	19	06037	33.99718729	-118.1506296	Los Angeles County
240107	Fee-for-Service	1609484831	1609484831	1	1	ADUT, SARAH PSYD	2/10/2025	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
240129	Fee-for-Service	1942689393	1942689393	1	1	AMIN, RAJ M MD	10/15/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	167640	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
240149	Fee-for-Service	1316287055	1316287055	1	1	ASPER, KARIZZA CNP	3/3/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4950 BARRANCA PARKWAY	SUITE 104	IRVINE	CA	92604	4630	30	06059	33.67620851	-117.7948348	Orange County
240152	Fee-for-Service	1528470739	1528470739	1	1	ATKINS, KATELYN M MD	9/9/2019	2085R0001X	NA	Other	026	PHYSICIANS	162728	30	Radiology	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
240186	Fee-for-Service	1508158197	1508158197	1	1	ANG, EDDY MD	8/5/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	150218	38	Geriatrics	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
240207	Fee-for-Service	1750581559	1750581559	1	1	ANDERS, JUDD E MD	4/19/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	235 W 6TH STREET	None	RENO	NV	89503	4548	00	None	39.53165987	-119.8181899	Washoe County
240238	Fee-for-Service	1891929832	1891929832	1	1	ALEXANDER, BRITNEY E MD	10/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	113793	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
240268	Fee-for-Service	1386724805	1386724805	2	1	ABELLERA, GUIDO D MD	8/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	33857	38	Geriatrics	0	In state provider	None	123 S COMMERCE ST	STE D	STOCKTON	CA	95202	2837	39	06077	37.95105947	-121.2920715	San Joaquin County
240276	Fee-for-Service	1598258022	1598258022	1	1	ALDAPE ESQUIVEL, PEDRO DPM	5/26/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1701 E CESAR E CHAVEZ AV	STE 100	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
240343	Fee-for-Service	1568978989	1568978989	1	1	AWEAU, ALINA LMFT	2/7/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
240350	Fee-for-Service	1174504252	1174504252	1	1	ATHILL, CHARLES A MD	1/1/1998	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	78671	None	None	0	In state provider	None	8010 FROST ST	STE 200	SAN DIEGO	CA	92123	4290	37	06073	32.80026879	-117.1520059	San Diego County
240403	Fee-for-Service	1508862566	1508862566	1	1	AZMOUN, LEYLA M MD	12/1/1998	261QR0200X	NA	Mammography/MRI Provider	026	PHYSICIANS	84984	None	None	0	In state provider	None	6191 N THESTA ST	None	FRESNO	CA	93710	5266	10	06019	36.826362	-119.7831265	Fresno County
240458	Fee-for-Service	1306557616	1306557616	1	1	ALONSO HALLIFAX, AMAYA C OT	1/12/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	39180 FARWELL DR	SUITE 211	FREMONT	CA	94538	1000	01	06001	37.53211262	-121.9981587	Alameda County
240469	Fee-for-Service	1508158197	1508158197	1	1	ANG, EDDY MD	8/5/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	150218	08	Family Practice	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
240474	Fee-for-Service	1306425640	1306425640	1	1	AHMED, AMIR	10/11/2024	208M00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
240518	Fee-for-Service	1811149834	1811149834	1	1	AMIN, NIMISHA MD	4/8/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	93348	40	Pediatrics	0	In state provider	None	9802 STOCKDALE HWY	STE 103	BAKERSFIELD	CA	93311	0000	15	06029	35.3544067	-119.1113372	Kern County
240533	Fee-for-Service	1184677650	1184677650	1	1	AGRAWAL, ARUN B MD	8/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	9073	08	Family Practice	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
240555	Fee-for-Service	1386724805	1386724805	2	1	ABELLERA, GUIDO D MD	8/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	33857	08	Family Practice	0	In state provider	None	123 S COMMERCE ST	STE D	STOCKTON	CA	95202	2837	39	06077	37.95105947	-121.2920715	San Joaquin County
240566	Fee-for-Service	1588778930	1588778930	1	2	ADVANCED FAMILY MEDICAL	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	30135	40	Pediatrics	0	In state provider	GRP	16415 COLORADO AVE	STE 304	PARAMOUNT	CA	90723	5053	19	06037	33.8853075	-118.1614695	Los Angeles County
240588	Fee-for-Service	1043804511	1043804511	1	1	ACOSTA-DUQUE, JOSHUA A LCSW	5/28/2024	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
240656	Fee-for-Service	1487610374	1487610374	1	1	ARORA, AJIT S MD INC	1/14/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	10	Gastroenterology (M.D. only)	0	In state provider	None	7407 N CEDAR	STE 101	FRESNO	CA	93720	3839	10	06019	36.84303529	-119.7568435	Fresno County
240709	Fee-for-Service	1063590123	1063590123	1	1	ANDERSON, DAVID J MD	10/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80948	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
240713	Fee-for-Service	1013530112	1013530112	1	1	ANTELOPE VALLEY HOME HEALTH	9/11/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY	445 W PALMDALE BLVD	STE L	PALMDALE	CA	93551	4509	19	06037	34.58309663	-118.1375142	Los Angeles County
240749	Fee-for-Service	1174933915	1174933915	1	1	ALOTAIBI, MONA A MD	7/27/2020	207RC0200X	NA	Other	026	PHYSICIANS	147271	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
240753	Fee-for-Service	1730119553	1730119553	1	11	AFFILIATED PATHOLOGISTS MEDI	12/19/2014	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CAL GRPOUP INCC	20001 S RANCHO WAY	None	COMPTON	CA	90220	6318	19	06037	33.8498073	-118.2223737	Los Angeles County
240783	Fee-for-Service	1619097938	1619097938	1	1	ALCANTAR, MARIA C LCSW	5/9/2023	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	69895	-	NOT APPLICABLE	0	In state provider	None	510 EAST MAGNOLIA ST	100	STOCKTON	CA	95202	1812	39	06077	37.96446348	-121.2872245	San Joaquin County
240796	Fee-for-Service	1861254989	1861254989	1	1	ACTIVE SENIOR HOME CARE, INC	10/24/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	26771 VIA VICTORIA	None	MISSION VIEJO	CA	92691	3433	30	06059	33.62031919	-117.66346	Orange County
240821	Fee-for-Service	1184677650	1184677650	1	1	AGRAWAL, ARUN B MD	8/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	9073	05	Anesthesiology	0	In state provider	None	2 W FERN AVE	None	REDLANDS	CA	92373	5916	36	06071	34.05016907	-117.1793443	San Bernardino County
240822	Fee-for-Service	1114912979	1114912979	1	1	ANTELOPE VALLEY	1/23/1980	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	NEUROSCIENCE MEDICAL	42135 10TH STREET WEST	SUITE 301	LANCASTER	CA	93534	6093	19	06037	34.648533	-118.1477975	Los Angeles County
240838	Fee-for-Service	1710568753	1710568753	1	1	AGAPI HOME HEALTH INC	8/12/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	6363 VAN NUYS BLVD	SUITE B	VAN NUYS	CA	91401	2612	19	06037	34.186095	-118.4487565	Los Angeles County
240882	Fee-for-Service	1184613168	1184613168	1	1	ADRIAN CHRISTOPHER MOYER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7400 E THOMPSON PEAK PKW	None	SCOTTSDALE	AZ	85255	4109	00	None	33.670791	-111.921669	Maricopa County
240889	Fee-for-Service	1093004061	1093004061	1	1	ADAMS, JOHN S MD	8/15/2018	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	141615	25	Physical Medicine and Rehabilitation	0	In state provider	None	7525 METROPOLITAN DR	302	SAN DIEGO	CA	92108	1161	37	06073	32.77677653	-117.1592911	San Diego County
240890	Fee-for-Service	1760945091	1760945091	1	1	AHMED, ARUBA S DO	2/14/2025	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	23132	25	Physical Medicine and Rehabilitation	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
240897	Fee-for-Service	1134323207	1134323207	1	1	ANTONIK BUXTON, URSULA LMFT	5/7/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1647 HARTNELL AVE	STE 14	REDDING	CA	96002	2268	45	06089	40.5637105	-122.3414955	Shasta County
240909	Fee-for-Service	1205218773	1205218773	2	1	AVB PHARMA INC	11/1/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10741 WESTMINSTER AVE	102	GARDEN GROVE	CA	92843	3398	30	06059	33.75970747	-117.9415305	Orange County
240923	Fee-for-Service	1518393008	1518393008	1	1	ADVENTIST HEALTH PHYSICIANS	7/20/2020	261QU0200X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	544 N GLENDALE AVE	None	GLENDALE	CA	91206	3311	19	06037	34.15454904	-118.2429872	Los Angeles County
240931	Fee-for-Service	1700816733	1700816733	1	1	ADVANCED ENDOSCOPY CENTER	12/26/2019	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	INC	386 WEST OLIVE AVENUE	SUITE B	MERCED	CA	95348	3137	24	06047	37.3191858	-120.4755046	Merced County
240949	Fee-for-Service	1568881365	1568881365	1	1	ANAYA, VALERIA K MD	3/31/2025	2084P0800X	NA	Psychiatry	026	PHYSICIANS	137494	36	Psychiatry	0	In state provider	None	800 S FAIRMONT STREET	120	PASADENA	CA	91105	3154	19	06037	34.13193177	-118.1517805	Los Angeles County
240982	Fee-for-Service	1720302714	1720302714	1	1	AVIV, RONIT LMFT	12/30/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
241005	Fee-for-Service	1083302350	1083302350	1	1	ANTELOPE VALLEY SNF	6/15/2023	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HEALTHCARE LLC	44567 15TH ST W	None	LANCASTER	CA	93534	2803	19	06037	34.6923888	-118.1569099	Los Angeles County
241054	Fee-for-Service	1265532659	1265532659	1	1	ARRAY DIAGNOSTICS INC	10/3/2011	No Taxonomy Provided	NA	None	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	640 N KEYSTONE BLVD	# B	BURBANK	CA	91506	1900	19	06037	34.17308508	-118.3304788	Los Angeles County
241081	Fee-for-Service	1316478555	1316478555	1	1	AMIN, NEAL D MD	6/7/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	157021	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
241085	Fee-for-Service	1477654614	1477654614	1	1	ALBERTY, BYRON S DPM	4/1/2000	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	12462 PUTNAM STREET	SUITE 303	WHITTIER	CA	90602	1049	19	06037	33.9709236	-118.0460596	Los Angeles County
241086	Fee-for-Service	1871083188	1871083188	1	1	ALLIANCE OF LATINO HEALTH	2/1/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	SERVICES MEDICAL GROUP	517 N MAIN ST	STE 220	SANTA ANA	CA	92701	6703	30	06059	33.74951945	-117.8675809	Orange County
241093	Fee-for-Service	1790833226	1790833226	1	1	AL-SHAIKH, RAAD A MD INC	5/4/2006	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	63005	20	Orthopedic Surgery	0	In state provider	None	38069 MARTHA AVE	SUITE 400	FREMONT	CA	94536	3729	01	06001	37.55978715	-121.991892	Alameda County
241116	Fee-for-Service	1720215460	1720215460	1	1	AKHTAR, SABRINA M MD	9/30/2020	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
241144	Fee-for-Service	1053516963	1053516963	1	1	ALRASHID, WUFAA MD	9/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95090	41	Internal Medicine	0	In state provider	None	50 BELLEFONTAINE STREET	STE 307	PASADENA	CA	91105	3132	19	06037	34.13155953	-118.1517525	Los Angeles County
241145	Fee-for-Service	1235258328	1235258328	1	1	AUSTIN, REBECCA L E MD	3/5/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	91784	40	Pediatrics	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
241146	Fee-for-Service	1891729414	1891729414	1	1	APRIA HEALTHCARE LLC	10/11/2006	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	9876 HAWTHORNE DR	None	RANCHO CUCAMONGA	CA	91730	7956	36	06071	34.08241893	-117.5897388	San Bernardino County
241164	Fee-for-Service	1073569075	1073569075	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	15970 LOS SERRANOS CTRY	CL DR	CHINO HILLS	CA	91709	4523	36	06071	33.96261887	-117.6945272	San Bernardino County
241165	Fee-for-Service	1861407652	1861407652	1	1	ALVAREZ JACINTO,ORESTES A MD	8/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141968	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MD	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
241249	Fee-for-Service	1275856106	1275856106	1	1	ABBASI, UZMA MD	1/21/2016	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	112558	41	Internal Medicine	0	In state provider	None	111 RALEY BLVD	STE 100	CHICO	CA	95928	8347	04	06007	39.71601447	-121.790817	Butte County
241259	Fee-for-Service	1841228764	1841228764	1	4	ARCADIA RADIOLOGY	1/1/1979	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GRP A PROF CORP	100 S RAYMOND AVE	None	ALHAMBRA	CA	91801	9972	19	06037	34.09027878	-118.1450083	Los Angeles County
241297	Fee-for-Service	1053367425	1053367425	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	23893 CLINTON KEITH RD	None	WILDOMAR	CA	92595	7894	33	06065	33.595668	-117.241912	Riverside County
241329	Fee-for-Service	1609276963	1609276963	1	1	AMIN, KRISHNA A LMFT	6/10/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
241356	Fee-for-Service	1285259473	1285259473	1	1	ADVANCE SJ PHARMACY, INC	7/28/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2331A MONTPELIER DR	A-10	SAN JOSE	CA	95116	1614	43	06085	37.36498451	-121.8480137	Santa Clara County
241358	Fee-for-Service	1528676988	1528676988	1	1	APRIL HOME HEALTH CARE INC	3/2/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2025 N GLENOAKS BLVD	STE 202	BURBANK	CA	91504	2809	19	06037	34.19736202	-118.3256874	Los Angeles County
241373	Fee-for-Service	1871083188	1871083188	1	1	ALLIANCE OF LATINO HEALTH	2/1/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	SERVICES MEDICAL GROUP	517 N MAIN ST	STE 220	SANTA ANA	CA	92701	6703	30	06059	33.74951945	-117.8675809	Orange County
241394	Fee-for-Service	1023386802	1023386802	1	1	AMBURGEY, JAMIE A	4/22/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3418 LOMA VISTA RD	A	VENTURA	CA	93003	3016	56	06111	34.27643562	-119.2503132	Ventura County
241404	Fee-for-Service	1801971569	1801971569	1	1	ACEVEDO, SUSANA MD	8/7/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74960	40	Pediatrics	0	In state provider	None	1300 BANCROFT AVE	STE 204	SAN LEANDRO	CA	94577	5147	01	06001	37.72690979	-122.1477291	Alameda County
241429	Fee-for-Service	1700499324	1700499324	1	1	ARNOLD, SCARLET LCSW	9/25/2024	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2401 MERCED ST	None	SAN LEANDRO	CA	94577	4228	01	06001	37.70670062	-122.1696327	Alameda County
241442	Fee-for-Service	1831228675	1831228675	1	1	ABCEDE, ERLINDA G MD	8/29/2007	174400000X	NA	Other	026	PHYSICIANS	44226	40	Pediatrics	0	In state provider	None	7601 ATLANTIC AVE	None	CUDAHY	CA	90201	5019	19	06037	33.96721523	-118.187457	Los Angeles County
241461	Fee-for-Service	1730442211	1730442211	1	1	ABERNATHY, VERONICA J MD	10/6/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	137283	01	General Practice	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
241482	Fee-for-Service	1760595029	1760595029	1	1	ALWAN, MARK MD	8/31/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	44569	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1310 SAN BERNARDINO RD	STE 205	UPLAND	CA	91786	4985	36	06071	34.10260261	-117.6332582	San Bernardino County
241493	Fee-for-Service	1073613675	1073613675	1	1	AKOLKAR, APARNA S MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79648	41	Internal Medicine	0	In state provider	None	1182 N EUCLID ST	None	ANAHEIM	CA	92801	1900	30	06059	33.849909	-117.9416115	Orange County
241502	Fee-for-Service	1467638601	1467638601	2	1	AGUILAR TABORA, LESLY G MD	6/20/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	106980	None	None	0	In state provider	MD	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
241535	Fee-for-Service	1700945789	1700945789	1	1	ABLES, DUANE DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2221 ELM ST	None	RAWLINS	WY	82301	5108	00	None	41.78641963	-107.2617813	Carbon County
241536	Fee-for-Service	1275856106	1275856106	1	1	ABBASI, UZMA MD	1/21/2016	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	112558	10	Gastroenterology (M.D. only)	0	In state provider	None	111 RALEY BLVD	STE 100	CHICO	CA	95928	8347	04	06007	39.71601447	-121.790817	Butte County
241587	Fee-for-Service	1073723144	1073723144	1	4	AMIT MITTAL M.D.	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5401 BASSWOOD BLVD	None	FT WORTH	TX	76137	6909	00	None	32.87429952	-97.2681975	Tarrant County
241603	Fee-for-Service	1194760173	1194760173	1	1	AHMAD KHILNANI MEDICAL	4/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	PARTNERSHIP	717 W FOOTHILL BLVD	None	MONROVIA	CA	91016	1940	19	06037	34.15122315	-118.0140837	Los Angeles County
241611	Fee-for-Service	1366974321	1366974321	1	1	AWAD, JOHN MD	5/13/2019	207R00000X	NA	Other	026	PHYSICIANS	156966	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
241623	Fee-for-Service	1427636653	1427636653	1	1	A MOTHER THERESA CARE	6/9/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	16192 CAIRO CIRCLE	None	PLACENTIA	CA	92870	3001	30	06059	33.88978352	-117.851409	Orange County
241661	Fee-for-Service	1871083188	1871083188	1	1	ALLIANCE OF LATINO HEALTH	2/1/2019	193200000X	NA	Other	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	SERVICES MEDICAL GROUP	517 N MAIN ST	STE 220	SANTA ANA	CA	92701	6703	30	06059	33.74951945	-117.8675809	Orange County
241669	Fee-for-Service	1255025342	1255025342	1	2	AJUNWA, MERCILLINA NNENNYA	3/12/2025	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	36427 PISTACHIO DRIVE	None	WINCHESTER	CA	92596	8654	33	06065	33.592455	-117.0899175	Riverside County
241691	Fee-for-Service	1306163274	1306163274	2	1	ALDERMAN AND MARSHALL INC	5/15/2018	No Taxonomy Provided	NA	None	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	3130 FIFTH AVE	None	SAN DIEGO	CA	92103	5839	37	06073	32.73813729	-117.1603812	San Diego County
241697	Fee-for-Service	1114750916	1114750916	1	1	ALAMAR MEDICAL GROUP	1/13/2025	193200000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	AL GROUP	340 4TH AVE	STE 11	CHULA VISTA	CA	91910	3813	37	06073	32.63831293	-117.0833536	San Diego County
241704	Fee-for-Service	1124010616	1124010616	1	1	ANNAMANENI, AMIT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ANNAMANENI, AMIT MD	845 FM 1960	SUITE 103	HOUSTON	TX	77090	0000	00	None	30.01714444	-95.44263332	Harris County
241720	Fee-for-Service	1285664029	1285664029	1	1	ALIMADADIAN, HOSSEIN MD	2/8/2015	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	25808	06	Cardiovascular Disease (M.D. only)	0	In state provider	INC	4050 BARRANCA PKWY	STE 200	IRVINE	CA	92604	1723	30	06059	33.68293726	-117.8067799	Orange County
241727	Fee-for-Service	1336422484	1336422484	1	1	ALMEIDA, HEATHER LMFT	5/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	735 SUNRISE AVE	SUITE 155	ROSEVILLE	CA	95661	4568	31	06061	38.73334248	-121.2720172	Placer County
241787	Fee-for-Service	1295722726	1295722726	1	2	AFRASIABI, ARDAVAN MD	3/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	52848	41	Internal Medicine	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
241818	Fee-for-Service	1750559431	1750559431	1	20	ALL STAR PHYSICAL THERAPY, I	4/8/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	39755 MURRIETA HOT SPRIN	STE F120	MURRIETA	CA	92563	9151	33	06065	33.55575954	-117.1627899	Riverside County
241842	Fee-for-Service	1578532370	1578532370	1	1	ALPERIN, PETER E MD	3/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	60048	41	Internal Medicine	0	In state provider	None	1783 EL CAMINO REAL	None	BURLINGAME	CA	94010	3205	41	06081	37.59324015	-122.3818088	San Mateo County
241854	Fee-for-Service	1952495608	1952495608	1	1	AIROLA, VIRGIL M MD	11/27/1985	207LP3000X	NA	Other	026	PHYSICIANS	38668	05	Anesthesiology	0	In state provider	VALLEY CHILDRENS HOSP	3151 N MILLBROOK AVE	None	FRESNO	CA	93703	1425	10	06019	36.77841	-119.7635455	Fresno County
241874	Fee-for-Service	1417324633	1417324633	1	1	ANSARI, SHAHNAWAZ MD	11/19/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	163656	30	Radiology	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
241876	Fee-for-Service	1336644558	1336644558	1	1	AKANDA, MARIB I MD	7/3/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	184833	None	None	0	In state provider	None	11370 ANDERSON ST	STE 1800	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
241884	Fee-for-Service	1376773234	1376773234	1	1	ARTSIOM TSYRKUNOU	2/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	725 NORTH ST	None	PITTSFIELD	MA	01201	4109	00	None	42.459417	-73.2494295	Berkshire County
241890	Fee-for-Service	1194760173	1194760173	1	1	AHMAD KHILNANI MEDICAL	4/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	44	Public Health	0	In state provider	PARTNERSHIP	717 W FOOTHILL BLVD	None	MONROVIA	CA	91016	1940	19	06037	34.15122315	-118.0140837	Los Angeles County
241900	Fee-for-Service	1093163222	1093163222	1	1	AHUJA, RAHUL DO	8/3/2020	208M00000X	NA	Other	026	PHYSICIANS	17411	08	Family Practice	0	In state provider	None	18460 ROSCOE BLVD	FL 3	NORTHRIDGE	CA	91325	4107	19	06037	34.22071454	-118.5357375	Los Angeles County
241911	Fee-for-Service	1215326053	1215326053	1	1	ABRUZZO, GRACE PT	10/12/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
241935	Fee-for-Service	1750559431	1750559431	1	18	ALL STAR PHYSICAL THERAPY, I	4/30/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	8901 ACTIVITY	200	SAN DIEGO	CA	92126	4432	37	06073	32.8960193	-117.1345934	San Diego County
241938	Fee-for-Service	1952754673	1952754673	1	1	ARRHYTHMIA CENTER OF	10/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	60788	06	Cardiovascular Disease (M.D. only)	0	In state provider	NORTHERN CALIFORNIA INC	1645 ESPLANADE	STE 3	CHICO	CA	95926	3367	04	06007	39.74374167	-121.8502328	Butte County
241957	Fee-for-Service	1982643763	1982643763	1	1	AGNELLI, VIRGINIA MD	8/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81960	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3650 SOUTH ST	STE 403	LAKEWOOD	CA	90712	1504	19	06037	33.86019847	-118.149255	Los Angeles County
241959	Fee-for-Service	1902865694	1902865694	2	1	AIR-WAY MEDICAL INC	9/1/2016	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	437 E LINE ST	None	BISHOP	CA	93514	3505	14	06027	37.36152241	-118.3882854	Inyo County
241983	Fee-for-Service	1437936598	1437936598	1	1	ASUNCION, ALYSSA RICCI R OT	5/24/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
241988	Fee-for-Service	1437147923	1437147923	1	1	AXELROD, RICHARD J MD	1/1/1982	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	43153	01	General Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
241989	Fee-for-Service	1457623043	1457623043	1	1	ALBERT, MARISSA L MD	10/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146256	30	Radiology	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
242014	Fee-for-Service	1417202508	1417202508	1	1	ADEY, JENNIFER A MD	9/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121129	None	None	0	In state provider	None	5575 W LAS POSITAS BLVD	SUITE 330	PLEASANTON	CA	94588	5808	01	06001	37.69214859	-121.8796532	Alameda County
242017	Fee-for-Service	1497109722	1497109722	1	1	ADAMS, DAVID J MD	9/2/2022	2084N0402X	NA	Neurology	026	PHYSICIANS	156649	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
242031	Fee-for-Service	1841738416	1841738416	1	1	AUROMIRA CORPORATION	8/2/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3805 SAN DIMAS ST	STE A	BAKERSFIELD	CA	93301	5724	15	06029	35.39508529	-119.0082516	Kern County
242054	Fee-for-Service	1619275021	1619275021	1	1	APOLLO FAMILY MEDICINE AND	11/16/2012	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	111219	08	Family Practice	0	In state provider	SLEEP MEDICINE INC	818 JACKSON ST	STE 202	SAN FRANCISCO	CA	94133	4849	38	06075	37.79580797	-122.4086365	San Francisco County
242056	Fee-for-Service	1427298710	1427298710	1	1	ASSATOURIANS, ANA M	12/7/2015	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
242087	Fee-for-Service	1558561266	1558561266	1	1	ALTAVILLA, MARIAPIA MD	2/26/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84453	30	Radiology	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
242091	Fee-for-Service	1003831447	1003831447	2	1	ACKER, BRIAN J MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	35691	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2865 ATLANTIC AVE	STE 202	LONG BEACH	CA	90806	1742	19	06037	33.809418	-118.185058	Los Angeles County
242101	Fee-for-Service	1386991677	1386991677	1	1	ADELMAN, NICOLE L	11/28/2016	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
242102	Fee-for-Service	1750559431	1750559431	1	5	ALL STAR PHYSICAL THERAPY, I	4/9/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	3989 STETSON	105	HEMET	CA	92545	9695	33	06065	33.72929866	-117.0132375	Riverside County
242109	Fee-for-Service	1508309089	1508309089	1	1	ACUPUNCTURE HELP CENTER INC	7/30/2017	261QM2500X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	411 N CENTRAL AVE	610	GLENDALE	CA	91203	2081	19	06037	34.15248444	-118.2579448	Los Angeles County
242162	Fee-for-Service	1871671941	1871671941	1	1	AKRISHNAN, LETHA J MD	7/19/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	85716	41	Internal Medicine	0	In state provider	None	5601 DEER VALLEY RD	None	ANTIOCH	CA	94531	8577	07	06013	37.9518204	-121.7780768	Contra Costa County
242166	Fee-for-Service	1508271149	1508271149	1	1	ANAND, NEIL MD	3/6/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	144457	30	Radiology	0	In state provider	None	3440 CALIFORNIA ST	None	SAN FRANCISCO	CA	94118	1837	38	06075	37.78673229	-122.4510148	San Francisco County
242168	Fee-for-Service	1053701060	1053701060	1	1	AUNG. ZAR N MD	9/22/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	132891	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
242175	Fee-for-Service	1548033681	1548033681	1	1	AHCS SPECIALTY CARE SACRAMEN	12/13/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	TO	1820 TRIBUTE RD	STE G	SACRAMENTO	CA	95815	4307	34	06067	38.599578	-121.444326	Sacramento County
242180	Fee-for-Service	1205926177	1205926177	1	1	ANDO, LINDA K MD	9/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	70763	22	Pathology (M.D. only)	0	In state provider	MULLIKIN MEDICAL CENTER	17820 PIONEER BLVD	None	ARTESIA	CA	90701	3902	19	06037	33.86871853	-118.082109	Los Angeles County
242219	Fee-for-Service	1568437028	1568437028	1	1	ALLISON SCHOENFELDER	4/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1000 LINCOLN CIR SE	None	ORANGE CITY	IA	51041	1836	00	None	42.99560241	-96.04464101	Sioux County
242220	Fee-for-Service	1356542682	1356542682	1	1	AGHAIAN, ELDA MD	9/19/2008	207W00000X	NA	Ophthalmology	026	PHYSICIANS	93307	None	None	0	In state provider	None	1450 SAN PABLO ST	STE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
242224	Fee-for-Service	1750559431	1750559431	1	18	ALL STAR PHYSICAL THERAPY, I	11/10/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	8901 ACTIVITY	200	SAN DIEGO	CA	92126	4432	37	06073	32.8960193	-117.1345934	San Diego County
242229	Fee-for-Service	1952352411	1952352411	1	1	AHMED, KAMAL E MD	12/23/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	50781	45	Nephrology (Renal-Kidney)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
242252	Fee-for-Service	1295113819	1295113819	1	1	ATTENTIVE SENIOR CARE LLC	4/5/2016	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	36 E. TUOLUMNE	None	FRESNO	CA	93706	2651	10	06019	36.73072644	-119.8121422	Fresno County
242264	Fee-for-Service	1356975239	1356975239	1	1	ALTAMED HEALTH SERVICES CORP	4/24/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1325 N ANAHEIM BLVD	SUITE 102	ANAHEIM	CA	92801	1202	30	06059	33.85331047	-117.9199617	Orange County
242266	Fee-for-Service	1750348090	1750348090	1	1	AHMED, ZULFIQAR MD	6/12/2007	207R00000X	NA	Other	026	PHYSICIANS	53666	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
242307	Fee-for-Service	1255746756	1255746756	1	1	AHMED, SULEMAN S DO	2/4/2019	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	3269 N STOCKTON HILL RD	None	KINGMAN	AZ	86409	3619	00	None	35.220006	-114.0380145	Mohave County
242330	Fee-for-Service	1124278916	1124278916	1	1	ANDINO, TANYA N LMFT	9/19/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	8300 UTICA AVE	STE 245	RANCHO CUCAMONGA	CA	91730	3852	36	06071	34.10227306	-117.5715643	San Bernardino County
242335	Fee-for-Service	1083969711	1083969711	1	1	A-1 HEALTHCARE MANAGEMENT	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	5011 ARGOSY AVE	SUITE 5	HUNTINGTON BEACH	CA	92649	1001	30	06059	33.74110809	-118.0409904	Orange County
242374	Fee-for-Service	1770740276	1770740276	1	1	ATG DESIGNING MOBILITY INC	10/29/2009	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	8195 MERCURY CT	STE 120	SAN DIEGO	CA	92111	1230	37	06073	32.83486332	-117.1475671	San Diego County
242379	Fee-for-Service	1003831447	1003831447	2	1	ACKER, BRIAN J MD	6/17/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	35691	02	General Surgery	0	In state provider	None	2865 ATLANTIC AVE	STE 202	LONG BEACH	CA	90806	1742	19	06037	33.809418	-118.185058	Los Angeles County
242396	Fee-for-Service	1750559431	1750559431	1	20	ALL STAR PHYSICAL THERAPY, I	4/22/2022	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	39755 MURRIETA HOT SPRIN	STE F120	MURRIETA	CA	92563	9151	33	06065	33.55575954	-117.1627899	Riverside County
242398	Fee-for-Service	1205881778	1205881778	1	1	ASSISTED HOME CARE INC	5/1/1999	251E00000X	NA	Other	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	10550 SEPULVEDA BLVD	STE 101	MISSION HILLS	CA	91345	1954	19	06037	34.2624709	-118.4672518	Los Angeles County
242424	Fee-for-Service	1215293014	1215293014	1	1	ADDANTE, ROCCO A MD	7/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141085	05	Anesthesiology	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
242462	Fee-for-Service	1477624435	1477624435	1	1	APPLEBAUM, GEOFFREY D MD	10/24/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	64467	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
242485	Fee-for-Service	1750141388	1750141388	1	1	ADVENTIST HEALTH PHYSICIANS	10/9/2024	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	6955 EL CAMINO REAL	200	ATASCADERO	CA	93422	4226	40	06079	35.48656009	-120.6652493	San Luis Obispo County
242486	Fee-for-Service	1417114141	1417114141	1	1	ANWAR, SHAFKAT MD	8/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	157657	35	Pediatric Cardiology (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
242487	Fee-for-Service	1225670490	1225670490	1	1	ALVA, NATHALY A LMFT	9/12/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
242510	Fee-for-Service	1750559431	1750559431	1	18	ALL STAR PHYSICAL THERAPY, I	3/12/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	8901 ACTIVITY	200	SAN DIEGO	CA	92126	4432	37	06073	32.8960193	-117.1345934	San Diego County
242523	Fee-for-Service	1740286640	1740286640	1	1	ARROYO, VICTOR M MD	4/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	84781	34	Urology and Urological Surgery	0	In state provider	None	1211 W LA PALMA AVE	STE 502	ANAHEIM	CA	92801	2812	30	06059	33.84718298	-117.933758	Orange County
242545	Fee-for-Service	1295934610	1295934610	1	1	ALIDINA, SULTANALI MD INC	9/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	47735	01	General Practice	0	In state provider	None	3300 E SOUTH ST	STE 209	LONG BEACH	CA	90805	4592	19	06037	33.86018093	-118.1537163	Los Angeles County
242554	Fee-for-Service	1750348090	1750348090	1	1	AHMED, ZULFIQAR MD	6/12/2007	207R00000X	NA	Other	026	PHYSICIANS	53666	01	General Practice	0	In state provider	None	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
242590	Fee-for-Service	1134862733	1134862733	1	1	ASENJO, PAUL H CRNA	6/15/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
242601	Fee-for-Service	1942519715	1942519715	1	1	APPLIED BEHAVIOR CONSULTANTS	8/25/2020	251S00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	, INC.	4540 HARLIN DR	None	SACRAMENTO	CA	95826	9716	34	06067	38.535831	-121.3573905	Sacramento County
242623	Fee-for-Service	1083969711	1083969711	1	1	A-1 HEALTHCARE MANAGEMENT	3/12/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	5011 ARGOSY AVE	SUITE 5	HUNTINGTON BEACH	CA	92649	1001	30	06059	33.74110809	-118.0409904	Orange County
242656	Fee-for-Service	1417369810	1417369810	1	1	ACE NEPHROLOGY INC	10/23/2014	207RN0300X	NA	Nephrology	026	PHYSICIANS	119019	45	Nephrology (Renal-Kidney)	0	In state provider	None	6700 N 1ST ST	STE 119	FRESNO	CA	93710	3947	10	06019	36.83586697	-119.7721176	Fresno County
242681	Fee-for-Service	1750559431	1750559431	1	5	ALL STAR PHYSICAL THERAPY, I	4/30/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	3989 STETSON	105	HEMET	CA	92545	9695	33	06065	33.72929866	-117.0132375	Riverside County
242686	Fee-for-Service	1205881778	1205881778	1	1	ASSISTED HOME CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	10550 SEPULVEDA BLVD	STE 101	MISSION HILLS	CA	91345	1954	19	06037	34.2624709	-118.4672518	Los Angeles County
242733	Fee-for-Service	1316678881	1316678881	1	1	ABOUEISHA, MOHAMED MD	2/14/2025	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	None	04	Otology, Laryngology, Rhinology	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
242737	Fee-for-Service	1982017760	1982017760	2	1	ARMEN DERBOGHOSSIANS, MD INC	2/6/2020	208800000X	NA	Other	026	PHYSICIANS	None	34	Urology and Urological Surgery	0	In state provider	None	116 S LOUISE ST	STE # A	GLENDALE	CA	91205	1025	19	06037	34.14557547	-118.2526054	Los Angeles County
242745	Fee-for-Service	1689785008	1689785008	2	1	ASSURED MEDICAL SUPPLY, INC	3/30/2011	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	23541 RIDGE ROUTE DRIVE	SUITE A	LAGUNA HILLS	CA	92653	1500	30	06059	33.62106703	-117.718876	Orange County
242781	Fee-for-Service	1154944437	1154944437	1	1	ARFEEN, SAFA MD	7/1/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	11370 ANDERSON ST	STE 1800	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
242787	Fee-for-Service	1396088258	1396088258	1	1	ANSARI, MUSTAFA K MD	7/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	133804	13	Neurology (M.D. only)	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06269295	-118.2030006	Los Angeles County
242809	Fee-for-Service	1275630196	1275630196	1	1	ANGSUPANICH, KRAIVIT MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	34208	02	General Surgery	0	In state provider	None	801 11TH ST	STE 1	LAKEPORT	CA	95453	4100	17	06033	39.04898862	-122.9217691	Lake County
242834	Fee-for-Service	1760018675	1760018675	1	1	ABBOTT, ALEXANDRA MD	9/15/2023	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	186618	None	None	0	In state provider	None	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	37	06073	32.90618683	-117.1814064	San Diego County
242836	Fee-for-Service	1629164777	1629164777	1	1	AMY HOFFMAN	5/17/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 E 149TH ST	None	BRONX	NY	10451	5504	00	None	40.817538	-73.9240965	Bronx County
242875	Fee-for-Service	1376056002	1376056002	1	2	AFFORDABLE SENIOR HOUSING FO	9/27/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	622 TRANQUILITY GLEN	None	ESCONDIDO	CA	92027	3984	37	06073	33.12495199	-117.0597066	San Diego County
242889	Fee-for-Service	1942519715	1942519715	1	1	APPLIED BEHAVIOR CONSULTANTS	8/25/2020	251S00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	, INC.	4540 HARLIN DR	None	SACRAMENTO	CA	95826	9716	34	06067	38.535831	-121.3573905	Sacramento County
242909	Fee-for-Service	1154827665	1154827665	1	1	ANACLETO GUTIERREZ AN OPTOME	6/14/2021	193400000X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	TRIC CORPORATION	2615 CAPITOL AVE	None	SACRAMENTO	CA	95816	5904	34	06067	38.571399	-121.472532	Sacramento County
242914	Fee-for-Service	1598873408	1598873408	1	1	A PLUS ADULT DAY HEALTH CARE	5/1/2012	No Taxonomy Provided	NA	None	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	INC	1640 PUENTE AVE	None	BALDWIN PARK	CA	91706	5952	19	06037	34.06528765	-117.9670928	Los Angeles County
242924	Fee-for-Service	1003483322	1003483322	1	1	AREV HOME HEALTH INC	3/15/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11565 LAUREL CANYON BLVD	SUITE 201	SAN FERNANDO	CA	91340	4651	19	06037	34.28018218	-118.4549135	Los Angeles County
242942	Fee-for-Service	1417369810	1417369810	1	1	ACE NEPHROLOGY INC	10/23/2014	207RN0300X	NA	Nephrology	026	PHYSICIANS	119019	41	Internal Medicine	0	In state provider	None	6700 N 1ST ST	STE 119	FRESNO	CA	93710	3947	10	06019	36.83586697	-119.7721176	Fresno County
242963	Fee-for-Service	1477939890	1477939890	1	2	AMG RESIDENTIAL CARE HOMES	9/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	9658 N WINERY AVE	None	FRESNO	CA	93720	4631	10	06019	36.876708	-119.7347725	Fresno County
242967	Fee-for-Service	1750559431	1750559431	1	5	ALL STAR PHYSICAL THERAPY, I	3/26/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	3989 STETSON	105	HEMET	CA	92545	9695	33	06065	33.72929866	-117.0132375	Riverside County
242974	Fee-for-Service	1467102525	1467102525	1	1	ACT PHARMACY, INC	11/6/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1440 E 41ST ST	SUITE B	LOS ANGELES	CA	90011	3304	19	06037	34.00866427	-118.2478621	Los Angeles County
242990	Fee-for-Service	1891449963	1891449963	1	1	AP MEDICAL GROUP INC	3/6/2024	246ZN0300X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	500 N GARFIELD AVE	STE 306	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
243001	Fee-for-Service	1336435270	1336435270	1	1	ANDERSON, JASON H MD	7/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149598	40	Pediatrics	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
243008	Fee-for-Service	1407149065	1407149065	1	1	AZICRI, JASON H	7/26/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3454 HILLCREST AVE	None	ANTIOCH	CA	94531	8238	07	06013	37.98739901	-121.7808007	Contra Costa County
243011	Fee-for-Service	1417997321	1417997321	1	1	ARBEL,MICHAEL Z MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9150 W INDIAN SCHOOL	RD STE 127	PHOENIX	AZ	85037	0000	00	None	33.494472	-112.2571845	Maricopa County
243018	Fee-for-Service	1235360157	1235360157	1	1	AYE, KHIN M MD	11/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106090	22	Pathology (M.D. only)	0	In state provider	None	250 HOSPITAL PKWY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
243045	Fee-for-Service	1518413871	1518413871	1	1	ALRABADI, SAIF MD	8/6/2020	208M00000X	NA	Other	026	PHYSICIANS	-	08	Family Practice	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
243047	Fee-for-Service	1639532740	1639532740	1	2	ASHRAF, SAAD MD	5/21/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	153874	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
243060	Fee-for-Service	1932125416	1932125416	1	1	ALLIANCE RETINA CONSULTANTS	8/25/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	68124	18	Ophthalmology	0	In state provider	None	8262 UNIVERSITY AVE	None	LA MESA	CA	91942	9321	37	06073	32.7675759	-117.0200132	San Diego County
243093	Fee-for-Service	1487070009	1487070009	1	1	AIRMED INTERNATIONAL LLC	10/1/2023	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	950 22ND ST	STE 800	BIRMINGHAM	AL	35203	5307	00	None	33.52485016	-86.80915798	Jefferson County
243098	Fee-for-Service	1871556605	1871556605	1	1	ANAND, SHILPI MD	2/11/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	104906	03	Allergy	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
243208	Fee-for-Service	1992810865	1992810865	2	1	APRIA HEALTHCARE LLC	1/19/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	43145 BUSINESS CENTER PK	SUITES 104 AND 105	LANCASTER	CA	93535	4564	19	06037	34.66726107	-118.1298147	Los Angeles County
243239	Fee-for-Service	1013934082	1013934082	1	1	ABC MEDICAL CLINIC INC	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63361	41	Internal Medicine	0	In state provider	None	500 N GARFIELD AVE	SUITE 110A	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
243260	Fee-for-Service	1255342846	1255342846	2	1	ALS PHARMACY AND COMPOUNDING	3/7/2013	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	2222 MAIN ST	None	CAMBRIA	CA	93428	3018	40	06079	35.564075	-121.0822504	San Luis Obispo County
243281	Fee-for-Service	1730190521	1730190521	1	1	AMY MUMBOWER, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
243287	Fee-for-Service	1699926535	1699926535	1	1	ALI, AMER MD	3/14/2018	208M00000X	NA	Other	026	PHYSICIANS	149615	41	Internal Medicine	0	In state provider	None	6555 COYLE AVENUE	SUITE 280	CARMICHAEL	CA	95608	0302	34	06067	38.66859	-121.3118055	Sacramento County
243288	Fee-for-Service	1811669757	1811669757	1	1	ACUMEN HOME HEALTH	2/7/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2826 S VERMONT AVE	UNIT 2	LOS ANGELES	CA	90007	2232	19	06037	34.02873	-118.291523	Los Angeles County
243292	Fee-for-Service	1881788503	1881788503	1	1	ABC RECOVERY CENTER INC	8/11/2016	324500000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	44-374 PALM STREET	None	INDIO	CA	92201	3117	33	06065	33.72380849	-116.227381	Riverside County
243333	Fee-for-Service	1326195538	1326195538	1	1	ARVIZU, JOHN H OD	2/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
243455	Fee-for-Service	1326388745	1326388745	1	1	ASIAN AMERICAN DRUG ABUSE	12/18/2015	251S00000X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	520 N LA BREA AVE	SUITE 236	INGLEWOOD	CA	90302	3026	19	06037	33.96960162	-118.3561567	Los Angeles County
243465	Fee-for-Service	1881795896	1881795896	1	2	AIDS PROJECT OF EAST BAY	5/4/2017	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	8400 ENTERPRISE WAY	SUITE 120	OAKLAND	CA	94621	1336	01	06001	37.74404265	-122.1948791	Alameda County
243471	Fee-for-Service	1801275391	1801275391	1	1	ALLEN, RACHAEL A DO	10/24/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	14877	18	Ophthalmology	0	In state provider	None	555 N 13TH AVE	None	UPLAND	CA	91786	4904	36	06071	34.10042233	-117.6335451	San Bernardino County
243500	Fee-for-Service	1528403557	1528403557	1	1	ALLGOOD, EVAN R MD	5/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	132650	None	None	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
243506	Fee-for-Service	1114497989	1114497989	1	1	AURORA HOME CARE INC	2/13/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	730 S CENTRAL AVE	SUITE 215	GLENDALE	CA	91204	4330	19	06037	34.136991	-118.2578235	Los Angeles County
243512	Fee-for-Service	1588876346	1588876346	1	2	AVALOS, SORAYA L LMFT	8/31/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
243529	Fee-for-Service	1013934082	1013934082	1	1	ABC MEDICAL CLINIC INC	2/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	63361	01	General Practice	0	In state provider	None	500 N GARFIELD AVE	SUITE 110A	MONTEREY PARK	CA	91754	1242	19	06037	34.0674894	-118.1228646	Los Angeles County
243537	Fee-for-Service	1427494616	1427494616	1	1	AVULA, HARSHITH R MD	11/17/2019	207RC0200X	NA	Other	026	PHYSICIANS	141293	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
243541	Fee-for-Service	1003040981	1003040981	1	1	AKSHAY V SHAH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	14155 N 83RD AVE	STE 122	PEORIA	AZ	85381	0000	00	None	33.612813	-112.2362415	Maricopa County
243565	Fee-for-Service	1396798690	1396798690	1	1	ACUTE CARE MED GRP OF	4/30/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	ORANGE, INC.	2601 E CHAPMAN AVE	None	ORANGE	CA	92869	3206	30	06059	33.78785251	-117.826365	Orange County
243581	Fee-for-Service	1043576481	1043576481	2	1	ARAIN, YASSAR MD	12/8/2022	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	126850	None	None	0	In state provider	None	1400 E CHURCH ST	BLDG 8	SANTA MARIA	CA	93454	5906	42	06083	34.95203385	-120.4131707	Santa Barbara County
243613	Fee-for-Service	1568588952	1568588952	1	1	ANDAYA, SERJUN MD	8/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
243650	Fee-for-Service	1073072914	1073072914	1	1	AHN, JOHN H	12/17/2023	207N00000X	NA	Dermatology	026	PHYSICIANS	186593	None	None	0	In state provider	None	2120 PROFESSIONAL DR	None	ROSEVILLE	CA	95661	3700	31	06061	38.74247397	-121.2508672	Placer County
243659	Fee-for-Service	1043489362	1043489362	1	1	AL MALKI, MHD M MD	7/10/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128983	41	Internal Medicine	0	In state provider	None	1500 E DUARTE ROAD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
243676	Fee-for-Service	1750559431	1750559431	1	22	ALL STAR PHYSICAL THERAPY, I	8/31/2022	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	77622 COUNTRY CLUB DR	STE G	PALM DESERT	CA	92211	0447	33	06065	33.75833438	-116.3101957	Riverside County
243707	Fee-for-Service	1295337848	1295337848	1	1	AZUMA, JILL LPCC	5/8/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	21125 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91355	1356	19	06037	34.41164827	-118.5053439	Los Angeles County
243759	Fee-for-Service	1083939706	1083939706	1	1	APPEL, JAMES E MD	6/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	76917	08	Family Practice	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
243800	Fee-for-Service	1407820111	1407820111	1	1	ADKINS, WILLIAM F OD	2/23/2004	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1340 E PROSPERITY AVE	None	TULARE	CA	93274	8052	54	06107	36.2260563	-119.3267458	Tulare County
243859	Fee-for-Service	1972899151	1972899151	1	1	ARGHAVANIFARD, PEIMAN MD	8/25/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128659	41	Internal Medicine	0	In state provider	None	215 WEST JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
243870	Fee-for-Service	1023728128	1023728128	1	1	AVDIMIRETZ, NICHOLAS A MD	12/7/2022	2080P0214X	NA	Pulmonology	026	PHYSICIANS	183470	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
243897	Fee-for-Service	1962508630	1962508630	1	1	ANZALDO, EPIFANIO MD	12/31/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	36638	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1310 W STEWART DR	STE 406	ORANGE	CA	92868	3855	30	06059	33.78236048	-117.8664975	Orange County
243901	Fee-for-Service	1154988012	1154988012	1	1	ARNETT, JUSTIN J MD	5/30/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	182125	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
243920	Fee-for-Service	1295874204	1295874204	1	1	AARON BRODSKY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
243947	Fee-for-Service	1679795280	1679795280	1	1	ADEWUSI, ADEMIJULO A	4/11/2016	208M00000X	NA	Other	026	PHYSICIANS	135329	None	None	0	In state provider	None	2 BON AIR RD	3RD FLOOR	GREENBRAE	CA	94904	1702	21	06041	37.94879347	-122.5367674	Marin County
243961	Fee-for-Service	1750559431	1750559431	1	22	ALL STAR PHYSICAL THERAPY, I	8/31/2022	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	77622 COUNTRY CLUB DR	STE G	PALM DESERT	CA	92211	0447	33	06065	33.75833438	-116.3101957	Riverside County
243999	Fee-for-Service	1366483943	1366483943	1	1	ALBERTS, MICHAEL B MD	5/1/2000	207P00000X	NA	Other	026	PHYSICIANS	63798	66	Emergency Medicine (Urgent Care)	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
244048	Fee-for-Service	1548329972	1548329972	1	1	AUERBACH, SAMUEL L MD	1/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53310	15	Obstetrics (D.O. only)	0	In state provider	None	5912 SANTA MONICA BLVD	None	LOS ANGELES	CA	90038	2043	19	06037	34.09072606	-118.3175287	Los Angeles County
244078	Fee-for-Service	1609970318	1609970318	1	1	AMINBAKHSH, ROXANA MD	6/25/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	38	Geriatrics	1	Border provider	None	1155 MILL STREET	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
244098	Fee-for-Service	1003516873	1003516873	1	1	A-2-Z BUSINESS INC	4/26/2023	332S00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	199 S MONTE VISTA AVE	STE 2	SAN DIMAS	CA	91773	3142	19	06037	34.10580672	-117.8093786	Los Angeles County
244110	Fee-for-Service	1265991509	1265991509	1	1	ARORA, ISHIKA MD	7/23/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20273	None	None	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
244119	Fee-for-Service	1740203082	1740203082	1	1	AZIZ, ADEL MD	11/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	74346	05	Anesthesiology	0	In state provider	None	9212 MIRA ESTE CT	STE 204	SAN DIEGO	CA	92126	6337	37	06073	32.88927901	-117.1482338	San Diego County
244191	Fee-for-Service	1134688054	1134688054	1	1	AFFIRM HOME HEALTH	12/14/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	315 W VERDUGO AVE	STE 113	BURBANK	CA	91502	2469	19	06037	34.17082135	-118.314366	Los Angeles County
244217	Fee-for-Service	1598903221	1598903221	1	1	ARCADIA SURGICAL MEDICAL	8/19/2015	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	CENTER LLC	638 W DUARTE ROAD	STE 18	ARCADIA	CA	91007	7616	19	06037	34.12629888	-118.0532077	Los Angeles County
244286	Fee-for-Service	1093497240	1093497240	1	1	ABRAHAM, ROBIN	10/17/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	15260 VENTURA BLVD	1200	SHERMAN OAKS	CA	91403	5307	19	06037	34.15370926	-118.4656644	Los Angeles County
244302	Fee-for-Service	1144303538	1144303538	1	1	ARGOUD, GEORGES M MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	61898	67	Endocrinology	0	In state provider	None	477 N EL CAMINO REAL	STE A308	ENCINITAS	CA	92024	1350	37	06073	33.05700866	-117.262449	San Diego County
244317	Fee-for-Service	1225697121	1225697121	1	1	ACHIEVE BEYOND PEDIATRICS SP	4/28/2020	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	8135 PAINTER AVENUE	SUITE 201	WHITTIER	CA	90602	3166	19	06037	33.965829	-118.032738	Los Angeles County
244339	Fee-for-Service	1548329972	1548329972	1	1	AUERBACH, SAMUEL L MD	1/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	53310	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5912 SANTA MONICA BLVD	None	LOS ANGELES	CA	90038	2043	19	06037	34.09072606	-118.3175287	Los Angeles County
244363	Fee-for-Service	1033249099	1033249099	1	1	AFROZ, SYED M MD	6/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54434	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
244390	Fee-for-Service	1588825129	1588825129	1	1	ALBORZIAN, SHERVIN MD	11/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	107093	18	Ophthalmology	0	In state provider	None	4601 DALE RD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
244402	Fee-for-Service	1225077050	1225077050	1	1	ALONZO, JOSEPH M MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	45798	41	Internal Medicine	0	In state provider	None	5475 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02627053	-117.684846	San Bernardino County
244451	Fee-for-Service	1104213081	1104213081	1	1	ALEXANDER, JACOB H MD	9/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144263	41	Internal Medicine	0	In state provider	None	1020 29TH ST	STE 120	SACRAMENTO	CA	95816	5173	34	06067	38.572803	-121.4685	Sacramento County
244478	Fee-for-Service	1669892295	1669892295	1	1	APPEL, KEREN L MD	8/5/2021	2080P0206X	NA	Gastroenterology	026	PHYSICIANS	147603	None	None	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
244492	Fee-for-Service	1265765556	1265765556	1	1	ALGT LLC	10/1/2009	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	14966 TERRENO DE FLORES	LANE	LOS GATOS	CA	95030	2023	43	06085	37.2511094	-121.952781	Santa Clara County
244560	Fee-for-Service	1174601900	1174601900	1	1	ARRAS, ERNEST E MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	23329	01	General Practice	0	In state provider	None	3284 JEFFERSON ST	None	NAPA	CA	94558	3436	28	06055	38.32147532	-122.2994954	Napa County
244585	Fee-for-Service	1578688297	1578688297	1	1	ADAMS, DANA C NP	2/10/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1515 NEWELL	None	WALNUT CREEK	CA	94596	5120	07	06013	37.89281357	-122.0598728	Contra Costa County
244587	Fee-for-Service	1144303538	1144303538	1	1	ARGOUD, GEORGES M MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	61898	41	Internal Medicine	0	In state provider	None	477 N EL CAMINO REAL	STE A308	ENCINITAS	CA	92024	1350	37	06073	33.05700866	-117.262449	San Diego County
244613	Fee-for-Service	1619676319	1619676319	1	1	APPLE URGENT CARE, INC.	5/5/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	49305 GRAPEFRUIT BLVD	STE 1	COACHELLA	CA	92236	1490	33	06065	33.69027168	-116.1830917	Riverside County
244640	Fee-for-Service	1134187115	1134187115	1	1	ANDREWS,CAROL L MD	2/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	84712	30	Radiology	0	In state provider	None	14860 ROSCOE BLVD	STE 100	PANORAMA CITY	CA	91402	4687	19	06037	34.2214515	-118.4573205	Los Angeles County
244648	Fee-for-Service	1124257407	1124257407	1	1	AGARWAL, ABHISHEK MD	8/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149729	01	General Practice	0	In state provider	None	225 NORTH JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
244657	Fee-for-Service	1225219025	1225219025	1	1	ANG, ROBERT C MD	12/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	55893	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	500 E REMINGTON DRIVE	STE 18	SUNNYVALE	CA	94087	2611	43	06085	37.35898474	-122.0281716	Santa Clara County
244668	Fee-for-Service	1548362064	1548362064	2	1	AZHAND, AZIM U MD	4/6/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	49621	40	Pediatrics	0	In state provider	None	27450 YNEZ RD	STE 108	TEMECULA	CA	92591	4649	33	06065	33.50684549	-117.1502048	Riverside County
244671	Fee-for-Service	1295872034	1295872034	1	1	ANGEL VIEW CRIPPLED CHLD	7/1/2013	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	MELVYN HABER HOUSE	12840 CACTUS DR	None	DESERT HOT SPRING	CA	92240	4514	33	06065	33.95532776	-116.5056684	Riverside County
244691	Fee-for-Service	1225077050	1225077050	1	1	ALONZO, JOSEPH M MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	45798	08	Family Practice	0	In state provider	None	5475 WALNUT AVE	None	CHINO	CA	91710	2609	36	06071	34.02627053	-117.684846	San Bernardino County
244747	Fee-for-Service	1356760045	1356760045	1	1	AGHAIE, SINA MD	2/22/2021	207R00000X	NA	Other	026	PHYSICIANS	147858	None	None	0	In state provider	None	3100 W CHRISTOFFERSEN PK	None	TURLOCK	CA	95382	9547	50	06099	37.52910755	-120.8840959	Stanislaus County
244754	Fee-for-Service	1013470525	1013470525	1	1	ADVENTIST HEALTH PHYSICIANS	9/17/2019	2084N0400X	NA	Neurology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	6 WOODLAND RD	STE 101	SAINT HELENA	CA	94574	9501	28	06055	38.54297115	-122.4754501	Napa County
244776	Fee-for-Service	1528146644	1528146644	1	2	AURO PHARMACIES, INC.	10/16/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	520 W. LA HABRA BLVD.	None	LA HABRA	CA	90631	5308	30	06059	33.9318335	-117.950868	Orange County
244853	Fee-for-Service	1720054125	1720054125	1	1	ALTIMUS RA BOLLEN MD	3/23/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 SCHNEIDER DR	None	MALVERN	AR	72104	4811	00	None	34.358751	-92.785941	Hot Spring County
244875	Fee-for-Service	1144303538	1144303538	1	1	ARGOUD, GEORGES M MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	61898	66	Emergency Medicine (Urgent Care)	0	In state provider	None	477 N EL CAMINO REAL	STE A308	ENCINITAS	CA	92024	1350	37	06073	33.05700866	-117.262449	San Diego County
244936	Fee-for-Service	1639524309	1639524309	1	1	ANESTHESIA CARE CONSULTANTS	2/9/2017	193400000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	INC	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
244947	Fee-for-Service	1225219025	1225219025	1	1	ANG, ROBERT C MD	12/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	55893	41	Internal Medicine	0	In state provider	None	500 E REMINGTON DRIVE	STE 18	SUNNYVALE	CA	94087	2611	43	06085	37.35898474	-122.0281716	Santa Clara County
244984	Fee-for-Service	1225040686	1225040686	1	1	ANTHONIMUTHU,NIRILLA	6/14/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 OCEAN PARKWAY	None	BROOKLYN	NY	11235	7745	00	None	40.586031	-73.9657305	Kings County
245030	Fee-for-Service	1184026338	1184026338	1	1	ATYABI, VANESSA NP	2/28/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
245082	Fee-for-Service	1679676910	1679676910	1	1	ASHLEY, WENDY	1/5/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	2940 W FLORIA AVE	STE B	HEMET	CA	92545	3655	33	06065	33.74744837	-117.0023698	Riverside County
245142	Fee-for-Service	1144377441	1144377441	1	1	ALIKIAN, ARLENE MD	9/2/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	71828	None	None	0	In state provider	None	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	29	06057	39.33573744	-120.180872	Nevada County
245150	Fee-for-Service	1295811719	1295811719	1	1	ACENAS, ANTOINETTE D MD	1/31/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	46315	36	Psychiatry	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
245166	Fee-for-Service	1821180993	1821180993	1	1	ALTEMUS, DEBORAH A DO	4/8/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	5157	07	Dermatology	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
245169	Fee-for-Service	1568402188	1568402188	1	1	ALI, OMAR MD	7/9/2018	2080P0205X	NA	Endocrinology	026	PHYSICIANS	51061	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
245178	Fee-for-Service	1326238650	1326238650	1	1	ASH, ROBERT B MD	12/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52450	30	Radiology	0	In state provider	None	2151 HARBOR BLVD	STE 1500	FULLERTON	CA	92835	3823	30	06059	33.89443025	-117.9288328	Orange County
245180	Fee-for-Service	1750490363	1750490363	1	2	ASIAN AMERICANS FOR COMM	6/15/2006	261Q00000X	NA	Other	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	INVOLVEMENT SANTA CLARA	2400 MOORPARK AVE	STE 319	SAN JOSE	CA	95128	2625	43	06085	37.3160785	-121.937121	Santa Clara County
245224	Fee-for-Service	1184713299	1184713299	1	1	ACKERMAN, JOSEPH R LCSW	6/12/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
245278	Fee-for-Service	1881862209	1881862209	1	1	ALKHOURI, GEORGE S MD	3/7/2008	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	97131	None	None	0	In state provider	None	797 WEST CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.2882498	-120.4963024	Merced County
245281	Fee-for-Service	1417027038	1417027038	2	1	AAYS RENTS & SELLS, INC	8/4/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	AAYS RENTS & SELLS, INC.	598 E SANTA CLARA ST.	None	SAN JOSE	CA	95112	2036	43	06085	37.34198566	-121.8782999	Santa Clara County
245289	Fee-for-Service	1184934770	1184934770	1	1	ADESINA. OYEBIMPE O MD	9/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109013	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
245298	Fee-for-Service	1801892773	1801892773	1	1	ALPERT, MARK W OD	12/1/1983	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	16102 BELLFLOWER BLVD	None	BELLFLOWER	CA	90706	4606	19	06037	33.8880297	-118.1252595	Los Angeles County
245321	Fee-for-Service	1073786802	1073786802	1	1	ABBASI, RANIA K MD	11/24/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135800	05	Anesthesiology	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
245326	Fee-for-Service	1457980757	1457980757	1	1	ANAND, RACHIT K DO	4/27/2023	207R00000X	NA	Other	026	PHYSICIANS	20923	None	None	0	In state provider	None	1501 TROUSDALE DRIVE	None	BURLINGAME	CA	94010	4506	41	06081	37.592811	-122.382351	San Mateo County
245386	Fee-for-Service	1215534888	1215534888	1	1	AGUERO, ROSA M NP	9/26/2022	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
245421	Fee-for-Service	1245427574	1245427574	1	1	AYLEN, BRIAN F	8/5/2008	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	2275 MYERS STREET	STE C	OROVILLE	CA	95966	5319	04	06007	39.50712757	-121.5514297	Butte County
245455	Fee-for-Service	1225162464	1225162464	1	1	ABELOWITZ, STEVEN MD	10/14/2020	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	56395	40	Pediatrics	0	In state provider	None	25500 RANCHO NIGUEL	110	LAGUNA NIGUEL	CA	92677	7302	30	06059	33.55578198	-117.6849338	Orange County
245456	Fee-for-Service	1568402188	1568402188	1	1	ALI, OMAR MD	7/9/2018	2080P0205X	NA	Endocrinology	026	PHYSICIANS	51061	67	Endocrinology	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
245457	Fee-for-Service	1477932739	1477932739	1	1	AMARAL, VALENTINA MD	3/26/2020	207RC0200X	NA	Other	026	PHYSICIANS	166915	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
245466	Fee-for-Service	1326238650	1326238650	1	1	ASH, ROBERT B MD	12/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	52450	78	Neoplastic Diseases/Oncology	0	In state provider	None	2151 HARBOR BLVD	STE 1500	FULLERTON	CA	92835	3823	30	06059	33.89443025	-117.9288328	Orange County
245491	Fee-for-Service	1255025342	1255025342	1	1	AJUNWA, MERCILLINA NNENNYA	4/15/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	32350 HEARTH GLEN CT	None	WINCHESTER	CA	92596	8676	33	06065	33.59280552	-117.0947925	Riverside County
245515	Fee-for-Service	1568431088	1568431088	1	2	ANALYTIC PATH MED GRP IN	11/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
245540	Fee-for-Service	1558749440	1558749440	1	2	ALAMEDA HEALTH SYSTEM	2/3/2017	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	None	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1009	01	06001	37.7069698	-122.1191104	Alameda County
245550	Fee-for-Service	1972630804	1972630804	1	1	AGNOST, VICTORIA L MD	5/11/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	71056	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
245581	Fee-for-Service	1164916474	1164916474	1	1	ASHEN-GARRY, DAVID DO	6/14/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	21123	None	None	0	In state provider	None	3828 SCHAUFELE AVE	STE 340	LONG BEACH	CA	90808	1793	19	06037	33.8283	-118.1479725	Los Angeles County
245587	Fee-for-Service	1114994548	1114994548	1	1	AL-NAJJAR, MUFID B MD	12/17/2018	2084P0800X	NA	Psychiatry	026	PHYSICIANS	39744	36	Psychiatry	0	In state provider	None	8772 CUYAMACA ST	104	SANTEE	CA	92071	4206	37	06073	32.83473094	-116.983917	San Diego County
245592	Fee-for-Service	1144304544	1144304544	1	1	ACOSTA, DANIEL T	5/11/2012	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	635 C ST	APT 502	SAN DIEGO	CA	92101	5381	37	06073	32.71673555	-117.158643	San Diego County
245622	Fee-for-Service	1508216532	1508216532	1	1	ALLEN, MICHAEL P DO	8/1/2020	207P00000X	NA	Other	026	PHYSICIANS	18211	66	Emergency Medicine (Urgent Care)	0	In state provider	None	350 TERRACINA BLVD	None	REDLANDS	CA	92373	4850	36	06071	34.03717616	-117.2046115	San Bernardino County
245641	Fee-for-Service	1326365651	1326365651	1	1	ANDERSON, JOHN D MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	832 WILLOW ST	None	RENO	NV	89434	9641	00	None	39.52468616	-119.8016173	Washoe County
245647	Fee-for-Service	1770849093	1770849093	1	1	AHMAD, HIRA MD	10/1/2023	2086S0120X	NA	General Surgery	026	PHYSICIANS	186396	None	None	0	In state provider	None	505 S MAIN ST	STE 225	ORANGE	CA	92868	4516	30	06059	33.78004808	-117.8672472	Orange County
245687	Fee-for-Service	1972964815	1972964815	1	1	ARCHWOOD CARE LLC	9/20/2018	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	13245 ARCHWOOD STREET	None	VAN NUYS	CA	91401	1221	19	06037	34.19195007	-118.4219518	Los Angeles County
245706	Fee-for-Service	1407803760	1407803760	1	1	ANDREW J AUERBACH MD	5/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	4502 MEDICAL DR	None	SAN ANTONIO	TX	78229	4402	00	None	29.508012	-98.578683	Bexar County
245744	Fee-for-Service	1467880880	1467880880	1	2	ADVANCE MEDICAL RX. INC.	9/18/2023	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	9122 VALLEY BLVD	None	ROSEMEAD	CA	91770	1920	19	06037	34.08086555	-118.0705507	Los Angeles County
245758	Fee-for-Service	1194106732	1194106732	1	1	ABADIE, SARA LCSW	12/16/2015	1041C0700X	NA	Mental Health Outpatient Services	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	285 W 6TH STREET	#424	SAN PEDRO	CA	90731	3379	19	06037	33.73871888	-118.2829985	Los Angeles County
245782	Fee-for-Service	1114154291	1114154291	1	1	AMEZCUA, IVY MD	2/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114120	01	General Practice	0	In state provider	None	200 MEDICAL PLAZA	STE 365	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
245833	Fee-for-Service	1629024393	1629024393	1	1	AVAKYAN, RAFAEL MD	6/25/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	84288	41	Internal Medicine	0	In state provider	None	301 SO FAIR OAKS DRIVE	#300	PASADENA	CA	91105	2562	19	06037	34.140348	-118.1504565	Los Angeles County
245837	Fee-for-Service	1710071717	1710071717	1	1	ABBASI, ABDUL S MD	5/8/1987	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	24632	06	Cardiovascular Disease (M.D. only)	0	In state provider	UCLA PROF SVCS OFF	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
245843	Fee-for-Service	1730110123	1730110123	1	1	AHMAD, SHAZAD MD	8/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	50516	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
245855	Fee-for-Service	1689094518	1689094518	1	1	ANTONIO, ALBERT O DO	8/1/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15264	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
245865	Fee-for-Service	1780927236	1780927236	1	1	AFTANDILIANS, TANIA MD	9/28/2017	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	140224	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
245871	Fee-for-Service	1013938109	1013938109	1	1	AFTAB, FOUZIA A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	88359	08	Family Practice	0	In state provider	None	200 S WELLS RD	STE 100	VENTURA	CA	93004	1378	56	06111	34.29321532	-119.1597424	Ventura County
245893	Fee-for-Service	1740991264	1740991264	1	1	AYALA, HECTOR D RCP	12/12/2022	2278P1006X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
245924	Fee-for-Service	1184855934	1184855934	1	1	AGUILERA, ETHEL A DO	8/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	11832	08	Family Practice	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
245927	Fee-for-Service	1316027170	1316027170	1	1	ADULT MEDICAL TRANSPORTATION	2/4/1998	3416L0300X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	INC	7048 DARBY AVE	None	RESEDA	CA	91335	4401	19	06037	34.198911	-118.533431	Los Angeles County
245973	Fee-for-Service	1497747356	1497747356	1	1	ALGOS INC, A MEDICAL CORPOR	2/21/2018	163W00000X	NA	Other	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	CORPORATION	1017 S FAIR OAKS AVE	None	PASADENA	CA	91105	2621	19	06037	34.12830178	-118.1503497	Los Angeles County
245982	Fee-for-Service	1265541361	1265541361	1	1	AHMED, SHEIKH S MD	8/6/2019	2080P0203X	NA	Other	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	657 TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	None	36.180999	-115.3174815	Clark County
246005	Fee-for-Service	1730370958	1730370958	1	1	APEWOKIN, SENU MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1500 S MILL AVE	None	TEMPE	AZ	85281	6699	00	None	33.41223	-111.9402765	Maricopa County
246036	Fee-for-Service	1790417434	1790417434	1	1	AKINES, VANESSA C CNP	9/1/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
246047	Fee-for-Service	1053834531	1053834531	1	1	ALVAREZ FLORES, MARIA I LCSW	9/1/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
246052	Fee-for-Service	1396462693	1396462693	1	1	AKSTIN, MARY I LCSW	10/28/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7365 CARNELIAN ST	STE 202	RANCHO CUCAMONGA	CA	91730	1100	36	06071	34.12038413	-117.6160525	San Bernardino County
246062	Fee-for-Service	1104125392	1104125392	1	1	AJALAT, JANINE G MD	9/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	124114	05	Anesthesiology	0	In state provider	None	1328 22ND STREET	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
246067	Fee-for-Service	1629467915	1629467915	1	1	AVILA, CELIA S LMFT	12/11/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92563	7906	30	06059	33.62516256	-117.7353393	Orange County
246118	Fee-for-Service	1093771073	1093771073	1	1	ARTEL LLC	4/7/1995	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	521 S HAM LN	SUITE F	LODI	CA	95242	3528	39	06077	38.12793778	-121.2883049	San Joaquin County
246122	Fee-for-Service	1538787387	1538787387	1	2	ABLE CARE TRANSPORTATION INC	5/12/2022	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	980 W 6TH ST	104	ONTARIO	CA	91762	1208	36	06071	34.085448	-117.667422	San Bernardino County
246132	Fee-for-Service	1730110123	1730110123	1	1	AHMAD, SHAZAD MD	8/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	50516	41	Internal Medicine	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
246133	Fee-for-Service	1770978298	1770978298	1	1	ABUDU, SHERIFF MD	12/7/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153285	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
246141	Fee-for-Service	1710363841	1710363841	1	1	ACEVES, MARIA DEL ROSARIO L	5/26/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CSW	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
246156	Fee-for-Service	1437682440	1437682440	1	1	ANYALEBECHI, JEROME MD	8/1/2024	390200000X	NA	Other	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
246197	Fee-for-Service	1083927750	1083927750	1	1	ANNEX PHARMACY AND MEDICAL	8/26/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	SUPPLY, INC.	20177 SATICOY STREET	None	WINNETKA	CA	91306	2506	19	06037	34.20840148	-118.572381	Los Angeles County
246259	Fee-for-Service	1497747356	1497747356	1	1	ALGOS INC, A MEDICAL CORPOR	4/9/2018	163W00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	CORPORATION	1017 S FAIR OAKS AVE	None	PASADENA	CA	91105	2621	19	06037	34.12830178	-118.1503497	Los Angeles County
246262	Fee-for-Service	1508178831	1508178831	2	1	ABLE HANDS HOME HEALTH	4/15/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES LLC	517 E WILSON AVE	SUITE 203B	GLENDALE	CA	91206	4359	19	06037	34.14818643	-118.2491864	Los Angeles County
246272	Fee-for-Service	1104856327	1104856327	1	1	ANVAR, ARIA MD	10/8/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51613	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
246274	Fee-for-Service	1043413321	1043413321	1	1	ALLIANCE HLTH CLINIC INC	7/26/2007	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	5952 EL CAJON BLVD	None	SAN DIEGO	CA	92115	3828	37	06073	32.76027883	-117.0693725	San Diego County
246278	Fee-for-Service	1861459554	1861459554	1	1	ALLEN, PAUL D MD	12/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138987	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
246294	Fee-for-Service	1255355053	1255355053	1	1	ANDERSEN, BARBARA G MD	11/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52853	32	Radiation Therapy (D.O. only)	0	In state provider	None	1180 N INDIAN CANYON DR	STE E218	PALM SPRINGS	CA	92262	4885	33	06065	33.839505	-116.5455735	Riverside County
246300	Fee-for-Service	1295255842	1295255842	1	1	AZIZI-GHANNAD, SABA DO	8/30/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18206	08	Family Practice	0	In state provider	None	1011 RIVERSIDE AVE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72827776	-121.2904066	Placer County
246310	Fee-for-Service	1639118359	1639118359	1	1	ALLEN, LATRICE M MD	2/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	63978	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	23430 HAWTHORNE BLVD	STE 200	TORRANCE	CA	90505	4730	19	06037	33.81316465	-118.3510077	Los Angeles County
246313	Fee-for-Service	1497865257	1497865257	1	1	AHEARN, ROBERT C MD	2/8/2015	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	54139	20	Orthopedic Surgery	0	In state provider	None	17742 BEACH BLVD	STE 250	HUNTINGTON BEACH	CA	92647	6835	30	06059	33.704487	-117.989061	Orange County
246419	Fee-for-Service	1730110123	1730110123	1	1	AHMAD, SHAZAD MD	8/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	50516	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	01	06001	37.55769729	-121.9808861	Alameda County
246459	Fee-for-Service	1134699986	1134699986	1	1	AEGIS TREATMENT CENTERS, LLC	7/26/2019	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	6390 RUNNYMEADE DR	SUITE B	PLACERVILLE	CA	95667	8623	09	06017	38.70457004	-120.8551474	El Dorado County
246463	Fee-for-Service	1700031507	1700031507	1	1	ARENAS, CECILY A NP	4/25/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
246473	Fee-for-Service	1790050193	1790050193	1	1	AKBER, AALIA MD	5/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107505	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDREN'S	None	MADERA	CA	93636	8761	20	06039	36.88437894	-119.8003484	Madera County
246500	Fee-for-Service	1205224334	1205224334	1	1	ANGELS HOME ICF INC	9/26/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	10712 WATERBURY DR	None	STOCKTON	CA	95209	4212	39	06077	38.05263395	-121.3375821	San Joaquin County
246516	Fee-for-Service	1477753341	1477753341	1	1	AHLUWALIA, BIKRAMJIT S	7/1/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	52278	None	None	0	In state provider	MD INC	16143 KOKANEE RD	STE C	APPLE VALLEY	CA	92307	1355	36	06071	34.54439055	-117.2678905	San Bernardino County
246520	Fee-for-Service	1427446335	1427446335	1	4	ANA S OSBORNE AND SCOTT S	3/16/2021	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	2870 WANEK RD	None	ESCONDIDO	CA	92027	2889	37	06073	33.14641838	-117.0363482	San Diego County
246545	Fee-for-Service	1497747356	1497747356	1	1	ALGOS INC, A MEDICAL CORPOR	2/21/2018	163W00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	CORPORATION	1017 S FAIR OAKS AVE	None	PASADENA	CA	91105	2621	19	06037	34.12830178	-118.1503497	Los Angeles County
246555	Fee-for-Service	1427382332	1427382332	1	1	ACCESS SUPPORT NETWORK	10/31/2009	No Taxonomy Provided	NA	None	073	AIDS WAIVER SERVICES	-	-	NOT APPLICABLE	0	In state provider	AIDS SUPPORT NETWORK	1320 NIPOMO ST	None	SAN LUIS OBISPO	CA	93401	3935	40	06079	35.2763518	-120.664111	San Luis Obispo County
246559	Fee-for-Service	1154862571	1154862571	1	1	ARCHULETA, KEVIN A LCSW	4/27/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2345 FAIR OAKS BLVD	None	SACRAMENTO	CA	95825	4708	34	06067	38.57535	-121.407633	Sacramento County
246562	Fee-for-Service	1942867718	1942867718	1	1	AKIKI, TEDDY MD	4/17/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	183341	36	Psychiatry	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
246582	Fee-for-Service	1245246941	1245246941	1	1	ADELSHEIM, STEVEN N MD	7/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	89299	36	Psychiatry	0	In state provider	None	725 WELCH ROAD	MC 5500	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
246586	Fee-for-Service	1255355053	1255355053	1	1	ANDERSEN, BARBARA G MD	11/18/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	52853	30	Radiology	0	In state provider	None	1180 N INDIAN CANYON DR	STE E218	PALM SPRINGS	CA	92262	4885	33	06065	33.839505	-116.5455735	Riverside County
246650	Fee-for-Service	1538377445	1538377445	1	2	ALZHEIMER'S SVS OF THE	7/1/1993	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	OF THE EAST BAY AHDC CTR	1105 WALPERT STREET	None	HAYWARD	CA	94541	0000	01	06001	37.66895076	-122.0750874	Alameda County
246651	Fee-for-Service	1235766056	1235766056	1	1	AMIN, SAJNI MD	9/3/2023	390200000X	NA	Other	026	PHYSICIANS	186063	None	None	0	In state provider	None	31625 DE PORTOLA RD	SUITE 101	TEMECULA	CA	92592	2770	33	06065	33.48359715	-117.1048345	Riverside County
246654	Fee-for-Service	1346011566	1346011566	1	1	ANDREWS PROF NURSING CORP	7/12/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3500 5TH AVE	103	SAN DIEGO	CA	92103	5020	37	06073	32.74173	-117.1604085	San Diego County
246706	Fee-for-Service	1528488467	1528488467	1	1	ABI-CHAKER, ANDREW MD	12/7/2021	2086S0129X	NA	General Surgery	026	PHYSICIANS	174936	None	None	0	In state provider	None	26357 MCBEAN PARKWAY	STE 150	VALENCIA	CA	91355	4493	19	06037	34.41257644	-118.5597683	Los Angeles County
246720	Fee-for-Service	1205026705	1205026705	1	1	AUGIUS, LINA MD	8/15/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	92962	None	None	0	In state provider	None	1100 W STEWART DR	None	ORANGE	CA	92868	3849	30	06059	33.78236558	-117.8648414	Orange County
246726	Fee-for-Service	1396345898	1396345898	1	1	ARKADIE COUNSELING & WELLNES	11/16/2021	1041C0700X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ESS CENTER	222 N MOUNTAIN AVE	SUITE 212	UPLAND	CA	91786	5714	36	06071	34.096401	-117.6700615	San Bernardino County
246727	Fee-for-Service	1750559431	1750559431	1	13	ALL STAR PHYSICAL THERAPY, I	3/26/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	24671 MONROE AVE	#101C	MURRIETA	CA	92562	2527	33	06065	33.56694181	-117.2021151	Riverside County
246746	Fee-for-Service	1134699986	1134699986	1	1	AEGIS TREATMENT CENTERS, LLC	7/26/2019	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	6390 RUNNYMEADE DR	SUITE B	PLACERVILLE	CA	95667	8623	09	06017	38.70457004	-120.8551474	El Dorado County
246755	Fee-for-Service	1427216720	1427216720	1	1	ANDERSON, MARIA P MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110158	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
246791	Fee-for-Service	1639284003	1639284003	1	1	AMADI, CHINYERE I MD	4/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	91346	01	General Practice	0	In state provider	None	1655 N MT VERNON AVE	SUITE B1	SAN BERNARDINO	CA	92411	1427	36	06071	34.129539	-117.3137845	San Bernardino County
246792	Fee-for-Service	1225004120	1225004120	1	1	ANDERSON, CHARLES A MD	2/28/1990	207RP1001X	NA	Pulmonology	026	PHYSICIANS	62930	01	General Practice	0	In state provider	None	1505 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5209	19	06037	34.098408	-118.296167	Los Angeles County
246832	Fee-for-Service	1184836819	1184836819	1	1	ADRIANA RODRIGUEZ MD	8/29/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	801 7TH AVE	None	FORT WORTH	TX	76104	2733	00	None	32.73710364	-97.3419336	Tarrant County
246835	Fee-for-Service	1497747356	1497747356	1	1	ALGOS INC, A MEDICAL CORPOR	2/21/2018	163W00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	CORPORATION	1017 S FAIR OAKS AVE	None	PASADENA	CA	91105	2621	19	06037	34.12830178	-118.1503497	Los Angeles County
246844	Fee-for-Service	1497251912	1497251912	1	1	AJITPAL S TIWANA MD INC	4/5/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	2700 F ST	100	BAKERSFIELD	CA	93301	1849	15	06029	35.384184	-119.023442	Kern County
246865	Fee-for-Service	1215147475	1215147475	1	1	ARPIN,LESLIE MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2314 NW KINGS BLVD	STE A	CORVALLI	OR	97330	3925	00	None	44.59018248	-123.2774548	Benton County
246866	Fee-for-Service	1770851719	1770851719	1	1	AJLANI, SHADHI CRNA	9/18/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	18111 BROOKHURST STREET	None	FOUNTAIN VALLEY	CA	92708	6728	30	06059	33.70027259	-117.9544055	Orange County
246875	Fee-for-Service	1912556721	1912556721	1	1	AMISTAD MULTI SPECIALTY MEDI	10/19/2020	207RC0000X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CAL GROUP INC.	201 S BROADWAY	None	SANTA ANA	CA	92701	5633	30	06059	33.744159	-117.8697125	Orange County
246916	Fee-for-Service	1053722736	1053722736	1	1	ADAM, TAREK N MD	9/27/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	154524	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
246932	Fee-for-Service	1154776151	1154776151	1	1	ALLIANCE HOME HEALTH &	4/16/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE LLC	6717 MISSION STREET	SUITE D2	DALY CITY	CA	94014	2070	41	06081	37.701208	-122.4633528	San Mateo County
247009	Fee-for-Service	1750559431	1750559431	1	13	ALL STAR PHYSICAL THERAPY, I	4/30/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	24671 MONROE AVE	#101C	MURRIETA	CA	92562	2527	33	06065	33.56694181	-117.2021151	Riverside County
247011	Fee-for-Service	1285712992	1285712992	1	1	AL-ANTABLY, YASSER A MD	6/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	65391	01	General Practice	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
247014	Fee-for-Service	1396345898	1396345898	1	1	ARKADIE COUNSELING & WELLNES	11/16/2021	1041C0700X	NA	Mental Health Outpatient Services	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	ESS CENTER	222 N MOUNTAIN AVE	SUITE 212	UPLAND	CA	91786	5714	36	06071	34.096401	-117.6700615	San Bernardino County
247017	Fee-for-Service	1003280892	1003280892	1	1	ADENIJI, JOHN	11/4/2018	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3634 ELIZABETH ST	None	RIVERSIDE	CA	92506	2506	33	06065	33.95782448	-117.3904065	Riverside County
247047	Fee-for-Service	1003347527	1003347527	1	1	ARORA, MILLIE MD	5/13/2020	390200000X	NA	Other	026	PHYSICIANS	17065	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
247049	Fee-for-Service	1750439733	1750439733	1	1	ARIAS, ANGELITO M MD	8/31/1982	207N00000X	NA	Dermatology	026	PHYSICIANS	32011	07	Dermatology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
247123	Fee-for-Service	1497747356	1497747356	1	1	ALGOS INC, A MEDICAL CORPOR	2/21/2018	163W00000X	NA	Other	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	CORPORATION	1017 S FAIR OAKS AVE	None	PASADENA	CA	91105	2621	19	06037	34.12830178	-118.1503497	Los Angeles County
247129	Fee-for-Service	1215356647	1215356647	1	1	AYOUB, MICHAEL F MD	7/3/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	138083	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
247134	Fee-for-Service	1205316833	1205316833	1	1	APTB, LLC	11/1/2018	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1115 B STREET	None	PETALUMA	CA	94952	4028	49	06097	38.22221655	-122.645792	Sonoma County
247161	Fee-for-Service	1265592174	1265592174	1	1	AUDEH, MOUNI W MD	12/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	40552	41	Internal Medicine	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
247168	Fee-for-Service	1437360328	1437360328	1	1	ATTERBURY, LESLIE H MD	1/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
247175	Fee-for-Service	1235423856	1235423856	1	1	ARAFAH, DEEMA B MD	7/29/2024	2080P0205X	NA	Endocrinology	026	PHYSICIANS	172555	40	Pediatrics	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
247180	Fee-for-Service	1508877473	1508877473	1	3	ANJANI THAKUR, MD, INC	4/5/2011	208600000X	NA	General Surgery	026	PHYSICIANS	66588	None	None	0	In state provider	None	900 W OLIVE AVE	STE A	MERCED	CA	95348	2401	24	06047	37.31913547	-120.4842784	Merced County
247189	Fee-for-Service	1205186442	1205186442	1	3	ACTION URGENT CARE INC	2/1/2023	261QU0200X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1680 E CAPITOL EXPY	10	SAN JOSE	CA	95121	1839	43	06085	37.3066751	-121.8111896	Santa Clara County
247260	Fee-for-Service	1356881486	1356881486	1	1	ANDERSON, AMBER NP	3/24/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	720 E CARNEGIE DR.	STE 140	SAN BERNARDINO	CA	92408	3516	36	06071	34.06914052	-117.2695442	San Bernardino County
247267	Fee-for-Service	1871250571	1871250571	1	1	ANNA PARFENOVA OD INC	5/17/2022	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	22809 HAWTHORNE BLVD	None	TORRANCE	CA	90505	3615	19	06037	33.819993	-118.3512385	Los Angeles County
247291	Fee-for-Service	1871513994	1871513994	1	1	AMIN, RAOUF S MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	2	Out of state provider	MEDICAL CENTER	3333 BURNET AVE	None	CINCINNATI	OH	45229	3039	00	None	39.14105892	-84.50040782	Hamilton County
247297	Fee-for-Service	1730323353	1730323353	1	1	ANEES, MUHAMMAD F MD	9/1/2013	207R00000X	NA	Other	026	PHYSICIANS	117756	41	Internal Medicine	0	In state provider	None	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	19	06037	34.19395645	-118.463265	Los Angeles County
247298	Fee-for-Service	1750559431	1750559431	1	13	ALL STAR PHYSICAL THERAPY, I	3/26/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	24671 MONROE AVE	#101C	MURRIETA	CA	92562	2527	33	06065	33.56694181	-117.2021151	Riverside County
247299	Fee-for-Service	1700047263	1700047263	1	1	AKHTAR, SHAHRZAD MD	9/4/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	107908	13	Neurology (M.D. only)	0	In state provider	None	4860 Y STREET	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
247300	Fee-for-Service	1194397117	1194397117	1	1	ATHWAL, GEET CRNA	4/22/2024	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	465 PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
247305	Fee-for-Service	1154526762	1154526762	1	1	AFTANDILIAN, CATHERINE C MD	7/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	115836	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
247314	Fee-for-Service	1376030619	1376030619	1	1	ALBARAN, MICHELLE L NP	3/25/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	2545 S BRUCE ST	STE 200	LAS VEGAS	NV	89169	1731	00	None	36.143271	-115.1254975	Clark County
247339	Fee-for-Service	1093019911	1093019911	1	1	ABELSON, RICK A	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	31878 DEL OBISPO ST	STE 122	SAN JUAN CAPISTRA	CA	92675	3253	30	06059	33.49835844	-117.6608148	Orange County
247357	Fee-for-Service	1871191742	1871191742	1	1	ALCAM MEDICAL INC.	2/19/2021	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1244 N MARIPOSA ST	10	FRESNO	CA	93703	3929	10	06019	36.75838198	-119.7792399	Fresno County
247378	Fee-for-Service	1376056002	1376056002	1	4	AFFORDABLE SENIOR HOUSING FO	9/27/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	642 TRANQUILITY GLEN	None	ESCONDIDO	CA	92027	3984	37	06073	33.1244644	-117.059386	San Diego County
247379	Fee-for-Service	1396121190	1396121190	1	1	AKL, SIMON DO	6/18/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	15327	01	General Practice	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
247411	Fee-for-Service	1497747356	1497747356	1	1	ALGOS INC, A MEDICAL CORPOR	3/20/2018	163W00000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1017 S FAIR OAKS AVE	None	PASADENA	CA	91105	2621	19	06037	34.12830178	-118.1503497	Los Angeles County
247445	Fee-for-Service	1558376947	1558376947	1	1	AVAGIMOV, RUBEN R MD	7/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	78851	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	400 N PEPPER AVE	FL 6	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
247448	Fee-for-Service	1265592174	1265592174	1	1	AUDEH, MOUNI W MD	12/16/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	40552	78	Neoplastic Diseases/Oncology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1865	19	06037	34.07671715	-118.3799413	Los Angeles County
247462	Fee-for-Service	1235423856	1235423856	1	1	ARAFAH, DEEMA B MD	7/29/2024	2080P0205X	NA	Endocrinology	026	PHYSICIANS	172555	67	Endocrinology	0	In state provider	None	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
247490	Fee-for-Service	1225131535	1225131535	1	1	ALFARO, MARIA V R MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	84818	41	Internal Medicine	0	In state provider	None	14901 RINALDI ST	SUITE 200	MISSION HILLS	CA	91345	1254	19	06037	34.27903452	-118.457433	Los Angeles County
247497	Fee-for-Service	1194719807	1194719807	1	1	ABOU-SAMRA, MOUSTAPHA MD	4/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	36688	14	Neurological Surgery	0	In state provider	None	168 N BRENT STREET	SUITE 408	VENTURA	CA	93003	2824	56	06111	34.27448266	-119.2572489	Ventura County
247524	Fee-for-Service	1740214618	1740214618	1	1	APPLEBAUM, JAY MD	6/30/1990	207N00000X	NA	Dermatology	026	PHYSICIANS	54219	07	Dermatology	0	In state provider	None	1506 E CHAPMAN AVE	None	ORANGE	CA	92866	2231	30	06059	33.78778851	-117.837621	Orange County
247581	Fee-for-Service	1760654719	1760654719	1	1	AVENTURA, DIANA C MD	3/23/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99487	41	Internal Medicine	0	In state provider	None	250 S GRAND AVE	None	GLENDORA	CA	91740	4218	19	06037	34.132842	-117.872523	Los Angeles County
247591	Fee-for-Service	1801039219	1801039219	1	1	ALSAHLI, HAITHAM MD	5/29/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	19	06037	34.27904453	-118.459944	Los Angeles County
247596	Fee-for-Service	1174903108	1174903108	1	1	AGAWU, ATU MD	11/8/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	182846	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
247598	Fee-for-Service	1063861540	1063861540	1	1	AMAZON HOSPICE INC	1/3/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2420 W CARSON ST	STE 205	TORRANCE	CA	90501	3157	19	06037	33.83131647	-118.3262625	Los Angeles County
247633	Fee-for-Service	1861600926	1861600926	1	1	ABEYSEKERA, HESHANI DO	8/23/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	9936	40	Pediatrics	0	In state provider	None	6555 COYLE AVE	STE 200	CARMICHAEL	CA	95608	0303	34	06067	38.66859	-121.3118055	Sacramento County
247683	Fee-for-Service	1568460772	1568460772	1	1	AVERA MCKENNAN	12/5/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	800 E 21ST ST	None	SIOUX FALLS	SD	57105	1016	00	None	43.534251	-96.7157055	Minnehaha County
247689	Fee-for-Service	1134232572	1134232572	1	1	ANUCHA, CHIBUIKE E MD	11/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	89094	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1508 GARCES HWY	STE 1	DELANO	CA	93215	3687	15	06029	35.76141641	-119.2369096	Kern County
247691	Fee-for-Service	1275637506	1275637506	1	2	AUJLA, NIRMAL S MD	5/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	42706	45	Nephrology (Renal-Kidney)	0	In state provider	None	3351 M ST	STE 125	MERCED	CA	95348	2731	24	06047	37.32477488	-120.4783805	Merced County
247700	Fee-for-Service	1497747356	1497747356	1	1	ALGOS INC, A MEDICAL CORPOR	4/5/2018	163W00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1017 S FAIR OAKS AVE	None	PASADENA	CA	91105	2621	19	06037	34.12830178	-118.1503497	Los Angeles County
247703	Fee-for-Service	1457916819	1457916819	1	1	AL-SHIFA HOME HEALTH CARE	3/16/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY	501 N BROOKHURST ST	STE 300-A	ANAHEIM	CA	92801	5204	30	06059	33.8384428	-117.9590628	Orange County
247725	Fee-for-Service	1942288113	1942288113	1	1	ABEL, BONNIE K PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	427 W COLORADO ST	STE 207	GLENDALE	CA	91204	3046	19	06037	34.1425505	-118.262142	Los Angeles County
247726	Fee-for-Service	1457508954	1457508954	1	1	ALLEN, SCOTT M MD	8/27/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	30	Radiology	1	Border provider	None	2900 DAGGETT AVE	None	KLAMATH FALLS	OR	97601	7101	00	None	42.2526295	-121.788099	Klamath County
247767	Fee-for-Service	1609972728	1609972728	1	1	AGUAYO, JOSE J. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1745 LAKELAND HILLS BLVD	None	LAKELAND	FL	33805	3016	00	None	28.06956	-81.95327449	Polk County
247771	Fee-for-Service	1134202658	1134202658	1	1	ALLEN, BYRON J MD	11/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	44917	41	Internal Medicine	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
247779	Fee-for-Service	1932756764	1932756764	1	6	ALTAMED HEALTH SERVICES	6/19/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	MOBILE UNIT 1	1325 N ANAHEIM BLVD	STE 200	ANAHEIM	CA	92801	1202	30	06059	33.85331047	-117.9199617	Orange County
247787	Fee-for-Service	1114948858	1114948858	1	1	A'S HOME HEALTH CARE INC	9/25/2017	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11030 ARROW ROUTE	STE 202	RANCHO CUCAMONGA	CA	91730	4837	36	06071	34.0991145	-117.563265	San Bernardino County
247797	Fee-for-Service	1770744286	1770744286	1	1	ABRAMOV, MICHAEL MD	6/28/2022	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	159558	None	None	0	In state provider	None	768 MOUNTAIN RANCH RD	None	SAN ANDREAS	CA	95249	9707	05	06009	38.19058212	-120.6709481	Calaveras County
247819	Fee-for-Service	1821316696	1821316696	1	1	AUBERT, PAMELA M MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135927	07	Dermatology	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
247823	Fee-for-Service	1801816764	1801816764	1	2	ALVA, ALEJANDRO MD	9/29/2022	2084P0800X	NA	Psychiatry	086	MEDICAL DIRECTORS	62396	-	NOT APPLICABLE	0	In state provider	None	49713 GORMAN POST ROAD	None	GORMAN	CA	93243	9701	19	06037	34.79615998	-118.8513898	Los Angeles County
247860	Fee-for-Service	1992269427	1992269427	1	1	AISNER, ADAM J CNP	12/6/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	8491 SANTA MONICA BLVD	None	WEST HOLLYWOOD	CA	90069	4218	19	06037	34.08988507	-118.3757716	Los Angeles County
247866	Fee-for-Service	1528288081	1528288081	1	1	ADKISSON, METTE-MARGRETH	11/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LN	None	LAS VEGAS	NV	89106	4119	00	None	36.163269	-115.1654465	Clark County
247887	Fee-for-Service	1063861540	1063861540	1	1	AMAZON HOSPICE INC	1/3/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2420 W CARSON ST	STE 205	TORRANCE	CA	90501	3157	19	06037	33.83131647	-118.3262625	Los Angeles County
247969	Fee-for-Service	1568460772	1568460772	1	1	AVERA MCKENNAN	12/5/2001	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	800 E 21ST ST	None	SIOUX FALLS	SD	57105	1016	00	None	43.534251	-96.7157055	Minnehaha County
247979	Fee-for-Service	1275637506	1275637506	1	2	AUJLA, NIRMAL S MD	5/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	42706	41	Internal Medicine	0	In state provider	None	3351 M ST	STE 125	MERCED	CA	95348	2731	24	06047	37.32477488	-120.4783805	Merced County
247986	Fee-for-Service	1497747356	1497747356	1	1	ALGOS INC, A MEDICAL CORPOR	8/3/2020	163W00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1017 S FAIR OAKS AVE	None	PASADENA	CA	91105	2621	19	06037	34.12830178	-118.1503497	Los Angeles County
247988	Fee-for-Service	1700014909	1700014909	1	1	ALAVEKIOS, DAMON A MD	4/15/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	115287	20	Orthopedic Surgery	0	In state provider	None	911 SUNSET DRIVE	None	HOLLISTER	CA	95023	5695	35	06069	36.83504962	-121.3858245	San Benito County
248017	Fee-for-Service	1457691685	1457691685	1	1	AWAN, SAEED U MD	2/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	55769	85	Surgery-Pediatric	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
248040	Fee-for-Service	1821200783	1821200783	1	1	AMERICAN STAR HOME	3/3/2006	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1209 DAKOTA AVE	None	SAN MATEO	CA	94401	3003	41	06081	37.5688518	-122.3109185	San Mateo County
248061	Fee-for-Service	1134202658	1134202658	1	1	ALLEN, BYRON J MD	11/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	44917	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
248069	Fee-for-Service	1932756764	1932756764	1	6	ALTAMED HEALTH SERVICES	6/19/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	MOBILE UNIT 1	1325 N ANAHEIM BLVD	STE 200	ANAHEIM	CA	92801	1202	30	06059	33.85331047	-117.9199617	Orange County
248087	Fee-for-Service	1851608012	1851608012	1	1	ATWAL, BHAVANDEEP LMFT	3/25/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
248092	Fee-for-Service	1801287354	1801287354	1	1	ARMENTA, RACHEL NP	3/9/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	None	32.683167	-114.633459	Yuma County
248099	Fee-for-Service	1609931054	1609931054	1	1	ABLANG, BRIAN P	11/8/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1635 DIVISADERO ST	None	SAN FRANCISCO	CA	94115	3036	38	06075	37.78487142	-122.4398095	San Francisco County
248156	Fee-for-Service	1831316124	1831316124	1	1	ALFREDO MOLINA, NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1900 DENVER AVE	None	EL PASO	TX	79902	3008	00	None	31.78141019	-106.4757478	El Paso County
248165	Fee-for-Service	1114383080	1114383080	1	1	ADVANCE COMPREHENSIVE PAIN C	11/5/2018	207LP2900X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	ARE INC	23020 ATLANTIC CIR	None	MORENO VALLEY	CA	92553	9255	33	06065	33.9330865	-117.260478	Riverside County
248166	Fee-for-Service	1164471223	1164471223	1	1	ALLISON, MARK D MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	50568	41	Internal Medicine	0	In state provider	None	4646 BROCKTON AVE	STE 203	RIVERSIDE	CA	92506	0102	33	06065	33.9760171	-117.3860626	Riverside County
248192	Fee-for-Service	1770589293	1770589293	1	1	AL-NASER, RAED A MD	9/1/2000	207RP1001X	NA	Pulmonology	026	PHYSICIANS	71932	41	Internal Medicine	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
248198	Fee-for-Service	1912416199	1912416199	1	1	ADVANCED INTERVENTIONAL SURG	6/19/2019	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	ICAL CENTER	3077 STEVENSON BLVD	None	FREMONT	CA	94538	2316	01	06001	37.54768241	-121.9722835	Alameda County
248224	Fee-for-Service	1114365699	1114365699	1	1	AVILA, PATRICK MD	2/6/2020	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	143067	10	Gastroenterology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
248227	Fee-for-Service	1902309735	1902309735	1	1	ALEXANDER, ANDREW O MD	5/3/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	166170	None	None	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
248254	Fee-for-Service	1073589081	1073589081	1	1	ACE MEDICAL SUPPLY, INC	4/3/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	ACE MEDICAL SUPPLY, INC.	6155 STONEY CREEK DR	None	FORT WAYNE	IN	46825	4409	00	None	41.13450344	-85.14009127	Allen County
248269	Fee-for-Service	1982790283	1982790283	1	1	ALEXANDER, JOAN M LCSW	6/1/2000	No Taxonomy Provided	NA	None	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1511 ADA ST	None	BERKELEY	CA	94703	1001	01	06001	37.88029418	-122.2824079	Alameda County
248282	Fee-for-Service	1962688853	1962688853	1	1	ABBOY, SRIDEVI MD	4/4/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	88483	40	Pediatrics	0	In state provider	None	4733 W SUNSET BOULEVARD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
248364	Fee-for-Service	1790885259	1790885259	1	1	ARANO, VICENTE J MD	7/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	55658	08	Family Practice	0	In state provider	None	57445 29 PALMS HWY	STE 303	YUCCA VALLEY	CA	92284	2947	36	06071	34.12434696	-116.4111216	San Bernardino County
248371	Fee-for-Service	1316005572	1316005572	1	7	APPLE URGENT CARE, INC	1/23/2023	207QG0300X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	301 N PEPPER AVE	100	COLTON	CA	92324	1838	36	06071	34.07085827	-117.353113	San Bernardino County
248397	Fee-for-Service	1780828798	1780828798	1	1	ASIF, AISHA F MD	12/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	119908	40	Pediatrics	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
248415	Fee-for-Service	1861465940	1861465940	1	1	ALAMSHAHI, MARY C NP	1/31/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
248479	Fee-for-Service	1770589293	1770589293	1	1	AL-NASER, RAED A MD	9/1/2000	207RP1001X	NA	Pulmonology	026	PHYSICIANS	71932	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	37	06073	32.781483	-117.007182	San Diego County
248535	Fee-for-Service	1104076280	1104076280	1	1	ARAIN, MOHAMMAD A MD INC	10/2/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	None	1019 W YOSEMITE AVE	None	MADERA	CA	93637	4584	20	06039	36.95438006	-120.0709254	Madera County
248538	Fee-for-Service	1083623540	1083623540	1	1	ARAIM, LEHEB H MD	9/29/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	111675	33	Thoracic Surgery	0	In state provider	None	202 W WILLOW AVE	SUITE 405	VISALIA	CA	93291	6238	54	06107	36.328536	-119.293569	Tulare County
248553	Fee-for-Service	1871170829	1871170829	1	1	ANWARI, YAMAH DO	9/6/2024	208M00000X	NA	Other	026	PHYSICIANS	22970	41	Internal Medicine	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
248575	Fee-for-Service	1255659355	1255659355	1	1	ARNOLD, ERIC B MD	2/1/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	117757	None	None	0	In state provider	None	2001 DWIGHT WAY	None	BERKELEY	CA	94704	2608	01	06001	37.86379498	-122.2689084	Alameda County
248618	Fee-for-Service	1639583321	1639583321	1	1	AHMAD, MANSOOR MD	9/27/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	167978	None	None	0	In state provider	None	19929 GREENLEY RD	None	SONORA	CA	95370	5996	55	06109	37.9837971	-120.366851	Tuolumne County
248658	Fee-for-Service	1316005572	1316005572	1	7	APPLE URGENT CARE, INC	1/23/2023	207QG0300X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	301 N PEPPER AVE	100	COLTON	CA	92324	1838	36	06071	34.07085827	-117.353113	San Bernardino County
248699	Fee-for-Service	1275768186	1275768186	1	1	AHMADI-KASHANI, MASTANEH MD	4/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	113496	33	Thoracic Surgery	0	In state provider	None	1019 S CENTRAL AVE	None	GLENDALE	CA	91204	2542	19	06037	34.13405999	-118.2578839	Los Angeles County
248737	Fee-for-Service	1528789534	1528789534	1	1	AVALON PALM CARE INC	10/6/2022	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	3271 INNUIT AVE	None	SAN DIEGO	CA	92117	3521	37	06073	32.82400079	-117.2169064	San Diego County
248741	Fee-for-Service	1699800219	1699800219	1	1	ANDERECK, WILLIAM S MD	2/8/2015	207R00000X	NA	Other	026	PHYSICIANS	33409	41	Internal Medicine	0	In state provider	None	2100 WEBSTER ST	STE 418	SAN FRANCISCO	CA	94115	2379	38	06075	37.7904826	-122.4324477	San Francisco County
248746	Fee-for-Service	1174814065	1174814065	1	1	ALLEN, ELIZABETH S MD	8/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	125542	22	Pathology (M.D. only)	0	In state provider	None	200 WEST ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
248766	Fee-for-Service	1780881284	1780881284	2	1	APEXCARE HOME HEALTH INC	8/4/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	20301 VENTURA BLVD	STE 351	WOODLAND HILLS	CA	91364	9648	19	06037	34.1695442	-118.5749513	Los Angeles County
248792	Fee-for-Service	1740368398	1740368398	1	1	ARGUELLES-GAVILOA,	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	71371	41	Internal Medicine	0	In state provider	WILMA MD	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
248819	Fee-for-Service	1902859390	1902859390	1	1	ANDERSON, JOHN L MD	11/30/1987	207L00000X	NA	Other	026	PHYSICIANS	54092	05	Anesthesiology	0	In state provider	None	555 E HARDY ST	None	INGLEWOOD	CA	90301	4011	19	06037	33.94909549	-118.3481595	Los Angeles County
248822	Fee-for-Service	1699127316	1699127316	1	1	ADVENTIST HEALTH PHYSICIANS	11/23/2016	193200000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	515 S FAIRMONT AVENUE	None	LODI	CA	95240	3834	39	06077	38.12786821	-121.2859247	San Joaquin County
248823	Fee-for-Service	1104076280	1104076280	1	1	ARAIN, MOHAMMAD A MD INC	10/2/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1019 W YOSEMITE AVE	None	MADERA	CA	93637	4584	20	06039	36.95438006	-120.0709254	Madera County
248841	Fee-for-Service	1245255124	1245255124	1	1	ARTHRITIS MEDICAL CLINIC	5/3/2005	207RR0500X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6180 BROCKTON AVE	SUITE 204	RIVERSIDE	CA	92506	2233	33	06065	33.958692	-117.3967415	Riverside County
248843	Fee-for-Service	1821011917	1821011917	1	1	ADVANCED ORTHOPAEDIC SURGERY	7/20/2010	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	None	20	Orthopedic Surgery	0	In state provider	CENTER	41278 MARGARITA RD	STE 201	TEMECULA	CA	92591	5579	33	06065	33.52438442	-117.1492152	Riverside County
248849	Fee-for-Service	1427795939	1427795939	2	1	ASTORIA PARK SENIOR LIVING	5/20/2025	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	LLC	925 EAST VILLA STREET	None	PASADENA	CA	91106	1027	19	06037	34.15432296	-118.1314401	Los Angeles County
248858	Fee-for-Service	1538497177	1538497177	1	1	ALEXANDER HEARING SERVICES	5/13/2010	193400000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	AN AUDIOLOGY CORPORATION	18411 CRENSHAW BLVD	STE 110	TORRANCE	CA	90504	5042	19	06037	33.86333387	-118.3265193	Los Angeles County
248892	Fee-for-Service	1992720379	1992720379	1	1	AMOS, EDWIN C III MD	7/31/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	52551	13	Neurology (M.D. only)	0	In state provider	None	2021 SANTA MONICA BLVD	STE 525E	SANTA MONICA	CA	90404	2208	19	06037	34.02922048	-118.4793681	Los Angeles County
248943	Fee-for-Service	1174302954	1174302954	1	1	ALTEA MEDICAL CALIFORNIA PC	2/5/2025	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	3000 N GATE ROAD	None	SEAL BEACH	CA	90740	2535	30	06059	33.77328499	-118.0776064	Orange County
248954	Fee-for-Service	1851468789	1851468789	1	1	ARDRON, PAULA D MD	11/1/1995	207RA0201X	NA	Other	026	PHYSICIANS	83309	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
249016	Fee-for-Service	1902244890	1902244890	1	1	AZER, PHILIP MD APC	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	13273	04	Otology, Laryngology, Rhinology	0	In state provider	None	3660 CLAIREMONT	SUITE 2	SAN DIEGO	CA	92117	5909	37	06073	32.80759429	-117.2010737	San Diego County
249029	Fee-for-Service	1720548472	1720548472	1	1	ADAMSKI, LAURA MD	9/27/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	179906	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
249034	Fee-for-Service	1376689778	1376689778	2	1	ADAMS, STEPHEN J DO	7/25/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	12637	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
249063	Fee-for-Service	1417362856	1417362856	1	1	ALYESH, NATHAN MD	1/26/2024	207R00000X	NA	Other	026	PHYSICIANS	146154	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
249064	Fee-for-Service	1861635278	1861635278	1	1	AUNG, ANDREW M MD	7/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	106089	05	Anesthesiology	0	In state provider	None	23845 MCBEAN PARKWAY	None	VALENCIA	CA	91355	2083	19	06037	34.39696803	-118.5525278	Los Angeles County
249066	Fee-for-Service	1376056002	1376056002	1	3	AFFORDABLE SENIOR HOUSING FO	9/27/2018	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	632 TRANQUILITY GLEN	None	ESCONDIDO	CA	92027	3984	37	06073	33.12472657	-117.059559	San Diego County
249080	Fee-for-Service	1104001759	1104001759	1	1	ALEXANDER, CHERYL L LMFT	7/12/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	303 POTRERO ST	STE 43-203	SANTA CRUZ	CA	95060	2741	44	06087	36.98079126	-122.030791	Santa Cruz County
249087	Fee-for-Service	1578556080	1578556080	1	1	ATWAL, MANINDER S MD	1/1/1998	207L00000X	NA	Other	026	PHYSICIANS	79872	05	Anesthesiology	0	In state provider	None	3315 WATT AVE	None	SACRAMENTO	CA	95821	3600	34	06067	38.626056	-121.3834455	Sacramento County
249108	Fee-for-Service	1154355832	1154355832	1	1	ALI, USMAN MD	6/30/1992	207R00000X	NA	Other	026	PHYSICIANS	50246	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2160 W GRANT LINE RD	STE 230	TRACY	CA	95377	7334	39	06077	37.75399922	-121.455877	San Joaquin County
249165	Fee-for-Service	1841243987	1841243987	1	1	AHMED,AMNA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	122 W 7TH AVE	STE 310	SPOKANE	WA	99204	2352	00	None	47.649717	-117.4138155	Spokane County
249232	Fee-for-Service	1548213457	1548213457	1	1	ASHBY, HANSEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ST. LUKE'S REG MED CTR	190 E BANNOCK ST	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
249240	Fee-for-Service	1073977120	1073977120	1	1	ALLRED, ERIKA T MD	7/11/2022	2080P0210X	NA	Nephrology	026	PHYSICIANS	151669	None	None	0	In state provider	None	8001 FROST STREET	None	SAN DIEGO	CA	92123	2746	37	06073	32.802147	-117.151371	San Diego County
249244	Fee-for-Service	1851468789	1851468789	1	1	ARDRON, PAULA D MD	11/1/1995	207RA0201X	NA	Other	026	PHYSICIANS	83309	03	Allergy	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
249248	Fee-for-Service	1033733134	1033733134	1	1	ALEJANDRO SORIA, LICENSED MA	12/12/2020	251S00000X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	110 N MACLAY AVENUE	SUITE 108	SAN FERNANDO	CA	91340	2986	19	06037	34.28449525	-118.4396137	Los Angeles County
249286	Fee-for-Service	1033304845	1033304845	1	2	ALFARO, SHEILA F LCSW	4/3/2020	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	SERVICES	50 W LEMON AVE	SUITE # 4	MONROVIA	CA	91016	5112	19	06037	34.14691794	-118.0013392	Los Angeles County
249293	Fee-for-Service	1942579008	1942579008	1	1	APONTES RUIZ, MARIO E MD	2/2/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
249294	Fee-for-Service	1346855087	1346855087	1	1	ALMACHAR, EMIL NP	4/26/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	6900 NORTH DURANGO DRIVE	None	LAS VEGAS	NV	89149	4409	00	None	36.28701289	-115.2877045	Clark County
249317	Fee-for-Service	1366959017	1366959017	1	1	AQE PHYSICAL THERAPY, INC	4/11/2018	261QP2000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	433 N 4TH STREET	SUITE 216	MONTEBELLO	CA	90640	4309	19	06037	34.01561115	-118.1019888	Los Angeles County
249318	Fee-for-Service	1033786694	1033786694	1	1	AGUILAR, BIANKA MD	3/15/2024	390200000X	NA	Other	026	PHYSICIANS	184198	None	None	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
249325	Fee-for-Service	1447286844	1447286844	1	1	ABILITY CENTER	2/2/1996	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4797 RUFFNER ST	None	SAN DIEGO	CA	92111	1439	37	06073	32.82859379	-117.1583487	San Diego County
249345	Fee-for-Service	1912045196	1912045196	1	2	ADDICTION RESEARCH AND TREAT	10/11/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1926 W. BEVERLY BLVD.	None	LOS ANGELES	CA	90057	2402	19	06037	34.06588198	-118.2686209	Los Angeles County
249381	Fee-for-Service	1760502710	1760502710	1	1	AHMED, MAQBOOL MD	6/5/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	62076	41	Internal Medicine	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
249382	Fee-for-Service	1083748685	1083748685	1	1	AMIRZADEH, ALI MD	2/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	85206	03	Allergy	0	In state provider	None	1 QUALITY DRIVE	None	VACAVILLE	CA	95688	9494	48	06095	38.38851772	-121.9382798	Solano County
249384	Fee-for-Service	1669046843	1669046843	1	1	ALLORO-LICHTENSTEIN, PAULA J	9/26/2022	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	NP	1001 SNEATH LN	None	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
249400	Fee-for-Service	1154355832	1154355832	1	1	ALI, USMAN MD	6/30/1992	207R00000X	NA	Other	026	PHYSICIANS	50246	41	Internal Medicine	0	In state provider	None	2160 W GRANT LINE RD	STE 230	TRACY	CA	95377	7334	39	06077	37.75399922	-121.455877	San Joaquin County
249404	Fee-for-Service	1033137963	1033137963	1	1	A & K PROFESSIONAL PHARMACY	4/20/1994	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY	265 E BEVERLY BLVD	STE B	MONTEBELLO	CA	90640	3776	19	06037	34.01488548	-118.095183	Los Angeles County
249405	Fee-for-Service	1154401347	1154401347	1	1	AKHTAR, NAEEM M MD INC	8/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45051	10	Gastroenterology (M.D. only)	0	In state provider	None	451 E ALMOND AVE	STE 103	MADERA	CA	93637	5562	20	06039	36.94554615	-120.0523936	Madera County
249484	Fee-for-Service	1245859297	1245859297	1	1	AVIGLIANO, JUSTIN DO	9/1/2024	207P00000X	NA	Other	026	PHYSICIANS	22620	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1515 E OCEAN AVE	None	LOMPOC	CA	93436	7092	42	06083	34.63941491	-120.4393023	Santa Barbara County
249507	Fee-for-Service	1194968362	1194968362	1	1	ADKINS, JESSICA M MD	4/18/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	106736	None	None	0	In state provider	None	1000 GREENLEY ROAD	None	SONORA	CA	95370	5200	55	06109	37.97749352	-120.3700335	Tuolumne County
249518	Fee-for-Service	1609066067	1609066067	1	2	APEX HOME HEALTH CARE IN	2/8/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1619 1/2 VICTORY BLVD	None	GLENDALE	CA	91201	3821	19	06037	34.16019267	-118.2987587	Los Angeles County
249526	Fee-for-Service	1477884765	1477884765	1	1	ALLWELL MEDICAL SERVICES	1/25/2010	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	ALLWELL PERSONAL CARE	826 GLENWAY DRIVE	None	INGLEWOOD	CA	90302	2711	19	06037	33.97047798	-118.3670242	Los Angeles County
249545	Fee-for-Service	1407353675	1407353675	1	1	ART VASCULAR & INTERVENTIONA	12/5/2023	2085R0204X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	L ASSOCIATES INC	1417 WEST BEVERLY BLVD.	SUITE 106	MONTEBELLO	CA	90640	4123	19	06037	34.01879041	-118.1136083	Los Angeles County
249560	Fee-for-Service	1902650781	1902650781	1	1	ATKINS, JENNIFER NP	8/7/2024	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1563	34	06067	38.546091	-121.447305	Sacramento County
249563	Fee-for-Service	1366574477	1366574477	1	1	ANAHEIM PULMONARY AND	1/28/1993	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	CRITICAL CARE GROUP	3400 W BALL RD	STE 212	ANAHEIM	CA	92804	3737	30	06059	33.81724472	-118.0083216	Orange County
249574	Fee-for-Service	1578650388	1578650388	1	1	ALSTON, GERALD A MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	84779	08	Family Practice	0	In state provider	None	3800 JANES ROAD	STE 101	ARCATA	CA	95521	4742	12	06023	40.89645172	-124.0930637	Humboldt County
249615	Fee-for-Service	1689628687	1689628687	1	1	ABEDON, STEPHEN I MD	8/1/2002	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	70312	None	None	0	In state provider	None	735 GALVESTON DR	None	REDWOOD CITY	CA	94063	4722	41	06081	37.4989557	-122.2170646	San Mateo County
249645	Fee-for-Service	1760807705	1760807705	1	1	AFRIDI, SHEHLA K	6/12/2014	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	200 MEDICAL PLAZA	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
249684	Fee-for-Service	1518265644	1518265644	1	1	ABSOLUTE HOME HEALTH INC	11/26/2012	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4740 MURPHY CANYON RD	SUITE 222	SAN DIEGO	CA	92123	4376	37	06073	32.82724116	-117.1194932	San Diego County
249695	Fee-for-Service	1154401347	1154401347	1	1	AKHTAR, NAEEM M MD INC	8/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	45051	41	Internal Medicine	0	In state provider	None	451 E ALMOND AVE	STE 103	MADERA	CA	93637	5562	20	06039	36.94554615	-120.0523936	Madera County
249697	Fee-for-Service	1184858599	1184858599	1	1	ALVAREZ, ARIANA Y LMFT	6/11/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3322 W VICTORY BLVD	None	BURBANK	CA	91505	1542	19	06037	34.18465529	-118.3476371	Los Angeles County
249722	Fee-for-Service	1497130405	1497130405	1	1	ABC PHARMACY OF BEVERLY HILL	7/16/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	S	9033 WILSHIRE	#102	BEVERLY HILLS	CA	90211	1800	19	06037	34.06707946	-118.388943	Los Angeles County
249736	Fee-for-Service	1922692821	1922692821	1	1	ARSMED HOSPICE CARE, INC	5/20/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	12444 VICTORY BLVD	STE 203	NORTH HOLLYWOOD	CA	91606	3199	19	06037	34.18663951	-118.4043555	Los Angeles County
249741	Fee-for-Service	1043229222	1043229222	1	1	AGNEW, JOHN S MD	1/12/1979	2083X0100X	NA	Adult Primary Care	026	PHYSICIANS	33106	08	Family Practice	0	In state provider	None	3100 MEADOWVIEW RD	None	SACRAMENTO	CA	95832	1438	34	06067	38.481057	-121.47309	Sacramento County
249759	Fee-for-Service	1750559431	1750559431	1	4	ALL STAR PHYSICAL THERAPY, I	3/12/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	1338 MAIN ST	None	RAMONA	CA	92065	0000	37	06073	33.03880322	-116.8742834	San Diego County
249783	Fee-for-Service	1255507760	1255507760	1	1	ALL CITY SLEEP CENTER	8/21/2018	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	341 WESTLAKE CENTER	SUITE 250	DALY CITY	CA	94015	1447	41	06081	37.70045364	-122.4828512	San Mateo County
249787	Fee-for-Service	1922514710	1922514710	1	1	ACCOLADE MEDICAL	1/22/2018	207RN0300X	NA	Nephrology	026	PHYSICIANS	None	45	Nephrology (Renal-Kidney)	0	In state provider	None	301 VICTORIA ST	None	COSTA MESA	CA	92627	1995	30	06059	33.65258952	-117.9121545	Orange County
249790	Fee-for-Service	1235671215	1235671215	1	1	ALGOS INC., A MEDICAL CORPOR	6/13/2019	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	16415 COLORADO AVE	SUITE 402	PARAMOUNT	CA	90723	5035	19	06037	33.8853075	-118.1614695	Los Angeles County
249801	Fee-for-Service	1457596371	1457596371	1	6	ALLSAFE MEDICAL GROUP INC.	2/21/2024	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	947 ANAHEIM BLVD	270	ANAHEIM	CA	92805	5582	30	06059	33.82164135	-117.909385	Orange County
249808	Fee-for-Service	1437338639	1437338639	1	1	ALMOND HOME INC	5/18/2006	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2962 ALMOND DR	None	SAN JOSE	CA	95148	2001	43	06085	37.3335221	-121.7991295	Santa Clara County
249814	Fee-for-Service	1841427143	1841427143	1	1	ADELI, AMIR MD	1/24/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144959	None	None	0	In state provider	None	515 FAIRCHILD CT	None	WOODLAND	CA	95695	5164	57	06113	38.66569664	-121.7925341	Yolo County
249817	Fee-for-Service	1194710483	1194710483	1	1	ABIODUN SANGOSENI MD	11/13/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1900 STATE ST	None	CHESTER	IL	62233	1116	00	None	37.91903392	-89.81190503	Randolph County
249831	Fee-for-Service	1609805910	1609805910	1	1	AMINIAN, AFSHIN MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68008	40	Pediatrics	0	In state provider	None	1310 W STEWART DR	STE 508	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
249842	Fee-for-Service	1104016468	1104016468	1	1	ALAV MEDICAL CORPORATION	12/16/2009	193200000X	NA	Other	026	PHYSICIANS	74033	None	None	0	In state provider	None	16465 SIERRA LAKES PKWY	STE 200	FONTANA	CA	92336	1242	36	06071	34.13805177	-117.4457839	San Bernardino County
249897	Fee-for-Service	1326020991	1326020991	1	1	ALFANO, MARK PHD	1/9/2007	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
249899	Fee-for-Service	1043211733	1043211733	1	1	AHMAD, MARYAM F CNP	4/9/2018	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2900 N SEPULVEDA BLVD	None	MANHATTAN BEACH	CA	90266	2730	19	06037	33.896799	-118.3959415	Los Angeles County
249932	Fee-for-Service	1962512145	1962512145	1	1	AWOBULUYI, MARC T MD	9/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	84420	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
249946	Fee-for-Service	1932694031	1932694031	1	1	AITA, MORGEN PHD	4/3/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3200 E GUASTI RD	100	ONTARIO	CA	91761	8661	36	06071	34.06518	-117.5822055	San Bernardino County
250003	Fee-for-Service	1114948718	1114948718	1	1	ABOOSH, KIMBERLY K	2/8/2015	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	20 ROCKMONT CR	None	SACRAMENTO	CA	95835	1503	34	06067	38.675592	-121.5244125	Sacramento County
250019	Fee-for-Service	1477807006	1477807006	1	1	ASHLI HEALTHCARE INC	7/7/2020	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	323 WEST CROMWELL AVENUE	117	FRESNO	CA	93711	6166	10	06019	36.84754253	-119.7978435	Fresno County
250023	Fee-for-Service	1922692821	1922692821	1	1	ARSMED HOSPICE CARE, INC	5/20/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	12444 VICTORY BLVD	STE 203	NORTH HOLLYWOOD	CA	91606	3199	19	06037	34.18663951	-118.4043555	Los Angeles County
250039	Fee-for-Service	1235185604	1235185604	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	31960 TEMECULA PKWY	None	TEMECULA	CA	92592	5897	33	06065	33.48082892	-117.0999334	Riverside County
250046	Fee-for-Service	1750559431	1750559431	1	4	ALL STAR PHYSICAL THERAPY, I	4/30/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	1338 MAIN ST	None	RAMONA	CA	92065	0000	37	06073	33.03880322	-116.8742834	San Diego County
250051	Fee-for-Service	1689831927	1689831927	1	1	ANTONOPULOS, ANNA S MD	12/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	40	Pediatrics	1	Border provider	None	2825 E BARNETT RD	None	MEDFORD	OR	97504	8332	00	None	42.31650147	-122.8306005	Jackson County
250077	Fee-for-Service	1235671215	1235671215	1	1	ALGOS INC., A MEDICAL CORPOR	6/13/2019	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	16415 COLORADO AVE	SUITE 402	PARAMOUNT	CA	90723	5035	19	06037	33.8853075	-118.1614695	Los Angeles County
250120	Fee-for-Service	1609805910	1609805910	1	1	AMINIAN, AFSHIN MD	5/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	68008	20	Orthopedic Surgery	0	In state provider	None	1310 W STEWART DR	STE 508	ORANGE	CA	92868	3856	30	06059	33.78236048	-117.8664975	Orange County
250143	Fee-for-Service	1790023547	1790023547	1	1	ADVANCED MOLECULAR DIAGNOSTI	12/5/2019	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	136 SUMMIT AVENUE	None	MONTVALE	NJ	07645	1745	00	None	41.0587764	-74.06075803	Bergen County
250157	Fee-for-Service	1639185630	1639185630	1	1	ANDERSON, JEFFREY L MD	9/20/2007	207L00000X	NA	Other	026	PHYSICIANS	58154	None	None	0	In state provider	None	1650 CREEKSIDE DR	None	FOLSOM	CA	95630	3400	34	06067	38.67021	-121.145382	Sacramento County
250167	Fee-for-Service	1336645191	1336645191	1	1	ANDERSON, TYLER MD	2/1/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	186486	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
250174	Fee-for-Service	1770105405	1770105405	1	1	AGER, EMILY E MD	7/15/2024	207P00000X	NA	Other	026	PHYSICIANS	None	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
250175	Fee-for-Service	1598777039	1598777039	1	1	ANESTHESIA PRAC ASSOC OF	12/5/2007	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	INTERCOMMUNITY MED CTR	210 W SAN BERNARDINO RD	None	COVINA	CA	91723	1549	19	06037	34.088004	-117.893475	Los Angeles County
250182	Fee-for-Service	1104184761	1104184761	1	1	ANGELUS HOME HEALTH	7/16/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	211 S LAUREL AVE	None	ONTARIO	CA	91762	3833	36	06071	34.062273	-117.6522795	San Bernardino County
250183	Fee-for-Service	1245929207	1245929207	1	1	AMALFI LIVING, INC	5/23/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	23518 EVALYN AVE	None	TORRANCE	CA	90505	4514	19	06037	33.812217	-118.358944	Los Angeles County
250193	Fee-for-Service	1659534121	1659534121	1	1	ANDERSON, JUSTIN P MD	3/11/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109334	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
250202	Fee-for-Service	1821003591	1821003591	1	1	AZZOLINI,SILVIO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2000 W BETHONY HOME	RD	PHOENIX	AZ	85015	2443	00	None	33.525405	-112.102461	Maricopa County
250263	Fee-for-Service	1417367541	1417367541	1	1	AMIR KAZEROUNINIA M.D.	11/21/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	939 CAROLINE ST	None	PORT ANGELES	WA	98362	3909	00	None	48.11505263	-123.4151177	Clallam County
250292	Fee-for-Service	1164487161	1164487161	1	1	AFSHINNIA, FARSAD MD	1/9/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91308	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
250293	Fee-for-Service	1144607888	1144607888	1	1	ALLEN, THOMAS M MD	3/29/2023	207P00000X	NA	Other	026	PHYSICIANS	161260	None	None	0	In state provider	None	15615 POMERADO ROAD	None	POWAY	CA	92064	2405	37	06073	32.99706	-117.05544	San Diego County
250334	Fee-for-Service	1750559431	1750559431	1	4	ALL STAR PHYSICAL THERAPY, I	11/10/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	1338 MAIN ST	None	RAMONA	CA	92065	0000	37	06073	33.03880322	-116.8742834	San Diego County
250341	Fee-for-Service	1871993691	1871993691	1	1	ABSOLUTE MEDICAL	1/12/2015	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	12417 FAIR OAKS BLVD	SUITE 600	FAIR OAKS	CA	95628	2501	34	06067	38.678004	-121.262688	Sacramento County
250344	Fee-for-Service	1477078467	1477078467	1	1	AGNEW, EMMA LCSW	6/30/2023	101Y00000X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
250375	Fee-for-Service	1093205247	1093205247	1	1	AGI, CHIKA MD	2/28/2023	207P00000X	NA	Other	026	PHYSICIANS	181329	None	None	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
250413	Fee-for-Service	1245673334	1245673334	1	1	AISEN, CARRIE MD	1/14/2020	208800000X	NA	Other	026	PHYSICIANS	161915	34	Urology and Urological Surgery	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
250440	Fee-for-Service	1396282406	1396282406	1	1	AHMED, SIRAJ K MD INC	11/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	None	None	0	In state provider	None	1140 NORMAN DRIVE	SUITE 104	MANTECA	CA	95336	5925	39	06077	37.79425988	-121.1998134	San Joaquin County
250528	Fee-for-Service	1841301884	1841301884	1	1	ASEBIOMO, BANKOLE S MD	5/1/2023	208M00000X	NA	Other	026	PHYSICIANS	163303	None	None	0	In state provider	None	10 WOODLAND ROAD	None	SAINT HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
250533	Fee-for-Service	1063148187	1063148187	1	1	ATALLAH, HANI M	3/22/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	2845 MOORPARK AVE	202	SAN JOSE	CA	95128	3158	43	06085	37.31609651	-121.944186	Santa Clara County
250551	Fee-for-Service	1134584436	1134584436	1	1	A & A PHARMACIES INC	7/18/2016	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9106 ADAMS AVE	None	HUNTINGTON BEACH	CA	92646	3405	30	06059	33.67215954	-117.969732	Orange County
250556	Fee-for-Service	1275549693	1275549693	1	1	ASSIMES, THEMISTOCLES L MD	7/21/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	75329	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
250572	Fee-for-Service	1346431145	1346431145	1	1	AGAS, EDILBERTO L JR MD	10/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	100860	40	Pediatrics	0	In state provider	None	900 S MAIN ST	STE 209A	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
250580	Fee-for-Service	1760882781	1760882781	1	1	AGYEMAN, KOFI D MD	3/9/2021	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	171535	None	None	0	In state provider	None	4234 RIVERWALK PKWY	SUITE 200	RIVERSIDE	CA	92505	8510	33	06065	33.90290859	-117.4941562	Riverside County
250608	Fee-for-Service	1528680790	1528680790	1	1	ANDREWS, TAYLOR LPCC	8/21/2024	101Y00000X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	818 MOUNTAIN AVE	STE 203	UPLAND	CA	91786	4165	36	06071	34.10424442	-117.6701797	San Bernardino County
250647	Fee-for-Service	1972573913	1972573913	1	1	ANTHONY DISCIULLO MD	2/2/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	330 MOUNT AUBURN ST	None	CAMBRIDGE	MA	02138	5502	00	None	42.373899	-71.1342405	Middlesex County
250716	Fee-for-Service	1275696080	1275696080	1	1	ALEXANDER, THOMAS H MD	5/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	90629	04	Otology, Laryngology, Rhinology	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
250741	Fee-for-Service	1154335248	1154335248	1	1	ALI, MIR M MD	7/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	36250	41	Internal Medicine	0	In state provider	None	3400 W BALL RD	SUITE 205	ANAHEIM	CA	92804	3737	30	06059	33.81724472	-118.0083216	Orange County
250749	Fee-for-Service	1205360104	1205360104	2	1	ALEXANDER, CHARLOTTE LYNN C	7/26/2023	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	172088	None	None	0	In state provider	ANDER	204 BEACH ST	None	WATSONVILLE	CA	95076	4809	44	06087	36.91224802	-121.7541363	Santa Cruz County
250812	Fee-for-Service	1023191053	1023191053	1	1	ARNOLD, JOHN C MD	11/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	70189	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
250814	Fee-for-Service	1538182712	1538182712	1	1	AVERILL, KENNETH E JR MD	4/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	68088	30	Radiology	0	In state provider	None	1661 SOQUEL DR	STE G	SANTA CRUZ	CA	95065	1709	44	06087	36.98895429	-121.9821088	Santa Cruz County
250841	Fee-for-Service	1023014511	1023014511	1	1	AMIN, HASMUKH C MD	11/10/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	31121	None	None	0	In state provider	None	9508 STOCKDALE HWY	STE 150	BAKERSFIELD	CA	93311	3623	15	06029	35.35453237	-119.1086014	Kern County
250884	Fee-for-Service	1134559685	1134559685	1	1	ADVANTA GENETICS LLC	9/2/2022	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	IES	10935 COUNTY ROAD	159	TYLER	TX	75703	3333	00	None	0	0	None
250901	Fee-for-Service	1174040166	1174040166	1	1	AAG HEALTHCARE INC	9/29/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	719 S VICTORY BLVD	UNIT A	BURBANK	CA	91502	2426	19	06037	34.16843415	-118.3102541	Los Angeles County
250956	Fee-for-Service	1720347222	1720347222	1	1	ARJOMANDI, NEDA DPM	12/12/2019	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	12520 MAGNOLIA BLVD	#304	VALLEY VILLAGE	CA	91607	2355	19	06037	34.16485451	-118.406106	Los Angeles County
250974	Fee-for-Service	1477085173	1477085173	1	1	AFROOZ, MAHYAR MD	10/5/2020	208M00000X	NA	Other	026	PHYSICIANS	169401	41	Internal Medicine	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
251004	Fee-for-Service	1013554930	1013554930	1	1	ALGOS INC., A MEDICAL CORPOR	7/30/2020	208VP0000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1325 E. COOLEY DR	SUITE 101	COLTON	CA	92324	3947	36	06071	34.05468148	-117.306261	San Bernardino County
251043	Fee-for-Service	1154732154	1154732154	1	1	AUNG, KHIN N MD	10/7/2021	207R00000X	NA	Other	026	PHYSICIANS	167716	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
251100	Fee-for-Service	1023191053	1023191053	1	1	ARNOLD, JOHN C MD	11/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	70189	77	Infectious Disease	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
251151	Fee-for-Service	1700950060	1700950060	1	1	ATRIUM MEDICAL CENTER	7/29/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1 MEDICAL CENTER DR	None	FRANKLIN	OH	45005	2584	00	None	39.49829743	-84.31530653	Warren County
251221	Fee-for-Service	1528015948	1528015948	1	1	ARTHUR Y GARDINER MD	4/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	389 S 900 E	None	SALT LAKE CTY	UT	84102	2310	00	None	40.761207	-111.865313	Salt Lake County
251237	Fee-for-Service	1174662175	1174662175	1	1	AXELROD, AMIR MD	10/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	80778	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
251245	Fee-for-Service	1922077569	1922077569	1	1	ALBURKI, ABDUSSALAM M MD	11/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1707 W CHARLESTON BLVD	STE 230	LAS VEGAS	NV	89102	2353	00	None	36.15879353	-115.1643015	Clark County
251262	Fee-for-Service	1538652680	1538652680	1	1	ANTOKU, DEREK A MD	8/16/2021	207R00000X	NA	Other	026	PHYSICIANS	173923	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
251263	Fee-for-Service	1700012317	1700012317	1	1	AGUAYO-HIRALDO, PAIBEL I MD	12/6/2018	2080P0207X	NA	Hematology	026	PHYSICIANS	159404	68	Hematology	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
251265	Fee-for-Service	1841750544	1841750544	1	1	AU, ANNIE DO	8/1/2022	207P00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	None	36.132948	-115.136874	Clark County
251272	Fee-for-Service	1922386481	1922386481	1	1	AQUILIZAN, ROXANNE C MD	9/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135143	41	Internal Medicine	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
251289	Fee-for-Service	1013554930	1013554930	1	1	ALGOS INC., A MEDICAL CORPOR	7/30/2020	208VP0000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1325 E. COOLEY DR	SUITE 101	COLTON	CA	92324	3947	36	06071	34.05468148	-117.306261	San Bernardino County
251320	Fee-for-Service	1316971518	1316971518	1	1	AMERICAN MEDICAL RESPONSE	1/1/1979	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	1300 ILLINOIS ST	None	SAN FRANCISCO	CA	94107	3107	38	06075	37.75488503	-122.3870553	San Francisco County
251338	Fee-for-Service	1922177872	1922177872	3	1	AK PHARMA, INC.	9/3/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	17313 E VALLEY BLVD	None	LA PUENTE	CA	91744	5653	19	06037	34.00938712	-117.9263949	Los Angeles County
251367	Fee-for-Service	1164430872	1164430872	1	1	ABDEL-FATTAH, EMAD K MD	2/22/2021	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	43535	None	None	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	12	06023	40.78355148	-124.1420294	Humboldt County
251380	Fee-for-Service	1649306614	1649306614	1	1	ALPHA MEDICAL SUPP INC	4/28/2004	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1827 E CHAPMAN AVE	None	ORANGE	CA	92867	7774	30	06059	33.78786145	-117.8338635	Orange County
251397	Fee-for-Service	1205186442	1205186442	1	2	ACTION URGENT CARE INC	8/26/2021	261QU0200X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	None	1680 E CAPITOL EXPY	10	SAN JOSE	CA	95121	1839	43	06085	37.3066751	-121.8111896	Santa Clara County
251415	Fee-for-Service	1851460950	1851460950	1	1	AMMAR, NEAL M MD	8/22/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92792	07	Dermatology	0	In state provider	None	6501 TRUXTUN AVE	None	BAKERSFIELD	CA	93309	0633	15	06029	35.36196445	-119.0749413	Kern County
251437	Fee-for-Service	1700950060	1700950060	1	1	ATRIUM MEDICAL CENTER	7/29/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	1 MEDICAL CENTER DR	None	FRANKLIN	OH	45005	2584	00	None	39.49829743	-84.31530653	Warren County
251456	Fee-for-Service	1023205408	1023205408	1	1	ADKINS, KATE W MD	9/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	115769	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1515 WEST FLORIDA AVENUE	None	HEMET	CA	92543	3817	33	06065	33.74738653	-116.9879535	Riverside County
251468	Fee-for-Service	1689146946	1689146946	1	1	ALIGN SPINE CENTER	5/14/2019	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	2720 N HARBOR BOULEVARD	SUITE 210	FULLERTON	CA	92835	2626	30	06059	33.90126238	-117.9292154	Orange County
251492	Fee-for-Service	1184116451	1184116451	1	1	ARTER, ZHAOHUI L MD	8/3/2024	390200000X	NA	Other	026	PHYSICIANS	174178	68	Hematology	0	In state provider	None	101 CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
251503	Fee-for-Service	1134318439	1134318439	1	1	ALAVI, ARMIN MD	12/8/2008	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	101555	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
251520	Fee-for-Service	1740555796	1740555796	1	1	ALVAREZ-GRAY, NAN LMFT	6/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3625 E THOUSAND OAKS BLV	106	WESTLAKE VILLAGE	CA	91362	3551	19	06037	34.16480359	-118.8299997	Ventura County
251580	Fee-for-Service	1265024707	1265024707	1	1	ATHELLA HOME HEALTH INC	2/21/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	27200 TOURNEY RD	STE 102	VALENCIA	CA	91355	4910	19	06037	34.41656755	-118.5763161	Los Angeles County
251589	Fee-for-Service	1598316606	1598316606	1	1	ATLANTIC CARE HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	12444 VICTORY BLVD	STE 303	NORTH HOLLYWOOD	CA	91606	3199	19	06037	34.18663951	-118.4043555	Los Angeles County
251591	Fee-for-Service	1699779231	1699779231	1	1	AHN, HONG GOO MD	2/28/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	33170	41	Internal Medicine	0	In state provider	None	17507 CRENSHAW BLVD	None	TORRANCE	CA	90504	3403	19	06037	33.871635	-118.326516	Los Angeles County
251612	Fee-for-Service	1407285927	1407285927	1	1	ALTRUISTIC HOSPICE, INC	11/17/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	17050 CHATSWORTH ST	SUITE 251	GRANADA HILLS	CA	91344	7815	19	06037	34.26477251	-118.5039945	Los Angeles County
251667	Fee-for-Service	1104982842	1104982842	1	1	ANDERS, ALPHA J MD INC	9/10/2007	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	2828 H ST	STE D	BAKERSFIELD	CA	93301	1900	15	06029	35.38544945	-119.0211132	Kern County
251682	Fee-for-Service	1346305422	1346305422	1	2	ASKARINAM, ALBERT MD	8/30/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	62932	-	NOT APPLICABLE	0	In state provider	None	8330 RESEDA BLVD	None	NORTHRIDGE	CA	91324	4619	19	06037	34.221609	-118.5360405	Los Angeles County
251687	Fee-for-Service	1366630840	1366630840	1	1	ARNOLD G ROXAS DPM INC	12/15/2009	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1000 E DOMINGUEZ ST	STE 110	CARSON	CA	90746	3600	19	06037	33.8404157	-118.2575491	Los Angeles County
251710	Fee-for-Service	1881132843	1881132843	1	1	ANDERSON VALLEY COMMUNITY	6/21/2017	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	SERVICES DISTRICT	14281 HWY 128	None	BOONVILLE	CA	95415	0398	23	06045	39.00696276	-123.3651509	Mendocino County
251746	Fee-for-Service	1023205408	1023205408	1	1	ADKINS, KATE W MD	9/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	115769	01	General Practice	0	In state provider	None	1515 WEST FLORIDA AVENUE	None	HEMET	CA	92543	3817	33	06065	33.74738653	-116.9879535	Riverside County
251755	Fee-for-Service	1689146946	1689146946	1	1	ALIGN SPINE CENTER	5/14/2019	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	25	Physical Medicine and Rehabilitation	0	In state provider	None	2720 N HARBOR BOULEVARD	SUITE 210	FULLERTON	CA	92835	2626	30	06059	33.90126238	-117.9292154	Orange County
251798	Fee-for-Service	1750360665	1750360665	1	1	ARY, BETH A MD	11/29/2021	207VG0400X	NA	Obstetrics & Gynecology	026	PHYSICIANS	40599	None	None	0	In state provider	None	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	42	06083	34.444782	-119.7794675	Santa Barbara County
251814	Fee-for-Service	1679954846	1679954846	1	1	ATKINS, LEAH K LMFT	7/23/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17777 VENTURA BLVD	STE 105	ENCINO	CA	91316	3738	19	06037	34.16286556	-118.5200521	Los Angeles County
251816	Fee-for-Service	1841484037	1841484037	1	1	ABBASI, FAHIM A MD	8/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	56080	41	Internal Medicine	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
251827	Fee-for-Service	1518390483	1518390483	1	1	ALMOND HOME II INC	6/13/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2551 GUMDROP DRIVE	None	SAN JOSE	CA	95148	2019	43	06085	37.33406895	-121.79756	Santa Clara County
251854	Fee-for-Service	1801424114	1801424114	1	1	AL-HILLI, YASIR MD	8/21/2023	207R00000X	NA	Other	026	PHYSICIANS	186693	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
251878	Fee-for-Service	1598316606	1598316606	1	1	ATLANTIC CARE HOSPICE INC	6/28/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	12444 VICTORY BLVD	STE 303	NORTH HOLLYWOOD	CA	91606	3199	19	06037	34.18663951	-118.4043555	Los Angeles County
251891	Fee-for-Service	1407285927	1407285927	1	1	ALTRUISTIC HOSPICE, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	17050 CHATSWORTH ST	SUITE 251	GRANADA HILLS	CA	91344	7815	19	06037	34.26477251	-118.5039945	Los Angeles County
251906	Fee-for-Service	1629748348	1629748348	1	1	ALL STAR TRANSPORTATION GROU	9/26/2022	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	13406 DONNER PASS RD	SUITE E	TRUCKEE	CA	96161	3822	29	06057	39.32819288	-120.2461775	Nevada County
251935	Fee-for-Service	1275980666	1275980666	1	1	ALSAIGH, TOM MD	7/27/2020	207R00000X	NA	Other	026	PHYSICIANS	152820	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
251956	Fee-for-Service	1104982842	1104982842	1	1	ANDERS, ALPHA J MD INC	9/10/2007	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2828 H ST	STE D	BAKERSFIELD	CA	93301	1900	15	06029	35.38544945	-119.0211132	Kern County
251959	Fee-for-Service	1609249994	1609249994	1	2	AXIS COMMUNITY HEALTH INC	1/8/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	7212 REGIONAL STREET	None	DUBLIN	CA	94568	2326	01	06001	37.70506367	-121.9345728	Alameda County
251992	Fee-for-Service	1902084148	1902084148	1	1	AYVAZYAN, SERGEY MD	6/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109680	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2776 PACIFIC AVE	None	LONG BEACH	CA	90806	2613	19	06037	33.80692698	-118.1936915	Los Angeles County
252025	Fee-for-Service	1174556849	1174556849	1	1	AMBARTSUMYAN, GAYANE MD	12/22/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	81410	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 MED PLAZA STE 430	None	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
252043	Fee-for-Service	1689146946	1689146946	1	1	ALIGN SPINE CENTER	5/14/2019	207X00000X	NA	Orthopedic Surgery	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	2720 N HARBOR BOULEVARD	SUITE 210	FULLERTON	CA	92835	2626	30	06059	33.90126238	-117.9292154	Orange County
252086	Fee-for-Service	1609292770	1609292770	1	1	AFKHAMI, HASTI LMFT	8/3/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	93301	-	NOT APPLICABLE	0	In state provider	None	18646 OXNARD STREET	None	TARZANA	CA	91356	1411	19	06037	34.17993229	-118.5397265	Los Angeles County
252094	Fee-for-Service	1700043775	1700043775	1	1	ALFRED, TRISTIN D LCSW	2/22/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
252100	Fee-for-Service	1497785034	1497785034	1	1	ADAMS, SAMUEL E MD	10/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92958	41	Internal Medicine	0	In state provider	None	3555 CESAR CHAVEZ	None	SAN FRANCISCO	CA	94110	4403	38	06075	37.74802705	-122.4207367	San Francisco County
252102	Fee-for-Service	1598355299	1598355299	1	1	ATAL, MARTIN FLORENTINE MD	6/3/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	185099	08	Family Practice	0	In state provider	None	555 TACHEVAH DR	SUITE 2E-107	PALM SPRINGS	CA	92262	5752	33	06065	33.83753681	-116.5424435	Riverside County
252122	Fee-for-Service	1518137736	1518137736	1	1	A&A CHINO HILLS MEDICAL	9/17/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	SUPPLIES INC	12345 MOUNTAIN AVE	#X	CHINO	CA	91710	2783	36	06071	34.02882	-117.667613	San Bernardino County
252143	Fee-for-Service	1679770770	1679770770	1	1	ANDREW M. ZBOJNIEWICZ, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 BURNET AVE	None	CINCINNATI	OH	45229	3026	00	None	39.14105892	-84.50040782	Hamilton County
252157	Fee-for-Service	1417253956	1417253956	1	1	ANDALEEB RAJA	7/23/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	234 E 149TH ST	None	BRONX	NY	10451	5504	00	None	40.817538	-73.9240965	Bronx County
252162	Fee-for-Service	1346305422	1346305422	1	1	ASKARINAM, ALBERT MD	10/10/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	62932	08	Family Practice	0	In state provider	None	6045 VINELAND AVENUE	None	NORTH HOLLYWOOD	CA	91606	4911	19	06037	34.180677	-118.370326	Los Angeles County
252192	Fee-for-Service	1790998177	1790998177	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	940 NORTH TUSTIN ST	None	ORANGE	CA	92867	5956	30	06059	33.803298	-117.837702	Orange County
252194	Fee-for-Service	1457361982	1457361982	1	1	APRIA HEALTHCARE LLC	10/26/1998	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1201 SOUTH HOPE ST	None	EL CENTRO	CA	92243	3465	13	06025	32.78198888	-115.5395744	Imperial County
252208	Fee-for-Service	1861178105	1861178105	1	1	A BTR SLTN IN HME CRE, INC	10/10/2024	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	8929 COMPLEX DR	FLOOR 2	SAN DIEGO	CA	92123	1454	37	06073	32.82996636	-117.1337181	San Diego County
252211	Fee-for-Service	1952628273	1952628273	1	1	ARANEZ, JOSE T MD INC	6/8/2010	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	51587	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2701 W ALAMEDA AVE	STE 407	BURBANK	CA	91505	4409	19	06037	34.15751343	-118.3303715	Los Angeles County
252236	Fee-for-Service	1245865682	1245865682	1	1	ASBW LLC	10/1/2019	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1623 ARIZONA AVENUE	None	SANTA MONICA	CA	90404	1209	19	06037	34.02753708	-118.4847249	Los Angeles County
252247	Fee-for-Service	1104982842	1104982842	1	1	ANDERS, ALPHA J MD INC	9/10/2007	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2828 H ST	STE D	BAKERSFIELD	CA	93301	1900	15	06029	35.38544945	-119.0211132	Kern County
252248	Fee-for-Service	1609249994	1609249994	1	2	AXIS COMMUNITY HEALTH INC	1/8/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	7212 REGIONAL STREET	None	DUBLIN	CA	94568	2326	01	06001	37.70506367	-121.9345728	Alameda County
252293	Fee-for-Service	1033174719	1033174719	1	1	ARIBINDI, SHANTHI MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140551	05	Anesthesiology	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
252294	Fee-for-Service	1164580692	1164580692	1	1	AKRAM, MUMTAZ MD	9/30/1981	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	34950	10	Gastroenterology (M.D. only)	0	In state provider	None	906 S SUNSET AVE	STE 104	WEST COVINA	CA	91790	3400	19	06037	34.06466364	-117.9424724	Los Angeles County
252326	Fee-for-Service	1568721843	1568721843	1	1	ABDELSAYED, GEORGE A MD	6/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	124694	34	Urology and Urological Surgery	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
252413	Fee-for-Service	1679832091	1679832091	1	1	AJEENA, ZAINAB MD	8/2/2017	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	148146	40	Pediatrics	0	In state provider	None	3441 MARYSVILLE BLVD	None	SACRAMENTO	CA	95838	4512	34	06067	38.631231	-121.431402	Sacramento County
252418	Fee-for-Service	1811927395	1811927395	1	1	AZZAM, AMIN N MD	9/23/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	73151	36	Psychiatry	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
252483	Fee-for-Service	1306021613	1306021613	1	1	AUSTIN, ADINA G LMFT	8/1/2022	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
252491	Fee-for-Service	1851498810	1851498810	1	1	ANDERSON,ERIC MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1101 26TH AVE S	None	GREAT FALLS	MT	59405	0000	00	None	47.49266292	-111.2625379	Cascade County
252546	Fee-for-Service	1184088940	1184088940	1	1	AHMAD, SARAH R MD	6/19/2019	2084N0400X	NA	Neurology	026	PHYSICIANS	146420	13	Neurology (M.D. only)	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
252553	Fee-for-Service	1033621396	1033621396	1	1	ANGUIANO AVILA, MARITZA LCS	10/11/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	W	765 N MAIN ST	127	CORONA	CA	92880	1440	33	06065	33.892072	-117.5636837	Riverside County
252571	Fee-for-Service	1477586808	1477586808	1	1	AMPLA HEALTH	10/1/1995	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	555 FREMONT ST	None	COLUSA	CA	95932	2534	06	06011	39.20789526	-122.0111935	Colusa County
252585	Fee-for-Service	1649264292	1649264292	1	1	AG ARCADIA LLC	10/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HEALTHCARE CENTER	400 W HUNTINGTON DR	None	ARCADIA	CA	91007	3470	19	06037	34.13118208	-118.0459995	Los Angeles County
252586	Fee-for-Service	1669470753	1669470753	1	1	AISEN, PAUL S MD	9/12/2008	207RG0300X	NA	Adult Primary Care	026	PHYSICIANS	88220	38	Geriatrics	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
252598	Fee-for-Service	1942220272	1942220272	1	1	AGUIRRE, FRANCISCO MD	5/13/2009	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	70313	40	Pediatrics	0	In state provider	None	7600 HOSPITAL DRIVE	STE I	SACRAMENTO	CA	95823	5406	34	06067	38.463876	-121.414698	Sacramento County
252615	Fee-for-Service	1750559431	1750559431	1	12	ALL STAR PHYSICAL THERAPY, I	3/26/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	27699 JEFFERSON AVENUE	SUITE 202	TEMECULA	CA	92590	0000	33	06065	33.51449799	-117.1593524	Riverside County
252631	Fee-for-Service	1700855491	1700855491	1	1	ANDREW J HAPUTA M.D.	9/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	16122 8TH AVE SW	STE D1	BURIEN	WA	98166	2967	00	None	47.45862063	-122.3445726	King County
252637	Fee-for-Service	1215470042	1215470042	1	1	ACCELERATED HEALTH HOME CARE	2/7/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	6350 LAUREL CANYON BLVD	STE 208	NORTH HOLLYWOOD	CA	91606	3200	19	06037	34.18640491	-118.3964824	Los Angeles County
252640	Fee-for-Service	1245794866	1245794866	1	1	ALLERGY AND ASTHMA SPECIALIS	7/27/2023	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	T DOCTORS, INC.	94 N MADISON AVE	None	PASADENA	CA	91101	1740	19	06037	34.14768278	-118.1383874	Los Angeles County
252651	Fee-for-Service	1831726181	1831726181	1	1	AJMERA, RISHABH P DO	6/28/2023	207P00000X	NA	Other	026	PHYSICIANS	20732	None	None	0	In state provider	None	225 N JACKSON AVE	EMERGENCY DEPARTMENT	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
252687	Fee-for-Service	1942419502	1942419502	1	1	ARNOLD, JENNIFER K MD	2/11/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	86514	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
252695	Fee-for-Service	1871511337	1871511337	1	1	ALDWINCKLE, ROBIN MD	11/7/2007	207L00000X	NA	Other	026	PHYSICIANS	112027	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
252790	Fee-for-Service	1497371488	1497371488	1	1	ABERGEL, PAZ	11/5/2024	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
252832	Fee-for-Service	1477015329	1477015329	1	1	ABBOTT, ROBERT DO	12/23/2022	207R00000X	NA	Other	026	PHYSICIANS	20266	None	None	0	In state provider	None	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	04	06007	39.506454	-121.5412785	Butte County
252834	Fee-for-Service	1841058120	1841058120	1	1	ADVENTIST HEALTH PHYSICIANS	10/9/2024	207T00000X	NA	General Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	6955 EL CAMINO REAL	101	ATASCADERO	CA	93422	4216	40	06079	35.48656009	-120.6652493	San Luis Obispo County
252837	Fee-for-Service	1497846588	1497846588	1	1	ARIAGNO, RONALD L MD	1/1/1982	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	20533	40	Pediatrics	0	In state provider	None	300 PASTEUR DR	None	PALO ALTO	CA	94304	2203	43	06085	37.43304542	-122.1759654	Santa Clara County
252857	Fee-for-Service	1477586808	1477586808	1	1	AMPLA HEALTH	3/25/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	555 FREMONT ST	None	COLUSA	CA	95932	2534	06	06011	39.20789526	-122.0111935	Colusa County
252863	Fee-for-Service	1568004083	1568004083	2	1	AHAVA PHARMACY INC	7/5/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	8835 W PICO BLVD	None	LOS ANGELES	CA	90035	3301	19	06037	34.05497252	-118.384637	Los Angeles County
252865	Fee-for-Service	1134271943	1134271943	1	1	ALDAVA, JOHN F IV PHD	9/4/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	710 S BROADWAY STREET	None	WALNUT CREEK	CA	94596	5294	07	06013	37.89702115	-122.0569066	Contra Costa County
252869	Fee-for-Service	1841856523	1841856523	1	1	ACADEMIC SURGICAL ASSOCIATES	6/15/2020	2086X0206X	NA	General Surgery	022	PHYSICIANS GROUP	-	04	Otology, Laryngology, Rhinology	0	In state provider	INC.	1505 WILSON TER	150	GLENDALE	CA	91206	4076	19	06037	34.14960934	-118.2313491	Los Angeles County
252883	Fee-for-Service	1255102372	1255102372	1	1	AMADOR, RAYLENE M LMFT	1/24/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
252895	Fee-for-Service	1568635704	1568635704	1	1	ADKINS, AMANDA C MD	4/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	129140	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
252903	Fee-for-Service	1750559431	1750559431	1	12	ALL STAR PHYSICAL THERAPY, I	4/30/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	27699 JEFFERSON AVENUE	SUITE 202	TEMECULA	CA	92590	0000	33	06065	33.51449799	-117.1593524	Riverside County
252953	Fee-for-Service	1588787253	1588787253	1	1	ALAMDAR, LADAN LMFT	9/17/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVENUE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
253002	Fee-for-Service	1063474120	1063474120	1	1	ADKINS, CARL E. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5323 HARRY HINES BLVD	None	DALLAS	TX	75390	7201	00	None	32.812245	-96.841584	Dallas County
253018	Fee-for-Service	1467867762	1467867762	1	1	AZUBUIKE, AKACHI C MD	8/19/2020	207P00000X	NA	Other	026	PHYSICIANS	168407	None	None	0	In state provider	None	5000 SAN BERNARDINO ST	None	MONTCLAIR	CA	91763	2326	36	06071	34.07768647	-117.6957498	San Bernardino County
253029	Fee-for-Service	1649276916	1649276916	3	1	ADLER, MITCHELL A MD	3/8/2023	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	72287	09	Gynecology (D.O. only)	0	In state provider	None	116 S PALISADE DR	STE 103	SANTA MARIA	CA	93454	8904	42	06083	34.9523869	-120.4120717	Santa Barbara County
253118	Fee-for-Service	1134398043	1134398043	1	1	ALTAMED HEALTH SERVICES CORP	2/13/2008	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CLINICA MEDICAL DE ELLA	2223 W 1ST ST	None	SANTA ANA	CA	92703	3505	30	06059	33.7453773	-117.8990221	Orange County
253147	Fee-for-Service	1477586808	1477586808	1	1	AMPLA HEALTH	3/1/1998	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	555 FREMONT ST	None	COLUSA	CA	95932	2534	06	06011	39.20789526	-122.0111935	Colusa County
253151	Fee-for-Service	1083725600	1083725600	1	1	AAMCARE ELECTROPEDIC	11/30/1998	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	KRAUS, LLOYD	907 N HOLLYWOOD WAY	None	BURBANK	CA	91505	2816	19	06037	34.16645012	-118.3463369	Los Angeles County
253156	Fee-for-Service	1992102420	1992102420	1	1	AKOLO, REBECCA M DPM	4/16/2018	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	1755 W HAMMER LN	STE 7B	STOCKTON	CA	95209	2900	39	06077	38.02145403	-121.3355659	San Joaquin County
253157	Fee-for-Service	1558306266	1558306266	2	4	AMG, A PROFESSIONAL MEDICAL	12/3/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	None	11236 WHITTIER BLVD	None	WHITTIER	CA	90606	1436	19	06037	33.98566533	-118.0578598	Los Angeles County
253193	Fee-for-Service	1750559431	1750559431	1	12	ALL STAR PHYSICAL THERAPY, I	3/26/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	27699 JEFFERSON AVENUE	SUITE 202	TEMECULA	CA	92590	0000	33	06065	33.51449799	-117.1593524	Riverside County
253219	Fee-for-Service	1851810816	1851810816	1	1	ALVAREZ, MITCHELL N LMFT	6/6/2023	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1041 E YORBA LINDA BLVD	202	PLACENTIA	CA	92870	3760	30	06059	33.88848865	-117.8451029	Orange County
253246	Fee-for-Service	1598078784	1598078784	1	1	ABOU-ISMAIL, ANAS MD	5/17/2019	207RN0300X	NA	Nephrology	026	PHYSICIANS	162151	45	Nephrology (Renal-Kidney)	0	In state provider	None	1100 N PALM CANYON DR	STE 211	PALM SPRINGS	CA	92262	4426	33	06065	33.838182	-116.546744	Riverside County
253254	Fee-for-Service	1114538402	1114538402	1	1	ALBERT, JACQUELINE N OD	8/17/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1721 WESTWIND DR	STE B	BAKERSFIELD	CA	93301	3026	15	06029	35.37519935	-119.0425415	Kern County
253267	Fee-for-Service	1184959611	1184959611	1	1	ALLEN, JENNIFER D LCSW	11/21/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	NG	4000 LONG BEACH BLVD	STE 252	LONG BEACH	CA	90807	2617	19	06037	33.830928	-118.189321	Los Angeles County
253287	Fee-for-Service	1871068866	1871068866	1	1	AVETISYAN, HAYA LMFT	9/18/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	230 N. MARYLAND AVE	303	GLENDALE	CA	91206	4281	19	06037	34.149357	-118.2537315	Los Angeles County
253312	Fee-for-Service	1013211580	1013211580	1	1	AHMAD, NADER A MD INC	6/9/2011	193400000X	NA	Other	026	PHYSICIANS	109192	08	Family Practice	0	In state provider	None	4318 SOUTH ST	None	LAKEWOOD	CA	90712	1152	19	06037	33.86005412	-118.1410168	Los Angeles County
253317	Fee-for-Service	1649276916	1649276916	3	1	ADLER, MITCHELL A MD	3/8/2023	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	72287	15	Obstetrics (D.O. only)	0	In state provider	None	116 S PALISADE DR	STE 103	SANTA MARIA	CA	93454	8904	42	06083	34.9523869	-120.4120717	Santa Barbara County
253361	Fee-for-Service	1033720131	1033720131	1	1	ALLEN, GWEN M LMFT	6/14/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
253363	Fee-for-Service	1306085493	1306085493	1	1	ANDERSON, GABRIELLE E PHD	8/30/2021	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
253395	Fee-for-Service	1063022812	1063022812	1	1	ALL GENTLE HOSPICE, INC	12/8/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	159 E LIVE OAK AVE	SUITE 202	ARCADIA	CA	91006	5252	19	06037	34.1082455	-118.0251857	Los Angeles County
253435	Fee-for-Service	1477586808	1477586808	1	1	AMPLA HEALTH	10/1/1995	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	555 FREMONT ST	None	COLUSA	CA	95932	2534	06	06011	39.20789526	-122.0111935	Colusa County
253443	Fee-for-Service	1558306266	1558306266	2	4	AMG, A PROFESSIONAL MEDICAL	12/3/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	11236 WHITTIER BLVD	None	WHITTIER	CA	90606	1436	19	06037	33.98566533	-118.0578598	Los Angeles County
253521	Fee-for-Service	1578685137	1578685137	1	1	AGRICULTURAL WORKERS	3/1/1997	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	HLTH CTRS/DIXON FAMILY	131 W A ST	STE 1	DIXON	CA	95620	3437	48	06095	38.4455395	-121.823283	Solano County
253558	Fee-for-Service	1861955460	1861955460	1	1	ADVENTIST HEALTH PHYSICIANS	12/7/2020	207RG0100X	NA	Gastroenterology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	2407 W VINE ST	None	LODI	CA	95242	3730	39	06077	38.12285348	-121.3044345	San Joaquin County
253565	Fee-for-Service	1295923035	1295923035	1	1	ANDERSON, ALBERT MD PC	12/14/2018	193400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	81767 DR CARREON BLVD	STE 102	INDIO	CA	92201	5598	33	06065	33.70738112	-116.237755	Riverside County
253646	Fee-for-Service	1942696406	1942696406	1	1	ARSHAD, MOHAMMAD A MD	9/20/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	151107	08	Family Practice	0	In state provider	None	10305 PROMENADE PKWY	None	ELK GROVE	CA	95757	9400	34	06067	38.384523	-121.371318	Sacramento County
253670	Fee-for-Service	1528440351	1528440351	1	1	ADVANCE SPECIALTY CARE NORTH	2/25/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	17315 STUDEBAKER RD	SUITE 211	CERRITOS	CA	90708	2508	19	06037	33.87330903	-118.0998456	Los Angeles County
253686	Fee-for-Service	1063022812	1063022812	1	1	ALL GENTLE HOSPICE, INC	12/8/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	159 E LIVE OAK AVE	SUITE 202	ARCADIA	CA	91006	5252	19	06037	34.1082455	-118.0251857	Los Angeles County
253709	Fee-for-Service	1265513121	1265513121	1	1	AHMED, SIRAJ K	9/17/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	138466	None	None	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
253722	Fee-for-Service	1730130287	1730130287	1	1	AMIR, ROY D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	81051	66	Emergency Medicine (Urgent Care)	0	In state provider	None	3252 HOLIDAY CT	STE 206	LA JOLLA	CA	92037	1808	37	06073	32.8705156	-117.2323734	San Diego County
253731	Fee-for-Service	1558306266	1558306266	2	4	AMG, A PROFESSIONAL MEDICAL	12/3/2024	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	11236 WHITTIER BLVD	None	WHITTIER	CA	90606	1436	19	06037	33.98566533	-118.0578598	Los Angeles County
253767	Fee-for-Service	1003549601	1003549601	1	1	ALMEIDA, ROSEMARY	5/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6203 SAN IGNACIO AVENUE	SUITE 110	SAN JOSE	CA	95119	1325	43	06085	37.23598537	-121.7783065	Santa Clara County
253768	Fee-for-Service	1881274900	1881274900	1	1	AZEVEDO, CHELSEA MD	4/2/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
253814	Fee-for-Service	1699288993	1699288993	1	3	ADVANCE NURSING PRACTICE MED	11/2/2022	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ICAL GROUP	321 TURNER	None	LODI	CA	95240	0517	39	06077	38.14571389	-121.2776835	San Joaquin County
253831	Fee-for-Service	1528412376	1528412376	1	1	ARD, MARK D MD	12/3/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	150501	36	Psychiatry	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
253842	Fee-for-Service	1902317290	1902317290	1	2	A1 TRANSPORTATION INC	10/21/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	5405 STOCKDALE HWY	110	BAKERSFIELD	CA	93309	2561	15	06029	35.35415166	-119.0620737	Kern County
253852	Fee-for-Service	1295923035	1295923035	1	1	ANDERSON, ALBERT MD PC	12/14/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	81767 DR CARREON BLVD	STE 102	INDIO	CA	92201	5598	33	06065	33.70738112	-116.237755	Riverside County
253900	Fee-for-Service	1972560381	1972560381	1	1	ALLERGY SPECIALISTS	1/1/1979	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	MEDICAL GROUP INC	2182 EAST ST	None	CONCORD	CA	94520	2012	07	06013	37.98065523	-122.0324655	Contra Costa County
253933	Fee-for-Service	1811317001	1811317001	1	1	ALDALUR, MAYDOLE L NP	6/22/2022	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
253938	Fee-for-Service	1730119553	1730119553	1	5	AFFILIATED PATHOLOGISTS MEDI	10/5/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	3700 SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.86019848	-118.148166	Los Angeles County
253949	Fee-for-Service	1275988339	1275988339	1	1	ARSHAD, NISA MD	11/5/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	3700 E SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.8601747	-118.148313	Los Angeles County
253964	Fee-for-Service	1760787188	1760787188	2	1	ASSURANCE MEDICAL SUPPLY INC	8/24/2020	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	10574 ACACIA ST	SUITE D1	RANCHO CUCAMONGA	CA	91730	5448	36	06071	34.0900135	-117.5741685	San Bernardino County
253968	Fee-for-Service	1649777061	1649777061	1	1	ANDERSON, JILL A NP	12/24/2020	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
253971	Fee-for-Service	1871107466	1871107466	1	1	ANGEL'S GUIDE HOSPICE INC	4/21/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	655 N CENTRAL AVE	STE 1706	GLENDALE	CA	91203	1422	19	06037	34.15562424	-118.2579732	Los Angeles County
254012	Fee-for-Service	1730130287	1730130287	1	1	AMIR, ROY D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	81051	84	Surgery-Head and Neck	0	In state provider	None	3252 HOLIDAY CT	STE 206	LA JOLLA	CA	92037	1808	37	06073	32.8705156	-117.2323734	San Diego County
254023	Fee-for-Service	1740288901	1740288901	1	1	ASHLEY, PHOEBE A MD	8/2/2022	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	180793	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
254094	Fee-for-Service	1801230248	1801230248	1	1	ALBASSAM, HASSAN MD	1/30/2023	208M00000X	NA	Other	026	PHYSICIANS	176277	None	None	0	In state provider	None	726 4TH ST	None	MARYSVILLE	CA	95901	5656	58	06115	39.13872267	-121.5944372	Yuba County
254103	Fee-for-Service	1699288993	1699288993	1	3	ADVANCE NURSING PRACTICE MED	11/10/2020	193400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ICAL GROUP	321 TURNER	None	LODI	CA	95240	0517	39	06077	38.14571389	-121.2776835	San Joaquin County
254108	Fee-for-Service	1366720278	1366720278	1	1	ADVANCED SLEEP MEDICINE SRVS	7/3/2018	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	949 CALHOUN PL	SUITE G	HEMET	CA	92543	4403	33	06065	33.7502744	-116.9618423	Riverside County
254111	Fee-for-Service	1609042472	1609042472	1	1	AUSTIN, ANNEMIEKE M MD	2/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	110627	08	Family Practice	0	In state provider	None	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	49	06097	38.471625	-122.7259935	Sonoma County
254118	Fee-for-Service	1740415470	1740415470	1	1	AGGARWAL, SARIKA MD	6/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156159	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
254158	Fee-for-Service	1003183179	1003183179	1	1	AHMED, SAMIRA Y MD	3/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	116192	41	Internal Medicine	0	In state provider	None	2238 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3416	38	06075	37.78324881	-122.4405738	San Francisco County
254182	Fee-for-Service	1871785014	1871785014	1	1	ASTHANA, ANUNAI R MD	2/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	101429	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
254188	Fee-for-Service	1245610963	1245610963	1	1	AVRAM E ADELMAN	1/6/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3260 HOSPITAL DR	None	JUNEAU	AK	99801	7808	00	None	58.32940561	-134.4658793	City and Borough of Juneau
254189	Fee-for-Service	1972560381	1972560381	1	1	ALLERGY SPECIALISTS	1/1/1979	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	MEDICAL GROUP INC	2182 EAST ST	None	CONCORD	CA	94520	2012	07	06013	37.98065523	-122.0324655	Contra Costa County
254197	Fee-for-Service	1558310896	1558310896	1	1	ASBILL, MARK C MD	3/1/1984	No Taxonomy Provided	NA	None	026	PHYSICIANS	45153	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
254205	Fee-for-Service	1679580765	1679580765	1	1	AFRIYIE, VICTORIA	11/7/2006	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	FOUR POINTS MED EQ & SUP	3756 SANTA ROSALIA DR	STE 225	LOS ANGELES	CA	90008	3616	19	06037	34.00888336	-118.3389334	Los Angeles County
254215	Fee-for-Service	1952711467	1952711467	1	1	ARBOR HOSPICE INC	10/22/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1250 E WALNUT ST	STE 240	PASADENA	CA	91106	5123	19	06037	34.14956033	-118.1246509	Los Angeles County
254238	Fee-for-Service	1275988339	1275988339	1	1	ARSHAD, NISA MD	11/5/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	3700 E SOUTH ST	None	LAKEWOOD	CA	90712	1419	19	06037	33.8601747	-118.148313	Los Angeles County
254257	Fee-for-Service	1871107466	1871107466	1	1	ANGEL'S GUIDE HOSPICE INC	4/21/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	655 N CENTRAL AVE	STE 1706	GLENDALE	CA	91203	1422	19	06037	34.15562424	-118.2579732	Los Angeles County
254259	Fee-for-Service	1063656122	1063656122	1	1	ARRIOLA, MAUREEN M C NP	6/19/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
254278	Fee-for-Service	1366641961	1366641961	1	1	ARIZMENDI, MARIA J MD	7/27/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	108074	None	None	0	In state provider	None	3291 LOMA VISTA ROAD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
254322	Fee-for-Service	1619545431	1619545431	1	1	ALCINDOR, CHRISTINA	6/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	740 W. 190TH ST	SUITE A	GARDENA	CA	90248	4235	19	06037	33.86022767	-118.2873851	Los Angeles County
254366	Fee-for-Service	1578651105	1578651105	1	1	APFEL, CHRISTIAN C MD	2/15/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
254374	Fee-for-Service	1154573616	1154573616	1	1	ADVANCED SLEEP MEDICINE SRVS	2/14/2011	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	INC	23961 CALLE DE LA MAGDAL	# 519	LAGUNA HILLS	CA	92653	3616	30	06059	33.60999658	-117.7126577	Orange County
254380	Fee-for-Service	1902927353	1902927353	1	1	ABU DAYYEH, BARHAM K MD	11/22/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
254407	Fee-for-Service	1740415470	1740415470	1	1	AGGARWAL, SARIKA MD	6/15/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156159	10	Gastroenterology (M.D. only)	0	In state provider	None	725 WELCH ROAD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
254415	Fee-for-Service	1528390069	1528390069	1	1	ASARE, JULIANA OBENG	1/20/2010	164X00000X	NA	Other	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	2055 NORTH CENTRAL AVE	BLDG 13H	HIGHLAND	CA	92346	2478	36	06071	34.133346	-117.217511	San Bernardino County
254471	Fee-for-Service	1912666827	1912666827	1	1	ALIDAD ZADEH DO, INC.	12/28/2022	2084B0040X	NA	Neurology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1600 S IMPERIAL AVE	STE 5	EL CENTRO	CA	92243	4242	13	06025	32.77882919	-115.5697116	Imperial County
254477	Fee-for-Service	1144593807	1144593807	1	1	ADVANI, MONISHA D LMFT	2/20/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
254490	Fee-for-Service	1821292368	1821292368	1	1	AGAHI, MASSOUD H MD INC	4/15/2008	2086S0129X	NA	General Surgery	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	8635 W 3RD STREET	SUITE 865-W	LOS ANGELES	CA	90048	6101	19	06037	34.07361928	-118.3803143	Los Angeles County
254500	Fee-for-Service	1952711467	1952711467	1	1	ARBOR HOSPICE INC	10/22/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1250 E WALNUT ST	STE 240	PASADENA	CA	91106	5123	19	06037	34.14956033	-118.1246509	Los Angeles County
254515	Fee-for-Service	1437615879	1437615879	1	1	ALLEN, EVERETT D MD	2/28/2019	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	54881	-	NOT APPLICABLE	0	In state provider	None	2413 2ND STREET	None	EUREKA	CA	95501	0811	12	06023	40.80634452	-124.1456445	Humboldt County
254532	Fee-for-Service	1326454158	1326454158	1	1	ASSAREH, SHAYA OD	6/23/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
254537	Fee-for-Service	1609071877	1609071877	1	1	ANNA LAWRENCE M.D.	1/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6001 E WOODMEN RD	RM 3111	COLORADO SPGS	CO	80923	2601	00	None	38.938365	-104.7168315	El Paso County
254630	Fee-for-Service	1245295666	1245295666	1	1	ADATIA, NAVIN H MD	10/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36988	36	Psychiatry	0	In state provider	None	4519 ROSEMEAD BLVD	None	ROSEMEAD	CA	91770	1476	19	06037	34.08794122	-118.0734653	Los Angeles County
254682	Fee-for-Service	1841731080	1841731080	1	1	ALIPOUR, OMEED MD	7/2/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	157508	10	Gastroenterology (M.D. only)	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
254685	Fee-for-Service	1457513012	1457513012	1	1	AVRAMIS, IOANNIS A MD	8/1/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	104320	20	Orthopedic Surgery	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
254709	Fee-for-Service	1033310925	1033310925	1	1	ALBARAN, LORETO G CRNA	12/27/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
254711	Fee-for-Service	1558962829	1558962829	1	1	ASTRAL HOSPICE AND	1/26/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE, INC	19634 VENTURA BLVD	STE 300	TARZANA	CA	91356	2993	19	06037	34.17264197	-118.5613482	Los Angeles County
254723	Fee-for-Service	1407981731	1407981731	1	1	ALI, MOHAMED S MD INC	8/1/2000	193400000X	NA	Other	026	PHYSICIANS	67534	41	Internal Medicine	0	In state provider	None	1183 E FOOTHILL BLVD	STE 160	UPLAND	CA	91786	4920	36	06071	34.10724648	-117.6359175	San Bernardino County
254749	Fee-for-Service	1063543148	1063543148	1	1	ALAMEDA CITY USD	2/13/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	None	2200 CENTRAL AVE	None	ALAMEDA	CA	94501	4411	01	06001	37.76541212	-122.2456395	Alameda County
254757	Fee-for-Service	1588839997	1588839997	1	1	AHEAR, AARON J MD	5/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	103008	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
254758	Fee-for-Service	1912666827	1912666827	1	1	ALIDAD ZADEH DO, INC.	12/28/2022	2084B0040X	NA	Neurology	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1600 S IMPERIAL AVE	STE 5	EL CENTRO	CA	92243	4242	13	06025	32.77882919	-115.5697116	Imperial County
254771	Fee-for-Service	1912476326	1912476326	1	1	A R SUZUKI, MD A PROFESSIONA	1/28/2025	2084B0040X	NA	Neurology	022	PHYSICIANS GROUP	-	36	Psychiatry	0	In state provider	None	1 JENNER	STE 210	IRVINE	CA	92618	3844	30	06059	33.65511338	-117.766776	Orange County
254804	Fee-for-Service	1487866216	1487866216	1	1	AHMAD, AZIZ MD	8/12/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	91679	02	General Surgery	0	In state provider	None	1328 22ND ST	FL 3	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
254860	Fee-for-Service	1548802499	1548802499	1	1	ASHLEY, ERIN E	5/14/2021	176B00000X	NA	Licensed Midwife	082	LICENSED MIDWIVES	-	-	NOT APPLICABLE	0	In state provider	None	134 S. HALCYON	None	ARROYO GRANDE	CA	93420	3116	40	06079	35.117586	-120.5916065	San Luis Obispo County
254898	Fee-for-Service	1790179661	1790179661	1	1	AGRAWAL, ANUBHAV MD	8/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	142749	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	290 N WAYTE LANE	None	FRESNO	CA	93701	2124	10	06019	36.74643429	-119.7837416	Fresno County
254959	Fee-for-Service	1316101298	1316101298	1	1	AZIZI, ROBERT	5/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	115565	None	None	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
254961	Fee-for-Service	1437188323	1437188323	1	1	ABDULLA GHORI, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2500 METROHEALTH DR	None	CLEVELAND	OH	44109	0000	00	None	41.46242416	-81.69888235	Cuyahoga County
254978	Fee-for-Service	1437263571	1437263571	1	1	ANDAL, GALICANO C MD	3/31/1981	207R00000X	NA	Other	026	PHYSICIANS	33888	41	Internal Medicine	0	In state provider	None	2250 GLADSTONE DR	STE 3	PITTSBURG	CA	94565	5124	07	06013	38.00610511	-121.8669076	Contra Costa County
254997	Fee-for-Service	1558962829	1558962829	1	1	ASTRAL HOSPICE AND	1/26/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE CARE, INC	19634 VENTURA BLVD	STE 300	TARZANA	CA	91356	2993	19	06037	34.17264197	-118.5613482	Los Angeles County
255011	Fee-for-Service	1841654944	1841654944	1	1	AGARWAL, SHREYA MD	8/2/2023	2080P0207X	NA	Hematology	026	PHYSICIANS	187770	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
255039	Fee-for-Service	1063543148	1063543148	1	1	ALAMEDA CITY USD	7/10/1997	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	2200 CENTRAL AVE	None	ALAMEDA	CA	94501	4411	01	06001	37.76541212	-122.2456395	Alameda County
255080	Fee-for-Service	1922024942	1922024942	1	1	ARATA, MICHAEL A MD	3/14/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	70967	30	Radiology	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
255124	Fee-for-Service	1902908288	1902908288	1	1	AZIMI, NOOR S MD	8/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87104	28	Proctology (colon and rectal)	0	In state provider	None	1300 S ELISEO DR	STE 203	GREENBRAE	CA	94904	2015	21	06041	37.94447529	-122.53657	Marin County
255171	Fee-for-Service	1912264938	1912264938	1	1	AZIZI, HAFIZULLAH MD	7/11/2024	2084P0800X	NA	Psychiatry	026	PHYSICIANS	139334	36	Psychiatry	0	In state provider	None	3625 E THOUSAND OAKS BLV	SUITE #232	WESTLAKE VILLAGE	CA	91362	6932	19	06037	34.16480359	-118.8299997	Ventura County
255189	Fee-for-Service	1295203669	1295203669	1	1	ASIAN HEALTH SERVICES	1/1/2019	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	101 CALLAN AVENUE	SUITE 105	SAN LEANDRO	CA	94577	4584	01	06001	37.72594042	-122.1562404	Alameda County
255205	Fee-for-Service	1477667426	1477667426	1	1	ACKERMAN, LAURIE L MD	9/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85969	14	Neurological Surgery	0	In state provider	None	455 S MAIN ST	None	ORANGE	CA	92868	3835	30	06059	33.78077578	-117.8673468	Orange County
255233	Fee-for-Service	1558988790	1558988790	1	1	ALI, AMRO MD	6/8/2023	207R00000X	NA	Other	026	PHYSICIANS	184071	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
255282	Fee-for-Service	1356459184	1356459184	1	1	ABU-SHAMSIEH, AIMEE M MD	12/18/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	71428	40	Pediatrics	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
255284	Fee-for-Service	1396203451	1396203451	1	1	ADVENTIST HEALTH PHYSICIANS	7/31/2019	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	111 RALEY BLVD	STE 140	CHICO	CA	95928	8351	04	06007	39.71601447	-121.790817	Butte County
255307	Fee-for-Service	1982784542	1982784542	1	1	ABAD, EDGAR F PT	4/11/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1017 S FAIR OAKS AVE	None	PASADENA	CA	91105	2621	19	06037	34.12830178	-118.1503497	Los Angeles County
255318	Fee-for-Service	1073924346	1073924346	1	1	AUNG, NOENOE M MD	10/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	145385	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
255362	Fee-for-Service	1649546193	1649546193	1	1	ACE OVIL	6/30/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	16601 N 40TH ST	STE 227	PHOENIX	AZ	85032	3345	00	None	33.637356	-111.995514	Maricopa County
255372	Fee-for-Service	1881291375	1881291375	1	1	ADLIFE HOSPICE INC	8/4/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	16468 NORWALK BLVD	None	NORWALK	CA	90703	1929	19	06037	33.88084368	-118.0727048	Los Angeles County
255377	Fee-for-Service	1083722060	1083722060	1	1	ANDERSON, JENNIFER K	6/11/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	925 BROADBECK DR	SUITE 225	NEWBURY PARK	CA	91320	1269	56	06111	34.19122428	-118.9362301	Ventura County
255387	Fee-for-Service	1073691762	1073691762	1	1	ALLEN, JENNIFER R MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75323	08	Family Practice	0	In state provider	None	2809 OLIVE HWY	STE 260	OROVILLE	CA	95966	6134	04	06007	39.50386798	-121.5410203	Butte County
255390	Fee-for-Service	1528278371	1528278371	1	1	ABLE	5/21/1991	320900000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	25 DE ANZA WAY	None	SAN RAFAEL	CA	94903	3868	21	06041	37.99521296	-122.5443943	Marin County
255395	Fee-for-Service	1205186442	1205186442	1	1	ACTION URGENT CARE INC	8/11/2020	261QU0200X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1375 BLOSSOM HILL RD	STE 49	SAN JOSE	CA	95118	3806	43	06085	37.24452522	-121.8887894	Santa Clara County
255398	Fee-for-Service	1508318874	1508318874	1	1	AULAKH, HARDEEP NP	1/18/2021	363LP2300X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2222 EAST STREET	STE 305	CONCORD	CA	94520	2066	07	06013	37.98125538	-122.0329375	Contra Costa County
255414	Fee-for-Service	1902908288	1902908288	1	1	AZIMI, NOOR S MD	8/2/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87104	02	General Surgery	0	In state provider	None	1300 S ELISEO DR	STE 203	GREENBRAE	CA	94904	2015	21	06041	37.94447529	-122.53657	Marin County
255442	Fee-for-Service	1255793204	1255793204	1	1	AUJLA, SATINDER K LMFT	10/30/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7300 WYNDHAM	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
255449	Fee-for-Service	1255670147	1255670147	1	1	AUSTIN, EVE C LMFT	10/24/2019	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2280 BIDWELL	SUITE 214	FOLSOM	CA	95630	3558	34	06067	38.668077	-121.142772	Sacramento County
255453	Fee-for-Service	1770117186	1770117186	1	1	ALELIGNE, YEABSRA K	2/1/2024	207R00000X	NA	Other	026	PHYSICIANS	181515	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
255478	Fee-for-Service	1295203669	1295203669	1	1	ASIAN HEALTH SERVICES	1/1/2019	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	101 CALLAN AVENUE	SUITE 105	SAN LEANDRO	CA	94577	4584	01	06001	37.72594042	-122.1562404	Alameda County
255502	Fee-for-Service	1588778930	1588778930	1	1	ADVANCED FAMILY MEDICAL	12/6/1978	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	30135	40	Pediatrics	0	In state provider	GRP	1771 W ROMNEYA DR	STE B	ANAHEIM	CA	92801	1817	30	06059	33.85067649	-117.9445635	Orange County
255526	Fee-for-Service	1609802552	1609802552	1	1	AFIFI, ALAA Y MD	11/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87135	33	Thoracic Surgery	0	In state provider	None	999 N TUSTIN AVE	STE 103	SANTA ANA	CA	92705	6504	30	06059	33.754167	-117.834191	Orange County
255537	Fee-for-Service	1154573707	1154573707	1	1	ARTINIAN, KYVELE R LMFT	5/23/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6520 LONETREE BLVD	None	ROCKLIN	CA	95765	5397	31	06061	38.80379769	-121.2936494	Placer County
255562	Fee-for-Service	1588682561	1588682561	1	1	AHMED, IMRAN MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	90089	01	General Practice	0	In state provider	None	130 CEDAR RD	None	VISTA	CA	92083	5102	37	06073	33.18682732	-117.2839184	San Diego County
255564	Fee-for-Service	1033264882	1033264882	1	1	ABOU, PAUL Y MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	56122	22	Pathology (M.D. only)	0	In state provider	SAN DIEGO CRITICAL CARE	8851 CENTER DR	STE 305	LA MESA	CA	91942	3048	37	06073	32.78189749	-117.0075062	San Diego County
255622	Fee-for-Service	1235473604	1235473604	1	1	ALL HEART HOME HEALTH CARE	7/13/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	OF CAMARILLO LLC	4000 CALLE TECATE	SUITE 109	CAMARILLO	CA	93012	5284	56	06111	34.22147843	-119.0178246	Ventura County
255665	Fee-for-Service	1881291375	1881291375	1	1	ADLIFE HOSPICE INC	8/4/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	16468 NORWALK BLVD	None	NORWALK	CA	90703	1929	19	06037	33.88084368	-118.0727048	Los Angeles County
255672	Fee-for-Service	1417766437	1417766437	1	1	ABBYSHELPINGHANDS LLC	1/3/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	33	06065	0	0	None
255710	Fee-for-Service	1659767820	1659767820	1	1	ASHLEY MOHADJER	2/23/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1001 TOWSON AVE	None	FORT SMITH	AR	72901	4921	00	None	35.374455	-94.42107	Sebastian County
255751	Fee-for-Service	1598102519	1598102519	1	1	AGUBUZU, OGOEGBUNAM MD	8/8/2018	208100000X	NA	Physical Medicine and Rehabilitation	026	PHYSICIANS	152852	25	Physical Medicine and Rehabilitation	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
255761	Fee-for-Service	1669682175	1669682175	1	1	ARTHUR, ERIN A MD	3/13/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	102526	41	Internal Medicine	0	In state provider	None	306 SPRUCE AVENUE	None	S SAN FRANCISCO	CA	94080	2741	41	06081	37.65669155	-122.4159146	San Mateo County
255787	Fee-for-Service	1013308485	1013308485	1	1	AMBATALI, REX NP	9/9/2019	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
255792	Fee-for-Service	1588778930	1588778930	1	1	ADVANCED FAMILY MEDICAL	12/6/1978	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	30135	01	General Practice	0	In state provider	GRP	1771 W ROMNEYA DR	STE B	ANAHEIM	CA	92801	1817	30	06059	33.85067649	-117.9445635	Orange County
255814	Fee-for-Service	1609802552	1609802552	1	1	AFIFI, ALAA Y MD	11/24/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	87135	02	General Surgery	0	In state provider	None	999 N TUSTIN AVE	STE 103	SANTA ANA	CA	92705	6504	30	06059	33.754167	-117.834191	Orange County
255833	Fee-for-Service	1700405453	1700405453	1	1	AFFINITY HOSPICE CARE INC	3/3/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	26234 INDUSTRIAL BLVD	None	HAYWARD	CA	94545	2922	01	06001	37.63423646	-122.1116616	Alameda County
255841	Fee-for-Service	1932248937	1932248937	1	1	ARIES, RICHARD S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
255851	Fee-for-Service	1033264882	1033264882	1	1	ABOU, PAUL Y MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	56122	66	Emergency Medicine (Urgent Care)	0	In state provider	SAN DIEGO CRITICAL CARE	8851 CENTER DR	STE 305	LA MESA	CA	91942	3048	37	06073	32.78189749	-117.0075062	San Diego County
255866	Fee-for-Service	1144303397	1144303397	2	1	ATEIA, NAZHAT N MD	11/30/1983	No Taxonomy Provided	NA	None	026	PHYSICIANS	40652	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	401 S FAIR OAKS AVE	None	PASADENA	CA	91105	2603	19	06037	34.13887038	-118.1504485	Los Angeles County
255867	Fee-for-Service	1194345975	1194345975	1	1	ASANAD, SAMUEL MD	7/23/2024	207W00000X	NA	Ophthalmology	026	PHYSICIANS	None	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO ST	STE 2505	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
255879	Fee-for-Service	1063005213	1063005213	1	1	ACOSTA-DUQUE, MANNYA S LCSW	4/12/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
255884	Fee-for-Service	1023657509	1023657509	1	1	ALVAREZ, ROBERTO PT	2/16/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1150 MORTON	B	PORTERVILLE	CA	93257	1940	54	06107	36.07332205	-119.0428201	Tulare County
255904	Fee-for-Service	1174781165	1174781165	1	1	AHMED, NATASHA MD	11/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	106365	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
256038	Fee-for-Service	1669096376	1669096376	1	1	ALB HOSPICE CARE INC	4/12/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1274 S WATERMAN AVE	STE 122	SAN BERNARDINO	CA	92408	2826	36	06071	34.078446	-117.2788185	San Bernardino County
256044	Fee-for-Service	1396890943	1396890943	1	1	ANDERSON, WAYNE R MD	12/3/2021	207L00000X	NA	Other	026	PHYSICIANS	64580	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
256072	Fee-for-Service	1801565908	1801565908	1	1	ALTA HOME HEALTH CARE	6/1/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	9140 TRASK AVE	SUITE 202	GARDEN GROVE	CA	92844	2211	30	06059	33.76664447	-117.969903	Orange County
256075	Fee-for-Service	1437438009	1437438009	1	1	ABDI, AMIN A MD	3/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	117660	66	Emergency Medicine (Urgent Care)	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
256078	Fee-for-Service	1558366856	1558366856	1	1	ASAD EHTISHAM	9/22/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	15396 N 83RD AV STE E	None	PEORIA	AZ	85381	5622	00	None	33.62364	-112.2390405	Maricopa County
256119	Fee-for-Service	1700405453	1700405453	1	1	AFFINITY HOSPICE CARE INC	3/3/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	26234 INDUSTRIAL BLVD	None	HAYWARD	CA	94545	2922	01	06001	37.63423646	-122.1116616	Alameda County
256139	Fee-for-Service	1033264882	1033264882	1	1	ABOU, PAUL Y MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	56122	41	Internal Medicine	0	In state provider	SAN DIEGO CRITICAL CARE	8851 CENTER DR	STE 305	LA MESA	CA	91942	3048	37	06073	32.78189749	-117.0075062	San Diego County
256143	Fee-for-Service	1518191949	1518191949	1	1	ARORA, NEVIN S DO	10/7/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	14315	36	Psychiatry	0	In state provider	None	1801 E MARCH LANE	STE C310	STOCKTON	CA	95210	6683	39	06077	38.00315652	-121.2868715	San Joaquin County
256183	Fee-for-Service	1730348053	1730348053	1	1	ABELSON, JONATHAN A MD	8/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105322	30	Radiology	0	In state provider	None	100 CASA STREET	STE C	SAN LUIS OBISPO	CA	93405	8805	40	06079	35.29273885	-120.6647926	San Luis Obispo County
256185	Fee-for-Service	1073871273	1073871273	1	1	AVIA HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	539 N GLENOAKS BLVD	SUITE 206	BURBANK	CA	91502	1417	19	06037	34.18652984	-118.310858	Los Angeles County
256233	Fee-for-Service	1205213204	1205213204	1	1	ALL SAINTSIDENCE OPCO LLC	3/1/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	1652 MONO AVE	None	SAN LEANDRO	CA	94578	2020	01	06001	37.70445656	-122.1197154	Alameda County
256261	Fee-for-Service	1164718334	1164718334	1	1	ALBA, CAYO K CNM	4/12/2018	176B00000X	NA	Licensed Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	333 LAWS AVE	None	UKIAH	CA	95482	6540	23	06045	39.12772164	-123.2111168	Mendocino County
256272	Fee-for-Service	1679860266	1679860266	1	1	AVAKIAN, ALLEN MD	1/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131538	01	General Practice	0	In state provider	None	1818 VERDUGO BLVD	STE 200	GLENDALE	CA	91208	1408	19	06037	34.20560177	-118.216054	Los Angeles County
256281	Fee-for-Service	1487425872	1487425872	1	1	ACOSTA, MONIQUE CNP	3/27/2024	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
256299	Fee-for-Service	1427173087	1427173087	1	1	AGUILAR, ROMERO J LCSW	12/3/2015	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	61929	-	NOT APPLICABLE	0	In state provider	None	1401 L STREET	None	BAKERSFIELD	CA	93301	4522	15	06029	35.37071435	-119.0164657	Kern County
256305	Fee-for-Service	1568968022	1568968022	1	1	AZIZ, SARA MD	9/15/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	165717	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
256307	Fee-for-Service	1164463055	1164463055	1	1	ANESTHESIA CONSULTANTS	11/3/1994	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OF CALIFORNIA MED GRP	555 E VALLEY PARKWAY	None	ESCONDIDO	CA	92025	9468	37	06073	33.12542915	-117.0764725	San Diego County
256312	Fee-for-Service	1669428447	1669428447	1	1	ALLEN, JOHN W CRNA	1/6/1997	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1025 N DOUTY ST	None	HANFORD	CA	93230	3722	16	06031	36.33611794	-119.6460191	Kings County
256325	Fee-for-Service	1669096376	1669096376	1	1	ALB HOSPICE CARE INC	4/12/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1274 S WATERMAN AVE	STE 122	SAN BERNARDINO	CA	92408	2826	36	06071	34.078446	-117.2788185	San Bernardino County
256331	Fee-for-Service	1699110213	1699110213	1	1	ANWAR, ZANE MD	5/25/2020	207W00000X	NA	Ophthalmology	026	PHYSICIANS	155667	18	Ophthalmology	0	In state provider	None	1033 3RD ST	None	SAN RAFAEL	CA	94901	3107	21	06041	37.97209412	-122.5280013	Marin County
256343	Fee-for-Service	1194987578	1194987578	1	1	ALMASHAT, SAMMY J MD	7/12/2019	207R00000X	NA	Other	026	PHYSICIANS	154710	39	Preventive (M.D. only)	0	In state provider	None	2081 BRONZE STAR DR	None	WOODLAND	CA	95776	5423	57	06113	38.67049812	-121.7238394	Yolo County
256349	Fee-for-Service	1700410107	1700410107	2	1	AFH ENTERPRISE	10/24/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10300 4TH ST	130	RANCHO CUCAMONGA	CA	91730	5808	36	06071	34.07750946	-117.5798875	San Bernardino County
256374	Fee-for-Service	1992816227	1992816227	1	1	ANSARI, NAJEEB K	4/8/2004	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	63682	40	Pediatrics	0	In state provider	None	220 E 13TH ST	None	MERCED	CA	95340	6242	24	06047	37.29309532	-120.4748791	Merced County
256380	Fee-for-Service	1114332079	1114332079	1	1	ADVENT HOSPICE CARE INC	8/16/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6711 VAN NUYS BLVD	STE 300 OFFICE 329	VAN NUYS	CA	91405	4620	19	06037	34.192539	-118.448776	Los Angeles County
256406	Fee-for-Service	1467454934	1467454934	1	1	AKBAR, ALIYA MD	7/30/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	72770	08	Family Practice	0	In state provider	None	6501 COYLE AVE	None	CARMICHAEL	CA	95608	0306	34	06067	38.669562	-121.31379	Sacramento County
256447	Fee-for-Service	1225061641	1225061641	1	1	AMERASIAN MED SUPPLY CO	3/21/1995	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INC	1668 ALUM ROCK AVE	None	SAN JOSE	CA	95116	2437	43	06085	37.35219201	-121.856757	Santa Clara County
256458	Fee-for-Service	1366884199	1366884199	1	1	AIDS HEALTHCARE FOUNDATION	9/4/2014	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1414 S GRAND AVE	SUITE 485	LOS ANGELES	CA	90015	3076	19	06037	34.03661142	-118.2657227	Los Angeles County
256471	Fee-for-Service	1730348053	1730348053	1	1	ABELSON, JONATHAN A MD	8/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	105322	78	Neoplastic Diseases/Oncology	0	In state provider	None	100 CASA STREET	STE C	SAN LUIS OBISPO	CA	93405	8805	40	06079	35.29273885	-120.6647926	San Luis Obispo County
256477	Fee-for-Service	1073871273	1073871273	1	1	AVIA HOSPICE INC	5/6/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	539 N GLENOAKS BLVD	SUITE 206	BURBANK	CA	91502	1417	19	06037	34.18652984	-118.310858	Los Angeles County
256526	Fee-for-Service	1780610253	1780610253	1	1	AAHLAD, SUBHA Y MD	3/31/1992	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	50976	40	Pediatrics	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
256540	Fee-for-Service	1699110395	1699110395	1	1	AHMED, NAJJIA S MD	10/21/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	134496	40	Pediatrics	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
256547	Fee-for-Service	1578600649	1578600649	1	1	ANDERSON, RICHARD L OD	2/8/2015	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	484 MOBIL AVE	STE 6	CAMARILLO	CA	93010	6359	56	06111	34.22213597	-119.0428992	Ventura County
256568	Fee-for-Service	1780945766	1780945766	1	1	ALBERTO, JOSE G MD	7/7/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	133124	01	General Practice	0	In state provider	None	2412 THIRD STREET	PO BOX 249	HUGHSON	CA	95326	0249	50	06099	37.596078	-120.866634	Stanislaus County
256645	Fee-for-Service	1447637467	1447637467	1	1	AHLSTROM, SHANE M MD	1/21/2021	207L00000X	NA	Other	026	PHYSICIANS	-	None	None	1	Border provider	None	1093 ROYAL COURT	None	MEDFORD	OR	97504	8383	00	None	42.34017467	-122.8666022	Jackson County
256669	Fee-for-Service	1114332079	1114332079	1	1	ADVENT HOSPICE CARE INC	8/16/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6711 VAN NUYS BLVD	STE 300 OFFICE 329	VAN NUYS	CA	91405	4620	19	06037	34.192539	-118.448776	Los Angeles County
256695	Fee-for-Service	1023275765	1023275765	1	1	AGUILAR, STEVE A MD	11/23/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110079	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
256713	Fee-for-Service	1275064362	1275064362	1	1	AFSARI, ALI MD	6/27/2022	390200000X	NA	Other	026	PHYSICIANS	173754	None	None	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
256729	Fee-for-Service	1447314513	1447314513	1	1	AMMON ANALYTICAL LABORATORIE	2/17/2020	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	S LLC	35 E BLANCKE ST	None	LINDEN	NJ	07036	4646	00	None	40.63280268	-74.25416255	Union County
256742	Fee-for-Service	1407183130	1407183130	1	1	AHMED, AIFRA MD	7/9/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	109449	41	Internal Medicine	0	In state provider	None	1150 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48948529	-122.2232468	San Mateo County
256748	Fee-for-Service	1720059413	1720059413	1	1	AWAN, TAMSEELA T MD	9/14/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	51379	41	Internal Medicine	0	In state provider	None	1700 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	5115	36	06071	34.130214	-117.2788065	San Bernardino County
256780	Fee-for-Service	1518977925	1518977925	1	1	AGUILA, LORENA PHD	11/30/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	282 LANDIS AVENUE	None	CHULA VISTA	CA	91910	2627	37	06073	32.64168665	-117.0812298	San Diego County
256812	Fee-for-Service	1831453596	1831453596	1	1	ADEEL, ALINA	4/9/2025	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	None	77	Infectious Disease	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
256818	Fee-for-Service	1396130696	1396130696	1	1	ALDIWANI, HAIDER MD	4/8/2019	208M00000X	NA	Other	026	PHYSICIANS	154964	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
256820	Fee-for-Service	1497398002	1497398002	1	1	AYALA, VERONICA M LMFT	6/28/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1451	43	06085	37.23418124	-121.7818366	Santa Clara County
256837	Fee-for-Service	1073733408	1073733408	1	2	ACARIAHEALTH PHARMACY #26, I	8/2/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	NC.	8715 HENDERSON RD	None	TAMPA	FL	33634	1143	00	None	28.03422669	-82.54971228	Hillsborough County
256932	Fee-for-Service	1982615654	1982615654	1	1	ALCONCEL, CELIA Q MD	12/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	56303	40	Pediatrics	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
256979	Fee-for-Service	1538367875	1538367875	1	1	ASCUNCION, DEVI G MD	12/17/2007	207RH0003X	NA	Oncology	026	PHYSICIANS	82602	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
256984	Fee-for-Service	1184634826	1184634826	1	1	ABDOLLAHZADEH, HOMAN	3/2/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	60802	10	Gastroenterology (M.D. only)	0	In state provider	None	1401 N PALM CANYON DR	STE 202	PALM SPRINGS	CA	92262	4434	33	06065	33.841269	-116.546807	Riverside County
256986	Fee-for-Service	1528221983	1528221983	1	1	AZAB, RAYMOND A MD	5/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124719	30	Radiology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
257021	Fee-for-Service	1396796751	1396796751	1	1	ARAKAKI, DAVID MD	8/1/1995	207L00000X	NA	Other	026	PHYSICIANS	42627	05	Anesthesiology	0	In state provider	None	23625 HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
257024	Fee-for-Service	1336361328	1336361328	1	1	ARIKAWA, TERRY MD	9/22/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	6972	08	Family Practice	0	In state provider	None	THREE MEDICAL PLAZA	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
257070	Fee-for-Service	1467471342	1467471342	1	1	A E G MEDICAL SUPPLY	7/29/1998	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	AVETISYAN, OVIK	5068 HOLLYWOOD BLVD	None	LOS ANGELES	CA	90027	6139	19	06037	34.10173003	-118.3002721	Los Angeles County
257156	Fee-for-Service	1598480766	1598480766	1	1	ARK ANGEL II, LLC	3/28/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	1641-1659 D STREET	None	HAYWARD	CA	94541	4320	01	06001	37.67691947	-122.0687547	Alameda County
257164	Fee-for-Service	1982734554	1982734554	1	1	ALARCON SAN-MIGUEL, ALMA Y	12/26/2014	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LMFT	16415 S COLORADO AVE	SUITE 305	PARAMOUNT	CA	90723	5053	19	06037	33.8853075	-118.1614695	Los Angeles County
257167	Fee-for-Service	1427686476	1427686476	1	1	AMONIC, ALEXIS MD	7/26/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
257171	Fee-for-Service	1235115635	1235115635	1	1	ALAN, THOMAS B MD	5/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85006	41	Internal Medicine	0	In state provider	None	2660 W COVELL BLVD	None	DAVIS	CA	95616	5645	57	06113	38.56101005	-121.7821776	Yolo County
257180	Fee-for-Service	1912951153	1912951153	1	1	ARJOMANDI, MEHRDAD MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65317	41	Internal Medicine	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
257196	Fee-for-Service	1568521185	1568521185	1	1	ACKERMAN, KENNETH V MD	6/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	48183	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
257206	Fee-for-Service	1255075909	1255075909	1	1	AVALOS, STACY DOULA	8/22/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	43	06085	0	0	None
257208	Fee-for-Service	1053741777	1053741777	1	1	ANDREWS, SARAH E LMFT	12/20/2017	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	605 STANDIFORD AVE	STE L	MODESTO	CA	95350	3550	50	06099	37.68922609	-121.00038	Stanislaus County
257252	Fee-for-Service	1649335324	1649335324	1	1	ALEXANDER, SCOTT LMFT	11/20/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	48075	-	NOT APPLICABLE	0	In state provider	None	1420 WILLOW PASS ROAD	STE 140	CONCORD	CA	94520	5823	07	06013	37.96956948	-122.0507563	Contra Costa County
257255	Fee-for-Service	1881640258	1881640258	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1520 BRUNDAGE LN	None	BAKERSFIELD	CA	93304	2949	15	06029	35.355456	-119.0196225	Kern County
257288	Fee-for-Service	1033476742	1033476742	1	1	ANAVITARTE, ADRIANA P MD	7/30/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	128398	40	Pediatrics	0	In state provider	None	725 WELCH ROAD	MC 5548	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
257290	Fee-for-Service	1710648332	1710648332	1	1	ANDERSON, IAN CRNA	10/26/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2175 ROSALINE AVE	None	REDDING	CA	96001	2549	45	06089	40.57278686	-122.3958519	Shasta County
257309	Fee-for-Service	1912954298	1912954298	1	1	ALICAWAY, EDGARDO G MD	4/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	50500	13	Neurology (M.D. only)	0	In state provider	None	1800 SULLIVAN AVE	RM 508	DALY CITY	CA	94015	2225	41	06081	37.68077723	-122.4728941	San Mateo County
257362	Fee-for-Service	1649513961	1649513961	1	1	AMERICAN PACIFIC MEDICAL	7/1/2013	207R00000X	NA	Other	026	PHYSICIANS	13355	29	Pulmonary Diseases (M.D. only)	0	In state provider	GROUP INC	1045 ATLANTIC AVENUE	SUITE 902	LONG BEACH	CA	90813	3410	19	06037	33.780267	-118.1850795	Los Angeles County
257418	Fee-for-Service	1184835498	1184835498	1	1	ALEX O RAISKIN, MD	4/19/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3333 RIVERBEND DR	None	SPRINGFIELD	OR	97477	8800	00	None	44.08199228	-123.0283538	Lane County
257420	Fee-for-Service	1285096198	1285096198	1	1	ACACIA HOME HEALTH AND	8/18/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	PALLIATIVE INC	11770 WARNER AVE	STE 102	FOUNTAIN VALLEY	CA	92708	2663	30	06059	33.71573417	-117.9239528	Orange County
257445	Fee-for-Service	1659785970	1659785970	1	1	ASSAF, SAMER A MD	3/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142931	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
257446	Fee-for-Service	1437472974	1437472974	1	1	ADEMOLA, TINUOLA O MD	4/29/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118388	41	Internal Medicine	0	In state provider	None	370 DISTEL CIRCLE	None	LOS ALTOS	CA	94022	1404	43	06085	37.39572142	-122.1051204	Santa Clara County
257469	Fee-for-Service	1912951153	1912951153	1	1	ARJOMANDI, MEHRDAD MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65317	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
257494	Fee-for-Service	1023448503	1023448503	1	1	ABC RECOVERY CENTER, INC.	4/19/2019	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	44435 BISKRA ST	None	INDIO	CA	92201	3103	33	06065	33.7248	-116.2262475	Riverside County
257497	Fee-for-Service	1669490660	1669490660	1	1	AZIZ, ALI D MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	45799	36	Psychiatry	0	In state provider	None	5225 WILSHIRE BLVD	STE 201	LOS ANGELES	CA	90036	4346	19	06037	34.06221752	-118.3436505	Los Angeles County
257502	Fee-for-Service	1780676221	1780676221	1	1	AHMC MONTEREY PARK HOSP	11/1/2004	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL	900 S ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	4780	19	06037	34.049623	-118.1388014	Los Angeles County
257510	Fee-for-Service	1508630666	1508630666	1	1	ALI, SABRINA N PT	12/27/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1533 OAKDALE RD	STE B	MODESTO	CA	95355	3305	50	06099	37.66667747	-120.957587	Stanislaus County
257511	Fee-for-Service	1265069686	1265069686	1	1	ALDERETTE, LAUREN	10/31/2024	207L00000X	NA	Other	026	PHYSICIANS	None	05	Anesthesiology	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
257522	Fee-for-Service	1841731098	1841731098	1	1	ADAMS, BRETT J	9/11/2020	207R00000X	NA	Other	026	PHYSICIANS	158052	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
257547	Fee-for-Service	1740261460	1740261460	1	1	ANDREW POWELL MD	1/31/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	300 LONGWOOD AVE	None	BOSTON	MA	02115	5724	00	None	42.337035	-71.105607	Suffolk County
257577	Fee-for-Service	1609196930	1609196930	1	1	AZER, DAVID DO	7/21/2011	207LP2900X	NA	Other	026	PHYSICIANS	10374	05	Anesthesiology	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
257600	Fee-for-Service	1841809415	1841809415	1	1	AHMC SETON MEDICAL CENTER	1/27/2021	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	LLC	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	41	06081	37.67984327	-122.4730264	San Mateo County
257623	Fee-for-Service	1033150123	1033150123	1	1	ALPERT, MARTIN L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	34933	08	Family Practice	0	In state provider	None	1304 15TH ST	STE 202	SANTA MONICA	CA	90404	1811	19	06037	34.02600773	-118.486172	Los Angeles County
257648	Fee-for-Service	1649513961	1649513961	1	1	AMERICAN PACIFIC MEDICAL	7/1/2013	207R00000X	NA	Other	026	PHYSICIANS	13355	41	Internal Medicine	0	In state provider	GROUP INC	1045 ATLANTIC AVENUE	SUITE 902	LONG BEACH	CA	90813	3410	19	06037	33.780267	-118.1850795	Los Angeles County
257653	Fee-for-Service	1568512176	1568512176	1	1	ADELANTO SCHOOL DIST	10/20/1993	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	11824 AIR EXPY	None	ADELANTO	CA	92301	1730	36	06071	34.5720543	-117.4059877	San Bernardino County
257676	Fee-for-Service	1851909782	1851909782	1	1	AGARWAL, SHRUTI MD	9/18/2023	207R00000X	NA	Other	026	PHYSICIANS	184979	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
257700	Fee-for-Service	1366784910	1366784910	1	1	ADAMS, SARAH J MD	10/26/2018	207N00000X	NA	Dermatology	026	PHYSICIANS	156436	07	Dermatology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
257751	Fee-for-Service	1831277847	1831277847	1	1	ARIMIE, CALIN S MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63334	41	Internal Medicine	0	In state provider	None	7320 WOODLAKE AVE	STE 260	WEST HILLS	CA	91307	1470	19	06037	34.20245266	-118.6321273	Los Angeles County
257757	Fee-for-Service	1912951153	1912951153	1	1	ARJOMANDI, MEHRDAD MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	65317	66	Emergency Medicine (Urgent Care)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
257774	Fee-for-Service	1972681682	1972681682	1	1	ARMSTRONG, HELEN G MD	8/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	65839	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
257790	Fee-for-Service	1780676221	1780676221	1	1	AHMC MONTEREY PARK HOSP	11/1/2004	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	HOSPITAL	900 S ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	4780	19	06037	34.049623	-118.1388014	Los Angeles County
257819	Fee-for-Service	1780685479	1780685479	1	1	ANDERSON, MARTIN M MD	1/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	48857	40	Pediatrics	0	In state provider	None	2300 S FLOWER ST	STE 200	LOS ANGELES	CA	90007	2676	19	06037	34.0294397	-118.2734132	Los Angeles County
257832	Fee-for-Service	1275580755	1275580755	1	1	ANTHONY POZUN	10/7/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	6316 W UNION HILLS DR	STE 210	GLENDALE	AZ	85308	1001	00	None	33.65425437	-112.1969493	Maricopa County
257835	Fee-for-Service	1487678512	1487678512	1	1	ADVANCED ANESTHESIA	11/16/2004	207L00000X	NA	Other	026	PHYSICIANS	77705	05	Anesthesiology	0	In state provider	CONSULTANT, INC	438 W LAS TUNAS DR	None	SAN GABRIEL	CA	91776	1216	19	06037	34.10243051	-118.105902	Los Angeles County
257839	Fee-for-Service	1306051032	1306051032	1	1	ALTAMEDIX CORP	11/9/2004	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	ALTAMEDIX ADHC	4234 N FREEWAY BLVD	None	SACRAMENTO	CA	95834	1237	34	06067	38.646495	-121.477518	Sacramento County
257869	Fee-for-Service	1770707044	1770707044	1	1	APARICIO, TERESA LCSW	3/15/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16200 VENTURA BLVD	403	ENCINO	CA	91436	4692	19	06037	34.15659457	-118.485532	Los Angeles County
257870	Fee-for-Service	1437424959	1437424959	1	1	ALONZO-AGUILUS, URITH OT	2/2/2024	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	16025 GALE AVE	STE B7	CITY OF INDUSTRY	CA	91745	1633	19	06037	34.00908153	-117.9571941	Los Angeles County
257910	Fee-for-Service	1598822488	1598822488	1	1	ARORA, RAVEEN R MD	3/31/1985	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	37910	41	Internal Medicine	0	In state provider	None	1712 W MEDICAL CENTER DR	None	ANAHEIM	CA	92801	1801	30	06059	33.85175653	-117.942597	Orange County
257920	Fee-for-Service	1164419834	1164419834	1	1	AOUTHMANY, MOUSTAFA M MD	8/6/2019	2080N0001X	NA	Pediatric Primary Care	026	PHYSICIANS	145911	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
257970	Fee-for-Service	1235853409	1235853409	1	1	ANDERSEN, HEATHER M PT	1/16/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1000 N CENTRAL AVE.	SUITE 110	GLENDALE	CA	91202	2957	19	06037	34.15992057	-118.2572221	Los Angeles County
257986	Fee-for-Service	1275614711	1275614711	1	1	ATWELL, GEORGE W MD	5/13/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	34666	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2700 DOLBEER STREET	None	EUREKA	CA	95501	4799	12	06023	40.78355148	-124.1420294	Humboldt County
257992	Fee-for-Service	1255735874	1255735874	1	1	ADAMS-ROSELLE, ANNIE R LCSW	12/13/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
258009	Fee-for-Service	1942836945	1942836945	1	1	AHN, LAWRENCE MD	8/8/2023	207R00000X	NA	Other	026	PHYSICIANS	185336	None	None	0	In state provider	None	4050 BARRANCA PKWY	STE 200	IRVINE	CA	92604	1723	30	06059	33.68293726	-117.8067799	Orange County
258012	Fee-for-Service	1043450612	1043450612	1	1	ANDERSON, MELISSA C LMFT	10/1/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3030 ASHBY AVE	119	BERKELEY	CA	94705	2439	01	06001	37.85806307	-122.2444866	Alameda County
258039	Fee-for-Service	1831277847	1831277847	1	1	ARIMIE, CALIN S MD	10/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	63334	10	Gastroenterology (M.D. only)	0	In state provider	None	7320 WOODLAKE AVE	STE 260	WEST HILLS	CA	91307	1470	19	06037	34.20245266	-118.6321273	Los Angeles County
258042	Fee-for-Service	1841076502	1841076502	1	1	ANGELS VIEW INC	6/12/2024	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	12840 CACTUS DRIVE	None	DSRT HOT SPGS	CA	92240	4514	33	06065	33.95532776	-116.5056684	Riverside County
258047	Fee-for-Service	1780754879	1780754879	1	1	APPEL, JASON A MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	20647	20	Orthopedic Surgery	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
258062	Fee-for-Service	1972681682	1972681682	1	1	ARMSTRONG, HELEN G MD	8/1/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	65839	01	General Practice	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
258076	Fee-for-Service	1467620930	1467620930	1	1	ABRAMS, CARINA J B PT	4/8/2008	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1340 LAKE BLVD	None	DAVIS	CA	95616	2619	57	06113	38.55491538	-121.7876886	Yolo County
258130	Fee-for-Service	1295918696	1295918696	1	1	ANSARI, AAMIR MD	8/13/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	143102	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
258168	Fee-for-Service	1598476038	1598476038	1	1	ANTONUCCI, TARA NP	4/6/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
258173	Fee-for-Service	1538692256	1538692256	1	1	ALLABADI, NAJIB M MD	8/27/2020	208600000X	NA	General Surgery	026	PHYSICIANS	166147	02	General Surgery	0	In state provider	None	5320 CARRINGTON CIRCLE	None	STOCKTON	CA	95210	3515	39	06077	38.00512188	-121.2937141	San Joaquin County
258190	Fee-for-Service	1578998118	1578998118	1	1	ADRIANOWICZ, MIRIAM PSYD	7/19/2024	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
258199	Fee-for-Service	1598822488	1598822488	1	1	ARORA, RAVEEN R MD	3/31/1985	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	37910	01	General Practice	0	In state provider	None	1712 W MEDICAL CENTER DR	None	ANAHEIM	CA	92801	1801	30	06059	33.85175653	-117.942597	Orange County
258278	Fee-for-Service	1073092698	1073092698	1	1	ANGUEIRA, JOSE E RCP	12/4/2019	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
258308	Fee-for-Service	1548516107	1548516107	1	1	ABRAHAM, SUSAN C LMFT	2/17/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3840 HOMESTEAD	None	SANTA CLARA	CA	95051	5173	43	06085	37.33774954	-122.002065	Santa Clara County
258317	Fee-for-Service	1669815940	1669815940	1	1	AHMED, SHUSHMITA M MD	8/1/2019	208600000X	NA	General Surgery	026	PHYSICIANS	132413	02	General Surgery	0	In state provider	None	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	34	06067	38.556288	-121.458474	Sacramento County
258355	Fee-for-Service	1033530977	1033530977	1	2	ALIXA RX LLC	11/17/2023	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	4727 W. SHAW AVE	SUITE 104	FRESNO	CA	93722	6209	10	06019	36.80812101	-119.8780512	Fresno County
258420	Fee-for-Service	1023551298	1023551298	1	1	AIR EVAC EMS, INC.	9/22/2019	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	2	Out of state provider	None	83 W HOLLEY STREET EXT	None	PARSONS	TN	38363	4800	00	None	35.6374743	-88.12517258	Decatur County
258427	Fee-for-Service	1184145682	1184145682	1	1	AL BAST, BASMA MD	10/4/2023	1835C0206X	NA	None	026	PHYSICIANS	186193	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
258432	Fee-for-Service	1912053539	1912053539	1	1	ALIYA G HASAN MD	9/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	None	39.742182	-104.8408515	Adams County
258439	Fee-for-Service	1568685840	1568685840	1	1	ANAHEIM CITY SCHOOL DIST	2/10/2025	No Taxonomy Provided	NA	None	112	CYBHI FEE SCHEDULE	-	-	NOT APPLICABLE	0	In state provider	ADMINISTRATION CENTER	1001 S EAST ST	None	ANAHEIM	CA	92805	5749	30	06059	33.82302745	-117.8977198	Orange County
258485	Fee-for-Service	1598822488	1598822488	1	1	ARORA, RAVEEN R MD	3/31/1985	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	37910	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1712 W MEDICAL CENTER DR	None	ANAHEIM	CA	92801	1801	30	06059	33.85175653	-117.942597	Orange County
258487	Fee-for-Service	1962071654	1962071654	1	1	AKL, RALPH DO	7/1/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	22123	08	Family Practice	0	In state provider	None	147 N BRENT ST	None	VENTURA	CA	93003	2854	56	06111	34.2746295	-119.2573399	Ventura County
258497	Fee-for-Service	1407084494	1407084494	1	1	ADITI, ANUPAM MD	6/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	120979	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
258518	Fee-for-Service	1275858458	1275858458	1	1	ARNOLD, CLEO A PSYD	9/20/2018	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	8247 E STOCKTON BLVD	None	SACRAMENTO	CA	95828	8200	34	06067	38.459187	-121.4080245	Sacramento County
258531	Fee-for-Service	1245383843	1245383843	1	1	ANDO, MAY T OD	1/11/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE ROAD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
258578	Fee-for-Service	1720212699	1720212699	1	1	ADUSUMILLI, SESHA S MD	11/14/2023	207R00000X	NA	Other	026	PHYSICIANS	171078	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
258579	Fee-for-Service	1689237414	1689237414	1	1	ABELSON, ZACHARY A MD	2/28/2024	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	182315	None	None	0	In state provider	None	824 E CARSON ST	SUITE 203	CARSON	CA	90745	2262	19	06037	33.83159904	-118.2605506	Los Angeles County
258639	Fee-for-Service	1154885671	1154885671	1	1	A&K HOME HEALTH INC	4/22/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	225 W BROADWAY	SUITE 115	GLENDALE	CA	91204	5108	19	06037	34.14673469	-118.257145	Los Angeles County
258647	Fee-for-Service	1841201688	1841201688	1	1	AGAIBY, ADEL D MD	7/14/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	80302	41	Internal Medicine	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
258692	Fee-for-Service	1841456647	1841456647	1	1	AGUSTIN, VALENTINA T MD	8/16/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	115922	08	Family Practice	0	In state provider	None	1190 VETERANS BLVD	None	REDWOOD CITY	CA	94063	2037	41	06081	37.48941956	-122.2227204	San Mateo County
258721	Fee-for-Service	1831771955	1831771955	1	1	ARIAS, VICENTE NP	10/18/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	140 CENTENNIAL WAY	None	TUSTIN	CA	92780	3711	30	06059	33.74496	-117.818857	Orange County
258722	Fee-for-Service	1568685840	1568685840	1	1	ANAHEIM CITY SCHOOL DIST	3/28/1994	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	ADMINISTRATION CENTER	1001 S EAST ST	None	ANAHEIM	CA	92805	5749	30	06059	33.82302745	-117.8977198	Orange County
258723	Fee-for-Service	1396285698	1396285698	1	1	AKPOROTU, AKPOBO MD	10/10/2022	207R00000X	NA	Other	026	PHYSICIANS	179694	None	None	0	In state provider	None	9939 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	33	06065	33.91571158	-117.4549231	Riverside County
258731	Fee-for-Service	1679635361	1679635361	2	2	AEGIS TREATMENT CENTERS, LLC	5/21/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	614 W MANCHESTER BLVD	104	INGLEWOOD	CA	90301	1656	19	06037	33.96153647	-118.3672845	Los Angeles County
258801	Fee-for-Service	1245393651	1245393651	1	2	ANDREWS, THOMAS J MD	10/17/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	79955	-	NOT APPLICABLE	0	In state provider	None	6302 THIRTEENTH AVE	None	LUCERNE	CA	95458	1024	17	06033	39.08779639	-122.79255	Lake County
258809	Fee-for-Service	1013537422	1013537422	1	1	AUNG, SU LAT MD	12/1/2023	208M00000X	NA	Other	026	PHYSICIANS	180873	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
258811	Fee-for-Service	1679643928	1679643928	1	1	ADAMS, AMY E MD	8/26/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	82760	07	Dermatology	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
258836	Fee-for-Service	1326139866	1326139866	1	1	ABRAMSON, LISA P MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69020	40	Pediatrics	0	In state provider	None	5301 F ST	STE 313	SACRAMENTO	CA	95819	3222	34	06067	38.571354	-121.4368695	Sacramento County
258837	Fee-for-Service	1467444059	1467444059	2	1	AMERICAN HEALTHCARE AND	1/12/2018	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	PHARMACY INC	518 W VALLEY BLVD	None	COLTON	CA	92324	2249	36	06071	34.06784567	-117.3307387	San Bernardino County
258845	Fee-for-Service	1861458002	1861458002	1	1	ARCE-HERNANDEZ, EDSEL MD	7/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52377	83	Rheumatology	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
258866	Fee-for-Service	1942374541	1942374541	1	1	AMARE, TADIOS A MD	8/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	74700	01	General Practice	0	In state provider	None	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	38	06075	37.78224789	-122.4412946	San Francisco County
258872	Fee-for-Service	1073072096	1073072096	1	1	AKIN, PATRICK DO	12/5/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	21389	None	None	0	In state provider	None	1510 FLORIDA AVE	STE B	MODESTO	CA	95350	4437	50	06099	37.666053	-120.996222	Stanislaus County
258879	Fee-for-Service	1730790734	1730790734	1	1	A1 QUALITY HEALTH CARE INC	8/4/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	2525 E COLORADO BLVD	SUITE 102	PASADENA	CA	91107	3771	19	06037	34.1461235	-118.097982	Los Angeles County
258880	Fee-for-Service	1578602686	1578602686	1	1	AGHILI, NOOSHIN PSYD	7/27/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	655 DEEP VALLEY DR	STE 125 S	ROLLING HILLS EST	CA	90274	3688	19	06037	33.77025037	-118.3710468	Los Angeles County
258884	Fee-for-Service	1780911263	1780911263	1	1	ADRANGI, ALIPASHA MD	8/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	109794	None	None	0	In state provider	None	100 W CALIFORNIA BLVD	None	PASADENA	CA	91105	3010	19	06037	34.133598	-118.1534895	Los Angeles County
258902	Fee-for-Service	1871912717	1871912717	1	1	ABDALLAH, WALID F MD	7/10/2019	207W00000X	NA	Ophthalmology	026	PHYSICIANS	146829	18	Ophthalmology	0	In state provider	None	1450 SAN PABLO ST	STE 4000	LOS ANGELES	CA	90033	4500	19	06037	34.06189518	-118.203256	Los Angeles County
258969	Fee-for-Service	1437543501	1437543501	1	1	ALRASHID, WUFAA MD INC	10/26/2015	193400000X	NA	Other	026	PHYSICIANS	95090	41	Internal Medicine	0	In state provider	None	10 CONGRESS ST	STE 512	PASADENA	CA	91105	3045	19	06037	34.13396893	-118.1528162	Los Angeles County
258986	Fee-for-Service	1619400801	1619400801	1	1	ABELHAD, NADIA MD	9/1/2023	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	183741	None	None	0	In state provider	None	765 MEDICAL CENTER CT	STE 211	CHULA VISTA	CA	91911	6656	37	06073	32.619069	-117.020835	San Diego County
259022	Fee-for-Service	1679635361	1679635361	2	2	AEGIS TREATMENT CENTERS, LLC	5/21/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	614 W MANCHESTER BLVD	104	INGLEWOOD	CA	90301	1656	19	06037	33.96153647	-118.3672845	Los Angeles County
259033	Fee-for-Service	1962580621	1962580621	1	1	ANDERSON, KAJ MD	10/31/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82364	66	Emergency Medicine (Urgent Care)	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
259041	Fee-for-Service	1720394331	1720394331	1	1	AVELAR, ANTHONY E LCSW	8/18/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
259132	Fee-for-Service	1861458002	1861458002	1	1	ARCE-HERNANDEZ, EDSEL MD	7/5/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52377	40	Pediatrics	0	In state provider	None	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93638	8761	20	06039	36.88437894	-119.8003484	Madera County
259187	Fee-for-Service	1407469216	1407469216	1	1	AREVALO, ANITA LMFT	10/30/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6904 VILLAGE PARKWAY	None	DUBLIN	CA	94568	2406	01	06001	37.70726135	-121.9248393	Alameda County
259224	Fee-for-Service	1780215210	1780215210	1	1	ALBERT ELHIANI DPM INC	10/25/2022	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	9233 W PICO BLVD	STE 201	LOS ANGELES	CA	90035	1255	19	06037	34.05530645	-118.3926645	Los Angeles County
259226	Fee-for-Service	1306429907	1306429907	1	1	AGUIRRE, VINCENT P PHD	6/4/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3443 W SHAW AVE	None	FRESNO	CA	93711	3249	10	06019	36.805356	-119.854413	Fresno County
259229	Fee-for-Service	1821358375	1821358375	1	1	ACEVES, THADEO J PA	7/1/2021	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	None	2000 W BRIGGSMORE AVE	STE I	MODESTO	CA	95350	3839	50	06099	37.67139252	-121.0281273	Stanislaus County
259230	Fee-for-Service	1134337975	1134337975	1	1	ANTONIO, ADELAIDA B MD	8/26/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	41801	41	Internal Medicine	0	In state provider	None	21001 SHERMAN WAY	SUITE 15	CANOGA PARK	CA	91301	1760	19	06037	34.20113553	-118.5912126	Los Angeles County
259252	Fee-for-Service	1457596371	1457596371	1	2	ALLSAFE MEDICAL GROUP INC.	8/17/2011	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	11061 ATLANTIC AVE	None	LYNWOOD	CA	90262	3048	19	06037	33.92849932	-118.1845739	Los Angeles County
259267	Fee-for-Service	1255882502	1255882502	1	1	ASHLEY, SKYE W LMFT	6/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3554 ROUNDBARN BLVD	None	SANTA ROSA	CA	95403	0929	49	06097	38.47599	-122.725557	Sonoma County
259303	Fee-for-Service	1184694309	1184694309	1	1	ATTAM, RAJEEV MD	5/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128014	10	Gastroenterology (M.D. only)	0	In state provider	None	9333 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
259377	Fee-for-Service	1760415236	1760415236	1	1	ASGARZADIE-GADIM, FARBOD MD	10/6/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	92692	14	Neurological Surgery	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
259386	Fee-for-Service	1679080311	1679080311	1	1	ACUTE MEDICAL PROVIDERS	1/22/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INPATIENT INC	10 WOODLAND RD	None	ST HELENA	CA	94574	9554	28	06055	38.54196972	-122.4751787	Napa County
259418	Fee-for-Service	1134574783	1134574783	1	1	ANSALDO, WARREN G OD	10/31/2019	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7038 KATELLA AVE	None	STANTON	CA	90680	2805	30	06059	33.8027637	-118.0101193	Orange County
259444	Fee-for-Service	1093010399	1093010399	1	1	AURO PHARMACIES INC	10/8/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1955 SUNNYCREST DR	STE 100	FULLERTON	CA	92835	3653	30	06059	33.89346742	-117.9312001	Orange County
259479	Fee-for-Service	1134559032	1134559032	1	1	AMERICAN CAREQUEST EAST BAY	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	302 CHERRY LANE	SUITE 107 108	MANTECA	CA	95337	3741	39	06077	37.8013889	-121.2310042	San Joaquin County
259481	Fee-for-Service	1023500527	1023500527	1	1	AYVAZIAN, ARTHUR	8/30/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	175609	None	None	0	In state provider	None	10 CONGRESS ST	STE 208	PASADENA	CA	91105	3027	19	06037	34.13396893	-118.1528162	Los Angeles County
259547	Fee-for-Service	1629147871	1629147871	1	1	ANOTHER CHOICE, ANOTHER	12/20/2013	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	CHANCE	7000 FRANKLIN BLVD	STE 625	SACRAMENTO	CA	95823	1884	34	06067	38.499408	-121.4627715	Sacramento County
259559	Fee-for-Service	1972502227	1972502227	1	1	ARIZONA CENTER FOR HAND SURG	4/1/2018	2086S0105X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	2	Out of state provider	ERY PC	370 E VIRGINIA AVE	SUITE 100	PHOENIX	AZ	85004	1214	00	None	33.476985	-112.0663215	Maricopa County
259592	Fee-for-Service	1609116649	1609116649	1	1	ANJANEYA RX	4/8/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3601 VISTA WAY	STE #103	OCEANSIDE	CA	92056	4559	37	06073	33.18140858	-117.3093221	San Diego County
259644	Fee-for-Service	1518968379	1518968379	1	1	AM-MED DIABETIC SUPPLIES INC	11/5/2013	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	5180 W ATLANTIC AVE	SUITE 107	DELRAY BEACH	FL	33484	8103	00	None	26.45772854	-80.1248085	Palm Beach County
259653	Fee-for-Service	1093091662	1093091662	1	2	AMERICAN HEARING AID CENTER	12/23/2011	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	2918 FIFTH AVE	STE 108	SAN DIEGO	CA	92103	5910	37	06073	32.735826	-117.1603565	San Diego County
259659	Fee-for-Service	1215161211	1215161211	1	1	ANWAR, MOSHIUR M MD	7/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114910	78	Neoplastic Diseases/Oncology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2203	38	06075	37.76344756	-122.4581992	San Francisco County
259694	Fee-for-Service	1730119553	1730119553	1	2	AFFILIATED PATHOLOGISTS MEDI	4/1/1998	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	1225 WILSHIRE BLVD	None	LOS ANGELES	CA	90017	2395	19	06037	34.05358988	-118.2661119	Los Angeles County
259766	Fee-for-Service	1134559032	1134559032	1	1	AMERICAN CAREQUEST EAST BAY	8/28/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	302 CHERRY LANE	SUITE 107 108	MANTECA	CA	95337	3741	39	06077	37.8013889	-121.2310042	San Joaquin County
259784	Fee-for-Service	1942576145	1942576145	1	1	ALDEN, DOUGLAS J MD	9/23/2019	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	160442	30	Radiology	0	In state provider	None	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	36	06071	34.26577765	-117.1695461	San Bernardino County
259806	Fee-for-Service	1821182338	1821182338	1	1	ALMENDAREZ, ERNEST R MD	9/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60246	08	Family Practice	0	In state provider	None	2740 M ST	None	MERCED	CA	95340	2813	24	06047	37.31239905	-120.478839	Merced County
259807	Fee-for-Service	1215484142	1215484142	1	1	APEX ANNEX HEALTH CENTER INC	10/30/2018	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	400 WEST I STREET	None	LOS BANOS	CA	93635	3479	24	06047	37.06347448	-120.858102	Merced County
259822	Fee-for-Service	1881684405	1881684405	1	1	ALBERT, CRAIG P MD	3/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	48555	08	Family Practice	0	In state provider	None	2445 MCCABE WAY	None	IRVINE	CA	92614	4293	30	06059	33.67952503	-117.8479012	Orange County
259847	Fee-for-Service	1457596371	1457596371	1	3	ALLSAFE MEDICAL GROUP INC.	6/6/2013	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PROFESSIONAL CORPORATION	4156 S CENTRAL AVE	None	LOS ANGELES	CA	90011	3154	19	06037	34.00809015	-118.2564774	Los Angeles County
259848	Fee-for-Service	1952609737	1952609737	1	1	ABOUNCE, ARMANDO G LMFT	6/5/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
259882	Fee-for-Service	1538507447	1538507447	1	1	ALP PSYCHOLOGY ASSOCIATES, P	9/16/2020	103K00000X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	C	1055 E COLORADO BLVD	STE 500	PASADENA	CA	91106	2380	19	06037	34.14595648	-118.1287575	Los Angeles County
259902	Fee-for-Service	1730141383	1730141383	2	1	ATCHISON, MARVIN J MD	3/4/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	70292	02	General Surgery	0	In state provider	None	27700 MEDICAL CENTER RD	None	MISSION VIEJO	CA	92691	6426	30	06059	33.56008604	-117.6657795	Orange County
259907	Fee-for-Service	1447223169	1447223169	1	1	ASH, LORRAINE M DO	6/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	8182	30	Radiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
259909	Fee-for-Service	1225610306	1225610306	1	1	AL-AMERI, NOOR MD	12/28/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
259925	Fee-for-Service	1154371334	1154371334	1	1	ALEXANDER, DAVID N MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	50851	13	Neurology (M.D. only)	0	In state provider	None	1158 26TH ST	# 560	SANTA MONICA	CA	90403	4621	19	06037	34.03622894	-118.4778119	Los Angeles County
259940	Fee-for-Service	1093091662	1093091662	1	2	AMERICAN HEARING AID CENTER	12/12/2011	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	2918 FIFTH AVE	STE 108	SAN DIEGO	CA	92103	5910	37	06073	32.735826	-117.1603565	San Diego County
259946	Fee-for-Service	1730632712	1730632712	1	1	AWAN, ASADULLAH MD	9/2/2021	207R00000X	NA	Other	026	PHYSICIANS	174577	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
259947	Fee-for-Service	1215161211	1215161211	1	1	ANWAR, MOSHIUR M MD	7/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114910	30	Radiology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2203	38	06075	37.76344756	-122.4581992	San Francisco County
259955	Fee-for-Service	1700399441	1700399441	3	1	AMPLA HEALTH	7/13/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1000 SUTTER STREET	SUITE B	YUBA CITY	CA	95991	0000	51	06101	39.14436772	-121.6133922	Sutter County
259960	Fee-for-Service	1124738257	1124738257	1	1	ABLE ORTHO CLINIC INC	1/31/2023	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	1411 RIMPAU AVE	SUITE110	CORONA	CA	92879	2681	33	06065	33.86591052	-117.5459417	Riverside County
259970	Fee-for-Service	1497396204	1497396204	1	1	APPROVED HOSPICE CARE INC	6/23/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1616 VICTORY BLVD	STE 203	GLENDALE	CA	91201	2959	19	06037	34.16022036	-118.2989479	Los Angeles County
259971	Fee-for-Service	1023164605	1023164605	1	1	ADAMS, CHRISTINA L MD	3/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108627	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
260008	Fee-for-Service	1700110657	1700110657	3	1	ADU-POKU, QUEEN	4/17/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2810 LONE TREE WAY	SUITE 9	ANTIOCH	CA	94509	4956	07	06013	37.99499587	-121.8077774	Contra Costa County
260009	Fee-for-Service	1295135101	1295135101	1	1	ADAMS, ALEXANDER C MD	4/16/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	01	General Practice	1	Border provider	None	2825 E BARNETT ROAD	None	MEDFORD	OR	97504	0001	00	None	42.31650147	-122.8306005	Jackson County
260015	Fee-for-Service	1568400265	1568400265	1	1	APPERSON, MICHELLE L MD	6/17/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82317	13	Neurology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
260064	Fee-for-Service	1255425054	1255425054	1	1	ARMSTRONG, PRISCILLA P PHD	8/15/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4700 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6082	19	06037	34.09812055	-118.2921165	Los Angeles County
260096	Fee-for-Service	1821182338	1821182338	1	1	ALMENDAREZ, ERNEST R MD	9/30/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60246	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2740 M ST	None	MERCED	CA	95340	2813	24	06047	37.31239905	-120.478839	Merced County
260098	Fee-for-Service	1215484142	1215484142	1	1	APEX ANNEX HEALTH CENTER INC	10/30/2018	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	400 WEST I STREET	None	LOS BANOS	CA	93635	3479	24	06047	37.06347448	-120.858102	Merced County
260113	Fee-for-Service	1427495563	1427495563	1	1	AU, ALLAN S L MD	3/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	146155	41	Internal Medicine	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
260134	Fee-for-Service	1942365648	1942365648	1	1	ALFARO, IVONE L RN	1/21/2011	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1019 E HOLT AVE	None	POMONA	CA	91767	5720	19	06037	34.06292287	-117.7302993	Los Angeles County
260155	Fee-for-Service	1912163791	1912163791	1	1	AAMIR, ASMAA MD	11/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	131824	30	Radiology	0	In state provider	None	300 PASTEUR DRIVE	MC 5548	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
260156	Fee-for-Service	1710267497	1710267497	1	1	ABBURI, TRIVENI MD	7/3/2023	207R00000X	NA	Other	026	PHYSICIANS	135456	None	None	0	In state provider	None	4501 SAND CREEK ROAD	None	ANTIOCH	CA	94531	8577	07	06013	37.94947636	-121.7752571	Contra Costa County
260170	Fee-for-Service	1205910114	1205910114	1	1	APPLEWHITE, TERRILL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	600 GRANT ST	None	GARY	IN	46402	6001	00	None	41.599755	-87.357897	Lake County
260171	Fee-for-Service	1538507447	1538507447	1	1	ALP PSYCHOLOGY ASSOCIATES, P	9/16/2020	103K00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	C	1055 E COLORADO BLVD	STE 500	PASADENA	CA	91106	2380	19	06037	34.14595648	-118.1287575	Los Angeles County
260226	Fee-for-Service	1679699821	1679699821	1	1	ADIBZADEH, LYDIA D CNM	10/18/2013	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
260227	Fee-for-Service	1467160192	1467160192	1	1	ALDRICH, DANIELLE E CNP	2/10/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3901 LONE TREE WAY	None	ANTIOCH	CA	94509	6200	07	06013	37.98252	-121.8030615	Contra Costa County
260249	Fee-for-Service	1215457015	1215457015	1	1	AZIMI, EHSAN MD	7/21/2021	207N00000X	NA	Dermatology	026	PHYSICIANS	172626	None	None	0	In state provider	None	713 N DOUGLAS ST.	None	EL SEGUNDO	CA	90245	2830	19	06037	33.92546537	-118.3832318	Los Angeles County
260260	Fee-for-Service	1023164605	1023164605	1	1	ADAMS, CHRISTINA L MD	3/17/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	108627	41	Internal Medicine	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
260262	Fee-for-Service	1497396204	1497396204	1	1	APPROVED HOSPICE CARE INC	6/23/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1616 VICTORY BLVD	STE 203	GLENDALE	CA	91201	2959	19	06037	34.16022036	-118.2989479	Los Angeles County
260286	Fee-for-Service	1144689647	1144689647	1	1	ABUKAMLEH, HISHAM J MD	1/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	150533	None	None	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
260287	Fee-for-Service	1679530018	1679530018	1	1	ABRAMS, DONALD I MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	36948	01	General Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
260311	Fee-for-Service	1659935096	1659935096	1	1	ARYA, MALVIKA MD	6/7/2023	207W00000X	NA	Ophthalmology	026	PHYSICIANS	186597	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
260356	Fee-for-Service	1285920637	1285920637	1	1	AMIRHAMZEH, DANIEL MD	6/8/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	122995	None	None	0	In state provider	None	1516 COTNER AVE	None	LOS ANGELES	CA	90025	3303	19	06037	34.04905416	-118.4477438	Los Angeles County
260363	Fee-for-Service	1447637731	1447637731	1	1	ANGEL CARE HOSPICE OF	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	ARCADIA INC	4115 E LIVE OAK AVE	SUITE 10	ARCADIA	CA	91006	5820	19	06037	34.10973715	-118.0143061	Los Angeles County
260373	Fee-for-Service	1164836086	1164836086	1	1	AZARMI, MOJAN N MD	7/11/2023	390200000X	NA	Other	026	PHYSICIANS	184294	None	None	0	In state provider	None	101 THE CITY DR S	BLDG 29	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
260382	Fee-for-Service	1184655730	1184655730	1	1	ASHBURN, NORMAN K MD INC	9/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	49733	40	Pediatrics	0	In state provider	None	2211 W MAGNOLIA BLVD	STE 210	BURBANK	CA	91506	1771	19	06037	34.1728873	-118.3320905	Los Angeles County
260389	Fee-for-Service	1740485531	1740485531	1	1	ABDELMALEK, JOSEPH A MD	7/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	107185	41	Internal Medicine	0	In state provider	None	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
260440	Fee-for-Service	1841277373	1841277373	1	1	ANDREW BERGGREN, M.D.	11/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	7801 LAKEVIEW PKWY	SUITE 100	ROWLETT	TX	75098	4248	00	None	32.91397217	-96.52510773	Dallas County
260448	Fee-for-Service	1093133829	1093133829	1	1	AMUNO, IRENE D MD	11/19/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	138082	40	Pediatrics	0	In state provider	None	4733 WEST SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
260459	Fee-for-Service	1538507447	1538507447	1	1	ALP PSYCHOLOGY ASSOCIATES, P	9/16/2020	103K00000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	C	1055 E COLORADO BLVD	STE 500	PASADENA	CA	91106	2380	19	06037	34.14595648	-118.1287575	Los Angeles County
260494	Fee-for-Service	1003080557	1003080557	1	1	ARMOUR, RYAN A DO	7/30/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	12174	13	Neurology (M.D. only)	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
260529	Fee-for-Service	1336225531	1336225531	1	1	ALLRED, EDWARD C MD	2/1/1983	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	13516	01	General Practice	0	In state provider	None	5862 AVALON BLVD	None	LOS ANGELES	CA	90003	1308	19	06037	33.987888	-118.2651735	Los Angeles County
260538	Fee-for-Service	1700071594	1700071594	1	1	AWAD, FADI MD	8/19/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	111520	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
260554	Fee-for-Service	1982198842	1982198842	1	2	ALCAM MEDICAL INC.	11/3/2020	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	5153 HOLT BLVD	SUITE A-4	MONTCLAIR	CA	91763	4837	36	06071	34.0631015	-117.692694	San Bernardino County
260645	Fee-for-Service	1770901548	1770901548	1	1	ABINADER, RAY R MD	8/2/2021	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	147562	None	None	0	In state provider	None	11370 ANDERSON ST	# 3900	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
260652	Fee-for-Service	1447637731	1447637731	1	1	ANGEL CARE HOSPICE OF	12/1/2016	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	ARCADIA INC	4115 E LIVE OAK AVE	SUITE 10	ARCADIA	CA	91006	5820	19	06037	34.10973715	-118.0143061	Los Angeles County
260656	Fee-for-Service	1033505672	1033505672	1	1	ALNOOR, MOHAMMAD S MD	6/29/2022	2080P0202X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	177951	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
260662	Fee-for-Service	1336195247	1336195247	1	1	APLYN, MONIKA MD	8/5/2009	207R00000X	NA	Other	026	PHYSICIANS	53659	66	Emergency Medicine (Urgent Care)	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
260667	Fee-for-Service	1104970540	1104970540	1	1	AHMED, OMAR MD	1/13/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	110375	None	None	0	In state provider	None	300 W HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
260688	Fee-for-Service	1760739056	1760739056	1	1	ANGULO, RAYLENE E LMFT	12/26/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	271 E WORKMAN ST	STE 101	COVINA	CA	91723	3547	19	06037	34.07534765	-117.8862217	Los Angeles County
260723	Fee-for-Service	1790401677	1790401677	1	1	AT HOME DIALYSIS, LLC	12/18/2023	No Taxonomy Provided	NA	None	042	CHRONIC DIALYSIS CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	340 E COMMONWEALTH AVE	None	FULLERTON	CA	92832	2017	30	06059	33.87037554	-117.9181035	Orange County
260733	Fee-for-Service	1093869596	1093869596	1	1	ADENIJI, ADEGOKE MD	2/8/2015	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	69154	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	501 N BRIDGE ST	None	VISALIA	CA	93291	5014	54	06107	36.334107	-119.289186	Tulare County
260745	Fee-for-Service	1548633605	1548633605	1	1	ASHE, SERAPHINA L LMFT	8/20/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	20244 TONIA COURT	None	PERRIS	CA	92570	6063	33	06065	33.82501803	-117.3677095	Riverside County
260747	Fee-for-Service	1538507447	1538507447	1	1	ALP PSYCHOLOGY ASSOCIATES, P	9/16/2020	103K00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	C	1055 E COLORADO BLVD	STE 500	PASADENA	CA	91106	2380	19	06037	34.14595648	-118.1287575	Los Angeles County
260752	Fee-for-Service	1124071972	1124071972	1	1	ALAVYNEJAD, BAHRAM MD	7/23/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74844	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92663	4162	30	06059	33.62421676	-117.9309656	Orange County
260776	Fee-for-Service	1083358758	1083358758	1	1	ALSAYED, AHMED A MD	5/26/2022	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	178131	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
260793	Fee-for-Service	1770653487	1770653487	1	1	AHMED, WALEED MD	4/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96991	41	Internal Medicine	0	In state provider	None	9888 GENESEE AVE	None	LA JOLLA	CA	92037	1205	37	06073	32.8865608	-117.2250386	San Diego County
260797	Fee-for-Service	1518126341	1518126341	1	1	ALEXANDER, ALAN A Z MD	12/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	117299	30	Radiology	0	In state provider	None	18436 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4107	19	06037	34.22078873	-118.5351265	Los Angeles County
260804	Fee-for-Service	1093285355	1093285355	1	1	ABILITY OUTPATIENT PHYSICAL	5/15/2019	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	THERAPY, INC.	2670 S WHITE RD STE 120	None	SAN JOSE	CA	95148	2072	43	06085	37.32892524	-121.7982851	Santa Clara County
260819	Fee-for-Service	1336225531	1336225531	1	1	ALLRED, EDWARD C MD	2/1/1983	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	13516	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	5862 AVALON BLVD	None	LOS ANGELES	CA	90003	1308	19	06037	33.987888	-118.2651735	Los Angeles County
260821	Fee-for-Service	1962044057	1962044057	1	1	ALERACARE MEDICAL GROUP OF C	10/7/2021	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ALIFORNIA	2331 A MONTPELIER DR	STE 20	SAN JOSE	CA	95116	1688	43	06085	37.3649965	-121.8479359	Santa Clara County
260900	Fee-for-Service	1043427065	1043427065	1	1	ADAMS, ELIZABETH A NP	8/18/2009	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	121 S GLENOAKS BLVD	SUITE 3	BURBANK	CA	91502	1315	19	06037	34.18291031	-118.3058877	Los Angeles County
260903	Fee-for-Service	1093724395	1093724395	1	1	ADANIEL TINDALO	1/2/2024	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2601 OCEAN PKWY	None	BROOKLYN	NY	11235	7745	00	None	40.586031	-73.9657305	Kings County
260908	Fee-for-Service	1982163481	1982163481	1	1	ALLENDORPH, TONI L PT	1/28/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	350 JOHN MUIR PKWY	250	BRENTWOOD	CA	94513	5183	07	06013	37.91980577	-121.734715	Contra Costa County
260922	Fee-for-Service	1205294204	1205294204	1	1	AMES, ERIK MD	5/23/2023	207ZP0105X	NA	Other	026	PHYSICIANS	163468	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
260949	Fee-for-Service	1205331527	1205331527	1	1	ACESO HOSPICE INC	10/7/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6420 COLDWATER CANYON AV	STE 199	NORTH HOLLYWOOD	CA	91606	1126	19	06037	34.18745584	-118.4137829	Los Angeles County
260952	Fee-for-Service	1093925182	1093925182	1	1	ALEXANDRIDIS, ALEXIS MD	3/1/2018	208600000X	NA	General Surgery	026	PHYSICIANS	151087	02	General Surgery	0	In state provider	None	246 PERKINS ST	None	SONOMA	CA	95476	6954	49	06097	38.2891423	-122.4629004	Sonoma County
260959	Fee-for-Service	1992774129	1992774129	1	1	AHMAD, BAKHTIAR MD	12/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	42585	02	General Surgery	0	In state provider	None	264 N HIGHLAND SPRINGS A	STE 3C	BANNING	CA	92220	3085	33	06065	33.93063	-116.946864	Riverside County
260977	Fee-for-Service	1538568068	1538568068	1	1	ANGEL MEDICAL CLINIC	12/26/2014	193400000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	8551 LA PALMA AVE	STE A	BUENA PARK	CA	90620	2278	30	06059	33.84682806	-117.983867	Orange County
261007	Fee-for-Service	1528626710	1528626710	1	1	ADABI, KIAN	8/12/2024	2251N0400X	NA	Physical Therapist	026	PHYSICIANS	None	13	Neurology (M.D. only)	0	In state provider	None	3801 HOWE ST	None	OAKLAND	CA	94611	5312	01	06001	37.8242732	-122.2568561	Alameda County
261018	Fee-for-Service	1659379634	1659379634	1	1	AZINGE-OBASI, MEZIA O MD	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53449	22	Pathology (M.D. only)	0	In state provider	DOCTOR PAUL MEMORIAL MED	3450 W 43RD ST	STE 106	LOS ANGELES	CA	90008	4944	19	06037	34.00569618	-118.3330634	Los Angeles County
261026	Fee-for-Service	1467683987	1467683987	1	1	ADAM CHRISTOPHER JOHNSON	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	250 THOMPSON ST	None	ST PAUL	MN	55102	2370	00	None	44.94428014	-93.10733608	Ramsey County
261035	Fee-for-Service	1538507447	1538507447	1	1	ALP PSYCHOLOGY ASSOCIATES, P	9/16/2020	103K00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	C	1055 E COLORADO BLVD	STE 500	PASADENA	CA	91106	2380	19	06037	34.14595648	-118.1287575	Los Angeles County
261053	Fee-for-Service	1770670713	1770670713	1	1	ALBOUIDANI, MOHAMAD MD	1/1/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	110080	41	Internal Medicine	0	In state provider	None	800 SOUTH MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
261058	Fee-for-Service	1649812587	1649812587	1	1	ARNOTT, MICHELLE CNM	3/10/2020	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	3601 S HARBOR BLVD	SUITE 100	SANTA ANA	CA	92704	6924	30	06059	33.698367	-117.9194115	Orange County
261075	Fee-for-Service	1376817973	1376817973	1	1	AMERICADE PALLIATIVE HEALTH	9/18/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	420 N MONTEBELLO BLVD	STE 204	MONTEBELLO	CA	90640	4274	19	06037	34.01651383	-118.1060207	Los Angeles County
261110	Fee-for-Service	1598983652	1598983652	1	1	ANTHONY MARTINEZ MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	111 DALLAS STREET	None	SAN ANTONIO	TX	78205	1201	00	None	29.43317376	-98.49236007	Bexar County
261129	Fee-for-Service	1598931131	1598931131	1	1	ASHFAEI, AFSHIN MD	6/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112203	41	Internal Medicine	0	In state provider	None	5150 HILL ROAD	STE C	LAKEPORT	CA	95453	5100	17	06033	39.10437349	-122.9088331	Lake County
261166	Fee-for-Service	1154400299	1154400299	1	1	ALVARADO, RICHARD G MD	9/7/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	82315	18	Ophthalmology	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
261191	Fee-for-Service	1720241961	1720241961	2	2	AMINI, SAMBIZ M MD	10/5/2020	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	40628	-	NOT APPLICABLE	0	In state provider	None	45335 SIERRA HWY	None	LANCASTER	CA	93534	1611	19	06037	34.7068568	-118.1383834	Los Angeles County
261195	Fee-for-Service	1497923296	1497923296	1	1	ALPIN, JULIA DO	1/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	13726	66	Emergency Medicine (Urgent Care)	0	In state provider	None	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	33	06065	33.763572	-116.4056895	Riverside County
261210	Fee-for-Service	1588775746	1588775746	1	1	ALVEY,JOHN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5656 SOUTH POWER RD	None	GILBERT	AZ	85295	0000	00	None	33.31386	-111.6877185	Maricopa County
261234	Fee-for-Service	1093871246	1093871246	1	1	ARUN, VEENA V MD	7/26/2021	207W00000X	NA	Ophthalmology	026	PHYSICIANS	167702	None	None	0	In state provider	None	1400 E PALOMAR ST	None	CHULA VISTA	CA	91931	1800	37	06073	32.62382113	-116.9960539	San Diego County
261239	Fee-for-Service	1205331527	1205331527	1	1	ACESO HOSPICE INC	10/7/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6420 COLDWATER CANYON AV	STE 199	NORTH HOLLYWOOD	CA	91606	1126	19	06037	34.18745584	-118.4137829	Los Angeles County
261282	Fee-for-Service	1861707325	1861707325	1	1	ABDALI, MASSOUD MD	12/2/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123656	01	General Practice	0	In state provider	None	3800 DALE ROAD	None	MODESTO	CA	95356	8627	50	06099	37.69395556	-121.0499498	Stanislaus County
261307	Fee-for-Service	1659379634	1659379634	1	1	AZINGE-OBASI, MEZIA O MD	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53449	01	General Practice	0	In state provider	DOCTOR PAUL MEMORIAL MED	3450 W 43RD ST	STE 106	LOS ANGELES	CA	90008	4944	19	06037	34.00569618	-118.3330634	Los Angeles County
261334	Fee-for-Service	1265873897	1265873897	1	1	ALTWER, ALLISON LMFT	5/30/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
261336	Fee-for-Service	1952757684	1952757684	1	1	ALTAHAN, ALAA MD	8/22/2022	207RH0003X	NA	Oncology	026	PHYSICIANS	180251	None	None	0	In state provider	None	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
261363	Fee-for-Service	1376817973	1376817973	1	1	AMERICADE PALLIATIVE HEALTH	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	420 N MONTEBELLO BLVD	STE 204	MONTEBELLO	CA	90640	4274	19	06037	34.01651383	-118.1060207	Los Angeles County
261367	Fee-for-Service	1750559431	1750559431	1	15	ALL STAR PHYSICAL THERAPY, I	4/30/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	577 EAST ELDER STREET	SUITE I	FALLBROOK	CA	92028	3079	37	06073	33.3801147	-117.2456536	San Diego County
261371	Fee-for-Service	1891864070	1891864070	1	1	AZER, NAGWA L MD	10/1/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	41880	01	General Practice	0	In state provider	None	931 BUENA VISTA ST	STE 503	DUARTE	CA	91010	1727	19	06037	34.141635	-117.9775755	Los Angeles County
261400	Fee-for-Service	1205364072	1205364072	1	1	ABELMAN, REBECCA A MD	6/23/2022	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	169307	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
261405	Fee-for-Service	1487940102	1487940102	1	1	ATAIE, FRISHTA MD	11/20/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128442	01	General Practice	0	In state provider	None	210 W SAN BERNARDINO RD	None	COVINA	CA	91723	1515	19	06037	34.088004	-117.893475	Los Angeles County
261408	Fee-for-Service	1891818951	1891818951	1	1	ADVANCED PAIN INSTITUTE	5/14/2007	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ADVANCED PAIN MED GRP	7230 MEDICAL CENTER DR	STE 500	WEST HILLS	CA	91307	4024	19	06037	34.20172814	-118.6294322	Los Angeles County
261423	Fee-for-Service	1477525863	1477525863	1	1	ARMFIELD, DEREK R MD	5/18/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	53402	30	Radiology	0	In state provider	None	1509 WILSON TER	None	GLENDALE	CA	91206	4007	19	06037	34.14950866	-118.2311155	Los Angeles County
261425	Fee-for-Service	1164950416	1164950416	1	1	ABUEG, ERIKA DO	2/21/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17580	None	None	0	In state provider	None	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	19	06037	33.969141	-118.0489095	Los Angeles County
261497	Fee-for-Service	1225553902	1225553902	1	1	AQUILINA, CHARLES M	1/25/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	01	06001	37.82519027	-122.2609525	Alameda County
261542	Fee-for-Service	1912392507	1912392507	1	1	AHMED, OMAR S MD	7/22/2019	207P00000X	NA	Other	026	PHYSICIANS	-	66	Emergency Medicine (Urgent Care)	1	Border provider	None	620 SHADOW LANE	None	LAS VEGAS	NV	89119	5168	00	None	36.163269	-115.1654465	Clark County
261598	Fee-for-Service	1659379634	1659379634	1	1	AZINGE-OBASI, MEZIA O MD	12/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	53449	08	Family Practice	0	In state provider	DOCTOR PAUL MEMORIAL MED	3450 W 43RD ST	STE 106	LOS ANGELES	CA	90008	4944	19	06037	34.00569618	-118.3330634	Los Angeles County
261617	Fee-for-Service	1124146311	1124146311	1	1	AGUILAR, ALEXANDRA E LCSW	4/24/2018	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	22960	-	NOT APPLICABLE	0	In state provider	None	710 E 111TH PLACE	None	LOS ANGELES	CA	90059	1518	19	06037	33.93454026	-118.2626368	Los Angeles County
261638	Fee-for-Service	1790833507	1790833507	1	1	AROVAS, N ELIZABETH MD	12/22/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	79027	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
261643	Fee-for-Service	1831326644	1831326644	1	1	ABRAHAM, ERIKA S MD	6/30/2017	207R00000X	NA	Other	026	PHYSICIANS	143502	41	Internal Medicine	0	In state provider	None	650 5TH STREET	STE 502	SAN FRANCISCO	CA	94107	1536	38	06075	37.77575268	-122.3977845	San Francisco County
261648	Fee-for-Service	1548339278	1548339278	1	1	AGUINALDO, ESTRELLA A MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	56493	01	General Practice	0	In state provider	None	23517 MAIN ST	STE 104	CARSON	CA	90745	5235	19	06037	33.81129174	-118.2756933	Los Angeles County
261656	Fee-for-Service	1750559431	1750559431	1	15	ALL STAR PHYSICAL THERAPY, I	11/10/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	577 EAST ELDER STREET	SUITE I	FALLBROOK	CA	92028	3079	37	06073	33.3801147	-117.2456536	San Diego County
261736	Fee-for-Service	1497400246	1497400246	1	1	ASHMUN, EMILY D CRNA	4/22/2022	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33578	-121.999329	Santa Clara County
261769	Fee-for-Service	1508997826	1508997826	1	1	ARBI GHAZARIAN MD INC	4/14/2008	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	81408	08	Family Practice	0	In state provider	None	2103 MONTROSE AVE	STE E	MONTROSE	CA	91020	1546	19	06037	34.206831	-118.224702	Los Angeles County
261775	Fee-for-Service	1407856057	1407856057	1	1	ANTHONY WADE ALVAREZ, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 MEDICAL VILLAGE DR	None	EDGEWOOD	KY	41017	3408	00	None	39.01457332	-84.56298791	Kenton County
261783	Fee-for-Service	1205666245	1205666245	1	1	AKHTAR, DAUD H MD	8/9/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	None	10	Gastroenterology (M.D. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
261794	Fee-for-Service	1497250955	1497250955	1	1	AHADIAT, OMEED	5/31/2024	207N00000X	NA	Dermatology	026	PHYSICIANS	163538	07	Dermatology	0	In state provider	None	26700 TOWNE CENTER DR	STE 170	FOOTHILL RANCH	CA	92610	2850	30	06059	33.67455886	-117.6639195	Orange County
261818	Fee-for-Service	1356705453	1356705453	1	1	ANAND, GAUTAM MD	12/22/2023	2086S0129X	NA	General Surgery	026	PHYSICIANS	188755	None	None	0	In state provider	None	1082 GLENDON AVE	None	LOS ANGELES	CA	90024	2908	19	06037	34.06109265	-118.4443071	Los Angeles County
261841	Fee-for-Service	1952590796	1952590796	1	1	AJANWACHUKU, VINCENT MD INC	9/30/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	43736	02	General Surgery	0	In state provider	None	16133 KAMANA RD	None	APPLE VALLEY	CA	92307	1317	36	06071	34.54444051	-117.2696169	San Bernardino County
261854	Fee-for-Service	1225242811	1225242811	1	1	ARCADE HEARING AID CENTER	1/12/2021	332S00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1911 WILSHIRE BLVD.	None	SANTA MONICA	CA	90403	5605	19	06037	34.03097999	-118.4838241	Los Angeles County
261909	Fee-for-Service	1801347307	1801347307	1	1	ADAMS, MICHELLE A LCSW	10/5/2018	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2930 W IMPERIAL HWY	STE 310	INGLEWOOD	CA	90303	3141	19	06037	33.93087352	-118.32534	Los Angeles County
261933	Fee-for-Service	1548339278	1548339278	1	1	AGUINALDO, ESTRELLA A MD	2/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	56493	41	Internal Medicine	0	In state provider	None	23517 MAIN ST	STE 104	CARSON	CA	90745	5235	19	06037	33.81129174	-118.2756933	Los Angeles County
261943	Fee-for-Service	1750559431	1750559431	1	15	ALL STAR PHYSICAL THERAPY, I	3/26/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	577 EAST ELDER STREET	SUITE I	FALLBROOK	CA	92028	3079	37	06073	33.3801147	-117.2456536	San Diego County
261972	Fee-for-Service	1962033951	1962033951	1	1	AMBASSADORE HEALTH CARE INC	8/12/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	17100 PIONEER BLVD	STE 270	ARTESIA	CA	90701	2736	19	06037	33.875748	-118.082224	Los Angeles County
261994	Fee-for-Service	1780258517	1780258517	1	1	ABADI, AHMAD MD	5/23/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
262005	Fee-for-Service	1922231737	1922231737	1	1	ABDULLAH, ISHA B MD	4/22/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	54057	01	General Practice	0	In state provider	None	1197 E ARQUES AVE	None	SUNNYVALE	CA	94085	3904	43	06085	37.38051652	-121.9964175	Santa Clara County
262013	Fee-for-Service	1760753388	1760753388	1	1	AL-DOSSARI, GHANNAM A MD	2/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55003	33	Thoracic Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
262060	Fee-for-Service	1013501444	1013501444	1	1	ALDRIDGE, JOHNNIE LCSW	4/30/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11801 PIERCE ST	200	RIVERSIDE	CA	92505	4400	33	06065	33.90100297	-117.49363	Riverside County
262061	Fee-for-Service	1831159607	1831159607	1	1	ANGEJA, BRAD G MD	8/1/2000	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	64013	41	Internal Medicine	0	In state provider	None	3291 LOMA VISTA RD	None	VENTURA	CA	93003	3099	56	06111	34.27623479	-119.2520218	Ventura County
262064	Fee-for-Service	1457310179	1457310179	1	1	ALBERTON, GREGORY M MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64692	20	Orthopedic Surgery	0	In state provider	None	3905 WARING RD	None	OCEANSIDE	CA	92056	4405	37	06073	33.18781249	-117.2923383	San Diego County
262065	Fee-for-Service	1164925038	1164925038	1	1	ARIF, MURAD MD	5/19/2020	207L00000X	NA	Other	026	PHYSICIANS	146468	None	None	0	In state provider	None	8700 BEVERLY BLVD	STE 8211	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
262075	Fee-for-Service	1164486676	1164486676	1	1	ANTONIUCCI, DIANA M MD	7/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74113	67	Endocrinology	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
262078	Fee-for-Service	1407278393	1407278393	1	1	ALTAMED HEALTH SERVICES CORP	8/7/2014	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1776 E CENTURY BLVD	None	LOS ANGELES	CA	90002	3050	19	06037	33.94556113	-118.2413137	Los Angeles County
262144	Fee-for-Service	1225242811	1225242811	1	1	ARCADE HEARING AID CENTER	1/12/2021	332S00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1911 WILSHIRE BLVD.	None	SANTA MONICA	CA	90403	5605	19	06037	34.03097999	-118.4838241	Los Angeles County
262157	Fee-for-Service	1679591598	1679591598	1	1	AMEERI, FARAH A DO INC	12/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	7860	08	Family Practice	0	In state provider	None	13768 ROSWELL AVE	STE 115	CHINO	CA	91710	1402	36	06071	34.0038	-117.7218555	San Bernardino County
262211	Fee-for-Service	1235243239	1235243239	1	1	ANDREWS, EDWARD B PT	6/20/2014	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	4151 FOOTHILL ROAD	None	SANTA BARBARA	CA	93110	1110	42	06083	34.45144647	-119.7604485	Santa Barbara County
262215	Fee-for-Service	1114536679	1114536679	1	1	ABRAMS, TARA NP	11/4/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
262263	Fee-for-Service	1952919979	1952919979	1	1	AMEZCUA, KATRINA	4/21/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1357 WEST SHAW AVENUE	100	FRESNO	CA	93711	3618	10	06019	36.80824094	-119.8162512	Fresno County
262283	Fee-for-Service	1649669979	1649669979	2	1	AEGIS TREATMENT CENTERS LLC	11/1/2016	261QR0405X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	541 S HAM LANE	SUITE A & B	LODI	CA	95242	3530	39	06077	38.12755919	-121.2882996	San Joaquin County
262321	Fee-for-Service	1255808929	1255808929	1	1	AZAM, AMIN S CRNA	11/30/2018	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
262330	Fee-for-Service	1871884122	1871884122	1	1	ARIAS, REBECA A MD	8/7/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	123309	40	Pediatrics	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
262344	Fee-for-Service	1003072786	1003072786	1	1	ALASIL, TAREK MD	8/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	108797	18	Ophthalmology	0	In state provider	None	160 E ARTESIA ST	STE 120	POMONA	CA	91767	2900	19	06037	34.07556833	-117.7507835	Los Angeles County
262349	Fee-for-Service	1447353701	1447353701	1	1	ARROYO VISTA FAMILY	7/1/1994	261QF0400X	NA	Federally Qualified Health Center	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	6000 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4232	19	06037	34.11150069	-118.1888319	Los Angeles County
262353	Fee-for-Service	1457310179	1457310179	1	1	ALBERTON, GREGORY M MD	4/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	64692	46	Hand Surgery	0	In state provider	None	3905 WARING RD	None	OCEANSIDE	CA	92056	4405	37	06073	33.18781249	-117.2923383	San Diego County
262384	Fee-for-Service	1063799740	1063799740	1	1	AMORNPONGCHAI, AUNYAPORN	5/15/2015	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3443 VILLA LANE	SUITE 3	NAPA	CA	94558	6417	28	06055	38.3259594	-122.2945735	Napa County
262402	Fee-for-Service	1023136504	1023136504	1	1	AMLING HEIKEN, JANE E LMFT	10/23/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5464 N PALM AVE	STE B	FRESNO	CA	93704	1946	10	06019	36.8167292	-119.8082743	Fresno County
262420	Fee-for-Service	1205566304	1205566304	1	1	ANDERSON, MARK CRNA	2/9/2023	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	50 ALESSANDRO PLACE	SUITE 440	PASADENA	CA	91105	0000	19	06037	34.13101049	-118.151532	Los Angeles County
262426	Fee-for-Service	1891741260	1891741260	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	30530 RANCHO CALIFORNIA	None	TEMECULA	CA	92591	3277	33	06065	33.50860426	-117.1275323	Riverside County
262451	Fee-for-Service	1790958452	1790958452	1	1	AZARKH, MICHAEL MD	10/14/2011	207R00000X	NA	Other	026	PHYSICIANS	116986	41	Internal Medicine	0	In state provider	None	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	18	06035	40.43816059	-120.6279677	Lassen County
262501	Fee-for-Service	1306133319	1306133319	1	1	ACON, PHYLLIS W MD	8/31/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	114283	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
262533	Fee-for-Service	1356014450	1356014450	1	1	AMERIPRIME HEALTHCARE INC	11/22/2022	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	324 E 11TH ST	STE E1A	TRACY	CA	95376	4084	39	06077	37.73968681	-121.4204312	San Joaquin County
262546	Fee-for-Service	1497135222	1497135222	1	1	ARBOLEDA, DAVID F MD	7/24/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	156727	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
262571	Fee-for-Service	1649669979	1649669979	2	1	AEGIS TREATMENT CENTERS LLC	11/1/2016	261QR0405X	NA	Other	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	541 S HAM LANE	SUITE A & B	LODI	CA	95242	3530	39	06077	38.12755919	-121.2882996	San Joaquin County
262597	Fee-for-Service	1730481318	1730481318	1	1	ALTAMED HEALTH SERVICES	12/14/2011	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1300 S SUNSET AVE	None	WEST COVINA	CA	91790	3342	19	06037	34.0601054	-117.9474205	Los Angeles County
262600	Fee-for-Service	1629162243	1629162243	1	2	AGUILAR, ALEJANDRO F MD	11/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	36086	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3100 E FLORENCE AVE	STE 6	HUNTINGTON PARK	CA	90255	5848	19	06037	33.97277388	-118.2118093	Los Angeles County
262616	Fee-for-Service	1528014990	1528014990	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	16600 BOLSA CHICA ST	None	HUNTINGTON BEACH	CA	92649	3583	30	06059	33.72120809	-118.041396	Orange County
262629	Fee-for-Service	1013210707	1013210707	1	1	ALLEVIATION HEALTHCARE	3/2/2012	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	15335 MORRISON ST	STE 103B	SHERMAN OAKS	CA	91403	1564	19	06037	34.16081721	-118.4680458	Los Angeles County
262638	Fee-for-Service	1447353701	1447353701	1	1	ARROYO VISTA FAMILY	1/6/1992	261QF0400X	NA	Federally Qualified Health Center	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	6000 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4232	19	06037	34.11150069	-118.1888319	Los Angeles County
262672	Fee-for-Service	1184735953	1184735953	1	1	ALEX, WILLIAM R MD INC	3/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	86010	02	General Surgery	0	In state provider	None	4000 14TH ST	STE 306	RIVERSIDE	CA	92501	4083	33	06065	33.97771007	-117.3818381	Riverside County
262709	Fee-for-Service	1760723035	1760723035	1	1	AMIN, CHIRAG DO	7/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	15532	05	Anesthesiology	0	In state provider	None	1050 LINDEN AVE	None	LONG BEACH	CA	90813	3321	19	06037	33.78003775	-118.1866604	Los Angeles County
262714	Fee-for-Service	1679926927	1679926927	1	1	AYANA, DANIEL A NP	3/7/2022	363LA2200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
262755	Fee-for-Service	1619340155	1619340155	1	2	AEGIS TREATMENT CENTERS, LLC	5/15/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	5225 TELEGRAPH ROAD	None	VENTURA	CA	93003	4113	56	06111	34.27661221	-119.2246197	Ventura County
262868	Fee-for-Service	1376891374	1376891374	1	2	ATUL AGGARWAL MD CARDIOLOGY	12/15/2021	207RI0011X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	CLINIC	1018 CALLOWAY	None	BAKERSFIELD	CA	93312	6337	15	06029	35.36734178	-119.1115596	Kern County
262888	Fee-for-Service	1831583442	1831583442	1	1	ARCHAMBEAU, BENJAMIN A DO	7/1/2019	207P00000X	NA	Other	026	PHYSICIANS	15153	66	Emergency Medicine (Urgent Care)	0	In state provider	None	400 NORTH PEPPER AVENUE	None	COLTON	CA	92324	1819	36	06071	34.073505	-117.3505995	San Bernardino County
262889	Fee-for-Service	1730481318	1730481318	1	1	ALTAMED HEALTH SERVICES	12/14/2011	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1300 S SUNSET AVE	None	WEST COVINA	CA	91790	3342	19	06037	34.0601054	-117.9474205	Los Angeles County
262923	Fee-for-Service	1447353701	1447353701	1	1	ARROYO VISTA FAMILY	1/6/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	6000 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4232	19	06037	34.11150069	-118.1888319	Los Angeles County
262928	Fee-for-Service	1639161581	1639161581	1	1	ARORA, ASHIM MD	4/25/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	51729	41	Internal Medicine	0	In state provider	None	215 WEST JANSS RD	None	THOUSAND OAKS	CA	91360	1847	56	06111	34.2064445	-118.8824085	Ventura County
262935	Fee-for-Service	1275949257	1275949257	1	1	AQUISAP, SAI DO	10/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14228	08	Family Practice	0	In state provider	None	7373 WEST LANE	None	STOCKTON	CA	95210	3377	39	06077	38.017701	-121.297869	San Joaquin County
262963	Fee-for-Service	1184735953	1184735953	1	1	ALEX, WILLIAM R MD INC	3/30/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	86010	33	Thoracic Surgery	0	In state provider	None	4000 14TH ST	STE 306	RIVERSIDE	CA	92501	4083	33	06065	33.97771007	-117.3818381	Riverside County
262968	Fee-for-Service	1932545258	1932545258	1	1	ASADOORIAN, MARIET S MD	7/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	136380	30	Radiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
262993	Fee-for-Service	1184282865	1184282865	1	1	ALLOS, ALEXANDER P PT	10/16/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	681 MOLLISON	None	EL CAJON	CA	92020	6908	37	06073	32.78816936	-116.9509395	San Diego County
263019	Fee-for-Service	1477785160	1477785160	1	1	ADEIMY, CAMILLE MD	10/11/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	161191	68	Hematology	0	In state provider	None	1100 SAN BERNARDINO RD	1100	UPLAND	CA	91786	4923	36	06071	34.10129201	-117.636283	San Bernardino County
263042	Fee-for-Service	1619340155	1619340155	1	2	AEGIS TREATMENT CENTERS, LLC	5/15/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	5225 TELEGRAPH ROAD	None	VENTURA	CA	93003	4113	56	06111	34.27661221	-119.2246197	Ventura County
263062	Fee-for-Service	1437374360	1437374360	1	1	ALEXANDER, SHANA PHD	12/24/2013	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	7300 WYNDHAM DRIVE	None	SACRAMENTO	CA	95823	4913	34	06067	38.467854	-121.4188155	Sacramento County
263075	Fee-for-Service	1497917629	1497917629	1	1	ATIANZAR, KIMBERLY C MD	11/2/2010	390200000X	NA	Other	026	PHYSICIANS	112559	41	Internal Medicine	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
263114	Fee-for-Service	1003395153	1003395153	1	1	ANDREEV, ALENIKA V LMFT	2/10/2021	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25000 AVENUE STANFORD	167	VALENCIA	CA	91355	4553	19	06037	34.43847322	-118.5729968	Los Angeles County
263119	Fee-for-Service	1629438775	1629438775	1	2	A.K. BEAN FOUNDATION	2/14/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2100 SACRAMENTO ST	None	VALLEJO	CA	94590	3126	48	06095	38.11731024	-122.2580791	Solano County
263124	Fee-for-Service	1073644316	1073644316	1	1	AXTELL, ALLISON E MD	10/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	87216	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
263125	Fee-for-Service	1891958245	1891958245	1	1	ANTHONY NICHOLAS SNOW	9/11/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
263172	Fee-for-Service	1730481318	1730481318	1	1	ALTAMED HEALTH SERVICES	10/19/2015	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1300 S SUNSET AVE	None	WEST COVINA	CA	91790	3342	19	06037	34.0601054	-117.9474205	Los Angeles County
263178	Fee-for-Service	1861563017	1861563017	1	1	ALSADIR, SADICK J MD	7/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	60696	41	Internal Medicine	0	In state provider	None	795 WILLOW RD	BLDG 334	MENLO PARK	CA	94025	2539	41	06081	37.466676	-122.160384	San Mateo County
263179	Fee-for-Service	1417121138	1417121138	1	1	AGUILERA, CLAUDINE J M MD	11/30/2009	207R00000X	NA	Other	026	PHYSICIANS	103261	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
263192	Fee-for-Service	1154829638	1154829638	1	1	ADVENTIST HEALTH PHYSICIANS	2/1/2019	208G00000X	NA	General Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	125 MALL DR	STE 213	HANFORD	CA	93230	5794	16	06031	36.3246477	-119.6685218	Kings County
263213	Fee-for-Service	1447353701	1447353701	1	1	ARROYO VISTA FAMILY	3/9/1999	261QF0400X	NA	Federally Qualified Health Center	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	6000 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4232	19	06037	34.11150069	-118.1888319	Los Angeles County
263237	Fee-for-Service	1528726809	1528726809	1	3	ACCESS CARE ANESTHESIA OF CA	5/2/2024	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	LIFORNIA PC	6076 BRISTOL PKWY	SUITE 108	CULVER CITY	CA	90230	6600	19	06037	33.98557948	-118.3873452	Los Angeles County
263242	Fee-for-Service	1457331365	1457331365	1	1	ARMOND LAPINE	8/21/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9660 S 1300 E	None	SANDY	UT	84094	3762	00	None	40.57617253	-111.8531739	Salt Lake County
263276	Fee-for-Service	1013283837	1013283837	1	1	ABRECHT, CHRISTOPHER R MD	7/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	140102	01	General Practice	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
263348	Fee-for-Service	1083820716	1083820716	1	1	ANSELMO, DEAN M MD	9/27/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	70021	85	Surgery-Pediatric	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
263352	Fee-for-Service	1740267343	1740267343	1	1	ABDOU, WAFIK A MD	11/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	66371	05	Anesthesiology	0	In state provider	None	4101 EMPIRE DR	# 130	BAKERSFIELD	CA	93309	0681	15	06029	35.37449372	-119.0467779	Kern County
263360	Fee-for-Service	1972055382	1972055382	1	1	ALLIANCE SURGERY PARTNERS, L	1/11/2023	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	LC	1828 E CESAR CHAVEZ AVE	6500	LOS ANGELES	CA	90033	2424	19	06037	34.05023174	-118.2154927	Los Angeles County
263361	Fee-for-Service	1003338476	1003338476	1	1	ACQUAH, ARNOLD LCSW	10/25/2022	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	16955 VANOWEN	None	VAN NUYS	CA	91406	4542	19	06037	34.19389751	-118.503342	Los Angeles County
263373	Fee-for-Service	1124106026	1124106026	1	1	ARORA, SHARAD C MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72036	41	Internal Medicine	0	In state provider	None	1035 TOMMYDON ST	None	STOCKTON	CA	95210	3363	39	06077	38.0188473	-121.2997044	San Joaquin County
263394	Fee-for-Service	1013959402	1013959402	1	1	ADULT & CHILD NEUROLOGY	4/16/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	13	Neurology (M.D. only)	0	In state provider	MEDICAL ASSOCIATES INC	2880 ATLANTIC AVE	SUITE 260	LONG BEACH	CA	90806	1714	19	06037	33.809382	-118.185001	Los Angeles County
263416	Fee-for-Service	1104836535	1104836535	1	1	ARIAS, ELIZABETH M MD	12/11/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55357	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
263434	Fee-for-Service	1609379536	1609379536	2	1	ASSIST MEDICAL SUPPLIES INC.	7/18/2019	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	5250 W CENTURY BLVD	207	LOS ANGELES	CA	90045	5972	19	06037	33.9451882	-118.371997	Los Angeles County
263453	Fee-for-Service	1841839123	1841839123	1	1	ALBERTSONS LLC	6/23/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1929 W SAN MARCOS BLVD	None	SAN MARCOS	CA	92078	3903	37	06073	33.13230673	-117.2107325	San Diego County
263460	Fee-for-Service	1730481318	1730481318	1	1	ALTAMED HEALTH SERVICES	12/14/2011	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1300 S SUNSET AVE	None	WEST COVINA	CA	91790	3342	19	06037	34.0601054	-117.9474205	Los Angeles County
263488	Fee-for-Service	1356574016	1356574016	1	1	ALAM, MOHAMMAD M MD	8/19/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	167701	08	Family Practice	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
263504	Fee-for-Service	1760830236	1760830236	1	1	ARBUCKLE-BERNSTEIN, VERONICA	2/24/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166376	08	Family Practice	0	In state provider	K MD	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
263506	Fee-for-Service	1891227906	1891227906	1	1	AMERICAN HEARING CENTER	8/2/2017	332S00000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	804 S VICTORY BLVD	SUITE A	BURBANK	CA	91502	2427	19	06037	34.16802216	-118.3095959	Los Angeles County
263515	Fee-for-Service	1265440770	1265440770	1	1	ANKUNDING, JULIA MD	5/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	69191	05	Anesthesiology	0	In state provider	None	300 HOSPITAL DR	None	VALLEJO	CA	94589	2574	48	06095	38.13070051	-122.237307	Solano County
263526	Fee-for-Service	1528726809	1528726809	1	3	ACCESS CARE ANESTHESIA OF CA	5/2/2024	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	LIFORNIA PC	6076 BRISTOL PKWY	SUITE 108	CULVER CITY	CA	90230	6600	19	06037	33.98557948	-118.3873452	Los Angeles County
263527	Fee-for-Service	1750559431	1750559431	1	2	ALL STAR PHYSICAL THERAPY, I	3/26/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	32785 TEMECULA PKWY	110	TEMECULA	CA	92592	6916	33	06065	33.48425015	-117.0858528	Riverside County
263537	Fee-for-Service	1336558485	1336558485	1	1	ARZUMANIAN, LUIZA LCSW	7/23/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	37	06073	33.12181055	-117.2840499	San Diego County
263560	Fee-for-Service	1689648511	1689648511	1	1	ADORADOR, LEONARD A PT	7/10/2018	174400000X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1676 EAST 6TH ST	None	BEAUMONT	CA	92223	2550	33	06065	33.92948188	-116.9484306	Riverside County
263567	Fee-for-Service	1699721191	1699721191	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	804 AVENIDA PICO	None	SAN CLEMENTE	CA	92672	5624	30	06059	33.44345358	-117.6145931	Orange County
263584	Fee-for-Service	1417292707	1417292707	1	1	ANGELS PEDIATRICS INC	9/17/2012	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	110082	40	Pediatrics	0	In state provider	None	1515 E ALLUVIAL AVE	STE 105	FRESNO	CA	93720	3832	10	06019	36.84470983	-119.7561692	Fresno County
263586	Fee-for-Service	1336328756	1336328756	1	1	ABCEE OPTICAL INC	8/1/2002	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	7272 W SUNSET BLVD	None	LOS ANGELES	CA	90046	3410	19	06037	34.0979755	-118.3488975	Los Angeles County
263592	Fee-for-Service	1538126735	1538126735	1	1	AFSHARI, NATALIE A MD	11/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	51849	18	Ophthalmology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
263594	Fee-for-Service	1154346161	1154346161	1	1	ALTRU HEALTH SYSTEM	1/1/1995	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	ALTRU HOSPITAL	1200 S COLUMBIA RD	None	GRAND FORKS	ND	58201	4044	00	None	47.910609	-97.06647551	Grand Forks County
263609	Fee-for-Service	1841826138	1841826138	1	1	ARTLEY, CHRISTOPHER B CRNA	5/3/2021	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
263637	Fee-for-Service	1982092029	1982092029	1	1	ABADJIAN, CAREEN L	4/12/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2405 TULARE ST	SUITE 200	FRESNO	CA	93721	2207	10	06019	36.73722057	-119.785418	Fresno County
263655	Fee-for-Service	1417626227	1417626227	1	1	A1 TRANSPORTATION SERVICES I	9/11/2021	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	NC	31080 UNION CITY BLVD	103	UNION CITY	CA	94587	2500	01	06001	37.59578558	-122.0807871	Alameda County
263689	Fee-for-Service	1952472128	1952472128	1	1	ASUNCION, ROY ALLAN Q	2/6/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
263690	Fee-for-Service	1568559102	1568559102	1	1	AHDOOT, JAHANGIR J MD	7/31/1993	174400000X	NA	Other	026	PHYSICIANS	44025	41	Internal Medicine	0	In state provider	None	16300 SAND CANYON AVE	STE 903	IRVINE	CA	92618	3709	30	06059	33.66115075	-117.7742405	Orange County
263722	Fee-for-Service	1528165008	1528165008	2	1	ARSLANIAN, SAHAG A MD	11/3/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	37370	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	318 W COLORADO STREET	SUITE 3	GLENDALE	CA	91204	1671	19	06037	34.14252447	-118.258893	Los Angeles County
263749	Fee-for-Service	1467491365	1467491365	1	1	ANTIN, CYNTHIA L MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	74159	05	Anesthesiology	0	In state provider	None	757 WESTWOOD PLAZA	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
263751	Fee-for-Service	1730481318	1730481318	1	1	ALTAMED HEALTH SERVICES	12/14/2011	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	CORPORATION	1300 S SUNSET AVE	None	WEST COVINA	CA	91790	3342	19	06037	34.0601054	-117.9474205	Los Angeles County
263760	Fee-for-Service	1356532287	1356532287	1	1	ALCANTARA, STEPHANIE LMFT	3/31/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	5755 COTTLE RD	None	SAN JOSE	CA	95123	3640	43	06085	37.246896	-121.8040865	Santa Clara County
263787	Fee-for-Service	1457375321	1457375321	1	1	AU, WILLIAM J MD	1/1/1982	2084N0400X	NA	Neurology	026	PHYSICIANS	32757	13	Neurology (M.D. only)	0	In state provider	None	PO BOX 696	None	DAVIS	CA	95617	0696	57	06113	0	0	None
263814	Fee-for-Service	1528726809	1528726809	1	3	ACCESS CARE ANESTHESIA OF CA	5/2/2024	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	LIFORNIA PC	6076 BRISTOL PKWY	SUITE 108	CULVER CITY	CA	90230	6600	19	06037	33.98557948	-118.3873452	Los Angeles County
263815	Fee-for-Service	1750559431	1750559431	1	2	ALL STAR PHYSICAL THERAPY, I	4/30/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	32785 TEMECULA PKWY	110	TEMECULA	CA	92592	6916	33	06065	33.48425015	-117.0858528	Riverside County
263836	Fee-for-Service	1932153616	1932153616	1	1	AULAKH, JASDEEP S MD	9/9/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	72469	36	Psychiatry	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
263872	Fee-for-Service	1174815484	1174815484	1	1	A.R. HINKEL CO., INC	1/27/2023	208800000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	5400 ATLANTIS COURT	None	MOORPARK	CA	93021	0000	56	06111	34.281954	-118.895041	Ventura County
263894	Fee-for-Service	1902936396	1902936396	1	1	ANDIMAN, RONALD M MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	21750	01	General Practice	0	In state provider	None	8631 W 3RD ST	STE 531E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
263896	Fee-for-Service	1073524211	1073524211	1	1	AYOUB, WALID S MD	11/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	74345	41	Internal Medicine	0	In state provider	None	202 N EUCLID ST	None	SANTA ANA	CA	92703	3006	30	06059	33.74648511	-117.9375318	Orange County
263950	Fee-for-Service	1093019051	1093019051	1	1	ALL INCLUSIVE COMMUNITY HLTH	12/1/2012	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	1311 N SAN FERNANDO BLVD	None	BURBANK	CA	91504	4236	19	06037	34.18947282	-118.3206362	Los Angeles County
263965	Fee-for-Service	1174662423	1174662423	1	1	ALLEN, DONNA R CRNA	5/12/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
263977	Fee-for-Service	1568559102	1568559102	1	1	AHDOOT, JAHANGIR J MD	7/31/1993	174400000X	NA	Other	026	PHYSICIANS	44025	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	16300 SAND CANYON AVE	STE 903	IRVINE	CA	92618	3709	30	06059	33.66115075	-117.7742405	Orange County
264011	Fee-for-Service	1518684695	1518684695	1	1	AL AMAL MEDICAL CLINIC INC.	1/13/2023	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	6766 PASSONS BLVD.	A&B	PICO RIVERA	CA	90660	3632	19	06037	33.97972571	-118.0896078	Los Angeles County
264015	Fee-for-Service	1033746680	1033746680	1	1	ALLEN, WARREN C	5/21/2020	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1631 MILL STREAM DRIVE	None	CHINO HILLS	CA	91709	1780	36	06071	33.99992014	-117.7689125	San Bernardino County
264035	Fee-for-Service	1619474558	1619474558	1	1	AHMED, SYED N	7/16/2021	213E00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	36	06071	34.47092468	-117.2977236	San Bernardino County
264069	Fee-for-Service	1306954979	1306954979	1	1	ANAGNOSTON, TAKI N MD	1/14/1970	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	MEDICAL CORPORATION	700 W 6TH ST	STE I	GILROY	CA	95020	6014	43	06085	37.00407753	-121.5779365	Santa Clara County
264078	Fee-for-Service	1871731620	1871731620	1	1	AYALA, ELVIA R LMFT	1/8/2019	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	23201 MILL CREEK DR	SUITE 220	LAGUNA HILLS	CA	92653	7906	30	06059	33.62516256	-117.7353393	Orange County
264093	Fee-for-Service	1700158060	1700158060	1	1	ARSHAKYAN, ARMEN MD	2/9/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	130429	01	General Practice	0	In state provider	None	43112 15TH STREET WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
264103	Fee-for-Service	1750559431	1750559431	1	2	ALL STAR PHYSICAL THERAPY, I	11/10/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	32785 TEMECULA PKWY	110	TEMECULA	CA	92592	6916	33	06065	33.48425015	-117.0858528	Riverside County
264106	Fee-for-Service	1538693650	1538693650	1	1	ABDELRAHIM, MARWAN MD	3/23/2021	207R00000X	NA	Other	026	PHYSICIANS	169939	None	None	0	In state provider	None	1205 E NORTH STREET	None	MANTECA	CA	95336	4932	39	06077	37.80110374	-121.1974853	San Joaquin County
264111	Fee-for-Service	1023547627	1023547627	1	1	ARBUES, FAYE S CCC-SLP	12/18/2023	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
264117	Fee-for-Service	1740204619	1740204619	1	1	ANDERSON, RICHARD G MD	3/31/1982	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	48182	30	Radiology	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
264153	Fee-for-Service	1750648374	1750648374	1	1	ANDERSON, DAVID R MD	6/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	142387	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
264177	Fee-for-Service	1902936396	1902936396	1	1	ANDIMAN, RONALD M MD	7/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	21750	13	Neurology (M.D. only)	0	In state provider	None	8631 W 3RD ST	STE 531E	LOS ANGELES	CA	90048	5901	19	06037	34.07361928	-118.3803143	Los Angeles County
264186	Fee-for-Service	1073524211	1073524211	1	1	AYOUB, WALID S MD	11/1/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	74345	10	Gastroenterology (M.D. only)	0	In state provider	None	202 N EUCLID ST	None	SANTA ANA	CA	92703	3006	30	06059	33.74648511	-117.9375318	Orange County
264213	Fee-for-Service	1750501623	1750501623	1	1	ASIF SAEED KAZMI, M.D.	11/1/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1120 STATE HIGHWAY 77	STE 1	MARION	AR	72364	9046	00	None	35.18379	-90.18405	Crittenden County
264220	Fee-for-Service	1750852802	1750852802	1	1	ANIKWEM, LOVINA	1/18/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	28032 EDDIE LANE	None	SANTA CLARITA	CA	91350	3693	19	06037	34.43987958	-118.4944108	Los Angeles County
264236	Fee-for-Service	1093019051	1093019051	1	1	ALL INCLUSIVE COMMUNITY HLTH	12/1/2012	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	1311 N SAN FERNANDO BLVD	None	BURBANK	CA	91504	4236	19	06037	34.18947282	-118.3206362	Los Angeles County
264241	Fee-for-Service	1023123288	1023123288	1	1	AHMED, SYED H MD	4/1/1999	207RH0003X	NA	Oncology	026	PHYSICIANS	54334	78	Neoplastic Diseases/Oncology	0	In state provider	None	1410 S LA BRUCHERIE RD	None	EL CENTRO	CA	92243	9676	13	06025	32.78048827	-115.578488	Imperial County
264261	Fee-for-Service	1104384601	1104384601	1	1	ADVENTIST HOSPICE CARE INC	8/4/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14549 ARCHWOOD ST	STE 202	VAN NUYS	CA	91405	4633	19	06037	34.19296379	-118.4505327	Los Angeles County
264265	Fee-for-Service	1568559102	1568559102	1	1	AHDOOT, JAHANGIR J MD	7/31/1993	174400000X	NA	Other	026	PHYSICIANS	44025	01	General Practice	0	In state provider	None	16300 SAND CANYON AVE	STE 903	IRVINE	CA	92618	3709	30	06059	33.66115075	-117.7742405	Orange County
264271	Fee-for-Service	1750559431	1750559431	1	10	ALL STAR PHYSICAL THERAPY, I	4/30/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	30141 ANTELOPE RD.	STE A	MENIFEE	CA	92584	7001	33	06065	33.68176015	-117.1680307	Riverside County
264298	Fee-for-Service	1033746680	1033746680	1	1	ALLEN, WARREN C	5/21/2020	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1631 MILL STREAM DRIVE	None	CHINO HILLS	CA	91709	1780	36	06071	33.99992014	-117.7689125	San Bernardino County
264301	Fee-for-Service	1467533737	1467533737	1	1	ASPEN FAMILY MEDICAL	3/1/2003	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	ES	1130 COFFEE RD	SUITE 10	MODESTO	CA	95355	4228	50	06099	37.65884948	-120.9755938	Stanislaus County
264311	Fee-for-Service	1497710545	1497710545	1	1	AHMAD, SAMIR A MD	4/12/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	81614	41	Internal Medicine	0	In state provider	None	38485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	33	06065	33.59408721	-117.2367937	Riverside County
264335	Fee-for-Service	1780786939	1780786939	1	1	ABBOTT, JEANNE E LCSW	12/26/2018	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3300 TULLY ROAD	SUITE C-1	MODESTO	CA	95350	0849	50	06099	37.68597355	-121.012414	Stanislaus County
264385	Fee-for-Service	1568468221	1568468221	1	1	ADVENTIST HEALTHCARE, INC	3/20/2008	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	9901 MEDICAL CENTER DR	None	ROCKVILLE	MD	20850	3357	00	None	39.09683663	-77.19664059	Montgomery County
264386	Fee-for-Service	1053579136	1053579136	1	1	AHN, ANDREW H MD INC	11/30/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	37061	02	General Surgery	0	In state provider	None	12555 GARDEN GROVE BLVD	STE 403	GARDEN GROVE	CA	92843	1903	30	06059	33.77450946	-117.913041	Orange County
264398	Fee-for-Service	1396785853	1396785853	1	1	ADAMS, ANNE M MD	3/23/2009	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	57672	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	6444 COYLE AVE	STE 3	CARMICHAEL	CA	95608	6337	34	06067	38.667807	-121.3129395	Sacramento County
264414	Fee-for-Service	1215370739	1215370739	1	1	ARMING HOME HEALTH INC	9/17/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	11565 LAUREL CANYON BLVD	SUITE 204	SAN FERNANDO	CA	91340	4651	19	06037	34.28018218	-118.4549135	Los Angeles County
264436	Fee-for-Service	1164795498	1164795498	1	1	AWDISHO, ALAN DO	1/13/2022	207R00000X	NA	Other	026	PHYSICIANS	18702	None	None	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
264445	Fee-for-Service	1184768285	1184768285	1	1	ASLANYAN, SILVA	11/1/1998	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	5122 SANTA MONICA BLVD	None	LOS ANGELES	CA	90029	2414	19	06037	34.09080056	-118.3013432	Los Angeles County
264472	Fee-for-Service	1336837442	1336837442	1	1	ALI, TAHIRA DOULA	5/12/2023	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	19	06037	0	0	None
264497	Fee-for-Service	1760970412	1760970412	1	1	AGUIRRE, ARIEL A LMFT	1/17/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2547 W SHAW AVE	STE 117	FRESNO	CA	93711	3321	10	06019	36.80804173	-119.8385565	Fresno County
264508	Fee-for-Service	1750852802	1750852802	1	1	ANIKWEM, LOVINA	1/18/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	28032 EDDIE LANE	None	SANTA CLARITA	CA	91350	3693	19	06037	34.43987958	-118.4944108	Los Angeles County
264510	Fee-for-Service	1538388038	1538388038	1	1	ANTIOCH ICF, INC	5/24/2004	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	FRANCISCO ICF	3359 S FRANCISCO WAY	None	ANTIOCH	CA	94509	5434	07	06013	37.98787959	-121.8243542	Contra Costa County
264511	Fee-for-Service	1316717135	1316717135	1	1	AVILA, VRINDAVANI BIRTH DOU	1/23/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	34	06067	0	0	None
264527	Fee-for-Service	1639343122	1639343122	1	1	A LINN MEDICAL PRACTICE	4/6/2010	261QM2500X	NA	Other	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	4000 SAN DIMAS ST	SUITE 2	BAKERSFIELD	CA	93301	1297	15	06029	35.396451	-119.0081525	Kern County
264547	Fee-for-Service	1104384601	1104384601	1	1	ADVENTIST HOSPICE CARE INC	8/4/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14549 ARCHWOOD ST	STE 202	VAN NUYS	CA	91405	4633	19	06037	34.19296379	-118.4505327	Los Angeles County
264550	Fee-for-Service	1710574827	1710574827	1	1	AL-SAYYED, AMANY A LCSW	2/8/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
264560	Fee-for-Service	1750559431	1750559431	1	10	ALL STAR PHYSICAL THERAPY, I	3/26/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	30141 ANTELOPE RD.	STE A	MENIFEE	CA	92584	7001	33	06065	33.68176015	-117.1680307	Riverside County
264563	Fee-for-Service	1770298754	1770298754	1	1	AVILA, NIKKI CD	3/3/2024	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	15	06029	0	0	None
264592	Fee-for-Service	1528557535	1528557535	1	1	ABDELSHAHED, MANAL F MD	6/3/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	173578	None	None	0	In state provider	None	498 W 4TH ST	None	PERRIS	CA	92570	2070	33	06065	33.78237192	-117.2367068	Riverside County
264613	Fee-for-Service	1356737282	1356737282	1	1	ALIPANAH-LECHNER, NARGES MD	9/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	146544	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVENUE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
264618	Fee-for-Service	1437114113	1437114113	1	1	ABDULIAN, JOHN D MD	7/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	65550	10	Gastroenterology (M.D. only)	0	In state provider	None	7095 N CHESTNUT AVENUE	SUITE 101	FRESNO	CA	93720	0360	10	06019	36.83995818	-119.7370077	Fresno County
264628	Fee-for-Service	1295787323	1295787323	1	1	AOKI,STEPHEN K MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	100 MARIO CAPECCHI DR	STE 4550	SALT LAKE CITY	UT	84113	1103	00	None	40.77048596	-111.8394574	Salt Lake County
264632	Fee-for-Service	1245500396	1245500396	1	1	ASHOK, SEETHARAMAN MD PC	10/25/2012	208800000X	NA	Other	026	PHYSICIANS	54457	None	None	0	In state provider	None	452 GRANGEVILLE BLVD	None	HANFORD	CA	93230	2856	16	06031	36.34270348	-119.6513325	Kings County
264658	Fee-for-Service	1568958437	1568958437	1	1	AVINA, BIANCA LMFT	6/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1705 WASHINGTON ST.	L	CALISTOGA	CA	94515	1134	28	06055	38.58103065	-122.5840216	Napa County
264661	Fee-for-Service	1356684096	1356684096	1	1	AL YASEEN, SAIF MD	8/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141962	None	None	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
264673	Fee-for-Service	1568468221	1568468221	1	1	ADVENTIST HEALTHCARE, INC	3/20/2008	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	9901 MEDICAL CENTER DR	None	ROCKVILLE	MD	20850	3357	00	None	39.09683663	-77.19664059	Montgomery County
264700	Fee-for-Service	1811006943	1811006943	1	1	ASWANI, MOHINI MD	10/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	39062	None	None	0	In state provider	None	3737 MARTIN LUTHER KING	STE 205	LYNWOOD	CA	90262	3527	19	06037	33.92872742	-118.2006921	Los Angeles County
264728	Fee-for-Service	1801909668	1801909668	1	1	ADULT & CHILD ALLERGY-ASTHMA	5/24/2019	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	CLINIC INC	1850 S AZUSA AVE STE 206	None	HACIENDA HEIGHTS	CA	91745	6853	19	06037	33.98895597	-117.9322797	Los Angeles County
264759	Fee-for-Service	1275700361	1275700361	1	1	ANDERSON, KENTON L MD	1/20/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	129952	66	Emergency Medicine (Urgent Care)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
264770	Fee-for-Service	1093972713	1093972713	1	1	ALFONSO GARCIA-BELLO M.D.	5/9/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2776 CLEVELAND AVE	None	FORT MYERS	FL	33901	5864	00	None	26.628237	-81.873945	Lee County
264779	Fee-for-Service	1184078362	1184078362	1	1	AQUINO, JANNELLE J DO	11/1/2019	207P00000X	NA	Other	026	PHYSICIANS	15929	66	Emergency Medicine (Urgent Care)	0	In state provider	None	27300 IRIS AVE	None	MORENO VALLEY	CA	92555	4802	33	06065	33.89552551	-117.186021	Riverside County
264848	Fee-for-Service	1750559431	1750559431	1	10	ALL STAR PHYSICAL THERAPY, I	3/26/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	30141 ANTELOPE RD.	STE A	MENIFEE	CA	92584	7001	33	06065	33.68176015	-117.1680307	Riverside County
264858	Fee-for-Service	1114626017	1114626017	1	1	ANAHEIM EMERGENCY MEDICAL GR	5/1/2023	207P00000X	NA	Other	022	PHYSICIANS GROUP	-	66	Emergency Medicine (Urgent Care)	0	In state provider	OUP	1111 LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
264903	Fee-for-Service	1558804633	1558804633	1	1	ARANOVICH, LINA R LMFT	10/27/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
264925	Fee-for-Service	1659835163	1659835163	1	1	ASAP HOME HEALTH CARE INC	7/20/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	227 N CENTRAL AVE	SUITE 506	GLENDALE	CA	91203	3558	19	06037	34.14910181	-118.2579537	Los Angeles County
264979	Fee-for-Service	1043656911	1043656911	1	1	AMACK, ANDREW J MD	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143039	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	48	06095	38.26109552	-122.0470245	Solano County
265030	Fee-for-Service	1184670002	1184670002	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	189 NIBLICK RD	None	PASO ROBLES	CA	93446	4845	40	06079	35.61505753	-120.6811935	San Luis Obispo County
265048	Fee-for-Service	1639187057	1639187057	1	1	ADAMSON, THOMAS C MD	1/1/1982	207RR0500X	NA	Other	026	PHYSICIANS	41599	66	Emergency Medicine (Urgent Care)	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
265066	Fee-for-Service	1235897877	1235897877	1	1	ANGELS CARE HOME HEALTH	4/5/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY	125 E BARSTOW AVE	STE 113	FRESNO	CA	93710	5023	10	06019	36.81570455	-119.787651	Fresno County
265100	Fee-for-Service	1629057229	1629057229	1	1	AHS HILLCREST MEDICAL	3/27/2018	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER LLC	1120 S UTICA AVE	None	TULSA	OK	74104	4060	00	None	36.14680804	-95.96713336	Tulsa County
265112	Fee-for-Service	1215095674	1215095674	1	1	ANDERSEN, DOUGLAS E	1/31/1992	231H00000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	1801 21ST ST	STE 4	BAKERSFIELD	CA	93301	3930	15	06029	35.37812255	-119.0226915	Kern County
265130	Fee-for-Service	1184195372	1184195372	1	1	ADVENTIST HEALTH PHYSICIANS	9/17/2019	231H00000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1165 S DORA ST	STE B2	UKIAH	CA	95482	6353	23	06045	39.13602308	-123.2095502	Mendocino County
265132	Fee-for-Service	1356379283	1356379283	1	1	AVGERIS, ARISTIDES C MD	5/18/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153293	None	None	0	In state provider	None	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	42	06083	34.42967671	-119.7228362	Santa Barbara County
265182	Fee-for-Service	1679914287	1679914287	1	1	ANSTETT, MELISSA J OD	5/16/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9201 BIG HORN BLVD	None	ELK GROVE	CA	95758	1240	34	06067	38.425365	-121.4068185	Sacramento County
265224	Fee-for-Service	1386990364	1386990364	1	1	ALLIANCE MEDICAL SUPPLY	10/18/2013	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	12601 SAN FERNANDO RD	STE F	SYLMAR	CA	91342	7733	19	06037	34.29834877	-118.4581767	Los Angeles County
265248	Fee-for-Service	1881910636	1881910636	1	1	ALEXANDER GORNY, M.D.	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1 HEALTHY WAY	None	OCEANSIDE	NY	11572	1551	00	None	40.651299	-73.63107	Nassau County
265268	Fee-for-Service	1376749861	1376749861	1	1	ALEMOZAFFAR, MEHRDAD MD	12/24/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124585	34	Urology and Urological Surgery	0	In state provider	None	1441 EASTLAKE AVENUE	None	LOS ANGELES	CA	90089	0112	19	06037	34.06169385	-118.2044698	Los Angeles County
265296	Fee-for-Service	1679127716	1679127716	1	1	ANDERSEN, CRYSTAL A CCC-SLP	5/16/2020	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
265305	Fee-for-Service	1427248988	1427248988	1	1	ALIKHAN, MIRZA A MD	10/9/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149786	07	Dermatology	0	In state provider	None	1020 29TH STREET	SUITE 570	SACRAMENTO	CA	95816	5125	34	06067	38.572803	-121.4685	Sacramento County
265333	Fee-for-Service	1639187057	1639187057	1	1	ADAMSON, THOMAS C MD	1/1/1982	207RR0500X	NA	Other	026	PHYSICIANS	41599	83	Rheumatology	0	In state provider	None	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	37	06073	32.89687721	-117.2418677	San Diego County
265338	Fee-for-Service	1790064517	1790064517	1	1	ACUTE RESCUE AND TRANSPORT	1/22/2014	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1104 W DUNDEE ST	# B	BOISE	ID	83706	4118	00	None	43.58574148	-116.1952529	Ada County
265354	Fee-for-Service	1245791979	1245791979	1	1	AURORA HOME HEALTH INC	5/20/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	18341 SHERMAN WAY	SUITE 107	RESEDA	CA	91335	4499	19	06037	34.20120746	-118.533105	Los Angeles County
265385	Fee-for-Service	1598196396	1598196396	1	2	AKHAVON, FARIBA MD PC	2/15/2014	193400000X	NA	Other	026	PHYSICIANS	112198	08	Family Practice	0	In state provider	None	316 WEST ACEQUIA AVE	None	VISALIA	CA	93291	6232	54	06107	36.329364	-119.295396	Tulare County
265387	Fee-for-Service	1629057229	1629057229	1	1	AHS HILLCREST MEDICAL	10/21/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CENTER LLC	1120 S UTICA AVE	None	TULSA	OK	74104	4060	00	None	36.14680804	-95.96713336	Tulsa County
265413	Fee-for-Service	1063569226	1063569226	1	1	AUERBACH, BURT J MD	5/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	39139	20	Orthopedic Surgery	0	In state provider	None	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	07	06013	38.00771973	-122.1331484	Contra Costa County
265456	Fee-for-Service	1578120929	1578120929	1	1	AGAPEHEART HOME HEALTH	8/16/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES LLC	15900 HAWTHORNE BLVD	SUITE 100	LAWNDALE	CA	90260	2644	19	06037	33.8863827	-118.352343	Los Angeles County
265490	Fee-for-Service	1801171947	1801171947	1	1	ARCHER, KENDRA LCSW	10/15/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
265499	Fee-for-Service	1730256645	1730256645	1	1	AMBROSINI, VIRGINIA L MD	9/30/1984	207R00000X	NA	Other	026	PHYSICIANS	53964	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
265524	Fee-for-Service	1487710968	1487710968	1	1	AKBARNEJAD-OSHAGH, AZIN MD	2/5/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	77941	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
265542	Fee-for-Service	1750559431	1750559431	1	21	ALL STAR PHYSICAL THERAPY, I	3/11/2022	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	1630 W REDLANDS BLVD.	SUITE L	REDLANDS	CA	92373	8032	36	06071	34.06293049	-117.2104992	San Bernardino County
265547	Fee-for-Service	1285043141	1285043141	1	1	ATHOME HEALTHCARE TEAM LLC	5/8/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	100 TOWER ROAD	SUITE 15	AMERICAN CANYON	CA	94503	3164	28	06055	38.21150599	-122.2572239	Napa County
265564	Fee-for-Service	1699756700	1699756700	1	1	ASPIRE HOME HEALTHCARE	12/8/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	5830 OBERLIN DRIVE	SUITE 200	SAN DIEGO	CA	92121	3042	37	06073	32.89419479	-117.1931293	San Diego County
265572	Fee-for-Service	1164566717	1164566717	1	1	AHMADINIA, REZA MD INC	3/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85204	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	18112 OUTER HWY 18	STE 101	APPLE VALLEY	CA	92307	0840	36	06071	34.54079736	-117.2688963	San Bernardino County
265586	Fee-for-Service	1144699588	1144699588	1	1	ARREDONDO, JOANNA LCSW	3/17/2022	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4221 WILSHIRE BLVD	STE 170-16	LOS ANGELES	CA	90010	3519	19	06037	34.06177566	-118.320844	Los Angeles County
265592	Fee-for-Service	1356481733	1356481733	1	1	ABUAV, RACHEL MD	1/7/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	99028	07	Dermatology	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
265607	Fee-for-Service	1992799787	1992799787	1	1	A1 DIABETES & MEDICAL SUPPLY	2/25/2014	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	None	1785 NONCONNAH BOULEVARD	SUITE 110	MEMPHIS	TN	38132	2140	00	None	35.07157054	-90.00365315	Shelby County
265613	Fee-for-Service	1215287966	1215287966	1	1	APOTHERA INC	11/18/2013	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	45 POST ST	#B	IRVINE	CA	92618	5216	30	06059	33.67874201	-117.7673508	Orange County
265626	Fee-for-Service	1821438805	1821438805	1	1	ATTARIPOURISFAHANI, SANAZ M	1/9/2020	390200000X	NA	Other	026	PHYSICIANS	163059	13	Neurology (M.D. only)	0	In state provider	D	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
265628	Fee-for-Service	1487005732	1487005732	1	1	ARAKELYAN, VIGEN A MD	9/22/2020	207L00000X	NA	Other	026	PHYSICIANS	158433	05	Anesthesiology	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
265644	Fee-for-Service	1205257284	1205257284	1	1	AAB, KATIE LMFT	6/23/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	41 E FOOTHILL BLVD	SUITE 102	ARCADIA	CA	91006	2361	19	06037	34.15102394	-118.0297543	Los Angeles County
265704	Fee-for-Service	1225084247	1225084247	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	41000 CALIFORNIA OAKS RD	None	MURRIETA	CA	92562	5749	33	06065	33.566922	-117.203733	Riverside County
265709	Fee-for-Service	1528562469	1528562469	1	1	ALLEN, ROBERT I MD	7/5/2022	207P00000X	NA	Other	026	PHYSICIANS	175779	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
265741	Fee-for-Service	1720265754	1720265754	1	1	AZHARUDDIN, TAHERA MD	10/11/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	170019	None	None	0	In state provider	None	7111 N FRESNO ST	STE. 200	FRESNO	CA	93720	2965	10	06019	36.83951763	-119.7815709	Fresno County
265782	Fee-for-Service	1700822160	1700822160	1	1	ALSAMMAN, MOUNZER MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	50016	10	Gastroenterology (M.D. only)	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
265810	Fee-for-Service	1811972847	1811972847	1	1	AREVALO, PABLO A MD	8/31/1987	2084N0400X	NA	Neurology	026	PHYSICIANS	44797	13	Neurology (M.D. only)	0	In state provider	None	3400 E FLORENCE AVE	STE A	HUNTINGTON PARK	CA	90255	5835	19	06037	33.97216076	-118.2058415	Los Angeles County
265823	Fee-for-Service	1013116128	1013116128	1	1	ALAN WU	2/12/2020	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	120 KAIULANI AVE	UNIT 10 & 11	HONOLULU	HI	96815	6203	00	None	21.27705388	-157.825421	Honolulu County
265826	Fee-for-Service	1750559431	1750559431	1	21	ALL STAR PHYSICAL THERAPY, I	3/11/2022	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	1630 W REDLANDS BLVD.	SUITE L	REDLANDS	CA	92373	8032	36	06071	34.06293049	-117.2104992	San Bernardino County
265854	Fee-for-Service	1093551343	1093551343	1	1	ALKIMIYA SURGICAL SYSTEMS, P	10/2/2024	208C00000X	NA	General Surgery	026	PHYSICIANS	None	28	Proctology (colon and rectal)	0	In state provider	C	455 OCONNOR DR	STE 270	SAN JOSE	CA	95128	1644	43	06085	37.326654	-121.939897	Santa Clara County
265859	Fee-for-Service	1164566717	1164566717	1	1	AHMADINIA, REZA MD INC	3/1/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	85204	01	General Practice	0	In state provider	None	18112 OUTER HWY 18	STE 101	APPLE VALLEY	CA	92307	0840	36	06071	34.54079736	-117.2688963	San Bernardino County
265880	Fee-for-Service	1023250545	1023250545	1	1	ADVANCED SLEEP MEDICINE SRVS	2/14/2011	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	299 W HILLCREST DRIVE	# 106	THOUSAND OAKS	CA	91360	4264	56	06111	34.18347138	-118.8843918	Ventura County
265883	Fee-for-Service	1891735643	1891735643	1	1	ADAMS, DAVID A MD	10/31/1985	No Taxonomy Provided	NA	None	026	PHYSICIANS	48321	None	None	0	In state provider	None	2800 BENEDICT DR	None	SAN LEANDRO	CA	94577	6840	01	06001	37.71593435	-122.131151	Alameda County
265898	Fee-for-Service	1457303760	1457303760	1	2	ANTHONY MOSLEY M.D.	2/6/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	68423	None	None	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
265899	Fee-for-Service	1033415138	1033415138	1	1	A1 SPEECH THERAPY INC	7/28/2016	261QH0700X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 CAMARILLO RANCH ROAD	SUITE 209	CAMARILLO	CA	93012	5903	56	06111	34.220943	-119.0186825	Ventura County
265901	Fee-for-Service	1255727178	1255727178	1	1	ANGELIC HOME HEALTH CARE LLC	11/16/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	22141 VENTURA BLVD	209	WOODLAND HILLS	CA	91364	5724	19	06037	34.16866225	-118.6095572	Los Angeles County
265909	Fee-for-Service	1821820978	1821820978	1	1	ALVI, TALHAH PHD	9/1/2024	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
265936	Fee-for-Service	1114429719	1114429719	1	1	ADIMORAH, ADAOBI M NP	3/17/2023	163W00000X	NA	Other	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1225 W 190TH ST	SUITE 280	GARDENA	CA	90248	4305	19	06037	33.85835623	-118.2987754	Los Angeles County
265946	Fee-for-Service	1184783706	1184783706	1	1	AHMED, TAREK E MD	5/31/1995	207R00000X	NA	Other	026	PHYSICIANS	60398	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
265956	Fee-for-Service	1003201450	1003201450	1	1	ARYAL, BARUN MD	7/13/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	172629	None	None	0	In state provider	None	1303 E HERNDON AVE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
266041	Fee-for-Service	1306617139	1306617139	1	1	ALDRICH, KEVIN CRNA	2/19/2025	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	465 PUTNAM AVE	None	PORTERVILLE	CA	93257	3320	54	06107	36.06953472	-119.0273379	Tulare County
266054	Fee-for-Service	1619487287	1619487287	1	2	ALLIED PSYCHOLOGICAL SERVICE	3/6/2020	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	S, P.C.	23 CORPORATE PLAZA DR	STE 150	NEWPORT BEACH	CA	92660	7908	30	06059	33.6090297	-117.8748261	Orange County
266071	Fee-for-Service	1700822160	1700822160	1	1	ALSAMMAN, MOUNZER MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	50016	08	Family Practice	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
266077	Fee-for-Service	1215126438	1215126438	1	1	ARCADIA CA ENDOSCOPY ASC	3/31/2006	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	LP	488 E SANTA CLARA ST	STE 102	ARCADIA	CA	91006	7230	19	06037	34.14235063	-118.0211625	Los Angeles County
266080	Fee-for-Service	1427315522	1427315522	1	1	AGHAJANOVA, LUSINE MD	6/28/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	124941	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	300 PASTEUR DRIVE	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
266105	Fee-for-Service	1205889698	1205889698	1	1	ALBERS, GREGORY W MD	3/31/1987	2084N0400X	NA	Neurology	026	PHYSICIANS	55661	13	Neurology (M.D. only)	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
266108	Fee-for-Service	1871670703	1871670703	1	1	AYYAR, RAJESHWARI MD	11/30/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	42666	01	General Practice	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
266128	Fee-for-Service	1093807661	1093807661	1	1	ALZHEIMER'S FAMILY SERVICES	9/7/1994	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CENTER	9451 INDIANAPOLIS AVE	None	HUNTINGTON BEACH	CA	92646	5955	30	06059	33.66506176	-117.9628967	Orange County
266129	Fee-for-Service	1558375022	1558375022	1	1	AGUINIGA, ELSA M MD	10/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	65743	45	Nephrology (Renal-Kidney)	0	In state provider	None	1414 S GRAND AVE	STE 385	LOS ANGELES	CA	90015	3072	19	06037	34.03661142	-118.2657227	Los Angeles County
266140	Fee-for-Service	1093551343	1093551343	1	1	ALKIMIYA SURGICAL SYSTEMS, P	10/2/2024	208C00000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	C	455 OCONNOR DR	STE 270	SAN JOSE	CA	95128	1644	43	06085	37.326654	-121.939897	Santa Clara County
266184	Fee-for-Service	1558433375	1558433375	1	1	AMBROSE, MARYALICE N MD	10/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94922	13	Neurology (M.D. only)	0	In state provider	None	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
266188	Fee-for-Service	1538206388	1538206388	1	1	ANGEL VIEW INC	6/23/1993	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	30400 DESERT PALM DR	None	THOUSAND PALMS	CA	92276	4339	33	06065	33.82799434	-116.3807084	Riverside County
266251	Fee-for-Service	1700081502	1700081502	1	1	ALWATTAR, BASIL J MD	10/29/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	112912	20	Orthopedic Surgery	0	In state provider	None	80 GRAND AVE	5TH FLOOR	OAKLAND	CA	94612	3725	01	06001	37.81147674	-122.2656076	Alameda County
266255	Fee-for-Service	1154598183	1154598183	1	1	AFSHINNIK, ARASH MD	9/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	126403	13	Neurology (M.D. only)	0	In state provider	None	2335 E KASHIAN LN	STE 301	FRESNO	CA	93701	2234	10	06019	36.74333844	-119.7831874	Fresno County
266273	Fee-for-Service	1497833974	1497833974	1	1	ALSPAUGH, DAHLIA M MD	5/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94450	33	Thoracic Surgery	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
266282	Fee-for-Service	1356110092	1356110092	1	2	AESTHETIC EYE CARE	7/2/2024	261QS0132X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	805 AEROVISTA PL	109	SAN LUIS OBISPO	CA	93401	7919	40	06079	35.24101691	-120.643055	San Luis Obispo County
266297	Fee-for-Service	1649223017	1649223017	1	1	AL-MUFTI, HASEEB I MD	3/1/1984	174400000X	NA	Other	026	PHYSICIANS	37195	01	General Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
266317	Fee-for-Service	1982237947	1982237947	1	1	AGREDANO, EDUARDO PT	6/24/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	25285 MADISON AVE	SUITE 103	MURRIETA	CA	92562	8981	33	06065	33.55369902	-117.1965543	Riverside County
266355	Fee-for-Service	1700822160	1700822160	1	1	ALSAMMAN, MOUNZER MD	5/31/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	50016	66	Emergency Medicine (Urgent Care)	0	In state provider	None	770 MASON ST	None	VACAVILLE	CA	95688	4646	48	06095	38.35504697	-121.983852	Solano County
266373	Fee-for-Service	1346222379	1346222379	1	1	ALTSHULER, JEFFREY M MD	12/30/2019	208G00000X	NA	General Surgery	026	PHYSICIANS	165944	33	Thoracic Surgery	0	In state provider	None	24411 HEALTH CENTER DR	STE 680	LAGUNA HILLS	CA	92653	3692	30	06059	33.6087201	-117.7076948	Orange County
266396	Fee-for-Service	1902880479	1902880479	1	1	AIDS HEALTHCARE	1/25/1991	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	HOLLYWOOD	4905 HOLLYWOOD BLVD	# 407	LOS ANGELES	CA	90027	6101	19	06037	34.10180109	-118.2963991	Los Angeles County
266414	Fee-for-Service	1093807661	1093807661	1	1	ALZHEIMER'S FAMILY SERVICES	5/15/2014	No Taxonomy Provided	NA	None	095	PRIVATE NON-PROFIT PROPRIETARY AGENCY	-	-	NOT APPLICABLE	0	In state provider	CENTER	9451 INDIANAPOLIS AVE	None	HUNTINGTON BEACH	CA	92646	5955	30	06059	33.66506176	-117.9628967	Orange County
266415	Fee-for-Service	1558375022	1558375022	1	1	AGUINIGA, ELSA M MD	10/3/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	65743	41	Internal Medicine	0	In state provider	None	1414 S GRAND AVE	STE 385	LOS ANGELES	CA	90015	3072	19	06037	34.03661142	-118.2657227	Los Angeles County
266430	Fee-for-Service	1558479212	1558479212	1	1	ADVOCATE HEALTH & HOSP	8/24/2001	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2320 E 93RD ST	None	CHICAGO	IL	60617	3983	00	None	41.72626686	-87.56715623	Cook County
266449	Fee-for-Service	1346489077	1346489077	1	1	ABRAMS, GLENN L LMFT	7/30/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	133 E BONITA AVE	STE 205	SAN DIMAS	CA	91773	3098	19	06037	34.1067035	-117.806076	Los Angeles County
266483	Fee-for-Service	1598298614	1598298614	1	1	AGARWAL, ANUJ K MD	7/18/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	FIVE MEDICAL PLAZA	STE 190	ROSEVILLE	CA	95661	2865	31	06061	38.76523677	-121.2493453	Placer County
266495	Fee-for-Service	1912317421	1912317421	2	1	AFTAB, FAHAD MD	5/18/2023	207R00000X	NA	Other	026	PHYSICIANS	151256	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
266510	Fee-for-Service	1407915606	1407915606	1	1	ARACOLA INC	9/11/1998	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	411 N CENTRAL AVE	STE 100	GLENDALE	CA	91203	2082	19	06037	34.15248444	-118.2579448	Los Angeles County
266511	Fee-for-Service	1558326629	1558326629	1	1	AOKI, ANDY A MD	12/17/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	170088	None	None	0	In state provider	None	1800 NORTH CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
266512	Fee-for-Service	1568925931	1568925931	1	1	AKBAR, CYRUS LMFT	10/25/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18191 VON KARMAN AVE	100	IRVINE	CA	92612	7103	30	06059	33.67831005	-117.852138	Orange County
266517	Fee-for-Service	1952598930	1952598930	1	1	ABSOLUTE CONTROL	3/7/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	TRANSITIONAL COUNSELING	3111 WINONA AVE	SUITE 201	BURBANK	CA	91504	2538	19	06037	34.19929449	-118.34496	Los Angeles County
266526	Fee-for-Service	1598892044	1598892044	1	1	ADVENT GROUP MINISTRIES, INC	1/22/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	90 GREAT OAKS BLVD	SUITE 108	SAN JOSE	CA	95119	1314	43	06085	37.23371405	-121.7789601	Santa Clara County
266559	Fee-for-Service	1497833974	1497833974	1	1	ALSPAUGH, DAHLIA M MD	5/30/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	94450	01	General Practice	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
266563	Fee-for-Service	1144915661	1144915661	1	1	AUSTRIA, DIONNE MELODY M CNP	6/11/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2650 JONES WAY	SUITE 9	SIMI VALLEY	CA	93065	1203	56	06111	34.28861251	-118.745991	Ventura County
266567	Fee-for-Service	1356110092	1356110092	1	2	AESTHETIC EYE CARE	7/2/2024	261QS0132X	NA	Other	022	PHYSICIANS GROUP	-	20	Orthopedic Surgery	0	In state provider	None	805 AEROVISTA PL	109	SAN LUIS OBISPO	CA	93401	7919	40	06079	35.24101691	-120.643055	San Luis Obispo County
266568	Fee-for-Service	1184723157	1184723157	1	1	AGUILAR, DAVID C MD	11/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	91201	None	None	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
266569	Fee-for-Service	1700815362	1700815362	1	1	AYLOR,MEGAN E MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3181 SW SAM JACKSON PK	RD	PORTLAND	OR	97239	0000	00	None	45.49936609	-122.6856232	Multnomah County
266575	Fee-for-Service	1417903428	1417903428	1	1	AMAYA, ZEDA GLASS	12/31/1989	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	48390	01	General Practice	0	In state provider	None	9985 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.07253232	-117.4356028	San Bernardino County
266581	Fee-for-Service	1043385289	1043385289	1	1	AMINIAN, ABDOLKARIM K MD	7/31/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	48107	13	Neurology (M.D. only)	0	In state provider	None	8920 WILSHIRE BLVD	STE 548	BEVERLY HILLS	CA	90211	1949	19	06037	34.06703599	-118.3863456	Los Angeles County
266588	Fee-for-Service	1215324645	1215324645	1	1	ADAMS, CHELSEA L	4/29/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE ROAD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
266623	Fee-for-Service	1578643482	1578643482	1	1	AMY GEROSO	7/29/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1078 S 300 EAST	None	SALT LAKE CTY	UT	84111	4638	00	None	40.745214	-111.884454	Salt Lake County
266680	Fee-for-Service	1265419154	1265419154	1	1	ALKALAY, ARIE L MD	10/8/1991	174400000X	NA	Other	026	PHYSICIANS	42154	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
266712	Fee-for-Service	1558479212	1558479212	1	1	ADVOCATE HEALTH & HOSP	8/24/2001	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	2320 E 93RD ST	None	CHICAGO	IL	60617	3983	00	None	41.72626686	-87.56715623	Cook County
266736	Fee-for-Service	1669887592	1669887592	1	1	AMAVI HOME HEALTH AND	3/20/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	HOSPICE CARE SERVICES	131 SAND CREEK RD	SUITE J	BRENTWOOD	CA	94513	7302	07	06013	37.94676716	-121.6989995	Contra Costa County
266745	Fee-for-Service	1861742991	1861742991	1	1	AHURA HEALTHCARE CORPORATION	5/26/2019	261QP3300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	1307 WEST SIXTH STREET	105	CORONA	CA	92882	3294	33	06065	33.87790309	-117.589666	Riverside County
266757	Fee-for-Service	1881821270	1881821270	1	1	ANTONSON, KRISTINA M MD	11/25/2015	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	113832	-	NOT APPLICABLE	0	In state provider	None	4343 WILLIAMSBOURGH DR	None	SACRAMENTO	CA	95823	2006	34	06067	38.498202	-121.457682	Sacramento County
266766	Fee-for-Service	1598298614	1598298614	1	1	AGARWAL, ANUJ K MD	7/18/2024	207RP1001X	NA	Pulmonology	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	FIVE MEDICAL PLAZA	STE 190	ROSEVILLE	CA	95661	2865	31	06061	38.76523677	-121.2493453	Placer County
266794	Fee-for-Service	1972673879	1972673879	1	1	AHN, JENNIFER MD	7/25/2019	207VM0101X	NA	Obstetrics & Gynecology	026	PHYSICIANS	160026	15	Obstetrics (D.O. only)	0	In state provider	None	7901 FROST ST	None	SAN DIEGO	CA	92123	2701	37	06073	32.8002375	-117.1546269	San Diego County
266875	Fee-for-Service	1811193618	1811193618	1	1	APEX HEALTHCARE MEDICAL	12/10/2010	174400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	391 N SAN JACINTO ST	None	HEMET	CA	92543	3118	33	06065	33.752565	-116.958687	Riverside County
266914	Fee-for-Service	1518493626	1518493626	1	1	AGARWAL, SHIVALI MD	1/10/2024	207QH0002X	NA	Adult Primary Care	026	PHYSICIANS	165102	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
266956	Fee-for-Service	1417488941	1417488941	1	1	AN, LUCIA S MD	7/25/2020	2251P0200X	NA	Physical Therapist	026	PHYSICIANS	158092	None	None	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
267008	Fee-for-Service	1558348318	1558348318	1	1	AMERICAN MEDFLIGHT INC	7/1/2000	3416A0800X	NA	Other	038	AIR AMBULANCE TRANSPORTATION SERVICES	-	-	NOT APPLICABLE	1	Border provider	None	485 S ROCK BLVD	None	RENO	NV	89502	4171	00	None	39.50767523	-119.7636152	Washoe County
267011	Fee-for-Service	1457499725	1457499725	1	1	ALL SOUTH BAY FOOTCARE	2/15/1983	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	PODIATRY GROUP INC	23365 HAWTHORNE BLVD	STE 101	TORRANCE	CA	90505	3720	19	06037	33.814098	-118.3512385	Los Angeles County
267028	Fee-for-Service	1861742991	1861742991	1	1	AHURA HEALTHCARE CORPORATION	5/15/2020	261QP3300X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	1307 WEST SIXTH STREET	105	CORONA	CA	92882	3294	33	06065	33.87790309	-117.589666	Riverside County
267047	Fee-for-Service	1689675498	1689675498	1	1	AL-MARAYATI, LAILA MD	10/1/2007	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	66786	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	1500-30 S OLIVE ST	None	LOS ANGELES	CA	90015	3023	19	06037	34.03568676	-118.2649769	Los Angeles County
267067	Fee-for-Service	1780703785	1780703785	1	2	ABLE HANDS, INC	2/8/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	18780 AMAR ROAD	SUITE 207	WALNUT	CA	91789	4559	19	06037	34.02807335	-117.8924765	Los Angeles County
267107	Fee-for-Service	1598213985	1598213985	1	1	ADU, ALEXANDER NP	11/10/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3610 CENTRAL AVE	SUITE 500	RIVERSIDE	CA	92506	5900	33	06065	33.95352247	-117.3917745	Riverside County
267119	Fee-for-Service	1518166651	1518166651	1	1	ALEJANDRO-WRIGHT, MARGUERITE	4/14/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	PSYD	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
267167	Fee-for-Service	1093833360	1093833360	1	1	APPLEBAUM, SAMUEL A MD	5/18/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96395	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300	SACRAMENTO	CA	95816	5241	34	06067	38.570076	-121.4657145	Sacramento County
267172	Fee-for-Service	1215067194	1215067194	1	1	AGAMYAN, RUZANNA PHD	6/4/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	275 VICTORIA STREET	SUITE 2A	COSTA MESA	CA	92627	1906	30	06059	33.6526055	-117.910746	Orange County
267177	Fee-for-Service	1598781403	1598781403	1	1	ANDERSEN, STEVEN C MD	7/27/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	76308	18	Ophthalmology	0	In state provider	None	38707 STIVERS ST	STE B	FREMONT	CA	94536	5337	01	06001	37.55702808	-121.9835466	Alameda County
267215	Fee-for-Service	1316569973	1316569973	1	1	ALTUS HOSPICE INC	7/29/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11490 BURBANK BLVD	STE 3D	NORTH HOLLYWOOD	CA	91601	2385	19	06037	34.17212154	-118.3819905	Los Angeles County
267289	Fee-for-Service	1891185955	1891185955	1	1	AZEVEDO, ERICA LMFT	8/30/2020	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
267311	Fee-for-Service	1861742991	1861742991	1	1	AHURA HEALTHCARE CORPORATION	10/14/2019	261QP3300X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1307 WEST SIXTH STREET	105	CORONA	CA	92882	3294	33	06065	33.87790309	-117.589666	Riverside County
267353	Fee-for-Service	1881056026	1881056026	1	1	AVILA, VANESA MD	4/14/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	157887	15	Obstetrics (D.O. only)	0	In state provider	None	1101 N CHERRY ST	None	TULARE	CA	93274	2231	54	06107	36.22333808	-119.337575	Tulare County
267478	Fee-for-Service	1376629261	1376629261	1	1	ALI, UZMA R MD INC	11/7/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	56304	40	Pediatrics	0	In state provider	None	16465 SIERRA LAKES PKWY	STE 240	FONTANA	CA	92336	1242	36	06071	34.13805177	-117.4457839	San Bernardino County
267498	Fee-for-Service	1316569973	1316569973	1	1	ALTUS HOSPICE INC	7/29/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11490 BURBANK BLVD	STE 3D	NORTH HOLLYWOOD	CA	91601	2385	19	06037	34.17212154	-118.3819905	Los Angeles County
267532	Fee-for-Service	1740095207	1740095207	1	1	ALVARADO, KATHY PT	3/6/2025	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1090 N PALM CANYON DR	STE D	PALM SPRINGS	CA	92262	4439	33	06065	33.83736372	-116.5467476	Riverside County
267561	Fee-for-Service	1811972565	1811972565	1	1	ADRANGI, BAHBAK	6/1/2010	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
267595	Fee-for-Service	1861742991	1861742991	1	1	AHURA HEALTHCARE CORPORATION	10/30/2023	261QP3300X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	1307 WEST SIXTH STREET	105	CORONA	CA	92882	3294	33	06065	33.87790309	-117.589666	Riverside County
267604	Fee-for-Service	1073052262	1073052262	2	1	ADVANCED REGENERATIVE CELL,	3/20/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	None	24	Plastic Surgery	0	In state provider	INC.	7325 MEDICAL CENTER DR	STE 304	WEST HILLS	CA	91307	4115	19	06037	34.20369349	-118.629837	Los Angeles County
267612	Fee-for-Service	1124144274	1124144274	1	1	ALLEY, JULIE L PHD	2/8/2015	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	3020 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
267619	Fee-for-Service	1962460782	1962460782	1	1	AHUJA, RAJIV R	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	48106	41	Internal Medicine	0	In state provider	None	674 MOWRY AVE	None	FREMONT	CA	94536	4113	01	06001	37.56683221	-121.9739694	Alameda County
267626	Fee-for-Service	1457812281	1457812281	1	1	ARAMBULO, MIKHAELA M MD	6/14/2023	207L00000X	NA	Other	026	PHYSICIANS	181594	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
267637	Fee-for-Service	1760590392	1760590392	1	1	ANDRADE, SCOTT GOMES LMFT	1/3/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2291 WEST MARCH LANE	SUITE D-200	STOCKTON	CA	95207	6670	39	06077	37.98597497	-121.3344334	San Joaquin County
267677	Fee-for-Service	1992021810	1992021810	1	1	AGUILAR, MICHELLE I MD	8/23/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	118876	40	Pediatrics	0	In state provider	None	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
267697	Fee-for-Service	1689321036	1689321036	1	1	ALL ELITE HOME HEALTH, INC	12/15/2024	251E00000X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	200 W GLENOAKS BLVD	STE 207	GLENDALE	CA	91202	3620	19	06037	34.15957045	-118.2582206	Los Angeles County
267699	Fee-for-Service	1679080311	1679080311	1	2	ACUTE MEDICAL PROVIDERS	6/21/2018	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	525 OREGON ST	None	VALLEJO	CA	94590	3201	48	06095	38.11827873	-122.2491077	Solano County
267711	Fee-for-Service	1083147953	1083147953	1	1	ANUFREICHIK, VERONIKA MD	8/18/2021	207L00000X	NA	Other	026	PHYSICIANS	159694	None	None	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
267758	Fee-for-Service	1689619512	1689619512	1	1	ATTAR, ATOUSA OD	9/26/2023	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	24422 AVENIDA DE LA CARL	110	LAGUNA HILLS	CA	92653	3634	30	06059	33.56726005	-117.705397	Orange County
267797	Fee-for-Service	1962550954	1962550954	1	1	ADLER, MARJORIE E MD	3/6/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	50312	36	Psychiatry	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
267877	Fee-for-Service	1861742991	1861742991	1	1	AHURA HEALTHCARE CORPORATION	5/26/2019	261QP3300X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	1307 WEST SIXTH STREET	105	CORONA	CA	92882	3294	33	06065	33.87790309	-117.589666	Riverside County
267889	Fee-for-Service	1740464692	1740464692	1	1	AGHALOO, TARA L DDS PHD	8/1/2014	204E00000X	NA	Dental Provider	026	PHYSICIANS	71480	02	General Surgery	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	8358	19	06037	34.06373445	-118.443537	Los Angeles County
267901	Fee-for-Service	1831210756	1831210756	1	1	ABEJIE, BELAYNEH A MD	12/13/2007	207R00000X	NA	Other	026	PHYSICIANS	100095	41	Internal Medicine	0	In state provider	None	445 S CEDAR AVE	None	FRESNO	CA	93702	2907	10	06019	36.7382512	-119.7543688	Fresno County
267902	Fee-for-Service	1962460782	1962460782	1	1	AHUJA, RAJIV R	11/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	48106	08	Family Practice	0	In state provider	None	674 MOWRY AVE	None	FREMONT	CA	94536	4113	01	06001	37.56683221	-121.9739694	Alameda County
267926	Fee-for-Service	1669839825	1669839825	1	1	ADVANCED HOME HEALTH CARE	2/4/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	LLC	35 E 10TH STREET	SUITE K-1 K-2	TRACY	CA	95376	4058	39	06077	37.73854032	-121.4249153	San Joaquin County
267948	Fee-for-Service	1760708606	1760708606	1	1	ACUNA, RODNEY L MD	11/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	143687	01	General Practice	0	In state provider	None	10725 INTERNATIONAL DR	None	RANCHO CORDOVA	CA	95670	7967	34	06067	38.576079	-121.2938325	Sacramento County
267965	Fee-for-Service	1093320418	1093320418	1	1	ANGEL ANASTASIA HOSPICE	9/11/2023	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2130 HUNTINGTON DR	STE 201	SOUTH PASADENA	CA	91030	4915	19	06037	34.10622227	-118.1358873	Los Angeles County
267980	Fee-for-Service	1407193220	1407193220	1	1	ALESSIO, ROXANA LCSW	6/26/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14500 ROSCOE BLVD.	400	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
267983	Fee-for-Service	1043221815	1043221815	1	1	ASKEW, KATIE C MD	7/21/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	76907	08	Family Practice	0	In state provider	None	1201 ALHAMBRA BLVD	STE 300230	SACRAMENTO	CA	95816	5238	34	06067	38.570076	-121.4657145	Sacramento County
268046	Fee-for-Service	1821382250	1821382250	1	1	ALI, SAMI M	6/12/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	149539	None	None	0	In state provider	None	11480 BROOKSHIRE AVE	STE 309	DOWNEY	CA	90241	5025	19	06037	33.93622932	-118.1311752	Los Angeles County
268051	Fee-for-Service	1174605612	1174605612	1	1	ALZA, GUSTAVO A MD INC	8/30/2005	207R00000X	NA	Other	026	PHYSICIANS	48749	41	Internal Medicine	0	In state provider	None	5224 N FIGUEROA ST	None	LOS ANGELES	CA	90042	4002	19	06037	34.1066436	-118.198721	Los Angeles County
268077	Fee-for-Service	1205522083	1205522083	1	1	AGUILAR, SHERLITA NP	2/10/2025	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	10538 MISSION GORGE RD	100	SANTEE	CA	92071	3154	37	06073	32.8384953	-116.9677746	San Diego County
268094	Fee-for-Service	1598344137	1598344137	1	1	ALPHAMED HOME HEALTH	3/20/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	21601 DEVONSHIRE ST	STE 300	CHATSWORTH	CA	91311	2946	19	06037	34.25726751	-118.5999345	Los Angeles County
268098	Fee-for-Service	1306468095	1306468095	1	1	AVENTUS HOSPICE INC	9/18/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	4425 W RIVERSIDE DR	STE 203	BURBANK	CA	91505	4057	19	06037	34.15222007	-118.3491225	Los Angeles County
268107	Fee-for-Service	1447679360	1447679360	1	1	ALI, ALI	2/21/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	147433	08	Family Practice	0	In state provider	None	3733 SAN DIMAS ST	STE 104	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
268144	Fee-for-Service	1891271771	1891271771	1	1	ANAHEIM URGENT CARE, INC	7/11/2019	261QU0200X	NA	Other	034	MEDICARE CROSSOVER PROVIDER ONLY	-	-	NOT APPLICABLE	0	In state provider	None	2100 S EUCLID ST	None	ANAHEIM	CA	92802	4572	30	06059	33.7955698	-117.9412136	Orange County
268175	Fee-for-Service	1932756764	1932756764	1	2	ALTAMED HEALTH SERVICES	6/19/2023	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3601 WEST SUNFLOWER AVE	SUITE 100	SANTA ANA	CA	92704	7916	30	06059	33.69568151	-117.918072	Orange County
268188	Fee-for-Service	1770843104	1770843104	1	1	ADVANCED GYNECOLOGY	9/27/2012	193400000X	NA	Other	026	PHYSICIANS	88913	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	SOLUTIONS INC	2701 W ALAMEDA AVENUE	STE 303	BURBANK	CA	91505	4411	19	06037	34.15751343	-118.3303715	Los Angeles County
268211	Fee-for-Service	1730119553	1730119553	1	4	AFFILIATED PATHOLOGISTS MEDI	2/5/1996	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	7901 WALKER ST	None	LA PALMA	CA	90623	1722	30	06059	33.84755382	-118.0373024	Orange County
268214	Fee-for-Service	1093971889	1093971889	1	1	AMIN, ZARIN DO	1/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	12510	None	None	0	In state provider	None	26520 CACTUS AVENUE	None	MORENO VALLEY	CA	92555	3927	33	06065	33.912117	-117.195849	Riverside County
268220	Fee-for-Service	1326547266	1326547266	1	1	AGIBI, FELICIA M PHD	3/1/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1552 COFFEE ROAD	SUITE 200	MODESTO	CA	95355	3122	50	06099	37.666872	-120.975684	Stanislaus County
268227	Fee-for-Service	1366925778	1366925778	1	1	ABSOLUTE HOSPICE AGENCY LLC	5/8/2024	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1554 S SEPULVEDA BLVD	STE 110B	LOS ANGELES	CA	90025	3334	19	06037	34.04932139	-118.4457323	Los Angeles County
268246	Fee-for-Service	1093320418	1093320418	1	1	ANGEL ANASTASIA HOSPICE	9/11/2023	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2130 HUNTINGTON DR	STE 201	SOUTH PASADENA	CA	91030	4915	19	06037	34.10622227	-118.1358873	Los Angeles County
268248	Fee-for-Service	1043253347	1043253347	1	1	ARREGUI, PABLO M MD	6/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	66789	18	Ophthalmology	0	In state provider	None	500 COHASSET RD	STE 17	CHICO	CA	95926	2260	04	06007	39.75142109	-121.8506286	Butte County
268261	Fee-for-Service	1689710915	1689710915	1	1	ADAMCZYK, PETER R MD	7/1/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	98461	13	Neurology (M.D. only)	0	In state provider	None	2800 L ST	#340	SACRAMENTO	CA	95816	5616	34	06067	38.571237	-121.469958	Sacramento County
268282	Fee-for-Service	1174532774	1174532774	2	1	APRIA HEALTHCARE LLC	5/19/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4345 HEDSTROM WAY	SUITE A	CHICO	CA	95973	4924	04	06007	39.79474867	-121.8979605	Butte County
268293	Fee-for-Service	1699288993	1699288993	1	1	ADVANCE NURSING PRACTICE MED	11/10/2020	193400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ICAL GROUP	1517 KNICKERBOCKER	None	STOCKTON	CA	95210	3119	39	06077	38.02415455	-121.2934722	San Joaquin County
268301	Fee-for-Service	1134205669	1134205669	1	1	AHUJAM SUNIL MD	6/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78815	None	None	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
268306	Fee-for-Service	1962596775	1962596775	1	1	AMERICAN HEALTH	8/2/2004	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	ASSOCIATES, INC	930 OAK ST	None	BAKERSFIELD	CA	93304	1060	15	06029	35.366463	-119.0387735	Kern County
268326	Fee-for-Service	1093196297	1093196297	1	1	ATWOOD, AMBER LPCC	6/27/2022	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	121 S PALM CANYON DR	SUITE 217	PALM SPRINGS	CA	92262	6378	33	06065	33.822774	-116.5468275	Riverside County
268360	Fee-for-Service	1003917923	1003917923	1	1	ARI UCSF LABORATORY	12/22/2005	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	OF CLINICAL VIROLOGY	1001 PORTRERO AVE	BLDG 100	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
268380	Fee-for-Service	1306468095	1306468095	1	1	AVENTUS HOSPICE INC	9/18/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	4425 W RIVERSIDE DR	STE 203	BURBANK	CA	91505	4057	19	06037	34.15222007	-118.3491225	Los Angeles County
268386	Fee-for-Service	1417969882	1417969882	2	2	ADVANCED INFUSION SYSTEMS LL	7/11/2022	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1214 N MARKET BLVD	STE C	SACRAMENTO	CA	95834	2931	34	06067	38.646243	-121.4891685	Sacramento County
268404	Fee-for-Service	1215334222	1215334222	1	1	ALVAREZ, ANGELA G NP	4/18/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
268426	Fee-for-Service	1508427055	1508427055	1	1	AREVALO, LILIANA LMFT	9/11/2024	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	144150	-	NOT APPLICABLE	0	In state provider	None	4439, 4445, 4455 BURNS A	None	LOS ANGELES	CA	90029	2702	19	06037	34.0877373	-118.2910045	Los Angeles County
268436	Fee-for-Service	1982052650	1982052650	1	1	ALTSCHUH, LAUREN B MD	6/28/2019	207P00000X	NA	Other	026	PHYSICIANS	161679	66	Emergency Medicine (Urgent Care)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
268471	Fee-for-Service	1770843104	1770843104	1	1	ADVANCED GYNECOLOGY	9/27/2012	193400000X	NA	Other	026	PHYSICIANS	88913	08	Family Practice	0	In state provider	SOLUTIONS INC	2701 W ALAMEDA AVENUE	STE 303	BURBANK	CA	91505	4411	19	06037	34.15751343	-118.3303715	Los Angeles County
268487	Fee-for-Service	1932756764	1932756764	1	2	ALTAMED HEALTH SERVICES	6/19/2023	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	INTERMITTENT	3601 WEST SUNFLOWER AVE	SUITE 100	SANTA ANA	CA	92704	7916	30	06059	33.69568151	-117.918072	Orange County
268500	Fee-for-Service	1992285605	1992285605	1	1	ANDERSON, MICHAEL CNP	3/8/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
268508	Fee-for-Service	1437837515	1437837515	1	1	ARUSEI, MIRIAM JEROTICH	8/2/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	21425 VANOWEN STREET	APT 633	CANOGA PARK	CA	91303	2775	19	06037	34.1937716	-118.5987953	Los Angeles County
268513	Fee-for-Service	1366925778	1366925778	1	1	ABSOLUTE HOSPICE AGENCY LLC	5/8/2024	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1554 S SEPULVEDA BLVD	STE 110B	LOS ANGELES	CA	90025	3334	19	06037	34.04932139	-118.4457323	Los Angeles County
268514	Fee-for-Service	1447575568	1447575568	1	1	ANDERSON, KRISTEN M MD	9/9/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	129812	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
268576	Fee-for-Service	1699288993	1699288993	1	1	ADVANCE NURSING PRACTICE MED	11/2/2022	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ICAL GROUP	1517 KNICKERBOCKER	None	STOCKTON	CA	95210	3119	39	06077	38.02415455	-121.2934722	San Joaquin County
268602	Fee-for-Service	1508386442	1508386442	1	1	ABDOLI, SHERWIN MD	4/17/2023	208600000X	NA	General Surgery	026	PHYSICIANS	156958	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
268660	Fee-for-Service	1376914788	1376914788	1	1	ADVENTIST HEALTH PHYSICIANS	2/27/2019	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1142 ROSE AVE	STE B	SELMA	CA	93662	3251	10	06019	36.56886527	-119.5983853	Fresno County
268663	Fee-for-Service	1134667751	1134667751	1	1	ABDULLATIF, QUTAYBA PHD	8/15/2017	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	175 N INDIAN HILL BLVD	STE 204	PASADENA	CA	91711	4665	19	06037	34.095447	-117.719338	Los Angeles County
268666	Fee-for-Service	1730667841	1730667841	1	1	ALLIANCE ANESTHESIA	10/24/2018	207L00000X	NA	Other	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	ASSOCIATES INC	900 SOUTH ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	4780	19	06037	34.049623	-118.1388014	Los Angeles County
268677	Fee-for-Service	1457472920	1457472920	1	1	ARGUELLES, LOVIE JAY E	5/25/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 CALIFORNIA STREET	None	REDLANDS	CA	92374	2910	36	06071	34.07159807	-117.2263378	San Bernardino County
268685	Fee-for-Service	1922600493	1922600493	1	1	ANAS ELIAS MD INC	1/13/2021	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	None	811 E 11TH ST	SUITE 104	UPLAND	CA	91786	4872	36	06071	34.1034335	-117.6398415	San Bernardino County
268706	Fee-for-Service	1811556103	1811556103	1	1	ABUTOUK, MONA M MD	3/10/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	183330	None	None	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
268741	Fee-for-Service	1366067241	1366067241	1	1	ADVENTIST HEALTH PHYSICIANS	9/22/2020	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1901 W KETTLEMAN LN	200	LODI	CA	95242	4337	39	06077	38.11558533	-121.2964501	San Joaquin County
268766	Fee-for-Service	1760686240	1760686240	1	1	ASCHNER, YAEL MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	29	Pulmonary Diseases (M.D. only)	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
268785	Fee-for-Service	1508937491	1508937491	1	1	ABBAS, MAHER A MD	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	54705	28	Proctology (colon and rectal)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
268788	Fee-for-Service	1437837515	1437837515	1	1	ARUSEI, MIRIAM JEROTICH	8/2/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	21425 VANOWEN STREET	APT 633	CANOGA PARK	CA	91303	2775	19	06037	34.1937716	-118.5987953	Los Angeles County
268791	Fee-for-Service	1568412542	1568412542	1	1	ATIENZA, PAMELA V MD	9/19/2006	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	A PROF MED CORP	890 EASTLAKE PKWY	STE 200	CHULA VISTA	CA	91914	4521	37	06073	32.65223126	-116.9677279	San Diego County
268795	Fee-for-Service	1861588030	1861588030	1	1	ABAD, VIVIEN C MD	3/14/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	36892	13	Neurology (M.D. only)	0	In state provider	None	301 OLD SAN FRANCISCO RD	None	SUNNYVALE	CA	94086	6386	43	06085	37.36797679	-122.0297112	Santa Clara County
268802	Fee-for-Service	1457856916	1457856916	1	1	ANDREW, WILLIAM W DO	6/15/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	17898	08	Family Practice	0	In state provider	None	2001 4TH AVE	None	SAN DIEGO	CA	92101	2393	37	06073	32.72663119	-117.1611714	San Diego County
268804	Fee-for-Service	1639857683	1639857683	1	1	AMANDA GIBSON, LCSW	7/11/2023	251S00000X	NA	Other	071	LICENSED CLINICAL SOCIAL WORKER GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2617 K ST	SUITE 125	SACRAMENTO	CA	95816	5133	34	06067	38.573595	-121.4715825	Sacramento County
268827	Fee-for-Service	1487920823	1487920823	1	1	ALI, KHIZAR MD	10/16/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	151680	05	Anesthesiology	0	In state provider	None	1601 YGNACIO VALLEY RD	None	WALNUT CREEK	CA	94598	3122	07	06013	37.9141514	-122.0422089	Contra Costa County
268898	Fee-for-Service	1326508029	1326508029	1	1	ARAKELYAN, ANNA MD	9/10/2024	207R00000X	NA	Other	026	PHYSICIANS	176385	41	Internal Medicine	0	In state provider	None	7018 OWENSMOUTH AVE	SUIT 102	CANOGA PARK	CA	91303	2073	19	06037	34.1979459	-118.6015228	Los Angeles County
268914	Fee-for-Service	1700095817	1700095817	1	1	ALBUKH, SOFYA N MD	1/3/1996	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	55465	01	General Practice	0	In state provider	A PROF CORP	6850 SEPULVEDA BLVD	STE 200	VAN NUYS	CA	91405	4467	19	06037	34.1955	-118.4661705	Los Angeles County
268944	Fee-for-Service	1629490693	1629490693	1	1	ABAD, MATTHEW DO	3/2/2023	207P00000X	NA	Other	026	PHYSICIANS	19347	None	None	0	In state provider	None	4929 VAN NUYS BLVD	ATTN: EMERGENCY DEPT	SHERMAN OAKS	CA	91403	1702	19	06037	34.1602022	-118.4487313	Los Angeles County
268947	Fee-for-Service	1730667841	1730667841	1	1	ALLIANCE ANESTHESIA	10/24/2018	207L00000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	ASSOCIATES INC	900 SOUTH ATLANTIC BLVD	None	MONTEREY PARK	CA	91754	4780	19	06037	34.049623	-118.1388014	Los Angeles County
268958	Fee-for-Service	1316273311	1316273311	1	1	AZARMEHR, YALDA MD	9/4/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	114484	41	Internal Medicine	0	In state provider	None	250 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90504	5513	19	06037	34.0696407	-118.3836988	Los Angeles County
268961	Fee-for-Service	1023170131	1023170131	1	1	ALAVI, SASSAN MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	81761	04	Otology, Laryngology, Rhinology	0	In state provider	None	101 CITY DR S	BLDG 25	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
268966	Fee-for-Service	1285933424	1285933424	1	1	ACOSTA, ANNA M MD	11/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153308	20	Orthopedic Surgery	0	In state provider	None	1760 TERMINO AVE	STE 308	LONG BEACH	CA	90804	2157	19	06037	33.78889871	-118.1458784	Los Angeles County
268977	Fee-for-Service	1780288605	1780288605	1	1	AVRA HOSPICE INC	3/24/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	9660 FLAIR DR	STE 225	EL MONTE	CA	91731	3098	19	06037	34.0720266	-118.0579495	Los Angeles County
268998	Fee-for-Service	1346232881	1346232881	1	1	AHMC GREATER EL MONTE	11/1/2004	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	COMMUNITY HOSPITAL	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
269008	Fee-for-Service	1629668892	1629668892	1	1	ALL TOGETHER HOME HEALTH CAR	3/14/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	E INC	1114 W MAGNOLIA BLVD	UNIT I	BURBANK	CA	91506	1812	19	06037	34.17651031	-118.3211266	Los Angeles County
269010	Fee-for-Service	1407695182	1407695182	1	1	ANDERSON, STACIE NP	7/17/2024	363LG0600X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	19270 SONOMA HIGHWAY 12	None	SONOMA	CA	95476	5414	49	06097	38.29871411	-122.4751509	Sonoma County
269031	Fee-for-Service	1821091836	1821091836	1	1	ANDERSEN, GILBERT O MD	1/1/1979	207R00000X	NA	Other	026	PHYSICIANS	29916	08	Family Practice	0	In state provider	None	1025 E OCEAN AVE	STE B	LOMPOC	CA	93436	7088	42	06083	34.6389048	-120.4454929	Santa Barbara County
269038	Fee-for-Service	1598979668	1598979668	1	1	ATMAKURI, SATYA MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 S DOBSON RD	None	MESA	AZ	85202	4707	00	None	33.38982	-111.8760885	Maricopa County
269050	Fee-for-Service	1760686240	1760686240	1	1	ASCHNER, YAEL MD	8/14/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	2	Out of state provider	None	13199 E MONTVIEW BLVD	None	AURORA	CO	80045	7201	00	None	39.748041	-104.834673	Adams County
269067	Fee-for-Service	1508937491	1508937491	1	1	ABBAS, MAHER A MD	11/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	54705	02	General Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
269085	Fee-for-Service	1659385391	1659385391	1	1	AL-BAGHDADI, MOHAMMAD MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	50810	05	Anesthesiology	0	In state provider	None	1600 W AVENUE J	None	LANCASTER	CA	93534	2814	19	06037	34.68938848	-118.158354	Los Angeles County
269086	Fee-for-Service	1639857683	1639857683	1	1	AMANDA GIBSON, LCSW	7/11/2023	251S00000X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	None	2617 K ST	SUITE 125	SACRAMENTO	CA	95816	5133	34	06067	38.573595	-121.4715825	Sacramento County
269120	Fee-for-Service	1417903923	1417903923	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1120 E CLARK AVE	None	ORCUTT	CA	93455	5123	42	06083	34.86500248	-120.417299	Santa Barbara County
269188	Fee-for-Service	1700610235	1700610235	1	1	ADVANCED CARDIOVASCULAR SPEC	11/20/2024	207RI0011X	NA	Cardiology/Interventional Cardiology	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	IALISTS OF CENTRAL CAL	729 N MEDICAL CENTER DR	STE 221	CLOVIS	CA	93611	6885	10	06019	36.84152435	-119.6624818	Fresno County
269192	Fee-for-Service	1790766038	1790766038	1	1	ADAMSON & DEMBITSKY	10/15/2003	208G00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL CORP	8010 FROST ST	SUITE 408	SAN DIEGO	CA	92123	2778	37	06073	32.80026879	-117.1520059	San Diego County
269246	Fee-for-Service	1285933424	1285933424	1	1	ACOSTA, ANNA M MD	11/6/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	153308	01	General Practice	0	In state provider	None	1760 TERMINO AVE	STE 308	LONG BEACH	CA	90804	2157	19	06037	33.78889871	-118.1458784	Los Angeles County
269250	Fee-for-Service	1023170131	1023170131	1	1	ALAVI, SASSAN MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	81761	01	General Practice	0	In state provider	None	101 CITY DR S	BLDG 25	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
269257	Fee-for-Service	1780288605	1780288605	1	1	AVRA HOSPICE INC	3/24/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	9660 FLAIR DR	STE 225	EL MONTE	CA	91731	3098	19	06037	34.0720266	-118.0579495	Los Angeles County
269277	Fee-for-Service	1346232881	1346232881	1	1	AHMC GREATER EL MONTE	11/1/2004	282N00000X	NA	Hospitals	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	COMMUNITY HOSPITAL	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
269284	Fee-for-Service	1760788632	1760788632	1	1	ALMASI, ANGINEH OD	3/7/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	477 E COLORADO BLVD	None	PASADENA	CA	91101	2024	19	06037	34.14587948	-118.140561	Los Angeles County
269306	Fee-for-Service	1114146370	1114146370	1	1	ARAGON, H S MD INC	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	51144	01	General Practice	0	In state provider	None	41750 WINCHESTER RD	STE N	TEMECULA	CA	92590	4898	33	06065	33.51771256	-117.1684213	Riverside County
269312	Fee-for-Service	1821091836	1821091836	1	1	ANDERSEN, GILBERT O MD	1/1/1979	207R00000X	NA	Other	026	PHYSICIANS	29916	01	General Practice	0	In state provider	None	1025 E OCEAN AVE	STE B	LOMPOC	CA	93436	7088	42	06083	34.6389048	-120.4454929	Santa Barbara County
269337	Fee-for-Service	1134188949	1134188949	1	1	ALFAR, JENNIFER A MD	1/14/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	159378	07	Dermatology	0	In state provider	None	2030 SUTTER PL	STE 1300	DAVIS	CA	95616	6201	57	06113	38.56292466	-121.7715423	Yolo County
269348	Fee-for-Service	1316912595	1316912595	1	1	ALAAELDIN,SHALABY MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 LOTHROP STREET	WING PUB 5B PUN	PITTSBURGH	PA	15213	0000	00	None	40.44188737	-79.96079711	Allegheny County
269355	Fee-for-Service	1568536860	1568536860	2	3	ATG-WCI INC	5/22/2020	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1650 TRIBUTE RD	None	SACRAMENTO	CA	95815	4400	34	06067	38.595204	-121.4456175	Sacramento County
269425	Fee-for-Service	1821389669	1821389669	1	2	AMRAMI, BINYAMIN MD	5/25/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	116722	-	NOT APPLICABLE	0	In state provider	None	5675 WEST OLYMPIC BLVD	None	LOS ANGELES	CA	90036	4712	19	06037	34.05742688	-118.3532118	Los Angeles County
269454	Fee-for-Service	1598150955	1598150955	1	1	AROMIN, JOURDAN T MD	2/11/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	164100	None	None	0	In state provider	None	847 W CHILDS AVE	None	MERCED	CA	95341	6805	24	06047	37.28825369	-120.4963159	Merced County
269461	Fee-for-Service	1235196494	1235196494	1	1	AHMANN, KEITH B MD	8/9/2018	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	72489	40	Pediatrics	0	In state provider	None	15400 LOS GATOS BLVD	None	LOS GATOS	CA	95032	2502	43	06085	37.24572659	-121.957997	Santa Clara County
269480	Fee-for-Service	1083347835	1083347835	1	1	ADVENTIST HEALTH PHYSICIANS	2/23/2023	207RH0003X	NA	Oncology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1505 WILSON TER	370	GLENDALE	CA	91206	4000	19	06037	34.14960934	-118.2313491	Los Angeles County
269509	Fee-for-Service	1942889522	1942889522	1	1	ATHWAL, PAL SATYAJIT SINGH	5/23/2024	207R00000X	NA	Other	026	PHYSICIANS	188863	41	Internal Medicine	0	In state provider	MD	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
269533	Fee-for-Service	1023170131	1023170131	1	1	ALAVI, SASSAN MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	81761	66	Emergency Medicine (Urgent Care)	0	In state provider	None	101 CITY DR S	BLDG 25	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
269536	Fee-for-Service	1689331399	1689331399	1	1	A & V HOME HEALTH CARE	11/21/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES	3171 LOS FELIZ BLVD	STE 302	LOS ANGELES	CA	90039	1537	19	06037	34.12369709	-118.2682266	Los Angeles County
269540	Fee-for-Service	1891286464	1891286464	1	1	AKHAVAN, JAMSHID MD	2/2/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166242	None	None	0	In state provider	None	16950 VIA TAZON	None	SAN DIEGO	CA	92127	1607	37	06073	33.02257788	-117.0856332	San Diego County
269558	Fee-for-Service	1346232881	1346232881	1	1	AHMC GREATER EL MONTE	11/1/2004	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	COMMUNITY HOSPITAL	1701 SANTA ANITA AVE	None	SOUTH EL MONTE	CA	91733	3411	19	06037	34.04810648	-118.0424794	Los Angeles County
269586	Fee-for-Service	1194833939	1194833939	1	1	AMERICAN MEDICAL RESPONSE	12/17/1981	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	AMBULANCE SERVICE INC	8808 BALBOA AVE	STE 150	SAN DIEGO	CA	92123	6502	37	06073	32.82092762	-117.1373709	San Diego County
269654	Fee-for-Service	1396781894	1396781894	1	1	ALLERGY CARE CENTER A	11/1/2010	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	03	Allergy	0	In state provider	MEDICAL CORPORATION	2412 N PONDEROSA DR	SUITE B111	CAMARILLO	CA	93010	2373	56	06111	34.24223352	-119.0227101	Ventura County
269656	Fee-for-Service	1386656148	1386656148	1	1	ACOSTA,ROBERT	6/3/2021	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1400 PELHAM PKWY SOUTH	None	BRONX	NY	10461	1138	00	None	40.857111	-73.847448	Bronx County
269706	Fee-for-Service	1235690397	1235690397	1	1	ADEDAYO, TOLULOPE TITILAYO	5/1/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	37571 BLACK SAGE PL	None	MURRIETA	CA	92563	3335	33	06065	33.57482249	-117.107868	Riverside County
269720	Fee-for-Service	1053087221	1053087221	1	1	ADDERLY, JENNIFER LMFT	2/14/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
269731	Fee-for-Service	1528562808	1528562808	1	1	ALBERT, KELSEY A DO	7/14/2022	390200000X	NA	Other	026	PHYSICIANS	19283	None	None	0	In state provider	None	3421 VILLA LANE	SUITE 2B	NAPA	CA	94558	3060	28	06055	38.32459323	-122.2934714	Napa County
269761	Fee-for-Service	1023100930	1023100930	1	1	ADAMS,DAVID MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	2	Out of state provider	CHILDREN'S ACUTE CARE	1638 OWEN DRIVE	None	FAYETTEVILLE	NC	28304	0000	00	None	35.032329	-78.933186	Cumberland County
269783	Fee-for-Service	1942697875	1942697875	1	1	ACTIVE 1 P & O	3/29/2016	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	295 W CROMWELL AVE	SUITE 102	FRESNO	CA	93711	6167	10	06019	36.84754253	-119.7978435	Fresno County
269847	Fee-for-Service	1477047355	1477047355	1	1	ALLEGIANT HEALTHCARE INC	6/1/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	363 SOUTH PARK AVE	STE 101	POMONA	CA	91766	1560	19	06037	34.05615	-117.7544751	Los Angeles County
269853	Fee-for-Service	1023031234	1023031234	1	1	ASTROMOFF, NICHOLAS MD	1/1/1999	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	72683	30	Radiology	0	In state provider	None	1661 SOQUEL DR	STE G	SANTA CRUZ	CA	95065	1709	44	06087	36.98895429	-121.9821088	Santa Cruz County
269860	Fee-for-Service	1083792881	1083792881	1	1	AYALA, JOSE A MD	5/31/1988	No Taxonomy Provided	NA	None	026	PHYSICIANS	64078	41	Internal Medicine	0	In state provider	None	2600 REDONDO AVE	None	LONG BEACH	CA	90806	2325	19	06037	33.806097	-118.151378	Los Angeles County
269862	Fee-for-Service	1013930874	1013930874	1	1	ARIUE, BARBARA K. MD	10/1/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	80863	40	Pediatrics	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
269945	Fee-for-Service	1750559431	1750559431	1	25	ALL STAR PHYSICAL THERAPY, I	9/19/2024	225100000X	NA	Physical Therapist	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	13313 PALM DR.	B - C	DESERT HOT SPRING	CA	92240	5980	33	06065	33.951663	-116.501339	Riverside County
269961	Fee-for-Service	1447605704	1447605704	1	1	AGGARWAL, ABHIMANYU MD	1/17/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	192046	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
269968	Fee-for-Service	1730492000	1730492000	1	1	AHN, HARRY H Y JR MD	1/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	121353	01	General Practice	0	In state provider	None	1441 CONSTITUTION BLVD	None	SALINAS	CA	93906	3100	27	06053	36.696987	-121.633164	Monterey County
269981	Fee-for-Service	1548521628	1548521628	1	1	ANWAR, SALAH U MD	11/9/2023	208M00000X	NA	Other	026	PHYSICIANS	162501	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
269988	Fee-for-Service	1235690397	1235690397	1	1	ADEDAYO, TOLULOPE TITILAYO	5/1/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	37571 BLACK SAGE PL	None	MURRIETA	CA	92563	3335	33	06065	33.57482249	-117.107868	Riverside County
270011	Fee-for-Service	1194337451	1194337451	1	1	ALLAIR, HILARY A CNM	10/20/2020	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	583 SUMMERFIELD RD	None	SANTA ROSA	CA	95405	5239	49	06097	38.45268	-122.672088	Sonoma County
270018	Fee-for-Service	1023499191	1023499191	1	1	ANI, FIYINFOLUWA K MD	3/5/2020	207L00000X	NA	Other	026	PHYSICIANS	148181	05	Anesthesiology	0	In state provider	None	2801 ATLANTIC AVE	None	LONG BEACH	CA	90806	1701	19	06037	33.808185	-118.1850575	Los Angeles County
270024	Fee-for-Service	1205986007	1205986007	1	1	ARABI, NEZHAT MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	65744	08	Family Practice	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
270028	Fee-for-Service	1316433303	1316433303	1	1	ANN, LYDIA MD	2/1/2021	390200000X	NA	Other	026	PHYSICIANS	164652	None	None	0	In state provider	None	520 N MAIN ST	SUITE 120	SANTA ANA	CA	92701	4623	30	06059	33.749316	-117.868123	Orange County
270060	Fee-for-Service	1538113725	1538113725	2	1	ADVENTIST HEALTH MENDOCINO C	7/1/2020	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	OAST	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
270133	Fee-for-Service	1144485822	1144485822	1	1	AHMED, ALI MD	12/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139204	41	Internal Medicine	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
270169	Fee-for-Service	1689711756	1689711756	1	1	AVON, MARK R MD	3/31/2008	208800000X	NA	Other	026	PHYSICIANS	43035	34	Urology and Urological Surgery	0	In state provider	None	1999 MOWRY AVE	STE 2M	FREMONT	CA	94538	1706	01	06001	37.55783419	-121.9808484	Alameda County
270199	Fee-for-Service	1356454300	1356454300	1	1	ALQAISI, MUNTHER E MD	12/31/1990	2085R0001X	NA	Other	026	PHYSICIANS	39982	30	Radiology	0	In state provider	None	16123 SISKIYOU RD	None	APPLE VALLEY	CA	92307	1314	36	06071	34.54487613	-117.2662808	San Bernardino County
270225	Fee-for-Service	1750559431	1750559431	1	25	ALL STAR PHYSICAL THERAPY, I	6/15/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	13313 PALM DR.	B - C	DESERT HOT SPRING	CA	92240	5980	33	06065	33.951663	-116.501339	Riverside County
270282	Fee-for-Service	1588927222	1588927222	1	1	AHMED, HAYDER MD	9/10/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	147272	41	Internal Medicine	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
270305	Fee-for-Service	1992776918	1992776918	1	1	ARCHAMBAULT, CHRISTIAN F	8/3/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	74776	40	Pediatrics	0	In state provider	None	292 EUCLID AVE	STE 220	SAN DIEGO	CA	92114	3629	37	06073	32.70706919	-117.0850896	San Diego County
270337	Fee-for-Service	1538113725	1538113725	2	1	ADVENTIST HEALTH MENDOCINO C	7/1/2020	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	OAST	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
270354	Fee-for-Service	1902848450	1902848450	1	1	AJAI SAWHNEY	11/27/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	901 W REX ALLEN DR	None	WILLCOX	AZ	85643	1009	00	None	32.265	-109.8382095	Cochise County
270360	Fee-for-Service	1255083259	1255083259	1	1	AUGUST CHAI ENTERPRISES LLC	1/7/2022	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CARE CENTER	1251 GROVE AVENUE	SUITE E	ATWATER	CA	95301	3653	24	06047	37.35097351	-120.6072051	Merced County
270437	Fee-for-Service	1477565257	1477565257	1	1	ASLAM, SAIMA MD	8/31/2010	207R00000X	NA	Other	026	PHYSICIANS	112604	77	Infectious Disease	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
270480	Fee-for-Service	1093711053	1093711053	1	1	AVENMARG, JAYSEN D MD	7/24/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65237	02	General Surgery	0	In state provider	None	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	8222	54	06107	36.330327	-119.351943	Tulare County
270484	Fee-for-Service	1730409806	1730409806	1	1	ANGELS HOSPICE CORPORATION	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	15335 FAIRFIELD RANCH RD	STE 125	CHINO HILLS	CA	91709	8831	36	06071	33.97256499	-117.6914453	San Bernardino County
270516	Fee-for-Service	1740550664	1740550664	1	1	ARCEO, PRISCILLA V CRNA	5/31/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6237	54	06107	36.327888	-119.294919	Tulare County
270535	Fee-for-Service	1225115173	1225115173	1	1	AHN, MICHAEL S MD	7/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80248	41	Internal Medicine	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
270540	Fee-for-Service	1013489400	1013489400	1	1	AVENAL EXPRESS PHARMACY LLC	11/1/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	317 E KINGS ST	None	AVENAL	CA	93204	1630	16	06031	36.00252916	-120.1340998	Kings County
270546	Fee-for-Service	1881669489	1881669489	1	1	APEX CARDIOLOGY	9/12/1988	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	0	In state provider	CONSULTANTS MED GROUP	501 E HARDY ST	STE 200	INGLEWOOD	CA	90301	4057	19	06037	33.9491005	-118.348857	Los Angeles County
270556	Fee-for-Service	1679863302	1679863302	1	1	AYLWARD, RICHARD CPO	6/25/2012	No Taxonomy Provided	NA	None	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	7601 HOSPITAL DRIVE	SUITE 140B	SACRAMENTO	CA	95823	5408	34	06067	38.464794	-121.415571	Sacramento County
270560	Fee-for-Service	1588927222	1588927222	1	1	AHMED, HAYDER MD	9/10/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	147272	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	39	06077	37.88652418	-121.2820956	San Joaquin County
270565	Fee-for-Service	1962938340	1962938340	1	1	ANDERSON, SHAYLAH LPCC	9/9/2024	101YP2500X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
270579	Fee-for-Service	1093533564	1093533564	1	1	ALAMEDA COUNTY CARE ALLIANCE	1/22/2025	171M00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	None	8501 INTERNATIONAL BLVD	None	OAKLAND	CA	94621	1549	01	06001	37.75305995	-122.1770578	Alameda County
270615	Fee-for-Service	1538113725	1538113725	2	1	ADVENTIST HEALTH MENDOCINO C	5/19/2023	282NC0060X	NEMT Provider	Hospitals	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	OAST	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
270627	Fee-for-Service	1861448862	1861448862	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	7676 FIRESTONE BLVD	None	DOWNEY	CA	90241	4206	19	06037	33.94594877	-118.1441458	Los Angeles County
270636	Fee-for-Service	1225777238	1225777238	1	1	ASHDOWN, MALLORY NP	2/1/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
270646	Fee-for-Service	1710955521	1710955521	1	1	ALTSCHULER, KENNETH A MD	2/1/1995	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	71127	08	Family Practice	0	In state provider	None	815 E PENNSYLVANIA AVE	None	ESCONDIDO	CA	92025	3424	37	06073	33.12757224	-117.0715637	San Diego County
270720	Fee-for-Service	1255417309	1255417309	1	1	ANAKWENZE, NWACHUKWU MD	2/19/1986	No Taxonomy Provided	NA	None	026	PHYSICIANS	50607	01	General Practice	0	In state provider	None	11149 CRENSHAW BLVD	None	INGLEWOOD	CA	90303	2338	19	06037	33.933465	-118.3265975	Los Angeles County
270738	Fee-for-Service	1588197826	1588197826	1	1	ALVAREZ-ESTRADA, MIGUEL MD	8/10/2020	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	157505	08	Family Practice	0	In state provider	None	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	37	06073	32.55831005	-117.0475102	San Diego County
270742	Fee-for-Service	1699849380	1699849380	2	1	ABSOLUTE HOME HEALTH AGENCY	10/12/2016	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	1554 S SEPULVEDA BLVD	SUITE 109	LOS ANGELES	CA	90025	3334	19	06037	34.04932139	-118.4457323	Los Angeles County
270749	Fee-for-Service	1669147047	1669147047	1	1	ABUZAHRA, KAREN J PSYD	11/27/2022	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	1660 E ROSEVILLE PARKWAY	None	ROSEVILLE	CA	95661	3988	31	06061	38.74827146	-121.2397281	Placer County
270753	Fee-for-Service	1164918363	1164918363	1	1	AGUILERA VASQUEZ, CARLA J PH	6/29/2023	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	D	1120 W LA VETA AVE	SUITE 470	ORANGE	CA	92868	4233	30	06059	33.78029455	-117.864369	Orange County
270762	Fee-for-Service	1730409806	1730409806	1	1	ANGELS HOSPICE CORPORATION	4/21/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	15335 FAIRFIELD RANCH RD	STE 125	CHINO HILLS	CA	91709	8831	36	06071	33.97256499	-117.6914453	San Bernardino County
270800	Fee-for-Service	1225115173	1225115173	1	1	AHN, MICHAEL S MD	7/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	80248	10	Gastroenterology (M.D. only)	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
270804	Fee-for-Service	1326032814	1326032814	1	1	AG WEST COVINA, LLC	10/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	COVINA HEALTHCARE CENTER	850 S SUNKIST AVE	None	WEST COVINA	CA	91790	2534	19	06037	34.07075728	-117.9489216	Los Angeles County
270808	Fee-for-Service	1851518401	1851518401	1	1	ARORA, AMARPRAL S MD	10/10/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89558	20	Orthopedic Surgery	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
270819	Fee-for-Service	1700867314	1700867314	1	1	AUGUSTINE S PARK, MD	10/17/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3705 MEDICAL PKWY	STE 570	AUSTIN	TX	78705	1024	00	None	30.30500791	-97.74430984	Travis County
270831	Fee-for-Service	1346670676	1346670676	1	1	AZAR, HAMSA M OD	8/26/2016	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	9961 SIERRA AVENUE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
270840	Fee-for-Service	1386009249	1386009249	1	1	AKHBARI, ELENA	3/21/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
270855	Fee-for-Service	1801898796	1801898796	1	1	ARNSTEIN, DAVID P MD	10/31/1991	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	56517	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	15861 WINCHESTER BLVD	None	LOS GATOS	CA	95030	3306	43	06085	37.23816199	-121.9770685	Santa Clara County
270881	Fee-for-Service	1902415623	1902415623	1	1	ACQUAH, PRINCE B NP	10/11/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	30	06059	33.80318951	-118.066068	Orange County
270898	Fee-for-Service	1538113725	1538113725	2	1	ADVENTIST HEALTH MENDOCINO C	7/1/2020	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	OAST	700 RIVER DR	None	FORT BRAGG	CA	95437	5403	23	06045	39.43163763	-123.8007631	Mendocino County
270904	Fee-for-Service	1881039238	1881039238	1	1	AMUBIEYA, OLAWALE O MD	5/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137077	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	SUITE 365 420 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
270913	Fee-for-Service	1316175912	1316175912	1	1	AJAYI, TOLUWALASE A MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121454	40	Pediatrics	0	In state provider	None	4311 THIRD AVE	None	SAN DIEGO	CA	92103	1407	37	06073	32.758578	-117.1637685	San Diego County
270928	Fee-for-Service	1982811212	1982811212	1	1	AGRAWAL, NITHYA V MD	12/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122236	41	Internal Medicine	0	In state provider	None	1600 NORTH ROSE AVE	None	OXNARD	CA	93030	3722	56	06111	34.21700406	-119.1582582	Ventura County
270930	Fee-for-Service	1427469758	1427469758	1	1	ARIAS-STELLA, JAVIER A MD	8/7/2018	207ZP0101X	NA	Other	026	PHYSICIANS	157416	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
271000	Fee-for-Service	1033387345	1033387345	1	1	ARON, MONISH MD	11/22/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117665	34	Urology and Urological Surgery	0	In state provider	None	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0122	19	06037	34.06169385	-118.2044698	Los Angeles County
271007	Fee-for-Service	1336351717	1336351717	1	1	ALI, SABINA A MD	7/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100338	10	Gastroenterology (M.D. only)	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
271012	Fee-for-Service	1730113903	1730113903	1	1	AGHA, AYAD DO	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	PHOENIX MEMEORIAL HOSP	515 N MESA DR	None	MESA	AZ	85201	0000	00	None	33.424767	-111.8219445	Maricopa County
271030	Fee-for-Service	1144299173	1144299173	1	1	AAZAMI, HESSAM MD	3/3/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85704	01	General Practice	0	In state provider	None	8781 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	2406	19	06037	34.22960628	-118.4502708	Los Angeles County
271123	Fee-for-Service	1629045372	1629045372	1	1	ARGENAL, AGUSTIN J MD	3/3/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	33520	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	2222 EAST ST	STE 365	CONCORD	CA	94520	2056	07	06013	37.98125538	-122.0329375	Contra Costa County
271125	Fee-for-Service	1588981468	1588981468	1	1	AHUJA, SAVEEN G MD	8/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	129411	30	Radiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
271135	Fee-for-Service	1801898796	1801898796	1	1	ARNSTEIN, DAVID P MD	10/31/1991	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	56517	84	Surgery-Head and Neck	0	In state provider	None	15861 WINCHESTER BLVD	None	LOS GATOS	CA	95030	3306	43	06085	37.23816199	-121.9770685	Santa Clara County
271160	Fee-for-Service	1508892605	1508892605	1	1	ABBOTT, DOUGLAS D MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	64869	20	Orthopedic Surgery	0	In state provider	None	500 DOYLE PARK DR	STE 105	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
271187	Fee-for-Service	1649586694	1649586694	1	1	ABALOS, ANNA P MD INC	9/16/2010	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	99301	08	Family Practice	0	In state provider	None	701 PLEASANT GROVE BLVD	STE 125	ROSEVILLE	CA	95678	6156	31	06061	38.79206468	-121.279158	Placer County
271194	Fee-for-Service	1801816764	1801816764	1	1	ALVA, ALEJANDRO MD	9/6/2019	2084P0800X	NA	Psychiatry	026	PHYSICIANS	62396	36	Psychiatry	0	In state provider	None	3151 AIRWAY AVE	SUITE G1	COSTA MESA	CA	92626	4624	30	06059	33.67783408	-117.8720921	Orange County
271214	Fee-for-Service	1932123155	1932123155	1	1	ASH, DEBORAH M MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	65823	30	Radiology	0	In state provider	None	1500 E CHEVY CHASE DR	STE 104	GLENDALE	CA	91206	4106	19	06037	34.15201194	-118.2322051	Los Angeles County
271260	Fee-for-Service	1902841901	1902841901	1	1	ALTERGOTT, CAROLINE MD	1/1/1997	2080P0204X	NA	Other	026	PHYSICIANS	69716	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
271262	Fee-for-Service	1730114372	1730114372	1	1	APOLLO, SARAH G DO INC	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	6613	08	Family Practice	0	In state provider	None	438 E KATELLA AVE	STE B	ORANGE	CA	92867	4857	30	06059	33.80908349	-117.849438	Orange County
271286	Fee-for-Service	1336351717	1336351717	1	1	ALI, SABINA A MD	7/21/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	100338	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
271309	Fee-for-Service	1588793574	1588793574	1	1	ALHAMBRA HOSP MED CTR	7/2/1998	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	None	100 S RAYMOND AVE	None	ALHAMBRA	CA	91801	3199	19	06037	34.09027878	-118.1450083	Los Angeles County
271381	Fee-for-Service	1083060875	1083060875	1	1	ALLEN, CAROLINE LCSW	1/21/2025	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2821 CROW CANYON RD	STE 202	SAN RAMON	CA	94583	1659	07	06013	37.77494135	-121.9805388	Contra Costa County
271470	Fee-for-Service	1639124357	1639124357	1	1	ALPERT, MARJORIE D MD	11/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	55094	40	Pediatrics	0	In state provider	None	2191 MOWRY AVE	STE 600C	FREMONT	CA	94538	1702	01	06001	37.55710897	-121.9814562	Alameda County
271479	Fee-for-Service	1205064805	1205064805	1	1	AMBROSIO, ART A MD	1/26/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	113427	04	Otology, Laryngology, Rhinology	0	In state provider	None	3030 CHILDRENS WAY	None	SAN DIEGO	CA	92123	4232	37	06073	32.798889	-117.150826	San Diego County
271498	Fee-for-Service	1477522548	1477522548	1	1	ANGEL, CLAY R MD	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	92598	41	Internal Medicine	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
271526	Fee-for-Service	1922206465	1922206465	1	1	ANDRUSS, KEVIN MD	11/12/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105449	66	Emergency Medicine (Urgent Care)	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
271532	Fee-for-Service	1225529241	1225529241	1	1	ABDELMISSEH, MICHAEL MD	7/3/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	189944	40	Pediatrics	0	In state provider	None	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	50	06099	37.666233	-120.993933	Stanislaus County
271537	Fee-for-Service	1902841901	1902841901	1	1	ALTERGOTT, CAROLINE MD	1/1/1997	2080P0204X	NA	Other	026	PHYSICIANS	69716	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
271586	Fee-for-Service	1023111044	1023111044	1	1	ALVAREZ, FRANK M MD	2/1/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	42726	40	Pediatrics	0	In state provider	None	432 E KING AVE	None	TULARE	CA	93274	4223	54	06107	36.20986698	-119.342978	Tulare County
271596	Fee-for-Service	1750559431	1750559431	1	16	ALL STAR PHYSICAL THERAPY, I	11/10/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	1191 N. STATE	#D	SAN JACINTO	CA	92583	0000	33	06065	33.802677	-116.972033	Riverside County
271620	Fee-for-Service	1710935887	1710935887	1	1	ANDREWS, BRIAN T MD	1/1/1995	207T00000X	NA	General Surgery	026	PHYSICIANS	48858	14	Neurological Surgery	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
271698	Fee-for-Service	1053307769	1053307769	1	1	ABIDI, MUSSARAT MD	12/21/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	37861	40	Pediatrics	0	In state provider	None	27800 MEDICAL CENTER RD	STE 216	MISSION VIEJO	CA	92691	6408	30	06059	33.55952733	-117.6645199	Orange County
271703	Fee-for-Service	1306128822	1306128822	1	1	ALL FOR HEALTH HEALTH	11/16/2015	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	FOR ALL INC	437 S PACIFIC AVE	None	GLENDALE	CA	91204	1441	19	06037	34.140231	-118.264439	Los Angeles County
271707	Fee-for-Service	1558808683	1558808683	1	1	ARIA HOSPICE INC	5/24/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2139 TAPO ST	UNIT 207	SIMI VALLEY	CA	93063	3478	56	06111	34.27388603	-118.7089725	Ventura County
271724	Fee-for-Service	1295803666	1295803666	1	1	ARRIETE, MAYRA A P LCSW	10/10/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7520 ARROYO CIR	None	GILROY	CA	95020	7303	43	06085	37.01225317	-121.5604444	Santa Clara County
271731	Fee-for-Service	1598911380	1598911380	1	1	ALEXANDER, REGINALD A MD	1/3/2019	No Taxonomy Provided	NA	None	026	PHYSICIANS	120121	20	Orthopedic Surgery	0	In state provider	None	1414 S GRAND AVE	STE 123	LOS ANGELES	CA	90015	3071	19	06037	34.03661142	-118.2657227	Los Angeles County
271735	Fee-for-Service	1720611650	1720611650	1	1	ALDRED, JENNIFER NP	11/1/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4900 BROADWAY	STE 2800	SACRAMENTO	CA	95820	1536	34	06067	38.546091	-121.447305	Sacramento County
271758	Fee-for-Service	1518369891	1518369891	1	1	ALL INCLUSIVE MEDICAL	5/21/2015	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	SERVICES INC	2540 CARMICHAEL WAY	None	CARMICHAEL	CA	95608	5314	34	06067	38.611062	-121.327011	Sacramento County
271770	Fee-for-Service	1861486813	1861486813	1	1	ABLIN, PENNY H MD	4/22/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	40240	41	Internal Medicine	0	In state provider	None	123 AHWAHNEE DR	None	YOSEMITE	CA	95370	0000	22	06043	37.74716586	-119.5736095	Mariposa County
271780	Fee-for-Service	1477522548	1477522548	1	1	ANGEL, CLAY R MD	11/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	92598	01	General Practice	0	In state provider	None	99 MONTECILLO ROAD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
271803	Fee-for-Service	1508904780	1508904780	2	1	ADDICTION RESEARCH AND TREAT	11/11/2021	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	1646 S COURT ST	None	VISALIA	CA	93277	4962	54	06107	36.315774	-119.2913235	Tulare County
271819	Fee-for-Service	1699288993	1699288993	1	2	ADVANCE NURSING PRACTICE MED	11/10/2020	193400000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ICAL GROUP	6041 FAIR OAKS BLVD	None	FAIR OAKS	CA	95628	4816	34	06067	38.6780625	-121.2622844	Sacramento County
271873	Fee-for-Service	1750559431	1750559431	1	16	ALL STAR PHYSICAL THERAPY, I	4/30/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	1191 N. STATE	#D	SAN JACINTO	CA	92583	0000	33	06065	33.802677	-116.972033	Riverside County
271941	Fee-for-Service	1477867877	1477867877	1	1	ARSLAN, SHUKAIB MD	6/28/2018	207RH0000X	NA	Hematology	026	PHYSICIANS	154669	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
271961	Fee-for-Service	1346208949	1346208949	1	1	ACCREDO HEALTH GROUP INC	5/14/2020	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	1620 CENTURY CENTER PKWY	STE 109	MEMPHIS	TN	38134	8849	00	None	35.170542	-89.845497	Shelby County
271969	Fee-for-Service	1093006512	1093006512	1	1	ARCH HEALTH PARTNERS	8/29/2011	193400000X	NA	Other	022	PHYSICIANS GROUP	-	17	Ophthalmology, Otolaryngology, Rhinology (D.O.only)	0	In state provider	None	15525 POMERADO RD	STE C-1	POWAY	CA	92064	2425	37	06073	32.99479918	-117.0579468	San Diego County
271979	Fee-for-Service	1306128822	1306128822	1	1	ALL FOR HEALTH HEALTH	11/16/2015	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	FOR ALL INC	437 S PACIFIC AVE	None	GLENDALE	CA	91204	1441	19	06037	34.140231	-118.264439	Los Angeles County
271982	Fee-for-Service	1558808683	1558808683	1	1	ARIA HOSPICE INC	5/24/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2139 TAPO ST	UNIT 207	SIMI VALLEY	CA	93063	3478	56	06111	34.27388603	-118.7089725	Ventura County
272034	Fee-for-Service	1518369891	1518369891	1	1	ALL INCLUSIVE MEDICAL	5/21/2015	207R00000X	NA	Other	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	SERVICES INC	2540 CARMICHAEL WAY	None	CARMICHAEL	CA	95608	5314	34	06067	38.611062	-121.327011	Sacramento County
272092	Fee-for-Service	1699288993	1699288993	1	2	ADVANCE NURSING PRACTICE MED	11/2/2022	193400000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ICAL GROUP	6041 FAIR OAKS BLVD	None	FAIR OAKS	CA	95628	4816	34	06067	38.6780625	-121.2622844	Sacramento County
272140	Fee-for-Service	1467610451	1467610451	1	1	ANDRES-ELIAS, PAMELA L	8/10/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
272144	Fee-for-Service	1750559431	1750559431	1	16	ALL STAR PHYSICAL THERAPY, I	3/12/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	1191 N. STATE	#D	SAN JACINTO	CA	92583	0000	33	06065	33.802677	-116.972033	Riverside County
272147	Fee-for-Service	1720192560	1720192560	1	1	AUBURN MEDICAL GROUP, INC	2/4/2020	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3280 PROFESSIONAL DR	N/A	AUBURN	CA	95602	2412	31	06061	38.943891	-121.100763	Placer County
272166	Fee-for-Service	1497131650	1497131650	1	1	ADVANCE CARE HOME HEALTH	2/5/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	AGENCY INC	805 N CENTRAL AVE	None	GLENDALE	CA	91203	1230	19	06037	34.15773868	-118.2580613	Los Angeles County
272167	Fee-for-Service	1740622604	1740622604	1	1	AMMERMAN, DOUGLAS J MD	10/25/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	139700	41	Internal Medicine	0	In state provider	None	901 NEVIN AVE	None	RICHMOND	CA	94801	3143	07	06013	37.93684848	-122.361345	Contra Costa County
272168	Fee-for-Service	1609954486	1609954486	1	1	ASENJO, JUAN C MD	12/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77526	41	Internal Medicine	0	In state provider	None	280 W MACARTHUR BLVD	None	OAKLAND	CA	94611	5642	01	06001	37.8242017	-122.2578306	Alameda County
272187	Fee-for-Service	1386907624	1386907624	1	1	AGUIRRE, ANTHONY RYAN M MD	5/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	120738	01	General Practice	0	In state provider	None	1001 RIVERSIDE AVENUE	None	ROSEVILLE	CA	95678	5134	31	06061	38.72845186	-121.2904134	Placer County
272196	Fee-for-Service	1861995813	1861995813	1	1	ALQAYSI, AHMED MD	8/3/2023	207R00000X	NA	Other	026	PHYSICIANS	183967	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
272215	Fee-for-Service	1477867877	1477867877	1	1	ARSLAN, SHUKAIB MD	6/28/2018	207RH0000X	NA	Hematology	026	PHYSICIANS	154669	68	Hematology	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
272241	Fee-for-Service	1093006512	1093006512	1	1	ARCH HEALTH PARTNERS	8/29/2011	193400000X	NA	Other	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	15525 POMERADO RD	STE C-1	POWAY	CA	92064	2425	37	06073	32.99479918	-117.0579468	San Diego County
272264	Fee-for-Service	1003898792	1003898792	1	1	ADADE-BOAFO, KOFI MD	3/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	77940	40	Pediatrics	0	In state provider	None	8110 MANGO AVE	None	FONTANA	CA	92335	3603	36	06071	34.10549796	-117.4314604	San Bernardino County
272265	Fee-for-Service	1801308697	1801308697	1	1	AMEDI HOSPICE CARE, INC	4/17/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14242 VENTURA BLVD	SUITE 208	SHERMAN OAKS	CA	91423	2757	19	06037	34.14999696	-118.4433632	Los Angeles County
272287	Fee-for-Service	1831149400	1831149400	1	1	AHLBERG, N THOMAS MD	12/1/1987	207L00000X	NA	Other	026	PHYSICIANS	36935	05	Anesthesiology	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
272296	Fee-for-Service	1437232337	1437232337	1	1	AMANI, RAMIN MD INC	8/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	53984	None	None	0	In state provider	None	950 CIVIC CENTER DR	STE A	VISTA	CA	92083	5208	37	06073	33.19303885	-117.2348616	San Diego County
272298	Fee-for-Service	1447245022	1447245022	1	1	ALBUQUERQUE, FELIPE C. MD	4/17/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2910 N 3RD AVE	None	PHOENIX	AZ	85013	4434	00	None	33.4805218	-112.0782792	Maricopa County
272341	Fee-for-Service	1053455535	1053455535	1	1	AGARWAL, RAJNI MD	5/10/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50583	68	Hematology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
272345	Fee-for-Service	1225013337	1225013337	1	1	AYYALAPU, ANITHA R MD	8/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	56416	05	Anesthesiology	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
272347	Fee-for-Service	1417490301	1417490301	1	1	ANYU, TSE F DO	8/9/2024	2085N0700X	NA	MRI Provider	026	PHYSICIANS	23001	30	Radiology	0	In state provider	None	FRESNO AND R ST	None	FRESNO	CA	93721	0000	10	06019	36.741663	-119.7841005	Fresno County
272355	Fee-for-Service	1700966652	1700966652	1	1	ALKHADDO, JAMIL MD	5/30/2024	207RE0101X	NA	Endocrinology	026	PHYSICIANS	186416	67	Endocrinology	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
272357	Fee-for-Service	1043323488	1043323488	1	1	AMAZONA, CARLO MD	6/14/2021	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	43291	None	None	0	In state provider	None	331 S H ST	None	BAKERSFIELD	CA	93304	3403	15	06029	35.35053984	-119.0213687	Kern County
272383	Fee-for-Service	1477887206	1477887206	1	1	AYVAZYAN, VLADIMIR MD	11/10/2009	207R00000X	NA	Other	026	PHYSICIANS	109556	41	Internal Medicine	0	In state provider	None	500 E OLIVE AVENUE	SUITE 315	BURBANK	CA	91501	3316	19	06037	34.1845331	-118.3048131	Los Angeles County
272405	Fee-for-Service	1962632372	1962632372	1	1	ANDERSON, LAURA E OD	7/29/2009	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1524 EUREKA ROAD	None	ROSEVILLE	CA	95661	2850	31	06061	38.7497045	-121.2490063	Placer County
272460	Fee-for-Service	1518259670	1518259670	1	1	ADAMS, PETER L LMFT	6/26/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	39350 CIVIC CENTER DR	None	FREMONT	CA	94538	2343	01	06001	37.55399458	-121.9756047	Alameda County
272520	Fee-for-Service	1841258340	1841258340	1	1	ARORA, SARTAJ M MD INC	6/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	73889	10	Gastroenterology (M.D. only)	0	In state provider	None	1135 S SUNSET AVE	STE 405	WEST COVINA	CA	91790	3965	19	06037	34.06215064	-117.9453997	Los Angeles County
272536	Fee-for-Service	1801308697	1801308697	1	1	AMEDI HOSPICE CARE, INC	4/17/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14242 VENTURA BLVD	SUITE 208	SHERMAN OAKS	CA	91423	2757	19	06037	34.14999696	-118.4433632	Los Angeles County
272537	Fee-for-Service	1770234288	1770234288	1	1	AREV HOME HEALTH SERVICES	3/19/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	21757 DEVONSHIRE ST	STE 7	CHATSWORTH	CA	91311	2973	19	06037	34.25725894	-118.603595	Los Angeles County
272546	Fee-for-Service	1669401196	1669401196	1	1	ARMSTRONG,SHERI MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	221 MAHALANI ST	None	WAILUKU	HI	96793	0000	00	None	20.88554026	-156.4902142	Maui County
272581	Fee-for-Service	1942431374	1942431374	1	2	ALTAMED HEALTH SERVICES CORP	4/13/2022	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	1900 E SLAUSON AVE	STE B	HUNTINGTON PARK	CA	90255	2725	19	06037	33.9891357	-118.2389609	Los Angeles County
272610	Fee-for-Service	1053455535	1053455535	1	1	AGARWAL, RAJNI MD	5/10/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50583	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
272615	Fee-for-Service	1225013337	1225013337	1	1	AYYALAPU, ANITHA R MD	8/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	56416	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
272626	Fee-for-Service	1427374321	1427374321	1	1	AGRAWAL, NISHA J MD	1/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	119499	01	General Practice	0	In state provider	None	1701 E CESAR E CHAVEZ	SUITE 230	LOS ANGELES	CA	90033	2496	19	06037	34.05112725	-118.2173921	Los Angeles County
272628	Fee-for-Service	1952478620	1952478620	1	1	ALWAHDANI, ABDULIAH MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SWIOWA CADIOLOGY ASSC.	1223 S GEAR AVE.,	SUITE 109	WEST BURLINGOTN	IA	52655	0000	00	None	40.809789	-91.1727495	Des Moines County
272654	Fee-for-Service	1992086185	1992086185	1	1	AOS PROFESSIONAL INC	5/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	111058	36	Psychiatry	0	In state provider	None	730 34TH STREET	None	BAKERSFIELD	CA	93301	2210	15	06029	35.39051913	-119.0100179	Kern County
272722	Fee-for-Service	1699715623	1699715623	1	1	AGUILAR, ROBERT J LMFT	5/4/2023	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	272 CHURCH AVE	STE 3	CHULA VISTA	CA	91910	2718	37	06073	32.64244569	-117.0792461	San Diego County
272731	Fee-for-Service	1235160730	1235160730	1	1	ANDERSON, CHRISTIAN B MD	11/6/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	46288	30	Radiology	0	In state provider	None	1000 TRANCAS ST	None	NAPA	CA	94558	2906	28	06055	38.32349768	-122.2963137	Napa County
272746	Fee-for-Service	1407962624	1407962624	1	1	ACTIVE POTENTIAL, INC	7/18/2007	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ACTIVE POTENTIAL, INC	7898 OSTROW ST	STE G	SAN DIEGO	CA	92111	3640	37	06073	32.8137476	-117.1552872	San Diego County
272760	Fee-for-Service	1457771909	1457771909	1	1	AZURDIA, JACOB MD	12/12/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	465 N ROXBURY DR	STE 101&715	BEVERLY HILLS	CA	90210	4206	19	06037	34.06832918	-118.4072114	Los Angeles County
272774	Fee-for-Service	1548560451	1548560451	1	1	AMUNDSEN, TONI M CNM	11/30/2015	No Taxonomy Provided	NA	None	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
272792	Fee-for-Service	1841258340	1841258340	1	1	ARORA, SARTAJ M MD INC	6/4/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	73889	41	Internal Medicine	0	In state provider	None	1135 S SUNSET AVE	STE 405	WEST COVINA	CA	91790	3965	19	06037	34.06215064	-117.9453997	Los Angeles County
272836	Fee-for-Service	1205034030	1205034030	1	1	ALLEN, STEWART G MD	11/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	122528	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	999 ADAMS ST	SUITE 106	ST HELENA	CA	94574	1148	28	06055	38.5071543	-122.4685546	Napa County
272842	Fee-for-Service	1457596371	1457596371	1	1	ALLSAFE MEDICAL GROUP INC.	8/17/2011	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	APC	8077 FLORENCE AVE	STE 112	DOWNEY	CA	90240	3894	19	06037	33.95245028	-118.1277345	Los Angeles County
272859	Fee-for-Service	1124589254	1124589254	1	1	ALFRAJI, NASAM B MD	10/12/2023	207R00000X	NA	Other	026	PHYSICIANS	180009	None	None	0	In state provider	None	400 PEPPER	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
272864	Fee-for-Service	1487143640	1487143640	1	1	ALBRIGHT, KRISTEN P	11/19/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	581 MCCRAY STREET	SUITE F	HOLLISTER	CA	95023	9502	35	06069	36.85042871	-121.3976694	San Benito County
272881	Fee-for-Service	1053455535	1053455535	1	1	AGARWAL, RAJNI MD	5/10/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50583	78	Neoplastic Diseases/Oncology	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
272915	Fee-for-Service	1316005572	1316005572	1	7	APPLE URGENT CARE, INC	1/23/2023	207QG0300X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	301 N PEPPER AVE	100	COLTON	CA	92324	1838	36	06071	34.07085827	-117.353113	San Bernardino County
272980	Fee-for-Service	1770894412	1770894412	2	1	ANWAR MOLANI MD INC APMC	8/2/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	53899	None	None	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
272985	Fee-for-Service	1457319485	1457319485	1	1	ALLINA HEALTH SYSTEM	2/3/2007	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	UNITED HOSP	333 N SMITH AVE	None	SAINT PAUL	MN	55102	2344	00	None	44.94251219	-93.1074995	Ramsey County
272994	Fee-for-Service	1245256130	1245256130	1	1	ABELL, GEOFFREY A MD	7/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	98712	40	Pediatrics	0	In state provider	None	202 EUCLID AVE	STE 220	SAN DIEGO	CA	92114	3609	37	06073	32.70601614	-117.0851361	San Diego County
273089	Fee-for-Service	1588645634	1588645634	1	3	ALEXANDER, JAMILE Y MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	508 S HIGHWAY 78	None	WYLIE	TX	75098	3947	00	None	33.00779062	-96.5464307	Collin County
273117	Fee-for-Service	1184772048	1184772048	1	1	ABRAHAMIAN, FLORA MD	2/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	85631	41	Internal Medicine	0	In state provider	None	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.78673844	-118.2965289	Los Angeles County
273144	Fee-for-Service	1740323559	1740323559	1	1	AGADZI, ANTHONY K MD	5/11/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89342	18	Ophthalmology	0	In state provider	None	2852 REDWOOD PKWY	None	VALLEJO	CA	94591	3633	48	06095	38.12289917	-122.2245306	Solano County
273159	Fee-for-Service	1881217974	1881217974	1	1	AT AWE LLC	3/17/2022	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	10876 MORNING RIDGE DR	None	MORENO VALLEY	CA	92557	4202	33	06065	33.96288648	-117.2286061	Riverside County
273186	Fee-for-Service	1316005572	1316005572	1	7	APPLE URGENT CARE, INC	1/23/2023	207QG0300X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	301 N PEPPER AVE	100	COLTON	CA	92324	1838	36	06071	34.07085827	-117.353113	San Bernardino County
273201	Fee-for-Service	1427604834	1427604834	1	1	ADVENTIST HEALTH PHYSICIANS	10/29/2019	207RG0100X	NA	Gastroenterology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	999 S FAIRMONT AVE	50	LODI	CA	95240	5139	39	06077	38.1206163	-121.2858323	San Joaquin County
273232	Fee-for-Service	1699295758	1699295758	1	1	AVANESYAN, FELIKS MD	10/17/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	166992	None	None	0	In state provider	None	4323 W RIVERSIDE DRIVE	None	BURBANK	CA	91505	4044	19	06037	34.15223748	-118.347426	Los Angeles County
273251	Fee-for-Service	1770894412	1770894412	2	1	ANWAR MOLANI MD INC APMC	9/29/2022	207ZP0102X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	16237 VENTURA BLVD	None	ENCINO	CA	91436	2201	19	06037	34.15686987	-118.4871369	Los Angeles County
273272	Fee-for-Service	1780909697	1780909697	1	1	AGUAYO, YVETTE A LMFT	12/12/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
273273	Fee-for-Service	1801095252	1801095252	1	1	AMIN, MALINI R MD	8/5/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	128502	40	Pediatrics	0	In state provider	None	27303 SLEEPY HOLLOW AVE	SOUTH	HAYWARD	CA	94545	4203	01	06001	37.63208871	-122.0939191	Alameda County
273315	Fee-for-Service	1770657074	1770657074	1	1	ARIAS, YESELI MD	7/13/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	87848	41	Internal Medicine	0	In state provider	None	4125 BANGS AVE	None	MODESTO	CA	95356	8713	50	06099	37.70451024	-121.0709696	Stanislaus County
273342	Fee-for-Service	1912177759	1912177759	1	1	AILING, JOSE-NITRAM P MD	8/12/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	101748	41	Internal Medicine	0	In state provider	None	900 HYDE ST	None	SAN FRANCISCO	CA	94109	4806	38	06075	37.78956486	-122.417072	San Francisco County
273382	Fee-for-Service	1659053999	1659053999	1	1	ASSESS FIRST LLC	9/1/2023	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	12626 THORNBERG WAY	None	RANCHO CORDOVA	CA	95742	7825	34	06067	38.567754	-121.198338	Sacramento County
273445	Fee-for-Service	1417298480	1417298480	1	1	AVILA-PEREZ, JESSICA M LMFT	10/6/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	56	06111	34.27771547	-119.2540344	Ventura County
273457	Fee-for-Service	1194878439	1194878439	1	1	ANDRESEN, JOSEPH S MD	2/8/2015	207L00000X	NA	Other	026	PHYSICIANS	50667	05	Anesthesiology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
273506	Fee-for-Service	1376318345	1376318345	1	1	ALVARADO PHARMACY SD	1/17/2024	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	5555 RESERVOIR DR	SUITE 114	SAN DIEGO	CA	92120	5197	37	06073	32.77628471	-117.0563688	San Diego County
273514	Fee-for-Service	1922030246	1922030246	1	1	ARORA, PRINCY MD	8/28/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	63203	13	Neurology (M.D. only)	0	In state provider	None	64 ASPEN WAY	STE 101	WATSONVILLE	CA	95076	3084	44	06087	36.93085993	-121.7799849	Santa Cruz County
273561	Fee-for-Service	1205093028	1205093028	1	1	AHMED, RAFI S MD	6/14/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	112161	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
273580	Fee-for-Service	1487053211	1487053211	1	1	ARREOLA, SAMANTHA LCSW	1/7/2021	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	611 S MILPITAS BLVD	None	MILPITAS	CA	95035	5473	43	06085	37.4246225	-121.8944566	Santa Clara County
273594	Fee-for-Service	1336714849	1336714849	1	1	ALWAYS HERE HOME HEALTH INC	8/16/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	4424 SANTA ANITA AVE	SUITE 205	EL MONTE	CA	91731	1684	19	06037	34.08667166	-118.0284088	Los Angeles County
273635	Fee-for-Service	1528786993	1528786993	1	1	ACOSTA, TERI	9/23/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	27412 ENTERPRISE CIR W	STE. 205	TEMECULA	CA	92590	4875	33	06065	33.51594134	-117.1669025	Riverside County
273646	Fee-for-Service	1194218503	1194218503	1	1	ARMSTRONG, ELIZABETH W	9/1/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	400 W FOREST AVE	APT 119	COALINGA	CA	93210	2567	10	06019	36.13338595	-120.3621592	Fresno County
273650	Fee-for-Service	1841461878	1841461878	1	1	AHUJA, RUCHI	5/24/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3553 WHIPPLE RD	None	UNION CITY	CA	94587	1507	01	06001	37.60573981	-122.0835989	Alameda County
273654	Fee-for-Service	1780005819	1780005819	1	1	ALGOS INC, A MEDICAL CORPOR	2/6/2019	208VP0000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	340 FOURTH AVE	SUITE 19	CHULA VISTA	CA	91910	3813	37	06073	32.63831293	-117.0833536	San Diego County
273689	Fee-for-Service	1205218732	1205218732	1	1	ALL SUPPORT AT HOME LLC	2/4/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	1038 LEIGH AVE	STE 216	SAN JOSE	CA	95126	4129	43	06085	37.30588367	-121.9214449	Santa Clara County
273747	Fee-for-Service	1649366378	1649366378	1	1	ABAN CARE CLINIC LLC	11/21/2011	193400000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	2182 HWY 95	None	BULLHEAD CITY	AZ	86442	6044	00	None	35.108838	-114.5975535	Mohave County
273810	Fee-for-Service	1144562703	1144562703	1	1	ARUTYUNOV, BORIS S MD	4/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	137892	None	None	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
273819	Fee-for-Service	1598104960	1598104960	1	1	ASHRAF, OMAR MD	9/19/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
273822	Fee-for-Service	1932429842	1932429842	1	1	AJMERA, VEERAL H MD	6/30/2017	207RI0008X	NA	Gastroenterology	026	PHYSICIANS	124545	10	Gastroenterology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
273844	Fee-for-Service	1083298400	1083298400	1	2	AMERICAN REGAL TRANS INC	6/8/2021	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	18455 BURBANK BLVD	STE 407	TARZANA	CA	91356	6651	19	06037	34.17237215	-118.5354469	Los Angeles County
273858	Fee-for-Service	1225292782	1225292782	1	1	ANDREW T COWAN MD	3/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
273904	Fee-for-Service	1164494274	1164494274	1	1	AZAR, ANGELA E MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	79191	None	None	0	In state provider	None	1001 N TUSTIN AVE	None	SANTA ANA	CA	92705	3502	30	06059	33.75363187	-117.8341886	Orange County
273912	Fee-for-Service	1194218503	1194218503	1	1	ARMSTRONG, ELIZABETH W	9/1/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	400 W FOREST AVE	APT 119	COALINGA	CA	93210	2567	10	06019	36.13338595	-120.3621592	Fresno County
273921	Fee-for-Service	1821385675	1821385675	1	1	ABANES, JANE J NP	4/3/2023	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	38	06075	37.7634502	-122.4579779	San Francisco County
273924	Fee-for-Service	1780005819	1780005819	1	1	ALGOS INC, A MEDICAL CORPOR	5/7/2021	208VP0000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	340 FOURTH AVE	SUITE 19	CHULA VISTA	CA	91910	3813	37	06073	32.63831293	-117.0833536	San Diego County
273926	Fee-for-Service	1356328249	1356328249	1	1	AGUS, DAVID B MD	4/1/2000	174400000X	NA	Other	026	PHYSICIANS	85631	78	Neoplastic Diseases/Oncology	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
273928	Fee-for-Service	1376995308	1376995308	1	1	ANDREWS, CAROL S LMFT	1/13/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	419 ELIZABETH ST	SUITE 4	VACAVILLE	CA	95688	4602	48	06095	38.35435832	-121.9875168	Solano County
273953	Fee-for-Service	1932459302	1932459302	1	1	ALMAGUER, ISAAC J LMFT	9/20/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2677 N MAIN ST	STE 110	SANTA ANA	CA	92705	6663	30	06059	33.77224313	-117.8672259	Orange County
273963	Fee-for-Service	1467911420	1467911420	1	1	AL-BEYATI, REFKA MD	5/17/2022	208M00000X	NA	Other	026	PHYSICIANS	177029	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
273988	Fee-for-Service	1255863841	1255863841	1	1	AYYAD, JAFAR A MD	4/1/2024	390200000X	NA	Other	026	PHYSICIANS	166085	None	None	0	In state provider	None	4955 VAN NUYS BLVD	SUITE 308	SHERMAN OAKS	CA	91403	1811	19	06037	34.160805	-118.4487295	Los Angeles County
273992	Fee-for-Service	1902173263	1902173263	1	2	APEX HEALTHCARE MEDICAL	10/1/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	CENTER INC	1225 E LATHAM AVE	STE A	HEMET	CA	92543	4423	33	06065	33.74937952	-116.959626	Riverside County
274004	Fee-for-Service	1740417948	1740417948	1	1	ARZANIPOUR, GADI DO	5/11/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	12709	05	Anesthesiology	0	In state provider	None	18321 CLARK STREET	None	TARZANA	CA	91356	3501	19	06037	34.16979433	-118.5312303	Los Angeles County
274016	Fee-for-Service	1194185637	1194185637	1	1	AVALON SURGERY AND ROBOTIC C	10/4/2024	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	435 ARDEN AVE	STE 520	GLENDALE	CA	91203	1138	19	06037	34.15848148	-118.2628845	Los Angeles County
274025	Fee-for-Service	1053470674	1053470674	1	1	AZZAM, SAMI J MD	7/1/1998	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	51391	41	Internal Medicine	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
274032	Fee-for-Service	1992557748	1992557748	1	1	ABAS, ALVIN ZAMORA	4/11/2025	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	19009 S LAUREL PARK RD	SPC 127	COMPTON	CA	90220	6083	19	06037	33.85659739	-118.219905	Los Angeles County
274051	Fee-for-Service	1437277092	1437277092	1	1	ABALOS-GALITO, MARIETTA	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	78499	41	Internal Medicine	0	In state provider	MD	1715 LUNDY AVE	STE 174	SAN JOSE	CA	95131	1859	43	06085	37.3881873	-121.8869157	Santa Clara County
274079	Fee-for-Service	1649632548	1649632548	1	1	AMTOFT, LINDSEY LMFT	11/13/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	111 SMITH RANCH ROAD	None	SAN RAFAEL	CA	94903	1939	21	06041	38.01951576	-122.5315893	Marin County
274123	Fee-for-Service	1649699299	1649699299	1	1	APRECIO, BYRON R A CRNA	5/27/2016	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	35-800 BOB HOPE DR	STE 100	RANCHO MIRAGE	CA	92270	1739	33	06065	33.78398109	-116.4059049	Riverside County
274173	Fee-for-Service	1457596371	1457596371	1	5	ALLSAFE MEDICAL GROUP INC.	12/21/2023	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	15	Obstetrics (D.O. only)	0	In state provider	None	2760 FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5747	19	06037	33.97370839	-118.2207184	Los Angeles County
274186	Fee-for-Service	1780005819	1780005819	1	1	ALGOS INC, A MEDICAL CORPOR	2/6/2019	208VP0000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	340 FOURTH AVE	SUITE 19	CHULA VISTA	CA	91910	3813	37	06073	32.63831293	-117.0833536	San Diego County
274218	Fee-for-Service	1790875995	1790875995	2	1	ARMSTRONG, JOHN T JR MD	6/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	37899	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3434 VILLA LN	STE 360	NAPA	CA	94558	6416	28	06055	38.32515937	-122.2938358	Napa County
274289	Fee-for-Service	1053470674	1053470674	1	1	AZZAM, SAMI J MD	7/1/1998	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	51391	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
274295	Fee-for-Service	1902000599	1902000599	1	1	ANGELES, CARMINA F MD	6/19/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	108308	14	Neurological Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
274298	Fee-for-Service	1992557748	1992557748	1	1	ABAS, ALVIN ZAMORA	4/11/2025	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	19009 S LAUREL PARK RD	SPC 127	COMPTON	CA	90220	6083	19	06037	33.85659739	-118.219905	Los Angeles County
274310	Fee-for-Service	1174787931	1174787931	1	1	ARCINUE, MARIA R A MD	8/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	112597	40	Pediatrics	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
274439	Fee-for-Service	1457596371	1457596371	1	5	ALLSAFE MEDICAL GROUP INC.	12/21/2023	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2760 FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5747	19	06037	33.97370839	-118.2207184	Los Angeles County
274443	Fee-for-Service	1306015607	1306015607	1	1	ALIAS, AMY MD	8/7/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118468	41	Internal Medicine	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
274486	Fee-for-Service	1841251899	1841251899	2	1	ANJALI SHARMA MD INC	3/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	92737	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	7501 HOSPITAL DR	STE 204	SACRAMENTO	CA	95823	5405	34	06067	38.464776	-121.416912	Sacramento County
274524	Fee-for-Service	1003062340	1003062340	1	1	AIDS HEALTHCARE FOUNDATION	9/30/2008	3336S0011X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	AHF PHARMACY	4905 HOLLYWOOD BLVD	None	LOS ANGELES	CA	90027	6101	19	06037	34.10180109	-118.2963991	Los Angeles County
274535	Fee-for-Service	1134273980	1134273980	1	1	APPLEBAUM, MARTIN MD INC	12/4/1986	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	25811	30	Radiology	0	In state provider	None	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1418	19	06037	34.2395322	-118.3939944	Los Angeles County
274538	Fee-for-Service	1982390936	1982390936	1	1	AMADOR, BRITTANY R NP	9/1/2023	363LN0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
274591	Fee-for-Service	1790311769	1790311769	1	1	ALMADA, ADRIENNE R CNM	7/24/2020	367A00000X	NA	Certified Nurse Midwife	005	CERTIFIED NURSE MIDWIFE	-	None	None	0	In state provider	None	23141 MOULTON PKWY	108	LAGUNA HILLS	CA	92653	1241	30	06059	33.62613379	-117.7305831	Orange County
274600	Fee-for-Service	1316019482	1316019482	1	1	ARTESIA HEALTHCARE, INC	10/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	ALAMEDA CARE CENTER	925 W ALAMEDA AVE	None	BURBANK	CA	91506	2801	19	06037	34.16337689	-118.312794	Los Angeles County
274614	Fee-for-Service	1174996177	1174996177	1	1	ALL-INCLUSIVE COMMUNITY	2/21/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	3920 EAGLE ROCK BLVD	SUITE A	LOS ANGELES	CA	90065	3606	19	06037	34.11936223	-118.230111	Los Angeles County
274665	Fee-for-Service	1306194022	1306194022	1	1	ARIAS HEALTH CARE INC	6/26/2017	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1220 W HEMLOCK WAY	SUITE 202-A	SANTA ANA	CA	92707	3656	30	06059	33.70975375	-117.8842792	Orange County
274704	Fee-for-Service	1457596371	1457596371	1	5	ALLSAFE MEDICAL GROUP INC.	12/21/2023	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	09	Gynecology (D.O. only)	0	In state provider	None	2760 FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5747	19	06037	33.97370839	-118.2207184	Los Angeles County
274719	Fee-for-Service	1962669531	1962669531	1	1	ASH, BRIAN G MD	8/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	103642	05	Anesthesiology	0	In state provider	None	2500 GRANT RD	None	MOUNTAIN VIEW	CA	94040	4378	43	06085	37.36893518	-122.0779448	Santa Clara County
274720	Fee-for-Service	1053741892	1053741892	1	1	AFFORDABLE MEDICAL SUPPLY	1/22/2015	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	INC	1535 EAST SHAW AVE	#102	FRESNO	CA	93710	8012	10	06019	36.80834051	-119.7600926	Fresno County
274730	Fee-for-Service	1396208443	1396208443	1	1	AL RAMO, KATHREEN MD	7/11/2023	207R00000X	NA	Other	026	PHYSICIANS	177079	None	None	0	In state provider	None	2823 FRESNO ST	None	FRESNO	CA	93721	1324	10	06019	36.7423511	-119.7834688	Fresno County
274753	Fee-for-Service	1649247396	1649247396	1	1	AMARILLO HEART GROUP LLP	5/16/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	06	Cardiovascular Disease (M.D. only)	2	Out of state provider	None	1901 PORT LANE	None	AMARILLO	TX	79106	2430	00	None	35.19394499	-101.9134555	Potter County
274771	Fee-for-Service	1497396972	1497396972	1	1	ALWAYS YES HOME HEALTH CARE	6/13/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	3959 FOOTHILL BOULEVARD	SUITE 307	LA CRESCENTA	CA	91214	1664	19	06037	34.24025956	-118.2658392	Los Angeles County
274802	Fee-for-Service	1548867419	1548867419	1	1	AVILES, LEAH J PT	12/4/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	37	06073	32.70162897	-117.1465065	San Diego County
274809	Fee-for-Service	1427363027	1427363027	1	1	ADAMS, III JOHN H	9/1/2010	No Taxonomy Provided	NA	None	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	3816 WOODRUFF AVENUE	SUITE 305	LONG BEACH	CA	90808	2146	19	06037	33.828102	-118.1165525	Los Angeles County
274817	Fee-for-Service	1093235780	1093235780	1	1	ARTHUR, CERA LMFT	1/22/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
274824	Fee-for-Service	1629835178	1629835178	1	1	ABDELHADI, SARA A LPCC	3/18/2024	101YM0800X	NA	Other	103	LICENSED PROFESSIONAL CLINICAL COUNSELOR - INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
274857	Fee-for-Service	1477757060	1477757060	1	1	AHMED, SONYA S MD	5/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	115923	20	Orthopedic Surgery	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
274878	Fee-for-Service	1174996177	1174996177	1	1	ALL-INCLUSIVE COMMUNITY	2/21/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	3920 EAGLE ROCK BLVD	SUITE A	LOS ANGELES	CA	90065	3606	19	06037	34.11936223	-118.230111	Los Angeles County
274886	Fee-for-Service	1851965131	1851965131	1	1	AB HEALTH SERVICES	4/6/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	225 E BROADWAY	SUITE 205D	GLENDALE	CA	91205	4096	19	06037	34.14633765	-118.2529554	Los Angeles County
274895	Fee-for-Service	1013985688	1013985688	1	1	ALBERT S CHARNEY	12/22/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SUN CITY IMAGING	14502 W MEEKER BLVD	None	SUN CITY	AZ	85375	0000	00	None	33.660657	-112.3736175	Maricopa County
274900	Fee-for-Service	1629854419	1629854419	1	1	ALTAMED HEALTH SERVICES CORP	10/16/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3208 SANTA ANITA AVE	#100	EL MONTE	CA	91733	1304	19	06037	34.06628897	-118.0425098	Los Angeles County
274901	Fee-for-Service	1174690929	1174690929	1	1	ALSON, CHARLES OD	12/16/2013	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1515 N VERMONT AVE	None	LOS ANGELES	CA	90027	5337	19	06037	34.09851639	-118.2918012	Los Angeles County
274924	Fee-for-Service	1306194022	1306194022	1	1	ARIAS HEALTH CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1220 W HEMLOCK WAY	SUITE 202-A	SANTA ANA	CA	92707	3656	30	06059	33.70975375	-117.8842792	Orange County
274941	Fee-for-Service	1538570106	1538570106	1	1	AMERICAN STELLAR HOME HEALTH	7/20/2017	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	2700 N MAIN STREET	SUITE 506	SANTA ANA	CA	92705	6657	30	06059	33.7737545	-117.8687284	Orange County
274970	Fee-for-Service	1659433860	1659433860	1	1	ARVESEN, DANIEL J LMFT	9/4/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
274990	Fee-for-Service	1497909832	1497909832	1	1	AC HOSPICE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3756 SANTA ROSALIA DRIVE	STE 520C	LOS ANGELES	CA	90008	3656	19	06037	34.00888336	-118.3389334	Los Angeles County
275015	Fee-for-Service	1649247396	1649247396	1	1	AMARILLO HEART GROUP LLP	5/16/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	2	Out of state provider	None	1901 PORT LANE	None	AMARILLO	TX	79106	2430	00	None	35.19394499	-101.9134555	Potter County
275052	Fee-for-Service	1285363556	1285363556	1	1	ANAHEIM PHARMACY, LLC	11/11/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1211 W LA PALMA AVE	STE 102	ANAHEIM	CA	92801	2809	30	06059	33.84718298	-117.933758	Orange County
275056	Fee-for-Service	1336747013	1336747013	1	1	ADVANCED HEALTHCARE ADMINIST	1/12/2024	171M00000X	NA	Other	108	COMMUNITY BASED ORGANIZATIONS	-	-	NOT APPLICABLE	0	In state provider	RATION	4800 GAGE AVE	SUITE 4	BELL	CA	90201	1425	19	06037	33.9772612	-118.1802327	Los Angeles County
275058	Fee-for-Service	1083972160	1083972160	1	1	AVERA MCKENNAN	1/23/2018	193400000X	NA	Other	022	PHYSICIANS GROUP	-	41	Internal Medicine	2	Out of state provider	None	1325 S CLIFF AVENUE	None	SIOUX FALLS	SD	57105	1007	00	None	43.533945	-96.714819	Minnehaha County
275138	Fee-for-Service	1174996177	1174996177	1	1	ALL-INCLUSIVE COMMUNITY	11/26/2019	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	HEALTH CENTER	3920 EAGLE ROCK BLVD	SUITE A	LOS ANGELES	CA	90065	3606	19	06037	34.11936223	-118.230111	Los Angeles County
275147	Fee-for-Service	1740351634	1740351634	1	1	AKHTAR, MUSTANSAR MD	2/28/1993	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	52494	40	Pediatrics	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
275168	Fee-for-Service	1720214729	1720214729	1	1	ALEJANDRINO, BERNADETTE P MD	10/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121496	01	General Practice	0	In state provider	None	420 W ROWLAND ST	None	COVINA	CA	91723	2943	19	06037	34.078949	-117.8963031	Los Angeles County
275170	Fee-for-Service	1891345815	1891345815	1	1	ARTERBURN, MADELINE OT	11/23/2021	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	22691 LAMBERT ST	502	LAKE FOREST	CA	92630	1614	30	06059	33.63321041	-117.7137117	Orange County
275201	Fee-for-Service	1215679691	1215679691	1	1	ARELLANO, LIZA A LCSW	10/1/2023	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	10255 CORAL LN	None	MORENO VALLEY	CA	92557	2877	33	06065	33.97197289	-117.2540003	Riverside County
275251	Fee-for-Service	1497909832	1497909832	1	1	AC HOSPICE INC	10/16/2009	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3756 SANTA ROSALIA DRIVE	STE 520C	LOS ANGELES	CA	90008	3656	19	06037	34.00888336	-118.3389334	Los Angeles County
275275	Fee-for-Service	1700873593	1700873593	1	1	AZIZ, IHAB N MD	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	66104	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	16917 ENADIA WAY	None	VAN NUYS	CA	91406	3602	19	06037	34.20015385	-118.5018777	Los Angeles County
275276	Fee-for-Service	1649247396	1649247396	1	1	AMARILLO HEART GROUP LLP	5/16/2016	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	42	Nuclear Medicine	2	Out of state provider	None	1901 PORT LANE	None	AMARILLO	TX	79106	2430	00	None	35.19394499	-101.9134555	Potter County
275320	Fee-for-Service	1003968009	1003968009	1	1	AMUNDSON, STANLEY A MD	1/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	31072	41	Internal Medicine	0	In state provider	None	4077 FIFTH AVE	None	SAN DIEGO	CA	92103	2105	37	06073	32.75034388	-117.161023	San Diego County
275343	Fee-for-Service	1255712733	1255712733	1	1	ADVANCED HOME HEALTH	10/13/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES INC	12509 OXNARD ST	SUITE 214	NORTH HOLLYWOOD	CA	91606	1250	19	06037	34.17943548	-118.405683	Los Angeles County
275363	Fee-for-Service	1912240318	1912240318	1	1	ANELLO, MARGARET D LMFT	10/29/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
275386	Fee-for-Service	1902173263	1902173263	1	1	APEX HEALTHCARE MEDICAL	12/26/2018	208600000X	NA	General Surgery	022	PHYSICIANS GROUP	-	02	General Surgery	0	In state provider	CENTER INC	29826 HAUN RD	STE 200	MENIFEE	CA	92586	6547	33	06065	33.68719818	-117.1748757	Riverside County
275414	Fee-for-Service	1700086493	1700086493	1	1	AGHAMOHAMMADI, MAZDA MD	8/13/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	94729	None	None	0	In state provider	None	1 HOAG DR	None	NEWPORT BEACH	CA	92263	4162	30	06059	33.62421676	-117.9309656	Orange County
275427	Fee-for-Service	1841582673	1841582673	1	1	AWAD, MARK Y MD	7/28/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	122123	05	Anesthesiology	0	In state provider	None	400 N PEPPER AVE	None	COLTON	CA	92324	1801	36	06071	34.073505	-117.3505995	San Bernardino County
275428	Fee-for-Service	1356788228	1356788228	1	1	ADACHI, NICOLE E	9/16/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	15446 S WESTERN AVE	None	GARDENA	CA	90249	4319	19	06037	33.89042107	-118.3091303	Los Angeles County
275431	Fee-for-Service	1720214729	1720214729	1	1	ALEJANDRINO, BERNADETTE P MD	10/5/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	121496	08	Family Practice	0	In state provider	None	420 W ROWLAND ST	None	COVINA	CA	91723	2943	19	06037	34.078949	-117.8963031	Los Angeles County
275447	Fee-for-Service	1285720011	1285720011	1	1	ALLEN, JOSEPH E MD	11/4/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	77476	08	Family Practice	0	In state provider	None	4116 W POINT LOMA BLVD	None	SAN DIEGO	CA	92110	5605	37	06073	32.75335292	-117.2246698	San Diego County
275465	Fee-for-Service	1548892045	1548892045	1	1	ADVENTIST HEALTH PHYSICIANS	11/17/2020	207Q00000X	NA	Adult Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	301 SCIENCE DRIVE	180	MOORPARK	CA	93021	2094	56	06111	34.27992368	-118.8694411	Ventura County
275466	Fee-for-Service	1922885037	1922885037	1	1	ARCHWAY RECOVERY SERVICES IN	10/9/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	C	2100 NAPA VALLEJO HWY	BUILDING 253, M1/M2	NAPA	CA	94558	6234	28	06055	38.277846	-122.2678305	Napa County
275468	Fee-for-Service	1538373592	1538373592	1	2	ARAIM, OMAR A MD INC	2/8/2015	193400000X	NA	Other	026	PHYSICIANS	97867	02	General Surgery	0	In state provider	None	440 N GREENFIELD AVE	SUITE F	HANFORD	CA	93230	3568	16	06031	36.32904	-119.6582155	Kings County
275530	Fee-for-Service	1578905675	1578905675	1	1	ABDRABBO, ALADEAN MD	7/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139376	41	Internal Medicine	0	In state provider	None	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	30	06059	33.78785649	-117.8276715	Orange County
275533	Fee-for-Service	1700873593	1700873593	1	1	AZIZ, IHAB N MD	7/2/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	66104	02	General Surgery	0	In state provider	None	16917 ENADIA WAY	None	VAN NUYS	CA	91406	3602	19	06037	34.20015385	-118.5018777	Los Angeles County
275556	Fee-for-Service	1831506898	1831506898	1	1	ARSHAD, JUNAID MD	5/13/2020	207R00000X	NA	Other	026	PHYSICIANS	146767	68	Hematology	0	In state provider	None	3300 E SOUTH ST	STE 304	LONG BEACH	CA	90805	4549	19	06037	33.86018093	-118.1537163	Los Angeles County
275574	Fee-for-Service	1104395656	1104395656	1	1	AL-HERTANI, WALLA M MD	9/1/2024	207SG0201X	NA	Other	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	30	06059	33.78034779	-117.8655767	Orange County
275582	Fee-for-Service	1013278704	1013278704	1	1	AYSON, NICOLE M K MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128091	41	Internal Medicine	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
275624	Fee-for-Service	1427443704	1427443704	1	1	ALHASSEN, ZIAD MD	6/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152553	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
275662	Fee-for-Service	1902358575	1902358575	1	1	ALI, BACHAR DO	11/22/2022	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	20287	None	None	0	In state provider	None	3110 CHINO AVE	SUITE 150	CHINO HILLS	CA	91709	1211	36	06071	34.01077341	-117.738406	San Bernardino County
275667	Fee-for-Service	1215126396	1215126396	1	1	AKHTAR, ADNAN J DO	12/1/2007	207R00000X	NA	Other	026	PHYSICIANS	9286	41	Internal Medicine	0	In state provider	None	2700 DOLBEER ST	None	EUREKA	CA	95501	4799	12	06023	40.78355148	-124.1420294	Humboldt County
275676	Fee-for-Service	1740629351	1740629351	1	1	AJAYI, OPEYEMI M MD	8/18/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	143496	01	General Practice	0	In state provider	None	600 N HIGHLAND SPRINGS	None	BANNING	CA	92220	3046	33	06065	33.9316595	-116.9468639	Riverside County
275679	Fee-for-Service	1154837912	1154837912	1	1	ABONGWA, AGNES NGENWIE	1/10/2024	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	10401 COLUMBIA FALLS DR	None	BAKERSFIELD	CA	93312	1862	15	06029	35.41892115	-119.11854	Kern County
275712	Fee-for-Service	1134325012	1134325012	1	1	ADAM BOETTCHER	10/18/2023	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1020 N SAN FRANCISCO ST	STE 100	FLAGSTAFF	AZ	86001	3281	00	None	35.206173	-111.642777	Coconino County
275717	Fee-for-Service	1821210329	1821210329	1	1	AKHAVAN, AFSHIN DO A	8/25/2009	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	PROFESSIONAL CORPORATION	2409 S VERMONT AVE	None	LOS ANGELES	CA	90007	1661	19	06037	34.0343121	-118.2915755	Los Angeles County
275738	Fee-for-Service	1225471006	1225471006	1	1	ATTIYEH, MARC A MD	7/22/2022	208600000X	NA	General Surgery	026	PHYSICIANS	168215	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
275739	Fee-for-Service	1386638476	1386638476	1	1	AUSTIN, ALLEN E OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	101 CITY BLVD	PAVILLION 2 SECOND FLOOR	ORANGE	CA	92868	0000	30	06059	33.78564547	-117.8943599	Orange County
275776	Fee-for-Service	1316917065	1316917065	1	1	AMUZIE, IFEANYICHUKWU MD	5/24/2009	208600000X	NA	General Surgery	026	PHYSICIANS	27773	02	General Surgery	0	In state provider	None	2230 LYNN RD	STE 310	THOUSAND OAKS	CA	91360	1992	56	06111	34.20894685	-118.885185	Ventura County
275835	Fee-for-Service	1700143914	1700143914	1	1	ACHOJA, RUKE O MD	8/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141181	05	Anesthesiology	0	In state provider	None	1111 W LA PALMA AVE	None	ANAHEIM	CA	92801	2804	30	06059	33.84718298	-117.933758	Orange County
275837	Fee-for-Service	1013278704	1013278704	1	1	AYSON, NICOLE M K MD	9/26/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128091	40	Pediatrics	0	In state provider	None	3020 CHILDRENS WAY	MC5069	SAN DIEGO	CA	92123	4223	37	06073	32.798691	-117.150829	San Diego County
275875	Fee-for-Service	1174553218	1174553218	1	1	ARIANI, MEHRDAD K MD INC	7/1/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	48708	None	None	0	In state provider	None	18350 ROSCOE BLVD	STE 400	NORTHRIDGE	CA	91325	4165	19	06037	34.22071855	-118.5341175	Los Angeles County
275879	Fee-for-Service	1427443704	1427443704	1	1	ALHASSEN, ZIAD MD	6/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	152553	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
275902	Fee-for-Service	1265029656	1265029656	1	1	ARMAS, ALEXANDRA CCC-SLP	10/28/2022	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
275922	Fee-for-Service	1164463055	1164463055	1	2	ANESTHESIA CONSULTANTS	2/6/2011	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	OF CALIFORNIA MED GRP	2185 CITRACADO PKWY	None	ESCONDIDO	CA	92029	4159	37	06073	33.12123297	-117.1199417	San Diego County
275930	Fee-for-Service	1407279367	1407279367	1	1	ADONAI CONGREGATE LIVING INC	3/19/2014	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	17527 COVELLO STREET	None	LAKE BALBOA	CA	91406	2320	19	06037	34.20758146	-118.5152482	Los Angeles County
275933	Fee-for-Service	1154837912	1154837912	1	1	ABONGWA, AGNES NGENWIE	1/10/2024	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	10401 COLUMBIA FALLS DR	None	BAKERSFIELD	CA	93312	1862	15	06029	35.41892115	-119.11854	Kern County
275954	Fee-for-Service	1366545733	1366545733	1	1	AIZIN, VITALI MD	3/21/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82761	None	None	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
275961	Fee-for-Service	1508977364	1508977364	1	1	AKHTAR, MUHAMMAD S MD	4/11/1985	207R00000X	NA	Other	026	PHYSICIANS	41586	40	Pediatrics	0	In state provider	None	1034 W RAMSEY ST	STE A	BANNING	CA	92220	4442	33	06065	33.9253965	-116.887968	Riverside County
275996	Fee-for-Service	1164774675	1164774675	1	1	AYALA, RAUL MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123165	08	Family Practice	0	In state provider	None	2141 HIGH STREET	SUITE E	SELMA	CA	93662	3065	10	06019	36.57049208	-119.6139528	Fresno County
275997	Fee-for-Service	1841577376	1841577376	1	1	AL-JASIM, MOHAMMED MD APC	8/10/2012	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	82827	77	Infectious Disease	0	In state provider	None	1600 SOUTH IMPERIAL 8	None	EL CENTRO	CA	92243	4242	13	06025	32.77882919	-115.5697116	Imperial County
276003	Fee-for-Service	1184763278	1184763278	1	1	ANDRADE, JOSEPH A CRNA	10/26/2010	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
276005	Fee-for-Service	1952319071	1952319071	1	1	ABADA, ROLANDO P MD	10/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	50358	05	Anesthesiology	0	In state provider	None	3626 RUFFIN RD	None	SAN DIEGO	CA	92123	1810	37	06073	32.80975208	-117.1193406	San Diego County
276007	Fee-for-Service	1306149166	1306149166	1	1	AHERN, RYANN M MD	11/21/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	114908	41	Internal Medicine	0	In state provider	None	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	30	06059	33.85429563	-117.8166478	Orange County
276011	Fee-for-Service	1134325699	1134325699	1	1	AHANTH NARAYAN MD	9/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	43 NEW SCOTLAND AVE	None	ALBANY	NY	12208	3412	00	None	42.653133	-73.7752995	Albany County
276061	Fee-for-Service	1427463140	1427463140	1	1	ABRAHAM, JEAN-PHILIPPE M MD	10/16/2018	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	144366	08	Family Practice	0	In state provider	None	23625 WR HOLMAN HWY	None	MONTEREY	CA	93940	5902	27	06053	36.5785911	-121.9150013	Monterey County
276062	Fee-for-Service	1992781173	1992781173	1	1	ACCARDI, ANDREW J MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	66382	66	Emergency Medicine (Urgent Care)	0	In state provider	None	500 W HOSPITAL RD	None	FRENCH CAMP	CA	95231	0000	39	06077	37.88652418	-121.2820956	San Joaquin County
276133	Fee-for-Service	1609067040	1609067040	1	1	AMINI, KAMYAR MD	9/6/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	99444	04	Otology, Laryngology, Rhinology	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
276163	Fee-for-Service	1073908604	1073908604	1	1	ADVANCED SURGICAL GROUP, INC	3/6/2024	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	2160 SUNSET BLVD	SUITE 502	ROCKLIN	CA	95765	4790	31	06061	38.80605929	-121.2742583	Placer County
276165	Fee-for-Service	1619408903	1619408903	1	1	AGARWALA, VINEETA MD	11/23/2020	207R00000X	NA	Other	026	PHYSICIANS	157908	41	Internal Medicine	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
276205	Fee-for-Service	1497247332	1497247332	1	1	AYALA, DANIEL MD	6/23/2023	207R00000X	NA	Other	026	PHYSICIANS	174865	None	None	0	In state provider	None	1800 CALIFORNIA ST	None	STOCKTON	CA	95204	6019	39	06077	37.97026329	-121.2890849	San Joaquin County
276214	Fee-for-Service	1508977364	1508977364	1	1	AKHTAR, MUHAMMAD S MD	4/11/1985	207R00000X	NA	Other	026	PHYSICIANS	41586	41	Internal Medicine	0	In state provider	None	1034 W RAMSEY ST	STE A	BANNING	CA	92220	4442	33	06065	33.9253965	-116.887968	Riverside County
276238	Fee-for-Service	1508897760	1508897760	1	1	ALMEIDA, BLANCA B MD	7/31/1995	No Taxonomy Provided	NA	None	026	PHYSICIANS	79820	41	Internal Medicine	0	In state provider	None	1414 E FLORENCE AVE	None	LOS ANGELES	CA	90001	1937	19	06037	33.97471853	-118.249407	Los Angeles County
276255	Fee-for-Service	1164774675	1164774675	1	1	AYALA, RAUL MD	8/15/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123165	01	General Practice	0	In state provider	None	2141 HIGH STREET	SUITE E	SELMA	CA	93662	3065	10	06019	36.57049208	-119.6139528	Fresno County
276281	Fee-for-Service	1922754696	1922754696	1	1	ANTICO, JOSEPH LCSW	1/20/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
276288	Fee-for-Service	1952988354	1952988354	1	1	ABRAHAMS, SARA J MD	8/15/2024	207R00000X	NA	Other	026	PHYSICIANS	188667	41	Internal Medicine	0	In state provider	None	1001 POTRERO AVE	RM 5H22	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
276293	Fee-for-Service	1114354305	1114354305	1	1	ALLAWAY, CAITLIN A PSYD	4/20/2020	103T00000X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	19000 HOMESTEAD RD	None	CUPERTINO	CA	95014	0712	43	06085	37.33773494	-122.0043395	Santa Clara County
276370	Fee-for-Service	1720200017	1720200017	1	1	ABALOS, ANNA T MD	3/3/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	99301	08	Family Practice	0	In state provider	None	3104 SUNSET BLVD	SUITE 2B	ROCKLIN	CA	95677	3093	31	06061	38.78632648	-121.2517479	Placer County
276373	Fee-for-Service	1225178494	1225178494	1	1	A M AGHA MD INC	12/6/2010	207Y00000X	NA	ENT/Otolaryngology	026	PHYSICIANS	41243	None	None	0	In state provider	None	2323 16TH ST	# 101	BAKERSFIELD	CA	93301	3453	15	06029	35.37238027	-119.0288508	Kern County
276385	Fee-for-Service	1043372733	1043372733	1	1	AEGIS TREATMENT CENTERS, LLC	1/25/2016	261QM2800X	NA	Other	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	501 COLUMBUS ST AND 4050	None	BAKERSFIELD	CA	93301	1263	15	06029	35.39750653	-118.9906155	Kern County
276387	Fee-for-Service	1730119553	1730119553	1	3	AFFILIATED PATHOLOGISTS MEDI	8/31/1992	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	4101 TORRANCE BLVD	None	TORRANCE	CA	90503	4607	19	06037	33.83760674	-118.3572569	Los Angeles County
276423	Fee-for-Service	1093811143	1093811143	1	1	AFA CONSULTING CORP	4/24/2014	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	4055 E GUASTI RD	STE 107	ONTARIO	CA	91761	1519	36	06071	34.064505	-117.564219	San Bernardino County
276428	Fee-for-Service	1184265183	1184265183	1	1	ALESSANDRO MEDICAL PROFESSIO	4/16/2020	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	IAR	1530 W 6TH ST	109	CORONA	CA	92882	2742	33	06065	33.87842412	-117.5950761	Riverside County
276468	Fee-for-Service	1306922117	1306922117	1	1	AJAM, KAMAL S. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	325 9TH AVE	MS 359110 C/O UWP	SEATTLE	WA	98104	2420	00	None	47.60414369	-122.3235136	King County
276498	Fee-for-Service	1649893660	1649893660	1	1	ANDAYA, STACYANN NP	10/1/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	100 HOSPITAL DR	STE 200	VALLEJO	CA	94589	2580	48	06095	38.13100118	-122.2403008	Solano County
276524	Fee-for-Service	1750878922	1750878922	1	1	ADVENTIST HEALTH PHYSICIANS	6/2/2020	208800000X	NA	Other	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	830 S HAM LN	26	LODI	CA	95242	7510	39	06077	38.123568	-121.2882225	San Joaquin County
276567	Fee-for-Service	1033934096	1033934096	1	1	APEXCARE PHARMA SOLUTIONS CO	12/24/2024	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3505 CADILLAC AVE	STE. O104	COSTA MESA	CA	92626	1436	30	06059	33.69739868	-117.9304331	Orange County
276612	Fee-for-Service	1821091836	1821091836	1	2	ANDERSEN, GILBERT O MD	5/6/2016	No Taxonomy Provided	NA	None	086	MEDICAL DIRECTORS	29916	-	NOT APPLICABLE	0	In state provider	None	1010 N H STREET	SUITE N	LOMPOC	CA	93436	3340	42	06083	34.65440771	-120.457617	Santa Barbara County
276632	Fee-for-Service	1043372733	1043372733	1	1	AEGIS TREATMENT CENTERS, LLC	1/30/2014	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	501 COLUMBUS ST AND 4050	None	BAKERSFIELD	CA	93301	1263	15	06029	35.39750653	-118.9906155	Kern County
276645	Fee-for-Service	1134418171	1134418171	1	1	APTER, BRIAN R MD	11/21/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	130773	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
276646	Fee-for-Service	1730636457	1730636457	1	1	AMJADI, SOGOL S DO	4/15/2020	207R00000X	NA	Other	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	None	102 E LAKE MEAD PKWY	None	HENDERSON	NV	89015	5575	00	None	36.03815706	-114.9842287	Clark County
276654	Fee-for-Service	1821210329	1821210329	1	2	AKHAVAN, AFSHIN DO A	4/12/2011	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	530 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3723	19	06037	34.02866849	-118.2597481	Los Angeles County
276674	Fee-for-Service	1689915225	1689915225	1	1	ANKENY, JAMIE L	1/23/2015	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	12062 VALLEY VIEW ST	STE 137	GARDEN GROVE	CA	92845	1741	30	06059	33.78720885	-118.028413	Orange County
276697	Fee-for-Service	1376557793	1376557793	1	1	ABADEE, PAYANDEH MD	6/19/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	39494	25	Physical Medicine and Rehabilitation	0	In state provider	None	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
276711	Fee-for-Service	1790779288	1790779288	1	1	AG REDLANDS LLC	10/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	700 E HIGHLAND AVE	None	REDLANDS	CA	92374	6233	36	06071	34.04565229	-117.1638363	San Bernardino County
276725	Fee-for-Service	1023276193	1023276193	1	1	ALVY, DIANE MFT	11/3/2014	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9107 WILSHIRE BLVD	SUITE 200	BEVERLY HILLS	CA	90210	5522	19	06037	34.06708751	-118.390068	Los Angeles County
276795	Fee-for-Service	1265033039	1265033039	1	1	ALDRED, MATTHEW MD	1/29/2021	207L00000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
276851	Fee-for-Service	1386262764	1386262764	1	1	ALONZO, AMANDA LMFT	4/26/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1109 W SAN BERNARDINO RD	150	COVINA	CA	91722	4163	19	06037	34.0887369	-117.9124702	Los Angeles County
276860	Fee-for-Service	1982148359	1982148359	1	1	AVENO, KIMBERLY C NP	3/12/2019	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
276879	Fee-for-Service	1295143907	1295143907	1	1	ADAMS, NINOS P MD	7/12/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144452	36	Psychiatry	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
276941	Fee-for-Service	1669807111	1669807111	1	1	ALASANTRO, LORI H PHD	3/30/2018	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	6010 HIDDEN VALLEY ROAD	SUITE 200	CARLSBAD	CA	92011	4219	37	06073	33.12288368	-117.3058276	San Diego County
276949	Fee-for-Service	1851479554	1851479554	1	1	ADAMS, JESSE W MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	47092	68	Hematology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
276950	Fee-for-Service	1588645634	1588645634	1	2	ALEXANDER, JAMILE Y MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2977 E GERMANN RD	None	CHANDLER	AZ	85286	1586	00	None	33.276609	-111.7905435	Maricopa County
276955	Fee-for-Service	1437507522	1437507522	1	1	ARMAS, MONICA R LMFT	6/2/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	15497 W SAND ST	None	VICTORVILLE	CA	92392	2910	36	06071	34.51312455	-117.325854	San Bernardino County
276991	Fee-for-Service	1932296985	1932296985	1	1	AVRIN, DAVID E MD	12/11/2002	2085R0204X	NA	Other	026	PHYSICIANS	32193	30	Radiology	0	In state provider	None	505 PARNASSUS AVE	# 628	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
277068	Fee-for-Service	1538549654	1538549654	1	1	ARTHUR PO-FEI CHOU MD INC	7/20/2015	207T00000X	NA	General Surgery	026	PHYSICIANS	111306	None	None	0	In state provider	None	9210 COLIMA ROAD	STE. 108	WHITTIER	CA	90605	1829	19	06037	33.94990465	-118.0056421	Los Angeles County
277108	Fee-for-Service	1154560654	1154560654	1	1	AMAX CARE SERVICES INC	2/9/2015	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	936 CRENSHAW BLVD	STE 203	LOS ANGELES	CA	90019	1949	19	06037	34.05527468	-118.3226348	Los Angeles County
277137	Fee-for-Service	1669406609	1669406609	1	1	ATTENTIVE CARE	1/7/2000	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	306 N GARFIELD AVE	STE 11	MONTEREY PARK	CA	91754	1770	19	06037	34.06532629	-118.1228457	Los Angeles County
277171	Fee-for-Service	1508074352	1508074352	1	1	AMIRI, NOZAR MD	10/23/1996	208D00000X	NA	Adult Primary Care	026	PHYSICIANS	56376	01	General Practice	0	In state provider	None	540 N CENTRAL AVE	STE 305	GLENDALE	CA	91203	3361	19	06037	34.15437	-118.257912	Los Angeles County
277192	Fee-for-Service	1124000898	1124000898	2	1	APGUARD INC	12/21/2018	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	6404 INDEPENDENCE AVE	None	WOODLAND HILLS	CA	91367	2607	19	06037	34.18707051	-118.5906018	Los Angeles County
277194	Fee-for-Service	1851479554	1851479554	1	1	ADAMS, JESSE W MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	47092	78	Neoplastic Diseases/Oncology	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
277241	Fee-for-Service	1932296985	1932296985	1	1	AVRIN, DAVID E MD	12/11/2002	2085R0204X	NA	Other	026	PHYSICIANS	32193	02	General Surgery	0	In state provider	None	505 PARNASSUS AVE	# 628	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
277267	Fee-for-Service	1336324334	1336324334	1	1	AGHAJANIAN, PAOLA MD	8/17/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	90216	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
277268	Fee-for-Service	1407295900	1407295900	1	1	ANAND, NEELESH K MD	8/28/2018	390200000X	NA	Other	026	PHYSICIANS	149073	05	Anesthesiology	0	In state provider	None	1001 POTRERO AVE	RM 3C34	SAN FRANCISCO	CA	94110	3518	38	06075	37.75548534	-122.4065362	San Francisco County
277314	Fee-for-Service	1649680471	1649680471	1	1	AVETISYAN, ARARAT A MD	8/10/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	144458	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
277329	Fee-for-Service	1558439562	1558439562	1	1	ADAMSON, JULIE L	7/17/2017	No Taxonomy Provided	NA	None	003	AUDIOLOGISTS	-	-	NOT APPLICABLE	0	In state provider	None	3180 ARDEN WAY	None	SACRAMENTO	CA	95825	3701	34	06067	38.595528	-121.3903395	Sacramento County
277348	Fee-for-Service	1750559431	1750559431	1	17	ALL STAR PHYSICAL THERAPY, I	3/27/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	2815 MAIN ST.,	SUITE 205	CORONA	CA	92882	0000	33	06065	33.84741266	-117.570694	Riverside County
277369	Fee-for-Service	1235400037	1235400037	1	1	ABNOUSI, FREDDY MD	11/4/2019	207R00000X	NA	Other	026	PHYSICIANS	111909	41	Internal Medicine	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
277385	Fee-for-Service	1073566568	1073566568	1	1	ADREAN, SEAN D MD	5/26/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	77222	18	Ophthalmology	0	In state provider	None	301 W BASTANCHURY	STE 285	FULLERTON	CA	92835	3432	30	06059	33.89397383	-117.9316737	Orange County
277390	Fee-for-Service	1427234012	1427234012	1	1	ANSARI, ADEELA N MD	8/18/2020	207RE0101X	NA	Endocrinology	026	PHYSICIANS	84699	67	Endocrinology	0	In state provider	None	9394 BIG HORN BLVD	None	ELK GROVE	CA	95758	7977	34	06067	38.420028	-121.40712	Sacramento County
277440	Fee-for-Service	1851479554	1851479554	1	1	ADAMS, JESSE W MD	4/30/1991	No Taxonomy Provided	NA	None	026	PHYSICIANS	47092	41	Internal Medicine	0	In state provider	None	2025 MORSE AVE	None	SACRAMENTO	CA	95825	2115	34	06067	38.602089	-121.3925895	Sacramento County
277445	Fee-for-Service	1619622479	1619622479	1	1	ALEXANDER, NICOLE E NP	2/26/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
277480	Fee-for-Service	1891118048	1891118048	1	1	ABAD-SANTOS, GREGORIO D APC	2/25/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	42068	40	Pediatrics	0	In state provider	None	11100 WARNER AVE	STE 352	FOUNTAIN VALLEY	CA	92708	7506	30	06059	33.716291	-117.9355051	Orange County
277487	Fee-for-Service	1356067151	1356067151	1	1	AGUINADA, JOSE J PT	8/18/2023	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	5971 VENICE BLVD	None	LOS ANGELES	CA	90034	1713	19	06037	34.03833368	-118.3726622	Los Angeles County
277499	Fee-for-Service	1265431563	1265431563	1	1	ANDREW MASON MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	SE GASTROENTEROLOGY ASSO	7788 JEFFERSON NE	None	ALBUQUERQUE	NM	87109	0000	00	None	35.17051067	-106.5890655	Bernalillo County
277506	Fee-for-Service	1508843368	1508843368	1	1	ALLEN, SUSAN PARK MD	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61446	01	General Practice	0	In state provider	SUSAN PARK ALLEN MD INC	320 SUPERIOR AVE	STE 280	NEWPORT BEACH	CA	92663	6140	30	06059	33.62657138	-117.9330754	Orange County
277548	Fee-for-Service	1528103983	1528103983	1	1	ASLAM, RUMMANA S MD	2/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	81834	25	Physical Medicine and Rehabilitation	0	In state provider	None	135 CARMEN LANE	None	SANTA MARIA	CA	93458	7729	42	06083	34.92484952	-120.4374645	Santa Barbara County
277585	Fee-for-Service	1437143088	1437143088	1	1	AVILA, JENNIFER K MD	6/28/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	86186	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4002 VISTA WAY	None	OCEANSIDE	CA	92056	4506	37	06073	33.1857	-117.290538	San Diego County
277595	Fee-for-Service	1750559431	1750559431	1	17	ALL STAR PHYSICAL THERAPY, I	11/10/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	2815 MAIN ST.,	SUITE 205	CORONA	CA	92882	0000	33	06065	33.84741266	-117.570694	Riverside County
277602	Fee-for-Service	1396742912	1396742912	1	1	ACTION MEDICAL SERVICES INC.	6/10/2009	No Taxonomy Provided	NEMT Provider	None	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1200 E SECOND ST	None	WINSLOW	AZ	86047	4130	00	None	35.019234	-110.6863875	Navajo County
277605	Fee-for-Service	1154311694	1154311694	1	1	AQUINO, SUZANNE L MD	7/20/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	63771	30	Radiology	0	In state provider	None	2975 SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	56	06111	34.28924598	-118.7439214	Ventura County
277640	Fee-for-Service	1841871621	1841871621	1	1	AGUAYO, ESTEBAN MD	10/28/2024	208600000X	NA	General Surgery	026	PHYSICIANS	None	02	General Surgery	0	In state provider	None	12669 ENCINITAS AVE	None	SYLMAR	CA	91342	3635	19	06037	34.29981583	-118.473722	Los Angeles County
277667	Fee-for-Service	1407880891	1407880891	1	1	ADAMS, THOMPSON MD	5/20/1987	No Taxonomy Provided	NA	None	026	PHYSICIANS	22561	41	Internal Medicine	0	In state provider	None	2001 SN MONICA BLVD 1285	None	SANTA MONICA	CA	90404	0000	19	06037	34.02891163	-118.4797466	Los Angeles County
277687	Fee-for-Service	1093011934	1093011934	1	1	ARASH ALBORZI MD INC	2/15/2011	207RI0200X	NA	HIV/AIDS/Infectious Disease	026	PHYSICIANS	89523	None	None	0	In state provider	None	1300 N VERMONT AVE	None	LOS ANGELES	CA	90027	6005	19	06037	34.0956033	-118.2916918	Los Angeles County
277705	Fee-for-Service	1750624920	1750624920	1	1	ALBUSTANI, MUSTAFA Q MD	12/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	153289	41	Internal Medicine	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
277722	Fee-for-Service	1699965087	1699965087	1	1	ALLIANCE DIGESTIVE	10/5/1999	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	DISEASE CONSULTANTS MED	50 ALESSANDRO PL	STE 410	PASADENA	CA	91105	3175	19	06037	34.13101049	-118.151532	Los Angeles County
277723	Fee-for-Service	1285898585	1285898585	1	1	AGGU SHER, RAVI K MD	8/5/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	123535	41	Internal Medicine	0	In state provider	None	225 NORTH JACKSON AVENUE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
277743	Fee-for-Service	1821288812	1821288812	1	1	ALAM, RABI U MD	11/13/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	96992	None	None	0	In state provider	None	13652 CANTARA ST	None	PANORAMA CITY	CA	91402	5423	19	06037	34.21980849	-118.4301135	Los Angeles County
277752	Fee-for-Service	1508843368	1508843368	1	1	ALLEN, SUSAN PARK MD	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61446	41	Internal Medicine	0	In state provider	SUSAN PARK ALLEN MD INC	320 SUPERIOR AVE	STE 280	NEWPORT BEACH	CA	92663	6140	30	06059	33.62657138	-117.9330754	Orange County
277840	Fee-for-Service	1750559431	1750559431	1	17	ALL STAR PHYSICAL THERAPY, I	4/30/2021	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	2815 MAIN ST.,	SUITE 205	CORONA	CA	92882	0000	33	06065	33.84741266	-117.570694	Riverside County
277924	Fee-for-Service	1427077411	1427077411	1	1	ALARID, OLGA MD	8/22/1996	No Taxonomy Provided	NA	None	026	PHYSICIANS	60765	41	Internal Medicine	0	In state provider	None	11211 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1115	19	06037	34.27497644	-118.4679634	Los Angeles County
277946	Fee-for-Service	1750624920	1750624920	1	1	ALBUSTANI, MUSTAFA Q MD	12/22/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	153289	40	Pediatrics	0	In state provider	None	200 MED PLAZA	365, 420, 120	LOS ANGELES	CA	90024	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
277957	Fee-for-Service	1548261316	1548261316	1	1	ABBASI, ADIL A MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	44636	None	None	0	In state provider	None	900 SANTA FE DR	None	ENCINITAS	CA	92024	3919	37	06073	33.0363135	-117.2723715	San Diego County
277980	Fee-for-Service	1215342720	1215342720	1	1	AL DANAF, JAD MD	12/16/2021	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	-	None	None	1	Border provider	None	1155 MILL ST	None	RENO	NV	89502	1576	00	None	39.52483792	-119.7968314	Washoe County
277982	Fee-for-Service	1275743932	1275743932	1	1	ALFARO, JULIAN MD	8/21/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	97986	08	Family Practice	0	In state provider	None	17500 FOOTHILL BLVD	STE A2	FONTANA	CA	92335	3798	36	06071	34.1067065	-117.4218885	San Bernardino County
277996	Fee-for-Service	1508843368	1508843368	1	1	ALLEN, SUSAN PARK MD	9/21/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	61446	77	Infectious Disease	0	In state provider	SUSAN PARK ALLEN MD INC	320 SUPERIOR AVE	STE 280	NEWPORT BEACH	CA	92663	6140	30	06059	33.62657138	-117.9330754	Orange County
278040	Fee-for-Service	1306093109	1306093109	1	1	ABDELKEDOUS, SANDY MD	2/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	126253	36	Psychiatry	0	In state provider	None	43112 15TH ST WEST	None	LANCASTER	CA	93534	6219	19	06037	34.66467	-118.1567445	Los Angeles County
278107	Fee-for-Service	1427090323	1427090323	1	1	ARCHER-LUX, PAMELA R DO	2/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	6195	41	Internal Medicine	0	In state provider	None	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92411	1217	36	06071	34.131303	-117.3225325	San Bernardino County
278124	Fee-for-Service	1548675754	1548675754	1	1	ANSELM, AIMEE MD	10/1/2019	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	152564	40	Pediatrics	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
278148	Fee-for-Service	1679150171	1679150171	1	1	ADEYEMI, ABAYOMI A MD	8/21/2024	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	187667	08	Family Practice	0	In state provider	None	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	19	06037	34.13998921	-118.7070142	Los Angeles County
278173	Fee-for-Service	1972569085	1972569085	1	1	ANCES, BEAU MD	11/1/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	92848	13	Neurology (M.D. only)	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
278187	Fee-for-Service	1588645634	1588645634	1	1	ALEXANDER, JAMILE Y MD	6/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	5171 W OLIVE AVE	None	GLENDALE	AZ	85302	4204	00	None	33.567093	-112.1719365	Maricopa County
278213	Fee-for-Service	1568617397	1568617397	1	1	ACCESS HOME HEALTH CARE LLC	6/10/2011	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	18445 VANOWEN ST	SUITE B	RESEDA	CA	91335	5324	19	06037	34.19387449	-118.5351975	Los Angeles County
278226	Fee-for-Service	1124048350	1124048350	1	1	ATTOUN, ADAM DO	2/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	7044	30	Radiology	0	In state provider	None	624 E ELDER ST	None	FALLBROOK	CA	92028	3004	37	06073	33.38020455	-117.2446307	San Diego County
278264	Fee-for-Service	1114353141	1114353141	1	1	AGAHOSPICE INC	6/25/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	16519 VICTOR ST	STE 324B	VICTORVILLE	CA	92395	3922	36	06071	34.5212432	-117.3044617	San Bernardino County
278285	Fee-for-Service	1528024544	1528024544	1	1	ARCIDI, JOSEPH M MD	11/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	50460	33	Thoracic Surgery	0	In state provider	None	1245 WILSHIRE BLVD	STE 703	LOS ANGELES	CA	90017	4807	19	06037	34.05362775	-118.2661889	Los Angeles County
278306	Fee-for-Service	1164539730	1164539730	1	1	ADVOCATE HEALTH & HOSPITALS	2/21/2010	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CORPORATION	1775 W. DEMPSTER ST	None	PARK RIDGE	IL	60068	1143	00	None	42.03979303	-87.8470033	Cook County
278332	Fee-for-Service	1053405506	1053405506	1	1	ALI, MOHAMMED M MD	8/10/2004	261QP2300X	NA	Other	026	PHYSICIANS	83688	08	Family Practice	0	In state provider	None	939 N GEM ST	None	TULARE	CA	93274	2127	54	06107	36.22113672	-119.3398776	Tulare County
278352	Fee-for-Service	1427090323	1427090323	1	1	ARCHER-LUX, PAMELA R DO	2/1/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	6195	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1805 MEDICAL CENTER DR	None	SAN BERNARDINO	CA	92411	1217	36	06071	34.131303	-117.3225325	San Bernardino County
278393	Fee-for-Service	1558578583	1558578583	1	1	ADVANCED CARDIOLOGY MEDICAL	11/16/2010	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	50042	06	Cardiovascular Disease (M.D. only)	0	In state provider	ASSOCIATES, INC	3940 SAN DIMAS STREET	None	BAKERSFIELD	CA	93301	1458	15	06029	35.39601	-119.0081515	Kern County
278395	Fee-for-Service	1346303716	1346303716	1	1	AURORA, SHEENA K MD	10/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	55330	13	Neurology (M.D. only)	0	In state provider	None	300 PASTEUR DRIVE	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
278445	Fee-for-Service	1992325526	1992325526	1	1	ALURU, PADMA S MD	11/1/2023	208M00000X	NA	Other	026	PHYSICIANS	189819	None	None	0	In state provider	None	1165 MONTGOMERY DR	None	SANTA ROSA	CA	95405	4801	49	06097	38.443806	-122.701374	Sonoma County
278450	Fee-for-Service	1255775326	1255775326	1	1	AUNG, HTUN N MD	11/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141417	41	Internal Medicine	0	In state provider	None	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
278489	Fee-for-Service	1447233358	1447233358	1	1	AIDS HEALTHCARE FOUNDATION	8/6/2013	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	8263 GROVE AVE	SUITE 201	RANCHO CUCAMONGA	CA	91730	3107	36	06071	34.10436536	-117.6285141	San Bernardino County
278503	Fee-for-Service	1922479930	1922479930	1	1	ALBUQUERQUE, KATARZYNA N MD	4/17/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	153709	08	Family Practice	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
278505	Fee-for-Service	1114353141	1114353141	1	1	AGAHOSPICE INC	6/25/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	16519 VICTOR ST	STE 324B	VICTORVILLE	CA	92395	3922	36	06071	34.5212432	-117.3044617	San Bernardino County
278525	Fee-for-Service	1528024544	1528024544	1	1	ARCIDI, JOSEPH M MD	11/18/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	50460	02	General Surgery	0	In state provider	None	1245 WILSHIRE BLVD	STE 703	LOS ANGELES	CA	90017	4807	19	06037	34.05362775	-118.2661889	Los Angeles County
278544	Fee-for-Service	1760652218	1760652218	1	1	APOGEE MEDICAL GROUP INC	6/17/2015	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
278547	Fee-for-Service	1164539730	1164539730	1	1	ADVOCATE HEALTH & HOSPITALS	2/21/2010	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	CORPORATION	1775 W. DEMPSTER ST	None	PARK RIDGE	IL	60068	1143	00	None	42.03979303	-87.8470033	Cook County
278582	Fee-for-Service	1497814685	1497814685	1	1	ALEXANDER, STANLEY J MD	7/24/2008	207RR0500X	NA	Other	026	PHYSICIANS	19343	83	Rheumatology	0	In state provider	None	301 W HUNTINGTON DR	STE 400	ARCADIA	CA	91007	3471	19	06037	34.13481053	-118.0425638	Los Angeles County
278587	Fee-for-Service	1902353618	1902353618	1	1	ALANIZ, ROSANA C LCSW	10/24/2023	101YM0800X	NA	Other	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	300 MONTGOMERY	STE 204	SAN FRANCISCO	CA	94104	1902	38	06075	37.7923269	-122.4026145	San Francisco County
278661	Fee-for-Service	1053446922	1053446922	1	1	AWAN, NAJAM AHSAN MD	6/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	26106	01	General Practice	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
278670	Fee-for-Service	1740516335	1740516335	1	1	APISAKKUL, JIMMY DO	9/6/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	10597	05	Anesthesiology	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
278682	Fee-for-Service	1669645222	1669645222	1	1	ABDALLA, MAISA I MD	7/16/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140585	41	Internal Medicine	0	In state provider	None	11370 ANDERSON STREET	None	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
278685	Fee-for-Service	1831379270	1831379270	1	1	ABRAHAM, REGINALD G M MD INC	7/31/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	75917	33	Thoracic Surgery	0	In state provider	None	11100 WARNER AVENUE	SUITE 258	FOUNTAIN VALLEY	CA	92708	7512	30	06059	33.716291	-117.9355051	Orange County
278733	Fee-for-Service	1255942389	1255942389	1	1	ALOZIE, IFEANYI C LCSW	8/26/2020	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	255 NORTH D STREET	401 - C	SAN BERNARDINO	CA	92401	1701	36	06071	34.1036709	-117.291874	San Bernardino County
278765	Fee-for-Service	1568046878	1568046878	1	1	AKSTINAS, JONATHAN DO	4/12/2024	207P00000X	NA	Other	026	PHYSICIANS	20752	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
278780	Fee-for-Service	1760652218	1760652218	1	1	APOGEE MEDICAL GROUP INC	11/21/2017	193200000X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	1	Border provider	None	101 CIVIC CENTER LANE	None	LAKE HAVASU CITY	AZ	86403	5607	00	None	34.480224	-114.3390555	Mohave County
278800	Fee-for-Service	1699115857	1699115857	1	1	ACCUPATH DIAGNOSTIC	6/5/2017	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	LABORATORIES INC	5005 SOUTH 40TH STREET	SUITE 1100	PHOENIX	AZ	85040	2969	00	None	33.40071	-111.9945735	Maricopa County
278820	Fee-for-Service	1497814685	1497814685	1	1	ALEXANDER, STANLEY J MD	7/24/2008	207RR0500X	NA	Other	026	PHYSICIANS	19343	41	Internal Medicine	0	In state provider	None	301 W HUNTINGTON DR	STE 400	ARCADIA	CA	91007	3471	19	06037	34.13481053	-118.0425638	Los Angeles County
278831	Fee-for-Service	1134518301	1134518301	1	1	ANNABERDYEV, KATIE S CRNA	8/14/2018	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	1	Border provider	None	2450 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2179	00	None	36.15900951	-115.175853	Clark County
278876	Fee-for-Service	1508612870	1508612870	1	1	ALAZZEH, NADIA	10/13/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	301 LENNON LN	202	WALNUT CREEK	CA	94598	2483	07	06013	37.92672613	-122.0291022	Contra Costa County
278886	Fee-for-Service	1568553055	1568553055	1	1	APEL, DAVID M MD	2/28/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	61691	20	Orthopedic Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
278898	Fee-for-Service	1053446922	1053446922	1	1	AWAN, NAJAM AHSAN MD	6/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	26106	41	Internal Medicine	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
278910	Fee-for-Service	1750743951	1750743951	1	1	ADKINS, JAKE M MD	6/16/2021	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	171006	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
278917	Fee-for-Service	1730119553	1730119553	1	1	AFFILIATED PATHOLOGISTS MEDI	10/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	30	Radiology	0	In state provider	None	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
278929	Fee-for-Service	1952066854	1952066854	1	1	ALPHASCRIPT INC	2/10/2022	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	400 INDUSTRIAL RD	None	SAN CARLOS	CA	94070	6286	41	06081	37.51320239	-122.2595324	San Mateo County
278930	Fee-for-Service	1578960910	1578960910	1	1	A1 PALLIATIVE AND HOSPICE	4/17/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	CARE INC	13645 VANOWEN ST	SUITE B	VAN NUYS	CA	91405	4262	19	06037	34.19397151	-118.4303925	Los Angeles County
278947	Fee-for-Service	1093144198	1093144198	1	1	ARNEY, MARIANN L MFT	12/20/2017	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	18826 N LOWER SACRAMENTO	STE C	WOODBRIDGE	CA	95258	9290	39	06077	38.15339358	-121.3009814	San Joaquin County
278999	Fee-for-Service	1255775912	1255775912	1	1	AHDOOT, MICHAEL A MD	3/6/2021	208800000X	NA	Other	026	PHYSICIANS	167281	None	None	0	In state provider	None	8700 BEVERLY BLVD	None	LOS ANGELES	CA	90048	1804	19	06037	34.07671715	-118.3799413	Los Angeles County
279062	Fee-for-Service	1770139487	1770139487	1	1	ANGELIAN MANAGEMENT GROUP	2/25/2021	261QA0600X	NA	Other	001	ADULT DAY HEALTH CARE CENTERS	-	-	NOT APPLICABLE	0	In state provider	CENTER	23551 MOULTON PARKWAY	None	LAGUNA HILLS	CA	92653	1911	30	06059	33.62030833	-117.7317009	Orange County
279081	Fee-for-Service	1790775278	1790775278	1	1	ABBAS, MAZEN I DO	12/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	14673	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1604	43	06085	37.43721275	-122.1744449	Santa Clara County
279083	Fee-for-Service	1407927387	1407927387	1	1	ALLEN, BRENT N MD	1/1/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	12091	20	Orthopedic Surgery	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
279121	Fee-for-Service	1568553055	1568553055	1	1	APEL, DAVID M MD	2/28/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	61691	01	General Practice	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
279129	Fee-for-Service	1790731313	1790731313	1	1	AILLONI-CHARAS, ORRIN MD	7/14/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86146	05	Anesthesiology	0	In state provider	None	CLAY & BUCHANAN ST	None	SAN FRANCISCO	CA	94115	0000	38	06075	37.791126	-122.4309105	San Francisco County
279133	Fee-for-Service	1053446922	1053446922	1	1	AWAN, NAJAM AHSAN MD	6/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	26106	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1207 FAIRCHILD CT	None	WOODLAND	CA	95695	4321	57	06113	38.6657551	-121.7922645	Yolo County
279142	Fee-for-Service	1649335324	1649335324	1	2	ALEXANDER, SCOTT LMFT	1/27/2025	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
279151	Fee-for-Service	1760654263	1760654263	1	1	AUNG, TANIA MD	3/26/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	135200	03	Allergy	0	In state provider	None	1100 PEAR TREE LANE	None	NAPA	CA	94558	6446	28	06055	38.32087983	-122.2946228	Napa County
279153	Fee-for-Service	1730119553	1730119553	1	1	AFFILIATED PATHOLOGISTS MEDI	10/1/1983	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	22	Pathology (M.D. only)	0	In state provider	None	1300 W 7TH ST	None	SAN PEDRO	CA	90732	3505	19	06037	33.73793948	-118.3036095	Los Angeles County
279165	Fee-for-Service	1578960910	1578960910	1	1	A1 PALLIATIVE AND HOSPICE	4/17/2019	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	CARE INC	13645 VANOWEN ST	SUITE B	VAN NUYS	CA	91405	4262	19	06037	34.19397151	-118.4303925	Los Angeles County
279170	Fee-for-Service	1932341641	1932341641	1	1	AL KAWASS, ANAS MD FAAP	3/19/2019	2080P0203X	NA	Other	026	PHYSICIANS	132739	40	Pediatrics	0	In state provider	None	2801 ATLANTIC AVENUE	None	LONG BEACH	CA	90809	1701	19	06037	33.808185	-118.1850575	Los Angeles County
279236	Fee-for-Service	1407071236	1407071236	1	2	AAA VINTAGE GASES INC	10/29/2018	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	907 TRANCAS ST	None	NAPA	CA	94558	2903	28	06055	38.3239298	-122.2936038	Napa County
279299	Fee-for-Service	1114043858	1114043858	1	1	AZUSA SURGERY CENTER INC	9/8/2010	No Taxonomy Provided	NA	None	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	830 SOUTH CITRUS AVE	None	AZUSA	CA	91702	5942	19	06037	34.108074	-117.8902345	Los Angeles County
279314	Fee-for-Service	1992944532	1992944532	1	1	ANGELES, ABDON C	11/7/2016	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	19	06037	34.03781261	-118.3755101	Los Angeles County
279321	Fee-for-Service	1316005572	1316005572	1	6	APPLE URGENT CARE, INC	3/28/2021	207QG0300X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	25970 IRIS AVE	STE 3B	MORENO VALLEY	CA	92551	1660	33	06065	33.8898301	-117.2117501	Riverside County
279343	Fee-for-Service	1740946862	1740946862	1	1	AYON, MARCO F	6/30/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
279365	Fee-for-Service	1932548633	1932548633	1	1	AYUB, GISELA NP	9/8/2020	363LP0808X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2830 GLENDESSARY LANE	None	SANTA BARBARA	CA	93105	2960	42	06083	34.44509477	-119.7186392	Santa Barbara County
279419	Fee-for-Service	1114015500	1114015500	1	1	AGUILERA, MANUEL C MD	4/27/1987	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	38823	01	General Practice	0	In state provider	None	12507 ALONDRA BLVD	None	NORWALK	CA	90650	7351	19	06037	33.88780847	-118.0660905	Los Angeles County
279506	Fee-for-Service	1164448734	1164448734	1	1	AGULNIK, MARK MD	10/6/2020	207RX0202X	NA	Oncology	026	PHYSICIANS	170270	41	Internal Medicine	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
279516	Fee-for-Service	1780781690	1780781690	1	1	ADAMSON, GEOFFREY D MD	10/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	37896	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
279526	Fee-for-Service	1083832752	1083832752	1	1	ANTIOCH ICF INC	5/24/2004	315P00000X	NA	Intermediate Care Faciltiy	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SAN JUAN ICF	3117 SAN JUAN CT	None	ANTIOCH	CA	94509	5313	07	06013	37.98870394	-121.8301638	Contra Costa County
279553	Fee-for-Service	1316005572	1316005572	1	6	APPLE URGENT CARE, INC	3/28/2021	207QG0300X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	25970 IRIS AVE	STE 3B	MORENO VALLEY	CA	92551	1660	33	06065	33.8898301	-117.2117501	Riverside County
279554	Fee-for-Service	1851782783	1851782783	1	1	ADRISSI, JENNIFER A MD	10/19/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	182650	None	None	0	In state provider	None	300 MEDICAL PLAZA	B200	LOS ANGELES	CA	90095	0001	19	06037	34.06473399	-118.445865	Los Angeles County
279574	Fee-for-Service	1851348916	1851348916	1	1	ALRASHID, ARKAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1880 W WINCHESTER RD	STE 201	LIBERTYVILLE	IL	60048	5336	00	None	42.298227	-87.9951915	Lake County
279592	Fee-for-Service	1053850529	1053850529	1	1	AMETRINE HOSPICE	11/10/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	3100 W BURBANK BLVD	SUITE 204	BURBANK	CA	91505	2348	19	06037	34.17660763	-118.3444514	Los Angeles County
279669	Fee-for-Service	1962997361	1962997361	1	1	ANG-RODRIGUEZ, MARIA CRISTIN	1/24/2022	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	None	-	NOT APPLICABLE	0	In state provider	A NP	1701 ZONAL AVE.	None	LOS ANGELES	CA	90033	1065	19	06037	34.06219051	-118.2106555	Los Angeles County
279687	Fee-for-Service	1639342330	1639342330	1	1	ANDERSON, MAXINE MD INC	10/27/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	68783	02	General Surgery	0	In state provider	None	3628 EAST IMPERIAL HWY	SUITE 401	LYNWOOD	CA	90262	2646	19	06037	33.93070837	-118.2044557	Los Angeles County
279688	Fee-for-Service	1053334300	1053334300	1	1	ANGELO, CAROLYN L CRNA	3/29/2004	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
279715	Fee-for-Service	1710030325	1710030325	2	2	AEGIS TREATMENT CENTERS, LLC	6/2/2020	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	(DBA: HEALTHY CONNECTIO	1947 N CALIFORNIA ST	B & C	STOCKTON	CA	95204	6029	39	06077	37.97199174	-121.2896956	San Joaquin County
279747	Fee-for-Service	1780781690	1780781690	1	1	ADAMSON, GEOFFREY D MD	10/5/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	37896	67	Endocrinology	0	In state provider	None	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	43	06085	37.37715796	-122.0651926	Santa Clara County
279756	Fee-for-Service	1720556053	1720556053	1	1	ACCESS OAKTOWN INC	2/26/2019	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	2693 FRUITVALE AVE	None	OAKLAND	CA	94601	2034	01	06001	37.79045542	-122.2201508	Alameda County
279785	Fee-for-Service	1316005572	1316005572	1	6	APPLE URGENT CARE, INC	3/28/2021	207QG0300X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	25970 IRIS AVE	STE 3B	MORENO VALLEY	CA	92551	1660	33	06065	33.8898301	-117.2117501	Riverside County
279804	Fee-for-Service	1841379971	1841379971	1	1	ASHER, ROBIN W MD	1/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	83555	36	Psychiatry	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
279821	Fee-for-Service	1053850529	1053850529	1	1	AMETRINE HOSPICE	11/10/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	3100 W BURBANK BLVD	SUITE 204	BURBANK	CA	91505	2348	19	06037	34.17660763	-118.3444514	Los Angeles County
279826	Fee-for-Service	1699090894	1699090894	1	1	AILLAUD, MARISSA MD	5/9/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	117663	40	Pediatrics	0	In state provider	None	910 MARSHALL ST	None	REDWOOD CITY	CA	94063	2033	41	06081	37.4876781	-122.2249265	San Mateo County
279828	Fee-for-Service	1376074112	1376074112	1	1	ACE CARE PHARMACY MANAGEMENT	2/20/2019	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	AND CONSULTING COMPANY	1053 N CHERRY ST	None	TULARE	CA	93274	2211	54	06107	36.22292509	-119.3376234	Tulare County
279834	Fee-for-Service	1508088840	1508088840	1	1	ABDEL-MALEK, SHAHIRA MD	7/1/1996	2080H0002X	NA	Pediatric Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	INC	3100 E FLORENCE AVE	STE 1	HUNTINGTON PARK	CA	90255	5848	19	06037	33.97277388	-118.2118093	Los Angeles County
279845	Fee-for-Service	1942326194	1942326194	1	1	ALFARO, MARICRUZ CRNA	10/12/2010	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
279879	Fee-for-Service	1124613625	1124613625	1	1	ALERACARE MEDICAL GROUP OF C	1/18/2022	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ALIFORNIA	39243 LIBERTY ST	None	FREMONT	CA	94538	1501	01	06001	37.55043899	-121.9813016	Alameda County
279940	Fee-for-Service	1801948336	1801948336	1	1	ALLIED PROFESSIONAL	12/3/2004	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	NURSING CARE, INC	2345 W FOOTHILL BLVD	STE 14	UPLAND	CA	91786	3579	36	06071	34.1069073	-117.697277	San Bernardino County
279947	Fee-for-Service	1710030325	1710030325	2	2	AEGIS TREATMENT CENTERS, LLC	6/2/2020	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	(DBA: HEALTHY CONNECTIO	1947 N CALIFORNIA ST	B & C	STOCKTON	CA	95204	6029	39	06077	37.97199174	-121.2896956	San Joaquin County
279963	Fee-for-Service	1942777354	1942777354	1	1	ALLEN, MYLAN LMFT	12/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1011 NORTH BEGONIA AVE.	SUITE 1009	ONTARIO	CA	91762	4274	36	06071	34.076493	-117.672147	San Bernardino County
280014	Fee-for-Service	1316005572	1316005572	1	6	APPLE URGENT CARE, INC	3/28/2021	207QG0300X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	25970 IRIS AVE	STE 3B	MORENO VALLEY	CA	92551	1660	33	06065	33.8898301	-117.2117501	Riverside County
280015	Fee-for-Service	1457596371	1457596371	1	7	ALLSAFE MEDICAL GROUP INC.	2/20/2024	207V00000X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	3661 TORRANCE BLVD	200	TORRANCE	CA	90503	4812	19	06037	33.83762646	-118.351116	Los Angeles County
280043	Fee-for-Service	1255609483	1255609483	1	2	ALFARO MCFIELD MEDICAL CLINI	3/30/2020	208D00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1374 N WATERMAN AVE.	None	SAN BERNARDINO	CA	92404	5313	36	06071	34.124805	-117.2788175	San Bernardino County
280049	Fee-for-Service	1720283070	1720283070	1	1	ARANDA, VICTORIA PT	10/18/2010	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1014 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06343528	-117.9856963	Los Angeles County
280081	Fee-for-Service	1134266885	1134266885	1	1	AZAR-CAVANAGH, MADELYNN	12/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	64777	29	Pulmonary Diseases (M.D. only)	0	In state provider	MD	200 W ARBOR DRIVE	None	SAN DIEGO	CA	92103	1911	37	06073	32.7537975	-117.1658298	San Diego County
280082	Fee-for-Service	1508221607	1508221607	1	1	ASIRYAN, VARDUI MD INC	1/21/2016	193400000X	NA	Other	026	PHYSICIANS	128242	None	None	0	In state provider	None	1411 W OLIVE AVE	SUITE D	BURBANK	CA	91506	2427	19	06037	34.16941338	-118.3209306	Los Angeles County
280123	Fee-for-Service	1154687242	1154687242	1	1	AL-HASHIMI, SABA MD	5/24/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141976	18	Ophthalmology	0	In state provider	None	100 STEIN PLAZA	1-340	LOS ANGELES	CA	90095	0001	19	06037	34.06489065	-118.4443287	Los Angeles County
280169	Fee-for-Service	1619474558	1619474558	1	2	AHMED, SYED N	7/16/2021	213ES0103X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	27403 YNEZ RD	108	TEMECULA	CA	92591	0000	33	06065	33.5066395	-117.15022	Riverside County
280172	Fee-for-Service	1437827243	1437827243	1	1	ASANA RECOVERY	7/5/2024	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	18101 MAGNOLIA ST	None	FOUNTAIN VALLEY	CA	92708	5647	30	06059	33.69976753	-117.9717527	Orange County
280209	Fee-for-Service	1063453868	1063453868	1	1	ASGERI, MEHRDAD MD	1/19/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	128282	10	Gastroenterology (M.D. only)	0	In state provider	None	1150 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
280271	Fee-for-Service	1326333600	1326333600	1	1	ABUD, AMANDA LMFT	6/7/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	2240 MERCURY WAY	None	SANTA ROSA	CA	95407	5413	49	06097	38.421135	-122.752008	Sonoma County
280276	Fee-for-Service	1629156401	1629156401	1	1	AZEBU, JANICE M MD	8/19/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	8357	41	Internal Medicine	0	In state provider	None	2417 CENTRAL AVE	None	ALAMEDA	CA	94501	4515	01	06001	37.76389996	-122.2420612	Alameda County
280333	Fee-for-Service	1316424872	1316424872	1	1	ABELEDA, CECILLE D RCP	11/26/2018	227800000X	NA	Other	056	RESPIRATORY CARE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
280360	Fee-for-Service	1568455269	1568455269	1	1	ASLIE, ARDAVAN M MD INC	5/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	60518	20	Orthopedic Surgery	0	In state provider	None	414 G ST	STE 120	MARYSVILLE	CA	95901	5670	58	06115	39.13913942	-121.5934649	Yuba County
280363	Fee-for-Service	1154332781	1154332781	1	1	AUM PHARMACY CORPORATION	11/2/2004	3336L0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	808 W COMMONWEALTH AVE	None	FULLERTON	CA	92832	1615	30	06059	33.87020128	-117.9399057	Orange County
280455	Fee-for-Service	1659305902	1659305902	1	1	AMERICAN MEDICAL RESPONSE	11/1/1997	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	WEST	1510 ROLLINS RD	None	BURLINGAME	CA	94010	2302	41	06081	37.59291977	-122.3702268	San Mateo County
280479	Fee-for-Service	1720806300	1720806300	1	1	ALFARO, STEPHANIE C BIRTH DO	12/13/2024	163W00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	27	06053	0	0	None
280480	Fee-for-Service	1982975959	1982975959	1	1	ARCHIBALD SURGERY CENTER	6/15/2012	261QA0006X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	9674 ARCHIBALD AVE	SUITE 125	RANCHO CUCAMONGA	CA	91730	7944	36	06071	34.07801196	-117.5934333	San Bernardino County
280525	Fee-for-Service	1073254587	1073254587	1	2	ANDREW M FOX MD INC A PROFES	1/17/2023	207T00000X	NA	General Surgery	022	PHYSICIANS GROUP	-	None	None	0	In state provider	SIONAL MEDICAL CORPORATI	23632 CALABASAS RD	100	CALABASAS	CA	91302	1553	19	06037	34.15613926	-118.6421933	Los Angeles County
280557	Fee-for-Service	1629198791	1629198791	1	1	ALFRED LAVI DO PROFESSIONAL	3/19/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CORPORATION	2324 W PICO BLVD	None	LOS ANGELES	CA	90006	4002	19	06037	34.0472397	-118.28722	Los Angeles County
280582	Fee-for-Service	1568455269	1568455269	1	1	ASLIE, ARDAVAN M MD INC	5/28/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	60518	02	General Surgery	0	In state provider	None	414 G ST	STE 120	MARYSVILLE	CA	95901	5670	58	06115	39.13913942	-121.5934649	Yuba County
280587	Fee-for-Service	1245393651	1245393651	1	1	ANDREWS, THOMAS J MD	11/24/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	79955	36	Psychiatry	0	In state provider	None	2865 CHURN CREEK ROAD	None	REDDING	CA	96002	1147	45	06089	40.566024	-122.3530815	Shasta County
280613	Fee-for-Service	1043808785	1043808785	1	1	AAA TRANSIT LLC	12/10/2021	343900000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	717 MISSOURI	E	FAIRFIELD	CA	94533	6252	48	06095	38.24809951	-122.042511	Solano County
280616	Fee-for-Service	1730873514	1730873514	1	1	ASPEN VILLA	2/23/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	25411 CHAMPLAIN ROAD	None	LAGUNA HILLS	CA	92653	0102	30	06059	33.59341707	-117.6815425	Orange County
280633	Fee-for-Service	1508936592	1508936592	1	1	ALAVI, ALI S MD	4/1/2025	208800000X	NA	Other	026	PHYSICIANS	79874	34	Urology and Urological Surgery	0	In state provider	None	1541 FLORIDA AVE	STE 100	MODESTO	CA	95350	4438	50	06099	37.666863	-120.9962775	Stanislaus County
280709	Fee-for-Service	1306267026	1306267026	1	1	ALAS, RONNIE MD	7/20/2020	207R00000X	NA	Other	026	PHYSICIANS	132456	41	Internal Medicine	0	In state provider	None	3501 S HARBOR BLVD	None	SANTA ANA	CA	92704	6919	30	06059	33.69981147	-117.9194272	Orange County
280741	Fee-for-Service	1366876468	1366876468	1	1	A & E HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	2920 WEST OLIVE AVE	SUITE 214	BURBANK	CA	91505	4547	19	06037	34.15744117	-118.3334122	Los Angeles County
280756	Fee-for-Service	1992334965	1992334965	1	1	ABRAMSON, ELIJAH MD	8/11/2023	207P00000X	NA	Other	026	PHYSICIANS	184698	None	None	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
280790	Fee-for-Service	1639194004	1639194004	1	1	AMPLA HEALTH	7/1/1994	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	520 KENTUCKY ST	None	GRIDLEY	CA	95948	2116	04	06007	39.36389682	-121.6965485	Butte County
280842	Fee-for-Service	1619911963	1619911963	1	1	ARIZONA CVS STORES LLC	11/14/2012	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	7434 W INDIAN SCHOOL RD	None	PHOENIX	AZ	85033	3138	00	None	33.495147	-112.219749	Maricopa County
280846	Fee-for-Service	1376259671	1376259671	1	1	AIKO, DUNCAN BONUKE	5/10/2023	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	15850 LOS ALTOS DRIVE	None	HACIENDA HEIGHTS	CA	91745	5310	19	06037	33.98631504	-117.9686788	Los Angeles County
280853	Fee-for-Service	1881859015	1881859015	1	1	ACHOR, TIMOTHY S MD	3/26/2019	207XX0801X	NA	Orthopedic Surgery	026	PHYSICIANS	-	20	Orthopedic Surgery	2	Out of state provider	None	6410 FANNIN STREET	SUITE 1500	HOUSTON	TX	77030	5306	00	None	29.71419639	-95.39755562	Harris County
280855	Fee-for-Service	1821389669	1821389669	1	1	AMRAMI, BINYAMIN MD	5/30/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	116722	36	Psychiatry	0	In state provider	None	4445 MAGNOLIA AVENUE	None	RIVERSIDE	CA	92501	4135	33	06065	33.9760587	-117.3800672	Riverside County
280882	Fee-for-Service	1497939771	1497939771	1	1	ALWAYS THE BEST CARE INC	6/7/2008	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	1581 S WEDGEWOOD LN	None	LA HABRA	CA	90631	7666	30	06059	33.91220181	-117.9548767	Orange County
280899	Fee-for-Service	1558472886	1558472886	1	1	ALPHA OMEGA MEDICAL	9/28/2005	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	SUPPLY, INC	1626 CENTINELA AVE	STE 8	INGLEWOOD	CA	90302	6913	19	06037	33.97713807	-118.3681255	Los Angeles County
280903	Fee-for-Service	1083018022	1083018022	1	1	ALVAREZ, ERIKA L LMFT	8/8/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	848 W LANCASTER BLVD	102	LANCASTER	CA	93534	2347	19	06037	34.69727236	-118.1462398	Los Angeles County
280941	Fee-for-Service	1245244029	1245244029	1	1	AZARI, JAMSHID MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	45998	66	Emergency Medicine (Urgent Care)	0	In state provider	None	12095 W WASHINGTON BLVD	STE 105	LOS ANGELES	CA	90066	5826	19	06037	33.99749606	-118.4238235	Los Angeles County
280952	Fee-for-Service	1780116830	1780116830	1	1	AJ HIGH RISK PREGNANCY INC	4/25/2017	207VM0101X	NA	Obstetrics & Gynecology	022	PHYSICIANS GROUP	-	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	999 W 7TH ST	None	OXNARD	CA	93030	6757	56	06111	34.19517346	-119.189297	Ventura County
280961	Fee-for-Service	1366876468	1366876468	1	1	A & E HOSPICE CARE INC	7/7/2015	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	2920 WEST OLIVE AVE	SUITE 214	BURBANK	CA	91505	4547	19	06037	34.15744117	-118.3334122	Los Angeles County
280997	Fee-for-Service	1316005572	1316005572	1	4	APPLE URGENT CARE, INC	5/1/2013	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	URGENT CARE INC	1688 N PERRIS BLVD	SUITE G2	PERRIS	CA	92571	4709	33	06065	33.802488	-117.2262385	Riverside County
281005	Fee-for-Service	1427362714	1427362714	1	1	ALLEN, KENNETH E PHD	3/8/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
281010	Fee-for-Service	1639194004	1639194004	1	1	AMPLA HEALTH	3/12/2025	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	520 KENTUCKY ST	None	GRIDLEY	CA	95948	2116	04	06007	39.36389682	-121.6965485	Butte County
281022	Fee-for-Service	1285045518	1285045518	1	1	ABDUL-AZIZ, AHMAD MD	10/25/2021	390200000X	NA	Other	026	PHYSICIANS	171987	None	None	0	In state provider	None	4600 CAMPUS DR	203	NEWPORT BEACH	CA	92660	1801	30	06059	33.67110839	-117.8658914	Orange County
281067	Fee-for-Service	1013199041	1013199041	1	1	ABRAHAM, ARIYA MD	12/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	50162	41	Internal Medicine	0	In state provider	None	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
281068	Fee-for-Service	1376259671	1376259671	1	1	AIKO, DUNCAN BONUKE	5/10/2023	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	15850 LOS ALTOS DRIVE	None	HACIENDA HEIGHTS	CA	91745	5310	19	06037	33.98631504	-117.9686788	Los Angeles County
281098	Fee-for-Service	1700047180	1700047180	1	1	AULAKH, AMARDEEP S OD	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	11638	78	Neoplastic Diseases/Oncology	0	In state provider	None	1791 E FIR AVENUE	None	FRESNO	CA	93720	3340	10	06019	36.8391145	-119.7505935	Fresno County
281125	Fee-for-Service	1205347762	1205347762	1	1	ADRIAN TRIPP MD MEDICAL CORP	11/2/2018	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	15095 AMARGOSA RD	280	VICTORVILLE	CA	92394	1885	36	06071	34.52479785	-117.3303132	San Bernardino County
281129	Fee-for-Service	1710466008	1710466008	1	1	AGENA, CYAN M PT	8/25/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	27699 JEFFERSON AVENUE	SUITE 202	TEMECULA	CA	92590	0000	33	06065	33.51449799	-117.1593524	Riverside County
281160	Fee-for-Service	1245244029	1245244029	1	1	AZARI, JAMSHID MD	3/1/1998	No Taxonomy Provided	NA	None	026	PHYSICIANS	45998	01	General Practice	0	In state provider	None	12095 W WASHINGTON BLVD	STE 105	LOS ANGELES	CA	90066	5826	19	06037	33.99749606	-118.4238235	Los Angeles County
281170	Fee-for-Service	1588630032	1588630032	1	1	ADHERERX INCORPORATED	4/3/2020	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	2	Out of state provider	None	118 MACKENAN DR STE 200	None	CARY	NC	27511	3600	00	None	35.732817	-78.8076135	Wake County
281184	Fee-for-Service	1851147938	1851147938	1	1	AVINA, JOSEPHINE	5/10/2024	237700000X	NA	Other	013	HEARING AID DISPENSERS	-	-	NOT APPLICABLE	0	In state provider	None	1807 XIMENO AVENUE	None	LONG BEACH	CA	90815	2850	19	06037	33.7907401	-118.1389039	Los Angeles County
281187	Fee-for-Service	1780189464	1780189464	1	1	ADELEKUN, ADESEWA E MD	4/28/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	166316	None	None	0	In state provider	None	924 WESTWOOD BLVD	515	LOS ANGELES	CA	90024	2926	19	06037	34.06309787	-118.4452763	Los Angeles County
281207	Fee-for-Service	1568617355	1568617355	1	1	ARENIVAR, LEROY MD	8/23/2021	2084P0800X	NA	Psychiatry	026	PHYSICIANS	116482	None	None	0	In state provider	None	333 UNIVERSITY AVENUE	STE 200	SACRAMENTO	CA	95825	6531	34	06067	38.570976	-121.416651	Sacramento County
281214	Fee-for-Service	1316005572	1316005572	1	4	APPLE URGENT CARE, INC	5/1/2013	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	URGENT CARE INC	1688 N PERRIS BLVD	SUITE G2	PERRIS	CA	92571	4709	33	06065	33.802488	-117.2262385	Riverside County
281217	Fee-for-Service	1154801256	1154801256	1	1	AMADOR REGIONAL TRANSIT	9/18/2019	347B00000X	NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	None	11400 AMERICAN LEGION DR	None	JACKSON	CA	95642	9525	03	06005	38.37589823	-120.8007172	Amador County
281219	Fee-for-Service	1336380286	1336380286	1	1	ALVAYAY, CAROLINA R MD	9/29/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	109071	34	Urology and Urological Surgery	0	In state provider	None	THREE MEDICAL PLAZA	None	ROSEVILLE	CA	95661	3087	31	06061	38.76566391	-121.2457432	Placer County
281223	Fee-for-Service	1225188238	1225188238	1	1	ARROSTUTO, JANET L	8/16/2013	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
281229	Fee-for-Service	1639194004	1639194004	1	1	AMPLA HEALTH	9/1/1992	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	520 KENTUCKY ST	None	GRIDLEY	CA	95948	2116	04	06007	39.36389682	-121.6965485	Butte County
281264	Fee-for-Service	1750559431	1750559431	1	9	ALL STAR PHYSICAL THERAPY, I	3/26/2020	225XH1200X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	215 S. HICKORY ST.	UNIT 112	ESCONDIDO	CA	92025	4359	37	06073	33.12335985	-117.0753842	San Diego County
281316	Fee-for-Service	1700047180	1700047180	1	1	AULAKH, AMARDEEP S OD	8/11/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	11638	41	Internal Medicine	0	In state provider	None	1791 E FIR AVENUE	None	FRESNO	CA	93720	3340	10	06019	36.8391145	-119.7505935	Fresno County
281317	Fee-for-Service	1972772184	1972772184	1	1	ALSOKARY, ZIAD CRNA	7/25/2011	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	825 DELBON AVENUE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
281360	Fee-for-Service	1043318363	1043318363	1	1	ALI, ROKSANA MD	9/11/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	52298	01	General Practice	0	In state provider	None	1730 PRAIRIE CITY RD	STE 120	FOLSOM	CA	95630	9594	34	06067	38.651472	-121.167387	Sacramento County
281361	Fee-for-Service	1376723809	1376723809	1	1	AGRAWAL, SUNAYNA OT	12/7/2007	No Taxonomy Provided	NA	None	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	1301 PROVIDENCE AVE	None	ORANGE	CA	92868	3808	30	06059	33.78142951	-117.866583	Orange County
281376	Fee-for-Service	1801850722	1801850722	1	1	ALLEN, WARREN M MD	5/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	39548	22	Pathology (M.D. only)	0	In state provider	None	1328 22ND ST	None	SANTA MONICA	CA	90404	2032	19	06037	34.03122319	-118.4797185	Los Angeles County
281398	Fee-for-Service	1922378215	1922378215	1	1	AURORA BEHAVIORAL HEALTHCARE	2/12/2014	No Taxonomy Provided	NA	None	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	SANTA ROSA LLC	1287 FULTON RD	None	SANTA ROSA	CA	95401	4923	49	06097	38.45043	-122.7715245	Sonoma County
281413	Fee-for-Service	1740270594	1740270594	1	1	ALANIS, ELSA	2/8/2015	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	637 3RD AVE	STE F	CHULA VISTA	CA	91910	5707	37	06073	32.62948951	-117.0752587	San Diego County
281414	Fee-for-Service	1588944201	1588944201	1	2	ADAMS, JOHN MD	9/29/2023	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	119705	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
281419	Fee-for-Service	1063508109	1063508109	1	1	AIGEN, ARNOLD B MD	5/31/1986	208800000X	NA	Other	026	PHYSICIANS	59614	34	Urology and Urological Surgery	0	In state provider	None	596 CARROLL ST	None	SUNNYVALE	CA	94086	6207	43	06085	37.36853041	-122.0305901	Santa Clara County
281445	Fee-for-Service	1639194004	1639194004	1	1	AMPLA HEALTH	9/1/1992	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	520 KENTUCKY ST	None	GRIDLEY	CA	95948	2116	04	06007	39.36389682	-121.6965485	Butte County
281481	Fee-for-Service	1750559431	1750559431	1	9	ALL STAR PHYSICAL THERAPY, I	3/26/2020	225XH1200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	NC.	215 S. HICKORY ST.	UNIT 112	ESCONDIDO	CA	92025	4359	37	06073	33.12335985	-117.0753842	San Diego County
281526	Fee-for-Service	1770681983	1770681983	1	1	ACCELLENCE-RENO	3/13/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	1	Border provider	ACCELLENCE-RENO	35 NORTH EDISON WAY	SUITE 37	RENO	NV	89502	2303	00	None	39.51537735	-119.7498148	Washoe County
281535	Fee-for-Service	1528050465	1528050465	1	1	ADJEI,POKU MICHAEL MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1160 E 3900	STE 2000	SALT LAKE CITY	UT	84124	0000	00	None	40.68703647	-111.85785	Salt Lake County
281539	Fee-for-Service	1104104538	1104104538	1	1	ABRAHAM, LIDA S	9/24/2018	No Taxonomy Provided	NA	None	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	706 N DIAMOND BAR BLVD	STE B	DIAMOND BAR	CA	91765	1059	19	06037	34.03167081	-117.8089198	Los Angeles County
281594	Fee-for-Service	1548248131	1548248131	1	1	ABATE, MICHAEL JON MD	6/30/1995	207R00000X	NA	Other	026	PHYSICIANS	78294	41	Internal Medicine	0	In state provider	None	2801 K ST	None	SACRAMENTO	CA	95816	5120	34	06067	38.572947	-121.46904	Sacramento County
281609	Fee-for-Service	1922378215	1922378215	1	1	AURORA BEHAVIORAL HEALTHCARE	7/31/2013	No Taxonomy Provided	NA	None	072	MENTAL HEALTH INPATIENT SERVICES	-	-	NOT APPLICABLE	0	In state provider	SANTA ROSA LLC	1287 FULTON RD	None	SANTA ROSA	CA	95401	4923	49	06097	38.45043	-122.7715245	Sonoma County
281624	Fee-for-Service	1649633991	1649633991	1	1	AHMAD, WASEEM MD	7/25/2022	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	152851	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
281631	Fee-for-Service	1508811803	1508811803	1	1	ARNDT, ROLF D MD	1/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	23328	30	Radiology	0	In state provider	None	14860 ROSCOE BLVD	STE 100	PANORAMA CITY	CA	91402	4687	19	06037	34.2214515	-118.4573205	Los Angeles County
281643	Fee-for-Service	1427073576	1427073576	2	1	ALONSO, LAZARO V MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	39343	01	General Practice	0	In state provider	None	5939 VAN NUYS BLVD	None	VAN NUYS	CA	91401	3624	19	06037	34.1786463	-118.4488083	Los Angeles County
281691	Fee-for-Service	1750559431	1750559431	1	9	ALL STAR PHYSICAL THERAPY, I	3/26/2020	225XH1200X	NA	Other	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	NC.	215 S. HICKORY ST.	UNIT 112	ESCONDIDO	CA	92025	4359	37	06073	33.12335985	-117.0753842	San Diego County
281715	Fee-for-Service	1811048069	1811048069	3	1	ARCHANA CORP	11/10/2010	No Taxonomy Provided	NA	None	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	9943 MAINE AVENUE	None	LAKESIDE	CA	92040	3107	37	06073	32.85965732	-116.9217607	San Diego County
281723	Fee-for-Service	1750072484	1750072484	1	1	AVERY GARDEN ASSISTED LIVING	2/27/2024	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	-RIVERSIDE	7675 WOODVIEW STREET	None	RIVERSIDE	CA	92506	5494	33	06065	33.913764	-117.374535	Riverside County
281726	Fee-for-Service	1215985494	1215985494	1	1	AVEDISSIAN, LENA S MD	4/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	140632	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1004 FOWLER WAY	SUITE 4	PLACERVILLE	CA	95667	5746	09	06017	38.72683597	-120.7921028	El Dorado County
281751	Fee-for-Service	1447351085	1447351085	1	1	AGNIHOTRI, PARAG MD	9/14/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	52218	38	Geriatrics	0	In state provider	None	3160 FOLSOM BLVD	None	SACRAMENTO	CA	95816	5219	34	06067	38.568393	-121.4658585	Sacramento County
281781	Fee-for-Service	1831544063	1831544063	1	1	AVILA, KATHLEEN LMFT	5/26/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	14500 ROSCOE BLVD	STE 400	PANORAMA CITY	CA	91402	4194	19	06037	34.2215055	-118.44918	Los Angeles County
281805	Fee-for-Service	1073156246	1073156246	1	1	ATLAS, COURTNEY E	3/9/2020	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	3600 BROADWAY	None	OAKLAND	CA	94611	5730	01	06001	37.8237837	-122.2590026	Alameda County
281809	Fee-for-Service	1770748014	1770748014	1	1	ALEXAN, RICHARD MD INC	4/13/2010	174400000X	NA	Other	026	PHYSICIANS	85082	None	None	0	In state provider	None	4900 COMMERCE DR	None	BAKERSFIELD	CA	93309	0418	15	06029	35.3696013	-119.0558857	Kern County
281819	Fee-for-Service	1295732592	1295732592	1	1	AGUILAR, OSCAR MD	5/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1800 N. OREGON	None	EL PASO	TX	79902	0000	00	None	31.77031111	-106.4985786	El Paso County
281826	Fee-for-Service	1720359938	1720359938	1	1	ALBERTS, GINNY B OT	4/20/2020	225XP0200X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
281846	Fee-for-Service	1194897900	1194897900	1	1	ASHOK, ROHINI MD	9/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	72037	41	Internal Medicine	0	In state provider	None	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	43	06085	37.24047903	-121.7998157	Santa Clara County
281855	Fee-for-Service	1194394494	1194394494	1	1	ATAM, SARIN MD	10/15/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
281856	Fee-for-Service	1427073576	1427073576	2	1	ALONSO, LAZARO V MD	11/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	39343	41	Internal Medicine	0	In state provider	None	5939 VAN NUYS BLVD	None	VAN NUYS	CA	91401	3624	19	06037	34.1786463	-118.4488083	Los Angeles County
281864	Fee-for-Service	1912447939	1912447939	1	1	ANDRESEN, YAZMIN NP	9/6/2023	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	3200 BELL RD	None	AUBURN	CA	95603	9244	31	06061	38.94193574	-121.103139	Placer County
281874	Fee-for-Service	1144744699	1144744699	1	1	ASHER-SCHAPIRO, SHAYNA LCSW	2/12/2024	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3505 BROADWAY	None	OAKLAND	CA	94611	5714	01	06001	37.82263926	-122.2597946	Alameda County
281882	Fee-for-Service	1790149805	1790149805	1	1	ABU-NASSER, SARA MD DO	8/23/2022	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	20193	None	None	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
281898	Fee-for-Service	1174696504	1174696504	1	1	ANDREWS, RUSSELL J MD	4/30/1983	207T00000X	NA	General Surgery	026	PHYSICIANS	46747	66	Emergency Medicine (Urgent Care)	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
281918	Fee-for-Service	1043244387	1043244387	1	1	AMERICAN MEDICAL RESPONSE	11/1/1997	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	WEST	34 SIMAS ST	STE G-N	SALINAS	CA	93901	3700	27	06053	36.67990336	-121.6439587	Monterey County
281949	Fee-for-Service	1841226388	1841226388	1	1	AWOBULUYI, MICHELE M MD	4/29/2020	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	154122	30	Radiology	0	In state provider	None	2820 N ONTARIO ST	None	BURBANK	CA	91504	2015	19	06037	34.20335077	-118.3443845	Los Angeles County
281964	Fee-for-Service	1073818084	1073818084	1	1	ALANES, KRISTINA E	6/10/2012	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	217 W CERRITOS AVENUE	None	ANAHEIM	CA	92805	6549	30	06059	33.81058193	-117.9065445	Orange County
281982	Fee-for-Service	1245212950	1245212950	1	1	AFIFY, ALAA M MD	4/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	76548	22	Pathology (M.D. only)	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
282029	Fee-for-Service	1750349718	1750349718	1	1	ARAYA, MONICA S MD	2/8/2015	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	51436	08	Family Practice	0	In state provider	None	275 S MADERA AVE	STE 201	KERMAN	CA	93630	1401	10	06019	36.73165922	-120.0602617	Fresno County
282030	Fee-for-Service	1497939813	1497939813	1	1	AYALA, DAVID J CRNA	5/6/2013	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	207 W LEGION ROAD	None	BRAWLEY	CA	92227	7780	13	06025	32.95809	-115.5537045	Imperial County
282053	Fee-for-Service	1821657115	1821657115	1	2	ACTIVE TRANSPORT MEDICAL SER	3/27/2023	343900000X	Both NEMT & NMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	VICES, LLC.	450 GROGAN AVE	SUITE B	MERCED	CA	95341	6471	24	06047	37.29406809	-120.5196791	Merced County
282064	Fee-for-Service	1376067827	1376067827	1	1	ADEOSUN, ALEXANDRIA LMFT	3/15/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	311 CALIFORNIA	#750	SAN FRANCISCO	CA	94104	2602	38	06075	37.79316768	-122.4002529	San Francisco County
282073	Fee-for-Service	1922365857	1922365857	1	1	AUYEUNG, WILLIAM C MD	9/23/2019	207RC0200X	NA	Other	026	PHYSICIANS	135659	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
282097	Fee-for-Service	1003109653	1003109653	1	1	ANNE HAWKINS	2/24/2016	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2530 CHICAGO AVE S	None	MINNEAPOLIS	MN	55404	4289	00	None	44.9561397	-93.26267997	Hennepin County
282105	Fee-for-Service	1174696504	1174696504	1	1	ANDREWS, RUSSELL J MD	4/30/1983	207T00000X	NA	General Surgery	026	PHYSICIANS	46747	14	Neurological Surgery	0	In state provider	None	900 KIELY BLVD	None	SANTA CLARA	CA	95051	5329	43	06085	37.34234284	-121.9776787	Santa Clara County
282106	Fee-for-Service	1619336740	1619336740	1	1	AVENIDA LIVING HOME, INC	11/1/2018	No Taxonomy Provided	NA	None	059	HOME AND COMMUNITY BASED SERVICES NURSING FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2465 AVENIDA DE LAS PLAN	None	THOUSAND OAKS	CA	91360	6619	56	06111	34.21171634	-118.8591115	Ventura County
282112	Fee-for-Service	1235767575	1235767575	1	1	AFFINITY HOSPICE INC	2/18/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	20246 SATICOY ST	SUITE 202	WINNETKA	CA	91306	4433	19	06037	34.20831848	-118.574766	Los Angeles County
282117	Fee-for-Service	1720241961	1720241961	2	1	AMINI, SAMBIZ M MD	6/4/2020	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	40628	-	NOT APPLICABLE	0	In state provider	None	4544 SAN FERNANDO ROAD	SUITE 201	GLENDALE	CA	91204	5015	19	06037	34.13475025	-118.2630831	Los Angeles County
282157	Fee-for-Service	1689484586	1689484586	1	1	ABDUL KUBLAN MD INC	3/14/2025	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	175 W LA VERNE AVE	SUITE D	POMONA	CA	91767	2347	19	06037	34.08615354	-117.7522473	Los Angeles County
282183	Fee-for-Service	1669649844	1669649844	1	1	ADVANI, SUNIL J MD	3/22/2010	2085R0001X	NA	Other	026	PHYSICIANS	110025	78	Neoplastic Diseases/Oncology	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
282217	Fee-for-Service	1770927899	1770927899	1	1	AHMED, RIMSHA MD	3/10/2023	207VX0000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	184654	None	None	0	In state provider	None	200 UCLA MEDICAL PLAZA	None	LOS ANGELES	CA	90095	8344	19	06037	34.065126	-118.446237	Los Angeles County
282218	Fee-for-Service	1407235708	1407235708	1	1	AMBROSY, JOANNA R NP	3/12/2021	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
282243	Fee-for-Service	1609249994	1609249994	1	1	AXIS COMMUNITY HEALTH INC	5/20/2016	No Taxonomy Provided	NA	None	200	DEVELOPMENTAL SCREENING AND TRAUMA	-	-	NOT APPLICABLE	0	In state provider	None	5925 W LAS POSITAS BLVD	STE 100	PLEASANTON	CA	94588	6239	01	06001	37.68360997	-121.8990082	Alameda County
282271	Fee-for-Service	1831152883	1831152883	1	1	ATREJA, ASHISH MD	11/18/2024	207RG0100X	NA	Gastroenterology	026	PHYSICIANS	184563	10	Gastroenterology (M.D. only)	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
282280	Fee-for-Service	1922365857	1922365857	1	1	AUYEUNG, WILLIAM C MD	9/23/2019	207RC0200X	NA	Other	026	PHYSICIANS	135659	41	Internal Medicine	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
282317	Fee-for-Service	1235767575	1235767575	1	1	AFFINITY HOSPICE INC	2/18/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	20246 SATICOY ST	SUITE 202	WINNETKA	CA	91306	4433	19	06037	34.20831848	-118.574766	Los Angeles County
282380	Fee-for-Service	1528251386	1528251386	1	1	AMINI, ALI MD	7/18/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	107671	41	Internal Medicine	0	In state provider	None	3701 BROADWAY	None	OAKLAND	CA	94611	5613	01	06001	37.82533768	-122.258094	Alameda County
282421	Fee-for-Service	1093950917	1093950917	1	1	AHMED, FAISAL A MD	4/14/2014	208800000X	NA	Other	026	PHYSICIANS	123658	34	Urology and Urological Surgery	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
282443	Fee-for-Service	1023639804	1023639804	1	1	AGUILERA, PAUL V MD	11/14/2023	207R00000X	NA	Other	026	PHYSICIANS	191845	None	None	0	In state provider	None	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	43	06085	37.36217918	-121.8472051	Santa Clara County
282447	Fee-for-Service	1609249994	1609249994	1	1	AXIS COMMUNITY HEALTH INC	5/20/2016	No Taxonomy Provided	NA	None	035	RURAL HEALTH CLINICS/FEDERALLY QUALIFIED HEALTH CENTER	-	-	NOT APPLICABLE	0	In state provider	None	5925 W LAS POSITAS BLVD	STE 100	PLEASANTON	CA	94588	6239	01	06001	37.68360997	-121.8990082	Alameda County
282453	Fee-for-Service	1497137236	1497137236	1	1	AKUZAWA, HIROKO MD	12/12/2018	207P00000X	NA	Other	026	PHYSICIANS	145581	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
282482	Fee-for-Service	1104840008	1104840008	1	1	ABATE, LORRAINE E MD	12/31/1994	No Taxonomy Provided	NA	None	026	PHYSICIANS	77196	08	Family Practice	0	In state provider	None	2020 SUTTER PL	None	DAVIS	CA	95616	6201	57	06113	38.56287659	-121.7715536	Yolo County
282490	Fee-for-Service	1861742991	1861742991	1	2	AHURA HEALTHCARE CORPORATION	2/26/2025	No Taxonomy Provided	NA	None	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	555 ANTON BLVD	150	COSTA MESA	CA	92626	7811	30	06059	33.69005054	-117.8769195	Orange County
282495	Fee-for-Service	1912911983	1912911983	1	1	ABUNTO, MARIA V	4/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	60694	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1001 SNEATH LN	STE 104	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
282513	Fee-for-Service	1386778967	1386778967	1	1	ANTONIO, ETHEL U NP	5/27/2020	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	5250 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91601	3186	19	06037	34.1665161	-118.3755868	Los Angeles County
282542	Fee-for-Service	1699861450	1699861450	1	1	AMY L MITCHELL, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1501 N CAMPBELL AVE	None	TUCSON	AZ	85724	0001	00	None	32.240493	-110.9460825	Pima County
282547	Fee-for-Service	1326196114	1326196114	1	1	ANG, JOHN G MD	3/6/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	42727	30	Radiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
282604	Fee-for-Service	1558586503	1558586503	1	1	ALLEN, ROBERT M MD	11/18/2008	208M00000X	NA	Other	026	PHYSICIANS	103831	41	Internal Medicine	0	In state provider	None	3000 Q STREET	None	SACRAMENTO	CA	95816	7058	34	06067	38.564991	-121.4696565	Sacramento County
282625	Fee-for-Service	1578626909	1578626909	1	1	ATTIA, AMIN MD	1/31/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	44842	41	Internal Medicine	0	In state provider	None	770 MAGNOLIA AVE	STE 2J	CORONA	CA	92879	3122	33	06065	33.85936872	-117.5534605	Riverside County
282648	Fee-for-Service	1609249994	1609249994	1	1	AXIS COMMUNITY HEALTH INC	7/5/2016	No Taxonomy Provided	NA	None	058	HEALTH ACCESS PROGRAM	-	-	NOT APPLICABLE	0	In state provider	None	5925 W LAS POSITAS BLVD	STE 100	PLEASANTON	CA	94588	6239	01	06001	37.68360997	-121.8990082	Alameda County
282660	Fee-for-Service	1013467265	1013467265	1	1	AMAG HOSPICE INC	10/20/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1736 ERRINGER RD	STE 106	SIMI VALLEY	CA	93065	3558	56	06111	34.26903	-118.7613725	Ventura County
282674	Fee-for-Service	1548675663	1548675663	1	1	AHMED, BASHAR K MD	12/8/2021	207LP2900X	NA	Other	026	PHYSICIANS	152947	None	None	0	In state provider	None	500 DOYLE PARK DR	STE 300	SANTA ROSA	CA	95405	4559	49	06097	38.44332	-122.6985255	Sonoma County
282677	Fee-for-Service	1821234774	1821234774	1	1	ANGEL VIEW INC	4/7/2011	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	66415 BUENA VISTA AVE	None	HOT SPRINGS	CA	92240	3913	33	06065	33.95955548	-116.502768	Riverside County
282679	Fee-for-Service	1760016943	1760016943	1	1	ANGELS IN HEAVEN HOSPICE INC	7/1/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR STREET	SUITE 160	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
282690	Fee-for-Service	1861742991	1861742991	1	2	AHURA HEALTHCARE CORPORATION	2/26/2025	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	555 ANTON BLVD	150	COSTA MESA	CA	92626	7811	30	06059	33.69005054	-117.8769195	Orange County
282693	Fee-for-Service	1912911983	1912911983	1	1	ABUNTO, MARIA V	4/22/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	60694	40	Pediatrics	0	In state provider	None	1001 SNEATH LN	STE 104	SAN BRUNO	CA	94066	2349	41	06081	37.63462925	-122.4259247	San Mateo County
282697	Fee-for-Service	1891954517	1891954517	1	1	ANDREWS, GAIL A LCSW	6/12/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	25825 S VERMONT AVE	None	HARBOR CITY	CA	90710	3518	19	06037	33.7892965	-118.2937327	Los Angeles County
282753	Fee-for-Service	1225266794	1225266794	1	1	ACOSTA, LUISA	2/8/2015	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	17291 IRVINE BLVD	SUITE 100	TUSTIN	CA	92780	2941	30	06059	33.74830852	-117.830817	Orange County
282770	Fee-for-Service	1093083651	1093083651	1	1	ABALOS-GALITO, MARIETTA MD	8/13/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	78499	None	None	0	In state provider	INC	125 N JACKSON AVE	STE 206	SAN JOSE	CA	95116	1915	43	06085	37.36117713	-121.8462226	Santa Clara County
282773	Fee-for-Service	1255357927	1255357927	1	1	ANDRE CROUCH, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2055 N MAIN ST	None	TOOELE	UT	84074	9819	00	None	40.56668579	-112.2959013	Tooele County
282781	Fee-for-Service	1891741153	1891741153	1	1	ALLEVEN, DANIELLE PSYD	11/26/2012	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
282816	Fee-for-Service	1841215605	1841215605	1	1	ARCE, DEBORAH S MD	9/19/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	67617	41	Internal Medicine	0	In state provider	None	2700 GRANT ST	STE 200	CONCORD	CA	94520	2268	07	06013	37.98417931	-122.0361585	Contra Costa County
282826	Fee-for-Service	1780127100	1780127100	1	1	AZAR, ALEES LMFT	9/1/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1475 HUNTINGTON AVE	218	SOUTH SAN FRANCIS	CA	94080	5990	41	06081	37.64239261	-122.4202978	San Mateo County
282829	Fee-for-Service	1124331426	1124331426	1	1	ANTONUCCI, STEPHEN A MD	5/16/2017	208M00000X	NA	Other	026	PHYSICIANS	143234	41	Internal Medicine	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
282842	Fee-for-Service	1609249994	1609249994	1	1	AXIS COMMUNITY HEALTH INC	9/1/2020	No Taxonomy Provided	NA	None	053	EVERY WOMAN COUNTS	-	-	NOT APPLICABLE	0	In state provider	None	5925 W LAS POSITAS BLVD	STE 100	PLEASANTON	CA	94588	6239	01	06001	37.68360997	-121.8990082	Alameda County
282855	Fee-for-Service	1013467265	1013467265	1	1	AMAG HOSPICE INC	10/20/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1736 ERRINGER RD	STE 106	SIMI VALLEY	CA	93065	3558	56	06111	34.26903	-118.7613725	Ventura County
282862	Fee-for-Service	1649595364	1649595364	1	1	ANDERSON UNION HIGH SCHOOL	7/19/2009	No Taxonomy Provided	NA	None	055	LOCAL EDUCATION AGENCY	-	-	NOT APPLICABLE	0	In state provider	DISTRICT	1469 FERRY ST	None	ANDERSON	CA	96007	3313	45	06089	40.44183719	-122.30602	Shasta County
282879	Fee-for-Service	1760016943	1760016943	1	1	ANGELS IN HEAVEN HOSPICE INC	7/1/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	14545 FRIAR STREET	SUITE 160	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
282887	Fee-for-Service	1477554707	1477554707	1	1	ADAPT 2 IT INC	6/27/2014	332BC3200X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	24100 EL TORO RD	STE E	LAGUNA WOODS	CA	92637	3129	30	06059	33.61257019	-117.7133881	Orange County
282897	Fee-for-Service	1003968454	1003968454	1	1	ABDELKARIM, BASIL Z MD	10/6/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	65148	41	Internal Medicine	0	In state provider	None	9400 ROSECRANS AVENUE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
282924	Fee-for-Service	1760937643	1760937643	1	1	ADAMS, ROSA LCSW	1/21/2025	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
282946	Fee-for-Service	1154409985	1154409985	1	1	ACKUAYI, SETH MD	8/1/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	72345	41	Internal Medicine	0	In state provider	None	1305 TOMMYDON ST	None	STOCKTON	CA	95210	3364	39	06077	38.01883046	-121.29624	San Joaquin County
282957	Fee-for-Service	1265517759	1265517759	1	1	ALEGENT HEALTH-BERGAN	7/24/2003	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MERCY HEALTH SYSTEM	800 MERCY DR	None	COUNCIL BLUFFS	IA	51503	3128	00	None	41.26845588	-95.83820469	Pottawattamie County
282993	Fee-for-Service	1952332173	1952332173	1	1	AIRPORT PLAYA WOMENS MEDICAL	1/1/1979	No Taxonomy Provided	NA	None	026	PHYSICIANS	37160	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	GROUP INC	8540 S SEPULVEDA BLVD	SUITE 1002	LOS ANGELES	CA	90045	3808	19	06037	33.96022076	-118.3961982	Los Angeles County
283010	Fee-for-Service	1437220316	1437220316	1	1	AGARWAL, SOMA MD	5/1/2002	No Taxonomy Provided	NA	None	026	PHYSICIANS	78602	18	Ophthalmology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
283039	Fee-for-Service	1649536780	1649536780	1	1	ALAMDARI, HABIBOLLAH S MD	8/29/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	139121	07	Dermatology	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
283040	Fee-for-Service	1801077540	1801077540	1	1	AKOPYAN, ASMIK MD INC	12/11/2008	207L00000X	NA	Other	026	PHYSICIANS	67854	05	Anesthesiology	0	In state provider	None	1720 CESAR CHAVEZ AVE	None	LOS ANGELES	CA	90033	5033	19	06037	34.04925	-118.2177405	Los Angeles County
283045	Fee-for-Service	1225258668	1225258668	1	1	ANDHAVARAPU, SWATI MD	3/3/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	106688	41	Internal Medicine	0	In state provider	None	250 HOSPITAL PARKWAY	None	SAN JOSE	CA	95119	1103	43	06085	37.23948065	-121.8005798	Santa Clara County
283053	Fee-for-Service	1780250894	1780250894	1	1	AHMED, KINZA	8/16/2024	207P00000X	NA	Other	026	PHYSICIANS	23128	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1720 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	2414	19	06037	34.04925	-118.2177405	Los Angeles County
283064	Fee-for-Service	1932664232	1932664232	1	1	ALEXANDER-LEWIS, CORTNI LMF	9/7/2024	101YM0800X	NA	Other	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	THERAPY	7951 ETIWANDA AVE	#6201	RANCHO CUCAMONGA	CA	91739	9416	36	06071	34.108812	-117.521325	San Bernardino County
283065	Fee-for-Service	1942563762	1942563762	1	1	ALVARADO, ENMA M MD	8/6/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118526	41	Internal Medicine	0	In state provider	None	4311 THIRD AVE	None	SAN DIEGO	CA	92103	1407	37	06073	32.758578	-117.1637685	San Diego County
283120	Fee-for-Service	1578831129	1578831129	1	1	ARBOR VITAE HOSPICE CARE INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	1780 TOWN AND COUNTRY DR	UNIT 106	NORCO	CA	92860	3618	33	06065	33.92813669	-117.5596436	Riverside County
283153	Fee-for-Service	1265517759	1265517759	1	1	ALEGENT HEALTH-BERGAN	7/24/2003	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	MERCY HEALTH SYSTEM	800 MERCY DR	None	COUNCIL BLUFFS	IA	51503	3128	00	None	41.26845588	-95.83820469	Pottawattamie County
283157	Fee-for-Service	1043315120	1043315120	1	1	ANTELOPE VALLEY IMPOTENCE &	5/15/2020	208800000X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	INCONTINENCE MEDICAL CEN	44241 NORTH 15TH STREET	SUITE 101	LANCASTER	CA	93534	5500	19	06037	34.68712999	-118.1569096	Los Angeles County
283158	Fee-for-Service	1003587858	1003587858	1	1	ANAYA-SOTO, RAYDA PHD	12/14/2021	103TC0700X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	9600 CENTER AVE	160	RANCHO CUCAMONGA	CA	91730	5838	36	06071	34.07922138	-117.5796173	San Bernardino County
283217	Fee-for-Service	1235648007	1235648007	1	1	ARANI, TANDIS NP	5/14/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	350 SAINT JOSEPHS AVE	None	SAN FRANCISCO	CA	94115	3255	38	06075	37.78245426	-122.4421849	San Francisco County
283222	Fee-for-Service	1326061896	1326061896	1	1	ABBOTT, ALLAN V MD	2/1/1984	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	32884	08	Family Practice	0	In state provider	None	52500 TEMECULA	None	IDYLLWILD	CA	92349	0000	33	06065	33.73337685	-116.7467167	Riverside County
283232	Fee-for-Service	1578718425	1578718425	1	1	AKIKWALA, TULSI V MD	9/24/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	101311	05	Anesthesiology	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
283235	Fee-for-Service	1104883644	1104883644	1	1	ADKINS, DAVID H MD	12/31/1989	No Taxonomy Provided	NA	None	026	PHYSICIANS	70127	41	Internal Medicine	0	In state provider	None	600 COFFEE RD	None	MODESTO	CA	95355	4201	50	06099	37.653219	-120.975542	Stanislaus County
283242	Fee-for-Service	1285898247	1285898247	1	1	AGKO, MOUCHAMMED MD	8/8/2022	208200000X	NA	General Surgery	026	PHYSICIANS	116784	None	None	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
283257	Fee-for-Service	1184822066	1184822066	1	1	ASAVASOPON, SKULPAN	4/12/2011	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1526 N EDGEMONT ST	None	LOS ANGELES	CA	90027	5260	19	06037	34.098921	-118.2961105	Los Angeles County
283287	Fee-for-Service	1477572113	1477572113	1	1	AWOYOMI-SEWELL, OLUSEGUN	10/16/2006	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	ANGELS PARADISE MED SPLY	8774 SEPULVEDA BLVD	STE 4	NORTH HILLS	CA	91343	5158	19	06037	34.22995063	-118.4675973	Los Angeles County
283293	Fee-for-Service	1467725846	1467725846	1	2	ANTONIO CARBAYO MD A MEDICAL	9/1/2001	261QP2300X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	CORPORATION	1911 N BROADWAY	None	SANTA ANA	CA	92706	2609	30	06059	33.762177	-117.8695735	Orange County
283314	Fee-for-Service	1578831129	1578831129	1	1	ARBOR VITAE HOSPICE CARE INC	5/8/2014	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	1780 TOWN AND COUNTRY DR	UNIT 106	NORCO	CA	92860	3618	33	06065	33.92813669	-117.5596436	Riverside County
283328	Fee-for-Service	1427127075	1427127075	1	1	AJANWACHUKU, VINCENT E	1/31/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	43736	02	General Surgery	0	In state provider	None	15247 11TH ST	STE 900	VICTORVILLE	CA	92395	3707	36	06071	34.52871157	-117.2924819	San Bernardino County
283330	Fee-for-Service	1578737243	1578737243	1	1	ABRAHAM, IYPE MD	9/24/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103223	41	Internal Medicine	0	In state provider	None	710 LAWRENCE EXPWY	None	SANTA CLARA	CA	95051	5173	43	06085	37.33636857	-121.9958111	Santa Clara County
283332	Fee-for-Service	1073578399	1073578399	1	1	AMIN, MAHUL B MD	10/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	52183	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
283342	Fee-for-Service	1407001134	1407001134	1	1	ABDELNUR, ROBERTO MD INC	1/12/1984	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	36085	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1503 N IMPERIAL AVE	STE 201	EL CENTRO	CA	92243	4156	13	06025	32.806881	-115.5697535	Imperial County
283401	Fee-for-Service	1487692372	1487692372	1	1	AREVALO, RODOLFO A MD	11/1/2001	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63506	01	General Practice	0	In state provider	None	353 N HUMPHREYS AVE	STE C	LOS ANGELES	CA	90022	1432	19	06037	34.04012235	-118.1714172	Los Angeles County
283406	Fee-for-Service	1851465066	1851465066	1	1	AWERBUCK, DAVID C MD	2/1/1999	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	51810	66	Emergency Medicine (Urgent Care)	0	In state provider	None	966 CASS ST	STE 250	MONTEREY	CA	93940	4541	27	06053	36.5924291	-121.8964192	Monterey County
283478	Fee-for-Service	1013151265	1013151265	1	1	AKINTONDE, OLADAPO MD	9/13/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	181332	None	None	0	In state provider	None	147 N BRENT ST.	None	VENTURA	CA	93003	2809	56	06111	34.2746295	-119.2573399	Ventura County
283485	Fee-for-Service	1528183035	1528183035	1	1	ALI, BABER H MD	12/1/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	55373	18	Ophthalmology	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
283493	Fee-for-Service	1124572631	1124572631	1	1	ALBERTSONS LLC	2/16/2017	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	1910 N CAMPUS AVE	None	UPLAND	CA	91784	1667	36	06071	34.13230802	-117.6383398	San Bernardino County
283517	Fee-for-Service	1407001134	1407001134	1	1	ABDELNUR, ROBERTO MD INC	1/12/1984	207RI0011X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	36085	41	Internal Medicine	0	In state provider	None	1503 N IMPERIAL AVE	STE 201	EL CENTRO	CA	92243	4156	13	06025	32.806881	-115.5697535	Imperial County
283519	Fee-for-Service	1588645634	1588645634	1	4	ALEXANDER, JAMILE Y MD	6/23/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	251 N ESTRELLA PKWY	None	GOODYEAR	AZ	85338	9334	00	None	33.449436	-112.3919055	Maricopa County
283522	Fee-for-Service	1073578399	1073578399	1	1	AMIN, MAHUL B MD	10/5/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	52183	22	Pathology (M.D. only)	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
283532	Fee-for-Service	1912239062	1912239062	1	1	ATLANTIC SURGICAL CENTER LLC	7/24/2019	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	850 S ATLANTIC BLVD	STE 104	MONTEREY PARK	CA	91754	6704	19	06037	34.05097684	-118.1379979	Los Angeles County
283534	Fee-for-Service	1255658746	1255658746	1	1	AYOUB, ROSANA J MD	3/11/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	119909	67	Endocrinology	0	In state provider	None	191 S BUENA VISTA STREET	STE 420	BURBANK	CA	91505	4504	19	06037	34.15872557	-118.3283863	Los Angeles County
283563	Fee-for-Service	1124266143	1124266143	1	1	ABDULBADER, ABDULBASET T MD	2/15/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	109607	41	Internal Medicine	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
283575	Fee-for-Service	1699341644	1699341644	1	1	ALERACARE MEDICAL GROUP OF C	8/14/2024	261QM1300X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ALIFORNIA	2001 SANTA MONICA BLVD	1160W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
283578	Fee-for-Service	1881899755	1881899755	1	1	ACKERMAN, SERENA M CRNA	2/8/2015	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	2550 SISTER MARY COLUMB	None	RED BLUFF	CA	96080	4327	52	06103	40.14847323	-122.2180997	Tehama County
283582	Fee-for-Service	1487692372	1487692372	1	1	AREVALO, RODOLFO A MD	11/1/2001	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	63506	08	Family Practice	0	In state provider	None	353 N HUMPHREYS AVE	STE C	LOS ANGELES	CA	90022	1432	19	06037	34.04012235	-118.1714172	Los Angeles County
283594	Fee-for-Service	1851465066	1851465066	1	1	AWERBUCK, DAVID C MD	2/1/1999	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	51810	04	Otology, Laryngology, Rhinology	0	In state provider	None	966 CASS ST	STE 250	MONTEREY	CA	93940	4541	27	06053	36.5924291	-121.8964192	Monterey County
283609	Fee-for-Service	1396783411	1396783411	1	1	ARCHER, SANFORD M MD	8/31/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	61178	04	Otology, Laryngology, Rhinology	0	In state provider	None	101 THE CITY DRIVE SOUTH	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
283613	Fee-for-Service	1144214628	1144214628	1	1	AG LYNWOOD, LLC	10/1/2003	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	HEALTHCARE CENTER	3611 E IMPERIAL HWY	None	LYNWOOD	CA	90262	2608	19	06037	33.93073129	-118.2045443	Los Angeles County
283620	Fee-for-Service	1346500691	1346500691	1	1	ATTAR, MICHELLE F DPM	10/4/2016	No Taxonomy Provided	NA	None	027	PODIATRISTS	-	None	None	0	In state provider	None	8250 WOODMAN AVENUE	None	PANORAMA CITY	CA	91402	5427	19	06037	34.22078654	-118.4326211	Los Angeles County
283642	Fee-for-Service	1801992813	1801992813	1	1	ADERHOLDT, KAREN G MD	1/6/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	65820	30	Radiology	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
283654	Fee-for-Service	1437492659	1437492659	1	1	ASIAN AMERICAN DRUG ABUSE	12/14/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	PROGRAM INC	5318 CRENSHAW BLVD	None	LOS ANGELES	CA	90043	1810	19	06037	33.99428023	-118.3306537	Los Angeles County
283724	Fee-for-Service	1639295678	1639295678	1	1	ADAL, ANA LMFT	10/23/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	11600 WASHINGTON PLACE	202E	LOS ANGELES	CA	90066	5068	19	06037	34.00465708	-118.4208535	Los Angeles County
283761	Fee-for-Service	1699341644	1699341644	1	1	ALERACARE MEDICAL GROUP OF C	11/6/2023	261QM1300X	NA	Other	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	ALIFORNIA	2001 SANTA MONICA BLVD	1160W	SANTA MONICA	CA	90404	2102	19	06037	34.02891163	-118.4797466	Los Angeles County
283795	Fee-for-Service	1023460284	1023460284	1	1	AHMAD, NADIA U NP	7/13/2022	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
283805	Fee-for-Service	1891993168	1891993168	1	1	AYROSO, VINCENT V DO	12/31/2007	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	9063	08	Family Practice	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
283807	Fee-for-Service	1013209568	1013209568	1	1	ANDERSON, LORRAINE L MD	11/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121140	41	Internal Medicine	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
283822	Fee-for-Service	1407461494	1407461494	1	1	ASCENTIA HOME HEALTH INC	9/13/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	18075 VENTURA BLVD	STE 130	ENCINO	CA	91316	3595	19	06037	34.16527698	-118.5267	Los Angeles County
283824	Fee-for-Service	1760638217	1760638217	1	1	ATLUS HEALTH INC	12/4/2024	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	151 N SUNRISE AVE	STE 1011	ROSEVILLE	CA	95661	2930	31	06061	38.74746043	-121.2655348	Placer County
283830	Fee-for-Service	1669531281	1669531281	1	1	ALEXANDER, JULIA C MD	12/11/2002	207N00000X	NA	Dermatology	026	PHYSICIANS	63618	07	Dermatology	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
283836	Fee-for-Service	1871995498	1871995498	1	1	ACHARYA, JAY MD	3/28/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	135912	None	None	0	In state provider	None	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	19	06037	34.06238259	-118.2030986	Los Angeles County
283902	Fee-for-Service	1306225123	1306225123	1	3	ARCE MEDICAL CARE, PC	1/5/2022	261QP2300X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	200 N LA CUMBRE RD	M	SANTA BARBARA	CA	93110	1577	42	06083	34.44255908	-119.7510269	Santa Barbara County
283912	Fee-for-Service	1639122815	1639122815	1	1	ASUNCION, RANILO L MD	2/4/2000	No Taxonomy Provided	NA	None	026	PHYSICIANS	70749	01	General Practice	0	In state provider	None	901 OLIVE DR	None	BAKERSFIELD	CA	93308	4137	15	06029	35.41225153	-119.0396655	Kern County
283926	Fee-for-Service	1740866615	1740866615	1	3	ATTENDA MEDICAL GROUP INC	5/6/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	506 S MAIN STREET	None	SEBASTOPOL	CA	95472	4261	49	06097	38.39799405	-122.8220018	Sonoma County
283947	Fee-for-Service	1013269539	1013269539	2	1	ALLERGY PARTNERS OF CALIFORN	1/10/2022	207K00000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	O	2655 CAMINO DEL RIO N	STE 425	SAN DIEGO	CA	92108	1633	37	06073	32.77261373	-117.1347389	San Diego County
283971	Fee-for-Service	1487615647	1487615647	1	1	ADUSUMILLI, VIJAY MD	3/1/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	84154	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1191 PHELPS AVE	None	COALINGA	CA	93210	9609	10	06019	36.15152163	-120.340676	Fresno County
283980	Fee-for-Service	1013300417	1013300417	1	1	ANDERSON, CHASE T MD	5/5/2023	2084P0800X	NA	Psychiatry	026	PHYSICIANS	170303	None	None	0	In state provider	None	675 18TH STREET	None	SAN FRANCISCO	CA	94143	0984	38	06075	37.76085391	-122.4356007	San Francisco County
283988	Fee-for-Service	1013209568	1013209568	1	1	ANDERSON, LORRAINE L MD	11/1/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	121140	03	Allergy	0	In state provider	None	200 MEDICAL PLAZA	STE 365, 420, 120	LOS ANGELES	CA	90095	0001	19	06037	34.06527974	-118.4462792	Los Angeles County
283990	Fee-for-Service	1235335563	1235335563	1	1	AL HANNAT, NIDAL MD	2/17/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	128838	41	Internal Medicine	0	In state provider	None	800 S MAIN ST	None	CORONA	CA	92882	3420	33	06065	33.872958	-117.568359	Riverside County
284047	Fee-for-Service	1982074571	1982074571	1	1	ARREOLA, GUADALUPE	2/4/2025	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	179258	08	Family Practice	0	In state provider	None	355 ABBOTT STREET	100	SALINAS	CA	93901	4310	27	06053	36.66552031	-121.6439174	Monterey County
284053	Fee-for-Service	1508136193	1508136193	1	1	ACQUISTAPACE, MICHAEL D CRNA	9/9/2019	367500000X	NA	Other	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
284109	Fee-for-Service	1740866615	1740866615	1	3	ATTENDA MEDICAL GROUP INC	5/6/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	None	506 S MAIN STREET	None	SEBASTOPOL	CA	95472	4261	49	06097	38.39799405	-122.8220018	Sonoma County
284140	Fee-for-Service	1528177631	1528177631	2	1	APRIA HEALTHCARE LLC	7/10/2019	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	265 SOUTH STREET	SUITE E	SAN LUIS OBISPO	CA	93401	5036	40	06079	35.26950048	-120.666789	San Luis Obispo County
284148	Fee-for-Service	1750314852	1750314852	1	1	AGZARIAN, ALICE E MD	1/31/1997	No Taxonomy Provided	NA	None	026	PHYSICIANS	37111	41	Internal Medicine	0	In state provider	None	#450,455,490,290,550,525	None	LOS ANGELES	CA	90095	0001	19	06037	0	0	None
284196	Fee-for-Service	1528463890	1528463890	1	1	ANDERSON, ANGELA M LMFT	10/11/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1930 TIENDA DR	STE 102	LODI	CA	95252	3935	39	06077	38.11681837	-121.2959834	San Joaquin County
284206	Fee-for-Service	1700059631	1700059631	1	2	ALL CARE HOME HEALTH	5/1/2018	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	OF SAN GABRIEL	3505 HART AVE	SUITE 203	ROSEMEAD	CA	91770	2061	19	06037	34.07294437	-118.0687952	Los Angeles County
284210	Fee-for-Service	1760658157	1760658157	1	1	ALTAS ICF INC	5/8/2008	320600000X	NA	Other	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	7820 FRUITRIDGE RD	None	SACRAMENTO	CA	95820	6743	34	06067	38.524734	-121.412412	Sacramento County
284237	Fee-for-Service	1972624021	1972624021	1	1	AWARIEFE, HENRY S OKPAKO	5/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	28705	33	Thoracic Surgery	0	In state provider	None	508 N LONG BEACH BLVD	None	COMPTON	CA	90221	2221	19	06037	33.89945043	-118.2081128	Los Angeles County
284252	Fee-for-Service	1740866615	1740866615	1	2	ATTENDA MEDICAL GROUP INC	5/5/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	4750 HOEN AVE	B	SANTA ROSA	CA	95405	7833	49	06097	38.442744	-122.6629485	Sonoma County
284258	Fee-for-Service	1881460533	1881460533	1	1	AL-MUSTAFA INC	1/10/2024	No Taxonomy Provided	NA	None	066	PERSONAL CARE AGENCY	-	-	NOT APPLICABLE	0	In state provider	None	18763 CEDAR CREST DR	None	SANTA CLARITA	CA	91387	1454	19	06037	34.38996333	-118.454977	Los Angeles County
284282	Fee-for-Service	1275981037	1275981037	1	1	ALLEN, ANDREW T MD	7/9/2020	2084P0800X	NA	Psychiatry	026	PHYSICIANS	152457	36	Psychiatry	0	In state provider	None	11878 AVENUE OF INDUSTRY	None	SAN DIEGO	CA	92128	3423	37	06073	32.99058739	-117.0752486	San Diego County
284293	Fee-for-Service	1740866615	1740866615	1	3	ATTENDA MEDICAL GROUP INC	5/6/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	506 S MAIN STREET	None	SEBASTOPOL	CA	95472	4261	49	06097	38.39799405	-122.8220018	Sonoma County
284300	Fee-for-Service	1578909743	1578909743	1	1	ARATANI, ASHLEY K MD	3/24/2020	207X00000X	NA	Orthopedic Surgery	026	PHYSICIANS	138414	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
284313	Fee-for-Service	1558306266	1558306266	2	3	AMG, A PROFESSIONAL MEDICAL	8/18/2023	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	40	Pediatrics	0	In state provider	ORPORATION	328 S. FIRST ST	F	ALHAMBRA	CA	91801	3790	19	06037	34.09104553	-118.1252904	Los Angeles County
284314	Fee-for-Service	1497817332	1497817332	1	1	AKHAVAN, MEHRAS MD	1/20/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	82275	25	Physical Medicine and Rehabilitation	0	In state provider	None	15243 VANOWEN ST	STE 107	VAN NUYS	CA	91405	3633	19	06037	34.19394848	-118.4654115	Los Angeles County
284342	Fee-for-Service	1407835507	1407835507	1	1	ALKAN, SERHAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	54569	None	None	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
284406	Fee-for-Service	1316206907	1316206907	1	1	AWARENESS PROGRAM, INC	4/6/2015	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	45926 OASIS ST	None	INDIO	CA	92201	4559	33	06065	33.715512	-116.2207015	Riverside County
284409	Fee-for-Service	1568686285	1568686285	1	1	ALLAUDEEN, NAZIMA MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92116	01	General Practice	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
284412	Fee-for-Service	1972624021	1972624021	1	1	AWARIEFE, HENRY S OKPAKO	5/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	28705	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	508 N LONG BEACH BLVD	None	COMPTON	CA	90221	2221	19	06037	33.89945043	-118.2081128	Los Angeles County
284426	Fee-for-Service	1740866615	1740866615	1	2	ATTENDA MEDICAL GROUP INC	5/5/2021	213E00000X	NA	Other	027	PODIATRISTS	-	None	None	0	In state provider	None	4750 HOEN AVE	B	SANTA ROSA	CA	95405	7833	49	06097	38.442744	-122.6629485	Sonoma County
284427	Fee-for-Service	1881616159	1881616159	1	1	ASHRAF, MOHAMMAD MD	7/29/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35686	41	Internal Medicine	0	In state provider	None	1260 E ALMOND AVE	None	MADERA	CA	93637	5000	20	06039	36.9453747	-120.0454403	Madera County
284461	Fee-for-Service	1518182799	1518182799	1	1	ALVAREZ, LANNETTE LCSW	3/10/2016	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	6620 VIA DEL ORO	None	SAN JOSE	CA	95119	1392	43	06085	37.23418124	-121.7818366	Santa Clara County
284466	Fee-for-Service	1659521359	1659521359	1	1	AVALOS, JOSE MD	3/17/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	105523	41	Internal Medicine	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
284487	Fee-for-Service	1558306266	1558306266	2	3	AMG, A PROFESSIONAL MEDICAL	8/18/2023	207Q00000X	NA	Adult Primary Care	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ORPORATION	328 S. FIRST ST	F	ALHAMBRA	CA	91801	3790	19	06037	34.09104553	-118.1252904	Los Angeles County
284493	Fee-for-Service	1851335624	1851335624	1	1	AUTRY, AMY MD	9/28/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	70559	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
284530	Fee-for-Service	1144918210	1144918210	1	1	ALCALA, CARLO RIEL D OT	6/5/2023	225X00000X	NA	Other	019	OCCUPATIONAL THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	2230 W SUNNYSIDE AVE STE	None	VISALIA	CA	93277	7269	54	06107	36.303912	-119.3156595	Tulare County
284535	Fee-for-Service	1184772576	1184772576	1	1	AVILES, JEANETTE MD	7/1/2000	207R00000X	NA	Other	026	PHYSICIANS	55206	41	Internal Medicine	0	In state provider	None	795 WILLOW RD	None	MENLO PARK	CA	94025	2539	41	06081	37.466676	-122.160384	San Mateo County
284537	Fee-for-Service	1063608719	1063608719	1	1	AYALA, ESTELA D MD	8/29/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	92908	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	44	06087	36.98191238	-121.9975767	Santa Cruz County
284556	Fee-for-Service	1346751096	1346751096	1	1	ALWARD, RYAN M MD	8/13/2021	207P00000X	NA	Other	026	PHYSICIANS	161782	None	None	0	In state provider	None	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	07	06013	37.89189148	-122.057999	Contra Costa County
284582	Fee-for-Service	1972624021	1972624021	1	1	AWARIEFE, HENRY S OKPAKO	5/31/2005	No Taxonomy Provided	NA	None	026	PHYSICIANS	28705	02	General Surgery	0	In state provider	None	508 N LONG BEACH BLVD	None	COMPTON	CA	90221	2221	19	06037	33.89945043	-118.2081128	Los Angeles County
284586	Fee-for-Service	1568686285	1568686285	1	1	ALLAUDEEN, NAZIMA MD	9/20/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	92116	41	Internal Medicine	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
284596	Fee-for-Service	1881616159	1881616159	1	1	ASHRAF, MOHAMMAD MD	7/29/1980	No Taxonomy Provided	NA	None	026	PHYSICIANS	35686	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	1260 E ALMOND AVE	None	MADERA	CA	93637	5000	20	06039	36.9453747	-120.0454403	Madera County
284597	Fee-for-Service	1740866615	1740866615	1	2	ATTENDA MEDICAL GROUP INC	5/5/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	33	Thoracic Surgery	0	In state provider	None	4750 HOEN AVE	B	SANTA ROSA	CA	95405	7833	49	06097	38.442744	-122.6629485	Sonoma County
284608	Fee-for-Service	1609834217	1609834217	1	1	ALARCON, J ANTONIO MD	5/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	40197	34	Urology and Urological Surgery	0	In state provider	INCORPOATED	880 S ATLANTIC BLVD	STE 204	MONTEREY PARK	CA	91754	4700	19	06037	34.05038485	-118.1383456	Los Angeles County
284615	Fee-for-Service	1194244756	1194244756	1	1	AKIZUKI, MARK S PT	7/4/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	39400 PASEO PADRE PKWY	None	FREMONT	CA	94538	2310	01	06001	37.55102172	-121.9759026	Alameda County
284625	Fee-for-Service	1023514411	1023514411	1	1	ASH, RYAN T MD	8/10/2022	2084P0800X	NA	Psychiatry	026	PHYSICIANS	165366	None	None	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
284652	Fee-for-Service	1881857175	1881857175	1	1	ABDELWAHED, GHADA S MD	10/3/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	108912	08	Family Practice	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
284673	Fee-for-Service	1558321745	1558321745	1	1	ALVARNAS, JOSEPH C	1/31/1994	207RH0003X	NA	Oncology	026	PHYSICIANS	71518	68	Hematology	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
284715	Fee-for-Service	1639104144	1639104144	1	1	ANESTHESIA PARTNERS OF	4/26/2004	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	05	Anesthesiology	0	In state provider	None	1600 WEST AVENUE J	None	LANCASTER	CA	93534	4289	19	06037	34.68938848	-118.158354	Los Angeles County
284722	Fee-for-Service	1457763989	1457763989	2	1	AMBROSIA HEALTHCARE INC	11/30/2015	3336H0001X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	75-060 GERALD FORD DRIVE	SUITE 2	PALM DESERT	CA	92211	0780	33	06065	33.78627944	-116.3613971	Riverside County
284742	Fee-for-Service	1982079406	1982079406	1	1	ADVOCATE HOME HEALTH	2/6/2019	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	16102 HART ST	None	VAN NUYS	CA	91406	0806	19	06037	34.19749625	-118.4843828	Los Angeles County
284767	Fee-for-Service	1740866615	1740866615	1	2	ATTENDA MEDICAL GROUP INC	5/5/2021	207Q00000X	NA	Adult Primary Care	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	4750 HOEN AVE	B	SANTA ROSA	CA	95405	7833	49	06097	38.442744	-122.6629485	Sonoma County
284774	Fee-for-Service	1467061002	1467061002	1	1	AKAMINE, ALICIA B NP	11/8/2021	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
284777	Fee-for-Service	1609834217	1609834217	1	1	ALARCON, J ANTONIO MD	5/2/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	40197	01	General Practice	0	In state provider	INCORPOATED	880 S ATLANTIC BLVD	STE 204	MONTEREY PARK	CA	91754	4700	19	06037	34.05038485	-118.1383456	Los Angeles County
284789	Fee-for-Service	1154815025	1154815025	1	1	ALCAM MEDICAL INC.	11/3/2020	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	None	6244 EL CAJON BLVD	UNIT 12	SAN DIEGO	CA	92115	3918	37	06073	32.76342577	-117.0636924	San Diego County
284794	Fee-for-Service	1376051383	1376051383	1	1	AHC HOME HEALTH OF	11/22/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SACRAMENTO LLC	1411 EXPO PKWY	STE 150	SACRAMENTO	CA	95815	4239	34	06067	38.598624	-121.457331	Sacramento County
284812	Fee-for-Service	1780692582	1780692582	2	2	APRIA HEALTHCARE LLC	6/20/2022	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	414 19TH STREET	None	BAKERSFIELD	CA	93301	4908	15	06029	35.37621551	-119.0062575	Kern County
284818	Fee-for-Service	1083058531	1083058531	1	1	ANDREW PAYNE	9/15/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	43 NEW SCOTLAND AVE	None	ALBANY	NY	12208	3412	00	None	42.653133	-73.7752995	Albany County
284834	Fee-for-Service	1124101316	1124101316	1	1	ATEIA, SAMIA G MD	5/31/1983	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	40653	01	General Practice	0	In state provider	None	1300 S SUNSET AVE	None	WEST COVINA	CA	91790	3342	19	06037	34.0601054	-117.9474205	Los Angeles County
284841	Fee-for-Service	1558321745	1558321745	1	1	ALVARNAS, JOSEPH C	1/31/1994	207RH0003X	NA	Oncology	026	PHYSICIANS	71518	41	Internal Medicine	0	In state provider	None	300 HOMER AVE	None	PALO ALTO	CA	94301	2726	43	06085	37.44411082	-122.157252	Santa Clara County
284852	Fee-for-Service	1114042165	1114042165	1	2	ATHLETIC PHYSICAL THERAPY IN	5/14/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	C	1464 MADERA RD	UNIT I-1	SIMI VALLEY	CA	93065	7034	56	06111	34.26580213	-118.7961902	Ventura County
284864	Fee-for-Service	1992312227	1992312227	1	1	APEX RECOVERY, LLC	1/27/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2810 CAMINO DEL RIO S	STE 106	SAN DIEGO	CA	92108	3819	37	06073	32.77081335	-117.1316557	San Diego County
284888	Fee-for-Service	1285863803	1285863803	1	1	ALLISON PEASLEY GAUTHIER MD	1/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	190 E BANNOCK ST	None	BOISE	ID	83712	6241	00	None	43.6124738	-116.1926844	Ada County
284904	Fee-for-Service	1780198085	1780198085	1	1	ALT RECOVERY GROUP 2 LLC	6/11/2018	261QM2800X	NA	Other	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	20946 DEVONSHIRE ST	SUITE 100	CHATSWORTH	CA	91311	2312	19	06037	34.25721947	-118.5905475	Los Angeles County
284905	Fee-for-Service	1740091909	1740091909	1	1	ABOODY, DANIELLA ADI TOLABO	3/25/2025	374J00000X	NA	Other	106	DOULA INDIVIDUAL PROVIDER	-	-	NOT APPLICABLE	0	In state provider	Addresses not published for Doula Providers	N/A	N/A	N/A	N/A	N/A	N/A	49	06097	0	0	None
284926	Fee-for-Service	1407899032	1407899032	1	1	ANA I GUZMAN-CRUZ, MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	167 NORTH MAIN ST	PO BOX 600	TUBA CITY	AZ	86045	0000	00	None	36.13538929	-111.2397388	Coconino County
284932	Fee-for-Service	1629369632	1629369632	1	1	AGUILAR, YENY LMFT	4/16/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
285026	Fee-for-Service	1023050135	1023050135	1	1	ALRAJAB, SAADAH MD	10/25/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	89139	None	None	0	In state provider	None	1180 E SHAW AVE	STE 101	FRESNO	CA	93710	7812	10	06019	36.80891142	-119.768244	Fresno County
285033	Fee-for-Service	1700475522	1700475522	1	1	ALL SEASON HOME CARE INC	8/29/2023	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	715 N CENTRAL AVE	STE 201	GLENDALE	CA	91203	1225	19	06037	34.15695962	-118.2580155	Los Angeles County
285035	Fee-for-Service	1063097285	1063097285	1	1	AVAN HOME HEALTH CARE INC	10/5/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	19231 VICTORY BLVD	SUITE 109	RESEDA	CA	91335	6320	19	06037	34.18659852	-118.552221	Los Angeles County
285044	Fee-for-Service	1902363237	1902363237	1	1	ARDENT HOME HEALTH CARE	4/16/2021	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	SERVICES	14545 FRIAR ST	SUITE 125	VAN NUYS	CA	91411	2397	19	06037	34.18570347	-118.450386	Los Angeles County
285055	Fee-for-Service	1427259217	1427259217	1	1	ALAMEDA COUNTY MED CTR	7/1/1998	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	SNT/DP	15400 FOOTHILL BLVD	None	SAN LEANDRO	CA	94578	1009	01	06001	37.7069698	-122.1191104	Alameda County
285073	Fee-for-Service	1780198085	1780198085	1	1	ALT RECOVERY GROUP 2 LLC	6/11/2018	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	20946 DEVONSHIRE ST	SUITE 100	CHATSWORTH	CA	91311	2312	19	06037	34.25721947	-118.5905475	Los Angeles County
285113	Fee-for-Service	1225566730	1225566730	1	1	AUER, JUSTINE CNP	2/17/2022	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1350 FLORIN RD	None	SACRAMENTO	CA	95822	4202	34	06067	38.495232	-121.505409	Sacramento County
285137	Fee-for-Service	1821176538	1821176538	1	1	ALOCOZY, MOHAMMAD N MD	3/1/1999	No Taxonomy Provided	NA	None	026	PHYSICIANS	63564	01	General Practice	0	In state provider	None	2155 IRON POINT RD	None	FOLSOM	CA	95630	8707	34	06067	38.644479	-121.1349735	Sacramento County
285145	Fee-for-Service	1568044006	1568044006	1	1	ARULMOZHI, KAVITHA MD	6/27/2024	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	None	40	Pediatrics	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
285172	Fee-for-Service	1780180935	1780180935	1	1	ADAMS, KYLE DO	8/24/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18696	None	None	0	In state provider	None	1020 29TH ST	STE 680	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
285173	Fee-for-Service	1942492673	1942492673	1	1	ASTAKHOVA, INGA V MD	12/26/2007	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	97450	40	Pediatrics	0	In state provider	None	3733 SAN DIMAS ST	None	BAKERSFIELD	CA	93301	1407	15	06029	35.393499	-119.008257	Kern County
285177	Fee-for-Service	1730434499	1730434499	1	1	ADVANTAGE COUNSELING SERVICE	4/25/2024	106H00000X	NA	Mental Health Outpatient Services	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	S, A MARRIAGE & FAMILY	6205 LAUREL CANYON BLVD	None	NORTH HOLLYWOOD	CA	91606	3210	19	06037	34.183314	-118.3965585	Los Angeles County
285178	Fee-for-Service	1952409393	1952409393	1	1	ANSARI, M ALI MD INC	9/1/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75046	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	6310 SAN VICENTE BLVD	STE 280	LOS ANGELES	CA	90048	5426	19	06037	34.06093425	-118.3673115	Los Angeles County
285222	Fee-for-Service	1639775612	1639775612	1	1	A CARE MED GP	2/23/2021	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	10837 DOWNEY AVE	None	DOWNEY	CA	90241	3706	19	06037	33.94292003	-118.1310117	Los Angeles County
285235	Fee-for-Service	1841584315	1841584315	1	1	AHMADIAN, NAZANIN S DO	11/2/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	9028	40	Pediatrics	0	In state provider	None	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
285279	Fee-for-Service	1013286939	1013286939	1	1	ADVENTIST HEALTH PHYSICIANS	11/21/2014	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	9330 STOCKDALE HWY	STE 400	BAKERSFIELD	CA	93311	3614	15	06029	35.35452946	-119.106351	Kern County
285291	Fee-for-Service	1356510846	1356510846	1	1	AM MEDICAL SUPPLY, INC	9/29/2009	No Taxonomy Provided	NA	None	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	AM MEDICAL SUPPLY, INC	1616 VICTORY BLVD	STE 105	GLENDALE	CA	91201	2947	19	06037	34.16022036	-118.2989479	Los Angeles County
285305	Fee-for-Service	1245328988	1245328988	2	1	AHLUWALIA, AMARDEEP S MD	12/4/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	92906	01	General Practice	0	In state provider	None	1020 29TH ST	STE 680	SACRAMENTO	CA	95816	5126	34	06067	38.572803	-121.4685	Sacramento County
285318	Fee-for-Service	1598925877	1598925877	1	1	ATHWAL, SUKHDEEP S DO	7/28/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	13258	05	Anesthesiology	0	In state provider	None	7417 N CEDAR AVE	None	FRESNO	CA	93720	3637	10	06019	36.844227	-119.7568975	Fresno County
285323	Fee-for-Service	1376525154	1376525154	1	1	AHMED, OMAR MD	7/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81109	40	Pediatrics	0	In state provider	None	2521 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2207	34	06067	38.55204	-121.455387	Sacramento County
285335	Fee-for-Service	1922441203	1922441203	1	1	ALMANZA, CARLOS A MD	7/14/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	141788	41	Internal Medicine	0	In state provider	None	5TH & ESPLANADE	None	CHICO	CA	95926	3326	04	06007	39.741948	-121.848921	Butte County
285336	Fee-for-Service	1225182801	1225182801	1	1	ALLEN, EUGENE DO INC	11/16/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	6802	66	Emergency Medicine (Urgent Care)	0	In state provider	None	16415 COLORADO AVE	STE 307	PARAMOUNT	CA	90723	5053	19	06037	33.8853075	-118.1614695	Los Angeles County
285339	Fee-for-Service	1619347465	1619347465	1	1	ALAL LLC	2/1/2016	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2221 LINCOLN PARK AVENUE	None	LOS ANGELES	CA	90031	2920	19	06037	34.07105982	-118.202527	Los Angeles County
285340	Fee-for-Service	1952409393	1952409393	1	1	ANSARI, M ALI MD INC	9/1/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	75046	41	Internal Medicine	0	In state provider	None	6310 SAN VICENTE BLVD	STE 280	LOS ANGELES	CA	90048	5426	19	06037	34.06093425	-118.3673115	Los Angeles County
285374	Fee-for-Service	1295154862	1295154862	1	1	ANTELOPE HILLS MANOR ICF-DDN	9/22/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	INCORPORATED	8014 RIVERGREEN DR	None	ELVERTA	CA	95626	9653	34	06067	38.71512	-121.4184555	Sacramento County
285431	Fee-for-Service	1770685935	1770685935	1	1	ARASOGHLI, SAM MD	11/1/1997	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	40547	04	Otology, Laryngology, Rhinology	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
285435	Fee-for-Service	1851785786	1851785786	1	1	ADDANTE, RAYMOND A MD	7/30/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	145677	41	Internal Medicine	0	In state provider	None	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	19	06037	34.069509	-118.383743	Los Angeles County
285447	Fee-for-Service	1205920220	1205920220	1	1	ANIL KUMAR SRIVASTAVA MD	1/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	621 S NEW BALLAS RD	STE 560A	SAINT LOUIS	MO	63141	8261	00	None	38.644902	-90.4462065	St. Louis County
285468	Fee-for-Service	1922041821	1922041821	1	1	ADELMAN, DANIEL C	8/31/1986	207K00000X	NA	Other	026	PHYSICIANS	53619	41	Internal Medicine	0	In state provider	None	10833 LE CONTE AVE	None	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
285483	Fee-for-Service	1578256301	1578256301	1	1	ARIANA APARICIO PHILLIPS, O.	6/29/2023	152WV0400X	NA	Other	023	GROUP OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	6700 INDIANA AVE	STE 155	RIVERSIDE	CA	92506	4290	33	06065	33.94397483	-117.3905469	Riverside County
285499	Fee-for-Service	1174258602	1174258602	1	1	APOLLO SURGERY CENTER LLC	2/9/2023	261QA1903X	NA	Other	044	SURGICAL CLINIC	-	-	NOT APPLICABLE	0	In state provider	None	43944 15TH STREET W	SUITE 101	LANCASTER	CA	93534	5207	19	06037	34.681626	-118.1566845	Los Angeles County
285544	Fee-for-Service	1649446543	1649446543	1	1	ALTA, PRADEEP R MD	7/31/2008	390200000X	NA	Other	026	PHYSICIANS	104575	41	Internal Medicine	0	In state provider	None	1180 EAST SHAW	#125	FRESNO	CA	93729	8901	10	06019	36.80891142	-119.768244	Fresno County
285566	Fee-for-Service	1295782654	1295782654	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	3255 GRAND AVE	None	CHINO HILLS	CA	91709	1488	36	06071	34.00187992	-117.7347038	San Bernardino County
285589	Fee-for-Service	1770685935	1770685935	1	1	ARASOGHLI, SAM MD	11/1/1997	207YX0905X	NA	ENT/Otolaryngology	026	PHYSICIANS	40547	84	Surgery-Head and Neck	0	In state provider	None	1798 N GAREY AVE	None	POMONA	CA	91767	2918	19	06037	34.076894	-117.7522688	Los Angeles County
285592	Fee-for-Service	1730234162	1730234162	1	1	ARORA, SANJAY MD	3/10/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	81333	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1011 BALDWIN PARK BLVD	None	BALDWIN PARK	CA	91706	5806	19	06037	34.06477215	-117.9845382	Los Angeles County
285615	Fee-for-Service	1083761084	1083761084	1	1	AHN, DAVID S MD FAAP	6/2/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	61137	40	Pediatrics	0	In state provider	None	19333 BEAR VALLEY RD	STE 201	APPLE VALLEY	CA	92308	5150	36	06071	34.47104148	-117.2413863	San Bernardino County
285630	Fee-for-Service	1427053453	1427053453	1	1	ACCENTCARE HOME HEALTH	4/30/1998	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA, INC	1455 S AUTO CENTER DR	STE 150	ONTARIO	CA	91761	2239	36	06071	34.046712	-117.545526	San Bernardino County
285639	Fee-for-Service	1215927900	1215927900	1	1	ANTANI, MEGHAL R MD	2/6/2024	2085R0204X	NA	Other	026	PHYSICIANS	None	None	None	0	In state provider	None	1415 ROSS AVE	None	EL CENTRO	CA	92243	4306	13	06025	32.78144947	-115.568541	Imperial County
285685	Fee-for-Service	1598984288	1598984288	1	1	AMAVI, A PMC	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	70	Clinic (mixed specialty)	0	In state provider	GUADALAJARA MED CLIN INC	2705 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1441	19	06037	34.03264707	-118.2117851	Los Angeles County
285699	Fee-for-Service	1558783738	1558783738	1	1	ALLCARE PHARMACY INC	3/24/2014	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	11028 LOWER AZUSA ROAD	None	EL MONTE	CA	91731	1440	19	06037	34.09193387	-118.0251713	Los Angeles County
285758	Fee-for-Service	1538594973	1538594973	1	1	AZIZI, NASON MD	4/5/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	138256	41	Internal Medicine	0	In state provider	None	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	15	06029	35.382555	-118.970757	Kern County
285784	Fee-for-Service	1396952545	1396952545	1	1	ARON, ZOE S MD	2/23/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	106202	36	Psychiatry	0	In state provider	None	11303 W WASHINGTON BLVD	SUITE 100	LOS ANGELES	CA	90066	6003	19	06037	34.00408212	-118.4147433	Los Angeles County
285840	Fee-for-Service	1598984288	1598984288	1	1	AMAVI, A PMC	1/1/1979	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	GUADALAJARA MED CLIN INC	2705 WHITTIER BLVD	None	LOS ANGELES	CA	90023	1441	19	06037	34.03264707	-118.2117851	Los Angeles County
285842	Fee-for-Service	1285735266	1285735266	1	1	ABRAMS, AARON	3/13/2024	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1301 E BIDWELL ST	#101	FOLSOM	CA	95630	3452	34	06067	38.66841	-121.151025	Sacramento County
285917	Fee-for-Service	1134388895	1134388895	1	1	ALLARD, JEAN R MD INC	5/11/2009	174400000X	NA	Other	026	PHYSICIANS	35174	33	Thoracic Surgery	0	In state provider	None	575 E HARDY ST	STE 322	INGLEWOOD	CA	90301	4053	19	06037	33.94909392	-118.3477665	Los Angeles County
285927	Fee-for-Service	1295965440	1295965440	1	1	AISTHETIKOS INC	10/8/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	84857	24	Plastic Surgery	0	In state provider	None	680 GUZZI LANE	STE 201	SONORA	CA	95370	5288	55	06109	37.97611058	-120.3719921	Tuolumne County
285945	Fee-for-Service	1578749776	1578749776	2	1	ALLISON, HOWARD H MD	8/22/2011	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	51865	41	Internal Medicine	0	In state provider	None	500 W EATON AVE	None	TRACY	CA	95376	3422	39	06077	37.74328152	-121.433373	San Joaquin County
285946	Fee-for-Service	1407272487	1407272487	1	1	AOTN LLC	6/15/2014	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	2361 E 29TH ST	None	OAKLAND	CA	94606	3511	01	06001	37.79522292	-122.2250412	Alameda County
286000	Fee-for-Service	1689709982	1689709982	1	1	ARDRON, GERARD E MD	4/30/1991	207W00000X	NA	Ophthalmology	026	PHYSICIANS	66625	18	Ophthalmology	0	In state provider	None	900 S MAIN ST	STE 206	CORONA	CA	92882	3401	33	06065	33.87190191	-117.5669613	Riverside County
286037	Fee-for-Service	1972548964	1972548964	1	1	ALSHEIK, NILA MD	5/30/2024	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	None	30	Radiology	0	In state provider	None	455 HICKEY DRIVE	SUITE 200	DALY CITY	CA	94015	2630	41	06081	37.66383747	-122.4671404	San Mateo County
286051	Fee-for-Service	1497127070	1497127070	1	1	AMIROVA, SAMIRA NP	8/28/2017	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
286071	Fee-for-Service	1134388895	1134388895	1	1	ALLARD, JEAN R MD INC	5/11/2009	174400000X	NA	Other	026	PHYSICIANS	35174	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	575 E HARDY ST	STE 322	INGLEWOOD	CA	90301	4053	19	06037	33.94909392	-118.3477665	Los Angeles County
286098	Fee-for-Service	1578749776	1578749776	2	1	ALLISON, HOWARD H MD	8/22/2011	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	51865	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	500 W EATON AVE	None	TRACY	CA	95376	3422	39	06077	37.74328152	-121.433373	San Joaquin County
286167	Fee-for-Service	1770517971	1770517971	1	1	AMERICAN MEDICAL RESPONSE	12/10/1997	341600000X	NEMT Provider	Other	030	GROUND MEDICAL TRANSPORTATION	-	-	NOT APPLICABLE	0	In state provider	WEST	2400 BISSO LANE	None	CONCORD	CA	94520	4832	07	06013	37.98411857	-122.0466636	Contra Costa County
286171	Fee-for-Service	1477866010	1477866010	1	1	AIRPORT URGENT CARE &	12/29/2011	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	INDUSTRIAL MEDICINE A	1117 W MANCHESTER DR	SUITE K	INGLEWOOD	CA	90301	1500	19	06037	33.95992353	-118.3759515	Los Angeles County
286209	Fee-for-Service	1851382378	1851382378	1	1	ANSLEY, STEVEN MD	1/1/1982	207P00000X	NA	Other	026	PHYSICIANS	38708	66	Emergency Medicine (Urgent Care)	0	In state provider	None	2333 BUCHANAN ST	None	SAN FRANCISCO	CA	94115	1925	38	06075	37.79071145	-122.4308506	San Francisco County
286248	Fee-for-Service	1528059490	1528059490	1	1	AHUJA, SONIA N MD	8/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	66330	41	Internal Medicine	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
286268	Fee-for-Service	1548884885	1548884885	1	1	APPLE, CASSANDRA LMFT	12/17/2024	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	19330 JESSE LN	STE 280	RIVERSIDE	CA	92508	5091	33	06065	33.90484164	-117.3254297	Riverside County
286294	Fee-for-Service	1336225044	1336225044	1	1	APPEL, RICHARD Y MD	9/9/2019	208M00000X	NA	Other	026	PHYSICIANS	74243	41	Internal Medicine	0	In state provider	None	26991 CROWN VALLEY PKWY	100	MISSION VIEJO	CA	92691	6528	30	06059	33.56210341	-117.6694207	Orange County
286378	Fee-for-Service	1114042165	1114042165	1	3	ATHLETIC PHYSICAL THERAPY IN	5/28/2021	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	C	12424 WILSHIRE BLVD	101	LOS ANGELES	CA	90025	0000	19	06037	34.04150435	-118.4706154	Los Angeles County
286394	Fee-for-Service	1528059490	1528059490	1	1	AHUJA, SONIA N MD	8/22/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	66330	66	Emergency Medicine (Urgent Care)	0	In state provider	None	354 SANTA FE DR	None	ENCINITAS	CA	92024	5142	37	06073	33.03623896	-117.2837308	San Diego County
286437	Fee-for-Service	1124255625	1124255625	1	1	ANNE S KEMBLE M.D.	2/22/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1301 PUNCHBOWL ST	None	HONOLULU	HI	96813	2402	00	None	21.30800017	-157.8550765	Honolulu County
286457	Fee-for-Service	1841348778	1841348778	1	1	AFAGH, ARMAN MD	12/8/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	82896	66	Emergency Medicine (Urgent Care)	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
286467	Fee-for-Service	1376956755	1376956755	1	1	ADAMS, OLA MD	8/26/2024	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	None	2732 NAVAJO RD	202A	EL CAJON	CA	92020	2149	37	06073	32.80217534	-117.0025853	San Diego County
286475	Fee-for-Service	1659790095	1659790095	1	1	AGARWAL, RESHEM MD	8/28/2017	390200000X	NA	Other	026	PHYSICIANS	147746	40	Pediatrics	0	In state provider	None	747 52ND ST	None	OAKLAND	CA	94609	1809	01	06001	37.83734639	-122.2672128	Alameda County
286509	Fee-for-Service	1295466316	1295466316	1	1	AVILA, SAMANTHA LMFT	7/17/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	7170 N FINANCIAL DR.	STE 110	FRESNO	CA	93720	2939	10	06019	36.84000952	-119.7711439	Fresno County
286518	Fee-for-Service	1184191033	1184191033	1	1	APER, ANNA P LCSW	10/12/2023	104100000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	99 S ALMADEN BLVD	STE 600	SAN JOSE	CA	95113	1605	43	06085	37.33257807	-121.8940377	Santa Clara County
286555	Fee-for-Service	1609927268	1609927268	1	2	AMADA ENTERPRISES, INC	2/9/2015	No Taxonomy Provided	NA	None	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	None	12619 S AVALON BLVD	None	LOS ANGELES	CA	90061	2727	19	06037	33.91821	-118.2652785	Los Angeles County
286626	Fee-for-Service	1245200674	1245200674	1	1	APPELBAUM, GORDON S MD	8/13/1990	No Taxonomy Provided	NA	None	026	PHYSICIANS	69453	None	None	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
286646	Fee-for-Service	1326044967	1326044967	1	1	ASSOC GASTROENTEROLOGY	6/15/1979	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	MEDICAL GROUP	1211 W LA PALMA AVE	STE 306	ANAHEIM	CA	92801	2811	30	06059	33.84718298	-117.933758	Orange County
286667	Fee-for-Service	1356764351	1356764351	1	1	ANDERSON, CHRISTINE NP	8/7/2024	363LF0000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1504 EUREKA ROAD	STE 150	ROSEVILLE	CA	95661	4051	31	06061	38.75063238	-121.2501559	Placer County
286678	Fee-for-Service	1093882839	1093882839	1	1	ARCEGA, ARLENE S OD	1/27/2014	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	399 E HIGHLAND AVE	STE 401	SAN BERNARDINO	CA	92402	3862	36	06071	34.1358627	-117.2757898	San Bernardino County
286697	Fee-for-Service	1548536055	1548536055	1	1	AHN, JENNIFER J MD	9/21/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	127763	41	Internal Medicine	0	In state provider	None	10800 MAGNOLIA AVE	None	RIVERSIDE	CA	92505	3043	33	06065	33.904782	-117.469323	Riverside County
286699	Fee-for-Service	1346682028	1346682028	1	1	ADVENTIST HEALTH PHYSICIANS	11/21/2014	No Taxonomy Provided	NA	None	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1142 ROSE AVENUE	STE A	SELMA	CA	93662	3251	10	06019	36.56886527	-119.5983853	Fresno County
286713	Fee-for-Service	1295574648	1295574648	1	1	ALTAMED HEALTH SERVICES	11/26/2024	No Taxonomy Provided	NA	None	041	COMMUNITY CLINIC	-	-	NOT APPLICABLE	0	In state provider	ANA, SUNFLOWER	3601 W SUNFLOWER AVE	200-242,245-251,253-261	SANTA ANA	CA	92704	7916	30	06059	33.69568151	-117.918072	Orange County
286741	Fee-for-Service	1124438528	1124438528	1	1	ADMERA HEALTH LLC	1/16/2018	291U00000X	NA	Other	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	2	Out of state provider	None	126 CORPORATE BOULEVARD	None	SOUTH PLAINFIELD	NJ	07080	2411	00	None	40.54638331	-74.4196029	Middlesex County
286813	Fee-for-Service	1881644813	1881644813	1	1	AVEY, GREGORY D MD	11/1/2020	2085N0700X	NA	MRI Provider	026	PHYSICIANS	-	None	None	2	Out of state provider	None	600 HIGHLAND AVE	None	MADISON	WI	53792	0001	00	None	43.07868393	-89.4316606	Dane County
286817	Fee-for-Service	1629162243	1629162243	1	1	AGUILAR, ALEJANDRO F MD	6/10/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	36086	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3034 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5828	19	06037	33.97302389	-118.2141733	Los Angeles County
286839	Fee-for-Service	1205410537	1205410537	1	1	ALLEN, ASHLEY E MD	5/28/2024	207P00000X	NA	Other	026	PHYSICIANS	187669	66	Emergency Medicine (Urgent Care)	0	In state provider	None	1303 EAST HERNDON AVENUE	None	FRESNO	CA	93720	3309	10	06019	36.83626596	-119.7674879	Fresno County
286843	Fee-for-Service	1487071452	1487071452	1	1	ALLY, FERAS MD	2/7/2019	207ZP0102X	NA	Other	026	PHYSICIANS	153047	21	Pathologic Anatomy: Clinical Pathology (D.O. only)	0	In state provider	None	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	19	06037	34.129683	-117.970857	Los Angeles County
286866	Fee-for-Service	1164414215	1164414215	1	1	ARGER, KOSTA MD MD	3/31/1982	No Taxonomy Provided	NA	None	026	PHYSICIANS	48317	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4747 ENGLE RD	None	CARMICHAEL	CA	95608	2223	34	06067	38.6320173	-121.3545928	Sacramento County
286877	Fee-for-Service	1205020435	1205020435	1	1	ALAGARSAMY, SUKIRTHABAI	10/2/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	87436	40	Pediatrics	0	In state provider	K MD	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
286881	Fee-for-Service	1851594451	1851594451	1	1	ASKIN, JAYANN LMFT	5/9/2018	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	681 MAIN ST	SUITE 212	PLACERVILLE	CA	95667	5748	09	06017	38.72992279	-120.7927701	El Dorado County
286884	Fee-for-Service	1144583428	1144583428	1	1	ALEXANDER-NATHANI, AMIT D MD	4/6/2022	207XX0005X	NA	Orthopedic Surgery	026	PHYSICIANS	147016	None	None	0	In state provider	None	511 BATH ST	None	SANTA BARBARA	CA	93101	3403	42	06083	34.41386476	-119.6993335	Santa Barbara County
286887	Fee-for-Service	1093860892	1093860892	1	1	ATKINSON, JANIS M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	355 RIDGE AVE	None	EVANSTON	IL	60202	3328	00	None	42.02450175	-87.68519074	Cook County
286912	Fee-for-Service	1023221371	1023221371	1	1	ABC VISION CENTER	2/8/2015	No Taxonomy Provided	NA	None	012	DISPENSING OPTICIANS	-	-	NOT APPLICABLE	0	In state provider	None	3130 W OLYMPIC BLVD	STE 110	LOS ANGELES	CA	90006	2491	19	06037	34.05258529	-118.3039795	Los Angeles County
286965	Fee-for-Service	1861678260	1861678260	1	2	AMANI, MOJDEH LMFT	6/5/2019	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1100 QUAIL ST	206	NEWPORT BEACH	CA	92660	2782	30	06059	33.65958081	-117.8666188	Orange County
287006	Fee-for-Service	1306821566	1306821566	1	1	AVILA-KIRWAN, GUADALUPE	6/1/1998	207R00000X	NA	Other	026	PHYSICIANS	84783	69	Unknown	0	In state provider	MD	6 TARMAN DR	None	CLOVERDALE	CA	95425	3932	49	06097	38.79822374	-123.0176641	Sonoma County
287050	Fee-for-Service	1427314855	1427314855	1	1	AHMED, FAISAL MD	4/3/2019	390200000X	NA	Other	026	PHYSICIANS	137401	None	None	0	In state provider	None	751 S BASCOM AVE	None	SAN JOSE	CA	95128	2604	43	06085	37.313433	-121.9318385	Santa Clara County
287060	Fee-for-Service	1467488023	1467488023	1	1	ADS, AYMAN M MD	9/16/2020	207L00000X	NA	Other	026	PHYSICIANS	169308	05	Anesthesiology	0	In state provider	None	603 E LATHAM AVE	None	HEMET	CA	92543	4342	33	06065	33.74933852	-116.96598	Riverside County
287072	Fee-for-Service	1629079181	1629079181	1	1	AXMINSTER MEDICAL GROUP	6/1/2002	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	INC	575 E HARDY ST	STE 109	INGLEWOOD	CA	90301	4039	19	06037	33.94909392	-118.3477665	Los Angeles County
287110	Fee-for-Service	1801810791	1801810791	1	1	ANDREW K VAALER MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	NORTH MEMORIAL MEDICAL	3300 OAK DALE AVE	None	ROBBINSDALE	MN	55422	0000	00	None	45.01443093	-93.32190604	Hennepin County
287140	Fee-for-Service	1669621611	1669621611	1	1	AICHELE, CHRISOPHE NP	2/8/2015	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	1615 DELAWARE ST	None	LONGVIEW	WA	98632	2367	00	None	46.1309207	-122.9408931	Cowlitz County
287171	Fee-for-Service	1588900096	1588900096	1	1	AL-HABIB, ALLA H MD	2/28/2020	2084N0400X	NA	Neurology	026	PHYSICIANS	166596	13	Neurology (M.D. only)	0	In state provider	None	28062 BAXTER RD	None	MURRIETA	CA	92563	1401	33	06065	33.61350847	-117.1691225	Riverside County
287219	Fee-for-Service	1780654988	1780654988	1	1	ALAM, SHAYAN MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	9327 N 3RD ST	STE 206	PHOENIX	AZ	85020	2473	00	None	33.571089	-112.069287	Maricopa County
287221	Fee-for-Service	1437137189	1437137189	1	1	AGRAWAL, DIPTI MD	10/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54879	41	Internal Medicine	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
287232	Fee-for-Service	1013391606	1013391606	1	1	ANKER, LAUREN	5/19/2025	No Taxonomy Provided	NA	None	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	4141 GEARY BLVD	None	SAN FRANCISCO	CA	94118	3109	38	06075	37.78096053	-122.4637512	San Francisco County
287262	Fee-for-Service	1730717513	1730717513	1	1	ASKARINAM, SAHAR MD	4/20/2023	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	184614	None	None	0	In state provider	None	1304 15TH STREET	400	SANTA MONICA	CA	90404	1813	19	06037	34.02600773	-118.486172	Los Angeles County
287272	Fee-for-Service	1194715193	1194715193	1	2	AHN, BYUNG D MD	5/1/1999	207RC0000X	NA	Cardiology/Interventional Cardiology	026	PHYSICIANS	39266	06	Cardiovascular Disease (M.D. only)	0	In state provider	None	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	36	06071	34.1010559	-117.6369445	San Bernardino County
287274	Fee-for-Service	1366457855	1366457855	1	1	ALBERT R DIPIERO MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	OREGON HEALTH SCIENCES	3181 SW SAM JACKSON PK	RD	PORTLAND	OR	97239	3011	00	None	45.49936609	-122.6856232	Multnomah County
287304	Fee-for-Service	1255801767	1255801767	1	1	AKUA BEHAVIORAL HEALTH, INC	2/17/2025	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	3025 REYNARD WY	None	SAN DIEGO	CA	92103	5434	37	06073	32.736906	-117.1698735	San Diego County
287312	Fee-for-Service	1326773946	1326773946	1	1	ASSAM, MICAELA CNP	4/1/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	825 DELBON AVE	None	TURLOCK	CA	95382	2016	50	06099	37.51052943	-120.8386573	Stanislaus County
287346	Fee-for-Service	1346702636	1346702636	1	1	AFFINITY ACUPUNCTURE INC.	5/24/2019	171100000X	NA	Other	032	CERTIFIED ACUPUNCTURIST	-	-	NOT APPLICABLE	0	In state provider	None	22481 EL TORO RD	STE D	LAKE FOREST	CA	92630	5052	30	06059	33.63542935	-117.6822042	Orange County
287358	Fee-for-Service	1437137189	1437137189	1	1	AGRAWAL, DIPTI MD	10/14/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	54879	77	Infectious Disease	0	In state provider	None	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	43	06085	37.43920432	-122.162109	Santa Clara County
287405	Fee-for-Service	1457829731	1457829731	1	1	ALLIED PSYCHIATRY AND MENTAL	11/3/2020	2084P0800X	NA	Psychiatry	031	PSYCHOLOGISTS	-	None	None	0	In state provider	HEALTH	1401 DOVE ST	420	NEWPORT BEACH	CA	92660	2420	30	06059	33.66331121	-117.8658763	Orange County
287416	Fee-for-Service	1861619124	1861619124	1	1	AIVAZIAN, ANATOLY DC	2/8/2015	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	237 E PALMDALE BLVD	STE B	PALMDALE	CA	93550	4514	19	06037	34.5800745	-118.1261565	Los Angeles County
287428	Fee-for-Service	1376293407	1376293407	1	1	AEGIS TREATMENT CENTERS, LLC	5/15/2023	No Taxonomy Provided	NA	None	051	OUTPATIENT HEROIN DETOX CENTER	-	-	NOT APPLICABLE	0	In state provider	None	2781 W. RAMSEY STREET	SUITES 3 & 4	BANNING	CA	92220	3700	33	06065	33.9257895	-116.9066655	Riverside County
287458	Fee-for-Service	1487816294	1487816294	1	1	ALEJANDRO, DELAINE M DO	2/5/2021	207Q00000X	NA	Adult Primary Care	026	PHYSICIANS	18589	None	None	0	In state provider	None	19270 SONOMA HIGHWAY 12	None	SONOMA	CA	95476	5414	49	06097	38.29871411	-122.4751509	Sonoma County
287471	Fee-for-Service	1215953278	1215953278	1	1	ALI, AFSHAN A MD	2/8/2015	2080P0207X	NA	Hematology	026	PHYSICIANS	54187	40	Pediatrics	0	In state provider	None	11190 WARNER AVE	STE 301	FOUNTAIN VALLEY	CA	92708	4047	30	06059	33.714	-117.9333585	Orange County
287476	Fee-for-Service	1619630464	1619630464	1	1	ACKERMAN, LYNDSEY D NP	11/9/2021	363LP0200X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
287488	Fee-for-Service	1699961706	1699961706	1	1	ATKINSON, LINDSEY M MD	7/29/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	95200	05	Anesthesiology	0	In state provider	None	300 PASTEUR DR	MC 5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
287513	Fee-for-Service	1447206446	1447206446	2	1	ALBERTSONS LLC	4/22/2013	333600000X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	None	775 TUCKER RD	None	TEHACHAPI	CA	93561	2502	15	06029	35.125704	-118.4678675	Kern County
287523	Fee-for-Service	1508549262	1508549262	1	1	ANGELICA'S HOME INC	9/19/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	None	31916 CORTE POSITAS	None	TEMECULA	CA	92592	6482	33	06065	33.511616	-117.1019938	Riverside County
287524	Fee-for-Service	1790815082	1790815082	1	1	ABRISHAMI, BABAK B DO	4/15/2008	207RP1001X	NA	Pulmonology	026	PHYSICIANS	7450	29	Pulmonary Diseases (M.D. only)	0	In state provider	None	1245 WILSHIRE RD	STE 305	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
287538	Fee-for-Service	1457829731	1457829731	1	1	ALLIED PSYCHIATRY AND MENTAL	11/3/2020	2084P0800X	NA	Psychiatry	022	PHYSICIANS GROUP	-	None	None	0	In state provider	HEALTH	1401 DOVE ST	420	NEWPORT BEACH	CA	92660	2420	30	06059	33.66331121	-117.8658763	Orange County
287551	Fee-for-Service	1871800102	1871800102	1	1	ASTRACK, ALLEN P LCSW	2/22/2021	106H00000X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	1600 HUMBOLDT RD	SUITE 3	CHICO	CA	95928	8100	04	06007	39.73660489	-121.8115227	Butte County
287559	Fee-for-Service	1376293407	1376293407	1	1	AEGIS TREATMENT CENTERS, LLC	5/15/2023	No Taxonomy Provided	NA	None	076	DRUG MEDI-CAL	-	-	NOT APPLICABLE	0	In state provider	None	2781 W. RAMSEY STREET	SUITES 3 & 4	BANNING	CA	92220	3700	33	06065	33.9257895	-116.9066655	Riverside County
287587	Fee-for-Service	1326724899	1326724899	1	1	ALLIANCE WELLNESS CARE	12/10/2024	261QU0200X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	23388 MULHOLLAND DR	None	WOODLAND HILLS	CA	91364	2733	19	06037	34.15672173	-118.6347091	Los Angeles County
287600	Fee-for-Service	1740242718	1740242718	2	1	ACCENTCARE HOME HEALTH OF	9/1/2009	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	CALIFORNIA INC	2344 S. 2ND STREET	SUITE A	EL CENTRO	CA	92243	5606	13	06025	32.77196997	-115.5460437	Imperial County
287602	Fee-for-Service	1215953278	1215953278	1	1	ALI, AFSHAN A MD	2/8/2015	2080P0207X	NA	Hematology	026	PHYSICIANS	54187	68	Hematology	0	In state provider	None	11190 WARNER AVE	STE 301	FOUNTAIN VALLEY	CA	92708	4047	30	06059	33.714	-117.9333585	Orange County
287624	Fee-for-Service	1245832419	1245832419	1	1	ALGOS INC., A MEDICAL CORPOR	1/8/2021	103TB0200X	NA	Mental Health Outpatient Services	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	None	137 S ASPEN COURT	SUITE B	VISALIA	CA	93291	5381	54	06107	36.32885419	-119.3529996	Tulare County
287652	Fee-for-Service	1922372283	1922372283	1	1	ADVANCED SLEEP MEDICINE SRVS	7/3/2018	261QS1200X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	1111 E TAHQUITZ CANYON	STE 110	PALM SPRINGS	CA	92262	0113	33	06065	33.8230345	-116.5331835	Riverside County
287654	Fee-for-Service	1487467601	1487467601	1	1	ANJALI DHAR, MD MEDICAL PROF	2/12/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	Y & WELLNESS	915 W HEDDING ST	UNIT 1	SAN JOSE	CA	95126	1216	43	06085	37.34291971	-121.9204335	Santa Clara County
287656	Fee-for-Service	1003047515	1003047515	1	1	ALAS, ALEXANDRIAH MD	6/26/2024	207VF0040X	NA	Obstetrics & Gynecology	026	PHYSICIANS	115628	15	Obstetrics (D.O. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
287657	Fee-for-Service	1790815082	1790815082	1	1	ABRISHAMI, BABAK B DO	4/15/2008	207RP1001X	NA	Pulmonology	026	PHYSICIANS	7450	41	Internal Medicine	0	In state provider	None	1245 WILSHIRE RD	STE 305	LOS ANGELES	CA	90017	4803	19	06037	34.05362775	-118.2661889	Los Angeles County
287707	Fee-for-Service	1457623266	1457623266	1	1	AMED, ZIBA OD	6/5/2020	152W00000X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	4601 DALE ROAD	None	MODESTO	CA	95356	9718	50	06099	37.706508	-121.052457	Stanislaus County
287715	Fee-for-Service	1063442143	1063442143	1	1	AGABABIAN, GOR MD	3/7/2011	207R00000X	NA	Other	026	PHYSICIANS	93668	None	None	0	In state provider	None	222 W EULALIA ST	SUITE 301	GLENDALE	CA	91204	2851	19	06037	34.12653215	-118.257121	Los Angeles County
287724	Fee-for-Service	1881893402	1881893402	1	1	AYALA, ANGELICA LMFT	7/31/2020	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	974 RALSTON AVE	SUITE 10	BELMONT	CA	94002	0010	41	06081	37.51941236	-122.2772344	San Mateo County
287729	Fee-for-Service	1215953278	1215953278	1	1	ALI, AFSHAN A MD	2/8/2015	2080P0207X	NA	Hematology	026	PHYSICIANS	54187	78	Neoplastic Diseases/Oncology	0	In state provider	None	11190 WARNER AVE	STE 301	FOUNTAIN VALLEY	CA	92708	4047	30	06059	33.714	-117.9333585	Orange County
287737	Fee-for-Service	1750325973	1750325973	1	1	ALLEN-AUERBACH, MARTIN S	10/15/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80425	42	Nuclear Medicine	0	In state provider	MD	10833 LE CONTE AVE	BLDG AR130	LOS ANGELES	CA	90095	3075	19	06037	34.06373445	-118.443537	Los Angeles County
287747	Fee-for-Service	1730114372	1730114372	1	2	APOLLO, SARAH	9/19/2023	207Q00000X	NA	Adult Primary Care	086	MEDICAL DIRECTORS	6613	-	NOT APPLICABLE	0	In state provider	None	265 SOUTH ANITA DRIVE	SUITES 202, 301, 302	ORANGE	CA	92868	3355	30	06059	33.78499409	-117.8811837	Orange County
287751	Fee-for-Service	1245832419	1245832419	1	1	ALGOS INC., A MEDICAL CORPOR	1/8/2021	103TB0200X	NA	Mental Health Outpatient Services	031	PSYCHOLOGISTS	-	None	None	0	In state provider	None	137 S ASPEN COURT	SUITE B	VISALIA	CA	93291	5381	54	06107	36.32885419	-119.3529996	Tulare County
287785	Fee-for-Service	1003047515	1003047515	1	1	ALAS, ALEXANDRIAH MD	6/26/2024	207VF0040X	NA	Obstetrics & Gynecology	026	PHYSICIANS	115628	09	Gynecology (D.O. only)	0	In state provider	None	300 PASTEUR DR	None	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
287835	Fee-for-Service	1780180703	1780180703	1	1	ALTENHOFEN, BRANNON Y MD	6/23/2023	207L00000X	NA	Other	026	PHYSICIANS	165612	None	None	0	In state provider	None	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	19	06037	34.06633051	-118.4452686	Los Angeles County
287838	Fee-for-Service	1417639782	1417639782	1	1	AMPLA HEALTH	9/21/2023	3336C0003X	NA	Pharmacies	024	PHARMACIES/PHARMACISTS	-	-	NOT APPLICABLE	0	In state provider	Y	614 J ST	None	MARYSVILLE	CA	95901	5413	58	06115	39.14089763	-121.598347	Yuba County
287862	Fee-for-Service	1114900537	1114900537	1	1	ASHBAUGH, CAMERON D MD	1/5/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	62747	77	Infectious Disease	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
287879	Fee-for-Service	1245832419	1245832419	1	1	ALGOS INC., A MEDICAL CORPOR	1/8/2021	103TB0200X	NA	Mental Health Outpatient Services	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	137 S ASPEN COURT	SUITE B	VISALIA	CA	93291	5381	54	06107	36.32885419	-119.3529996	Tulare County
287888	Fee-for-Service	1942846472	1942846472	1	1	ALL VALLEY HOSPICE INC	4/30/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	12440 FIRESTONE BLVD	STE 1020	NORWALK	CA	90650	4366	19	06037	33.90523023	-118.0681168	Los Angeles County
287932	Fee-for-Service	1578099552	1578099552	1	1	ASIF, MARYAM MD	8/18/2021	207ZP0102X	NA	Other	026	PHYSICIANS	167028	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
287944	Fee-for-Service	1346332780	1346332780	1	1	ALCORN, DEBORAH M MD	11/30/1989	207W00000X	NA	Ophthalmology	026	PHYSICIANS	49220	18	Ophthalmology	0	In state provider	None	1350 WILLOW RD	STE 202	MENLO PARK	CA	94025	1516	41	06081	37.47713734	-122.1521704	San Mateo County
287968	Fee-for-Service	1306908959	1306908959	1	1	ANCOB, RONNY J CRNA	7/19/2005	No Taxonomy Provided	NA	None	018	NURSE ANESTHETISTS	-	None	None	0	In state provider	None	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	34	06067	38.470392	-121.4223975	Sacramento County
287983	Fee-for-Service	1396368809	1396368809	1	1	ALLAM, KAREEM MD	10/11/2023	207ZP0102X	NA	Other	026	PHYSICIANS	186560	None	None	0	In state provider	None	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	34	06067	38.555181	-121.4566785	Sacramento County
287986	Fee-for-Service	1396372298	1396372298	1	1	ASIIMWE, EDGAR MD	8/14/2023	207R00000X	NA	Other	026	PHYSICIANS	186689	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
288001	Fee-for-Service	1245832419	1245832419	1	1	ALGOS INC., A MEDICAL CORPOR	1/8/2021	103TB0200X	NA	Mental Health Outpatient Services	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	137 S ASPEN COURT	SUITE B	VISALIA	CA	93291	5381	54	06107	36.32885419	-119.3529996	Tulare County
288013	Fee-for-Service	1942846472	1942846472	1	1	ALL VALLEY HOSPICE INC	4/30/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	12440 FIRESTONE BLVD	STE 1020	NORWALK	CA	90650	4366	19	06037	33.90523023	-118.0681168	Los Angeles County
288049	Fee-for-Service	1215294210	1215294210	1	1	AEBI, BRYCE L CO	5/9/2012	No Taxonomy Provided	NA	None	021	ORTHOTISTS	-	-	NOT APPLICABLE	0	In state provider	None	3520 E SHIELDS AVE	SUITE 102	FRESNO	CA	93726	6923	10	06019	36.77947947	-119.765781	Fresno County
288074	Fee-for-Service	1477013571	1477013571	1	1	A&A WOMEN'S HEALTH	11/1/2019	207V00000X	NA	Obstetrics & Gynecology	026	PHYSICIANS	None	None	None	0	In state provider	None	5153 HOLT BLVD	B2	MONTCLAIR	CA	91763	4837	36	06071	34.0631015	-117.692694	San Bernardino County
288108	Fee-for-Service	1316995111	1316995111	1	1	AGBUNAG, RODOLFO V MD	9/7/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	67171	02	General Surgery	0	In state provider	None	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
288113	Fee-for-Service	1093938524	1093938524	1	1	ALIASON, INGER P MD	9/18/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	84155	05	Anesthesiology	0	In state provider	None	6235 N FRESNO ST	SUITE 103	FRESNO	CA	93710	5269	10	06019	36.82733123	-119.7814229	Fresno County
288118	Fee-for-Service	1114042165	1114042165	1	1	ATHLETIC PHYSICAL THERAPY IN	1/13/2020	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	C	30837 E THOUSAND OAKS BL	None	WESTLAKE VILLAGE	CA	91362	0000	19	06037	34.15512537	-118.7921942	Los Angeles County
288120	Fee-for-Service	1053632356	1053632356	1	1	AHLUWALIA, ROHAN MD	8/7/2019	207RH0003X	NA	Oncology	026	PHYSICIANS	141525	68	Hematology	0	In state provider	None	2850 COMMERCIAL CROSSING	None	SANTA CRUZ	CA	95065	1816	44	06087	36.98796413	-121.9825327	Santa Cruz County
288185	Fee-for-Service	1851300818	1851300818	1	1	AKINLADE, BOLANLE K MD	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	63834	66	Emergency Medicine (Urgent Care)	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
288202	Fee-for-Service	1184070427	1184070427	1	1	AMINZADEH, MARK A MD	3/4/2020	207R00000X	NA	Other	026	PHYSICIANS	158205	41	Internal Medicine	0	In state provider	None	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	39	06077	37.97026329	-121.2890849	San Joaquin County
288229	Fee-for-Service	1295030401	1295030401	1	1	AMEZOLA, VALERIA	7/19/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	19	06037	34.14595648	-118.1287575	Los Angeles County
288230	Fee-for-Service	1134357981	1134357981	1	1	AMIDI, FATANEH MD	2/21/2012	No Taxonomy Provided	NA	None	026	PHYSICIANS	118879	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	9400 ROSECRANS AVE	None	BELLFLOWER	CA	90706	2246	19	06037	33.9040752	-118.1328995	Los Angeles County
288238	Fee-for-Service	1538193289	1538193289	1	1	AJANI, ZAHRA A MD	1/3/2008	2084N0400X	NA	Neurology	026	PHYSICIANS	97523	13	Neurology (M.D. only)	0	In state provider	None	4733 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6021	19	06037	34.09817553	-118.293237	Los Angeles County
288253	Fee-for-Service	1669790317	1669790317	1	1	ANDREWS, KENNETH R DO	8/31/2010	No Taxonomy Provided	NA	None	026	PHYSICIANS	10817	08	Family Practice	0	In state provider	None	7600 OLD DOMINION CT	None	APTOS	CA	95003	1522	44	06087	36.97913818	-121.9099818	Santa Cruz County
288261	Fee-for-Service	1073935862	1073935862	1	1	ALL AMERICAN MEDICAL	12/17/2014	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	SUPPLIES LLC	7261 SHERIDAN STREET	SUITE 310	HOLLYWOOD	FL	33024	2706	00	None	26.03145274	-80.23423727	Broward County
288302	Fee-for-Service	1851300818	1851300818	1	1	AKINLADE, BOLANLE K MD	5/1/2003	No Taxonomy Provided	NA	None	026	PHYSICIANS	63834	41	Internal Medicine	0	In state provider	None	525 W ACACIA ST	None	STOCKTON	CA	95203	2405	39	06077	37.9611947	-121.3009489	San Joaquin County
288310	Fee-for-Service	1629198791	1629198791	1	2	ALFRED LAVI DO PROFESSIONAL	3/19/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	1835 S LA CIENEGA BLVD	STE 205 & 215	LOS ANGELES	CA	90035	4651	19	06037	34.04410366	-118.3768223	Los Angeles County
288334	Fee-for-Service	1578573747	1578573747	1	1	APRIA HEALTHCARE LLC	10/23/1998	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	0	In state provider	None	2339 COURAGE DR	STE G	FAIRFIELD	CA	94533	6718	48	06095	38.23453011	-122.0764127	Solano County
288352	Fee-for-Service	1376549568	1376549568	1	1	ACHILLES P&O INC	7/1/1996	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	ACHILLES P&O INC	622 E MAIN ST	None	SANTA MARIA	CA	93454	4506	42	06083	34.95311453	-120.4273755	Santa Barbara County
288377	Fee-for-Service	1124693304	1124693304	1	1	AMIANI, CAROLYNE K	6/29/2021	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	1124 CORELLA	None	NEWPORT BEACH	CA	92660	3288	30	06059	33.64157147	-117.8624107	Orange County
288387	Fee-for-Service	1235592957	1235592957	1	1	AUCLAIR, ROMANY MD	5/2/2023	207ZP0102X	NA	Other	026	PHYSICIANS	184838	None	None	0	In state provider	None	183 E 8TH AVE	None	CHICO	CA	95926	2341	04	06007	39.74568757	-121.8498156	Butte County
288391	Fee-for-Service	1598830564	1598830564	1	1	ARMSTRONG, JOHN T JR MD INC	1/1/1981	No Taxonomy Provided	NA	None	026	PHYSICIANS	37899	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	3434 VILLA LN	STE 360	NAPA	CA	94558	6416	28	06055	38.32515937	-122.2938358	Napa County
288396	Fee-for-Service	1316200504	1316200504	1	1	AMERICAN SPECIALTY	6/12/2013	No Taxonomy Provided	NA	None	009	CLINICAL LABORATORIES	-	-	NOT APPLICABLE	0	In state provider	LABORATORY INC	8841 CANOGA AVE	None	CANOGA PARK	CA	91304	1502	19	06037	34.231527	-118.597576	Los Angeles County
288434	Fee-for-Service	1144550989	1144550989	1	1	AUSTIN, WILLIAM K MD	7/1/2014	No Taxonomy Provided	NA	None	026	PHYSICIANS	123855	01	General Practice	0	In state provider	None	3288 BELL RD	None	AUBURN	CA	95603	9243	31	06061	38.94193048	-121.1046075	Placer County
288465	Fee-for-Service	1902468564	1902468564	1	1	ADENIMIRAN, OLUWOLE H	9/13/2019	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	3902 MIDWAY AVE	None	CULVER CITY	CA	90232	3746	19	06037	34.01516184	-118.4069926	Los Angeles County
288467	Fee-for-Service	1376549568	1376549568	1	1	ACHILLES P&O INC	5/1/2001	No Taxonomy Provided	NA	None	080	CA CHILDRENS SERVICES/GENETICALLY HANDICAPPED PERSONS PROGRAM NON- INSTITUTIONAL	-	-	NOT APPLICABLE	0	In state provider	ACHILLES P&O INC	622 E MAIN ST	None	SANTA MARIA	CA	93454	4506	42	06083	34.95311453	-120.4273755	Santa Barbara County
288494	Fee-for-Service	1124693304	1124693304	1	1	AMIANI, CAROLYNE K	6/29/2021	No Taxonomy Provided	NA	None	067	RVNS INDIVIDUAL NURSE PROVIDERS	-	-	NOT APPLICABLE	0	In state provider	None	1124 CORELLA	None	NEWPORT BEACH	CA	92660	3288	30	06059	33.64157147	-117.8624107	Orange County
288535	Fee-for-Service	1538178777	1538178777	1	1	ANDREW GEORGE	9/7/2022	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	47 S FOURTH ST	None	ROLLING FORK	MS	39159	5146	00	None	32.904744	-90.88501071	Sharkey County
288550	Fee-for-Service	1912751595	1912751595	1	1	ARMIJO, DENISE NP	7/15/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	11340 MOUNTAIN VIEW AVE	STE B	LOMA LINDA	CA	92354	3858	36	06071	34.04699925	-117.2436953	San Bernardino County
288581	Fee-for-Service	1902468564	1902468564	1	1	ADENIMIRAN, OLUWOLE H	9/13/2019	No Taxonomy Provided	NA	None	057	EARLY AND PERIODIC SCREENING, DIAGNOSIS, AND TREATMENT SUPPLEMENTAL SERVICES PROVIDER	-	None	None	0	In state provider	None	3902 MIDWAY AVE	None	CULVER CITY	CA	90232	3746	19	06037	34.01516184	-118.4069926	Los Angeles County
288605	Fee-for-Service	1518999218	1518999218	1	1	AJIR, MAHYAR DO	8/30/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	6683	01	General Practice	0	In state provider	CARLSBAD VILLAGE FAMILY	2690 ROOSEVELT ST	None	CARLSBAD	CA	92008	1613	37	06073	33.16348692	-117.3503557	San Diego County
288668	Fee-for-Service	1477974681	1477974681	1	1	ADVENTIST HEALTH PHYSICIANS	7/18/2019	207RC0000X	NA	Cardiology/Interventional Cardiology	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	124 MACAW LN	None	SIMI VALLEY	CA	93065	3152	56	06111	34.2595744	-118.7948374	Ventura County
288690	Fee-for-Service	1972122828	1972122828	1	1	ARAVINDABOSE, VARSHA	6/6/2024	207P00000X	NA	Other	026	PHYSICIANS	22543	66	Emergency Medicine (Urgent Care)	0	In state provider	None	18300 ROSCOE BLVD	None	NORTHRIGE	CA	91325	4105	19	06037	34.22073847	-118.532988	Los Angeles County
288692	Fee-for-Service	1568567600	1568567600	1	1	A TU SALUD A MEDICAL	10/6/2008	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CORPORATION	10563 MILLS AVE	None	MONTCLAIR	CA	91763	4610	36	06071	34.0619883	-117.7176403	San Bernardino County
288695	Fee-for-Service	1467475228	1467475228	1	1	ASHWAL, STEPHEN MD	7/28/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	31511	40	Pediatrics	0	In state provider	None	11370 ANDERSON ST	STE B100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
288696	Fee-for-Service	1104191287	1104191287	1	1	ANESOIR, HAYLENE A S MD	11/13/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	120593	40	Pediatrics	0	In state provider	None	320 LENNON LN	None	WALNUT CREEK	CA	94598	2419	07	06013	37.92699561	-122.0292732	Contra Costa County
288701	Fee-for-Service	1861943391	1861943391	1	1	ALBERTOLLE, ELIZABETH C NP	10/31/2019	363LA2100X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	37	06073	32.7537975	-117.1658298	San Diego County
288732	Fee-for-Service	1023157021	1023157021	1	1	ARCHAMBAULT, MARA R MD	2/20/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	144690	41	Internal Medicine	0	In state provider	None	7117 BROCKTON AVE	None	RIVERSIDE	CA	92506	2620	33	06065	33.94354395	-117.394926	Riverside County
288759	Fee-for-Service	1710404983	1710404983	1	1	AL AMERI, MANSOOR A PT	8/9/2018	225100000X	NA	Physical Therapist	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	3908 10 STREET	None	RIVERSIDE	CA	92501	3522	33	06065	33.98117228	-117.3785355	Riverside County
288769	Fee-for-Service	1669431201	1669431201	1	1	ACHREKAR, ABINASH P. MD	7/21/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	2211 LOMAS BLVD NE	None	ALBUQUERQUE	NM	87106	2745	00	None	35.08771808	-106.6192188	Bernalillo County
288797	Fee-for-Service	1528590734	1528590734	1	1	ADADA, MOHAMAD M	1/5/2024	207R00000X	NA	Other	026	PHYSICIANS	185371	None	None	0	In state provider	None	1643 EUREKA ROAD	None	ROSEVILLE	CA	95661	3027	31	06061	38.74688342	-121.2469903	Placer County
288802	Fee-for-Service	1467475228	1467475228	1	1	ASHWAL, STEPHEN MD	7/28/1994	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	31511	13	Neurology (M.D. only)	0	In state provider	None	11370 ANDERSON ST	STE B100	LOMA LINDA	CA	92354	3450	36	06071	34.047153	-117.2611485	San Bernardino County
288840	Fee-for-Service	1316005572	1316005572	1	5	APPLE URGENT CARE, INC	5/1/2013	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	41	Internal Medicine	0	In state provider	None	1207 E FLORIDA AVE	None	HEMET	CA	92543	4513	33	06065	33.74753552	-116.9593245	Riverside County
288853	Fee-for-Service	1407870652	1407870652	1	1	ALLAN, JEFFREY B MD	8/20/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	74327	41	Internal Medicine	0	In state provider	None	58 WEST LOOP DRIVE	None	CAMARILLO	CA	93010	2035	56	06111	34.23642208	-119.0416885	Ventura County
288894	Fee-for-Service	1497701833	1497701833	1	1	ALL-STATES MEDICAL SUPPLY	4/1/2014	332B00000X	NA	Other	002	ASSISTIVE DEVICE AND SICK ROOM SUPPLY DEALERS	-	-	NOT APPLICABLE	2	Out of state provider	INC	221 OLD HENDERSONVILLE	STE A	FLETCHER	NC	28732	9826	00	None	35.406387	-82.5056505	Henderson County
288947	Fee-for-Service	1316005572	1316005572	1	5	APPLE URGENT CARE, INC	5/1/2013	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	01	General Practice	0	In state provider	None	1207 E FLORIDA AVE	None	HEMET	CA	92543	4513	33	06065	33.74753552	-116.9593245	Riverside County
289007	Fee-for-Service	1851958516	1851958516	1	1	ART OF HOSPICE INC	7/2/2020	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	6345 BALBOA BLVD	SUITE 195	ENCINO	CA	91316	1515	19	06037	34.18620241	-118.5011527	Los Angeles County
289015	Fee-for-Service	1043471279	1043471279	1	1	ATHANASSIOUS, CHRISTIAN N MD	7/25/2013	No Taxonomy Provided	NA	None	026	PHYSICIANS	124589	20	Orthopedic Surgery	0	In state provider	None	300 PASTEUR DRIVE	MC:5500	STANFORD	CA	94305	2200	43	06085	37.43304542	-122.1759654	Santa Clara County
289025	Fee-for-Service	1841809365	1841809365	1	1	ALIVE HOSPICE CARE INC	9/1/2022	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	712 S MAIN STREET	SUITE A	BURBANK	CA	91506	2529	19	06037	34.16633234	-118.3130026	Los Angeles County
289050	Fee-for-Service	1316005572	1316005572	1	5	APPLE URGENT CARE, INC	5/1/2013	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	08	Family Practice	0	In state provider	None	1207 E FLORIDA AVE	None	HEMET	CA	92543	4513	33	06065	33.74753552	-116.9593245	Riverside County
289063	Fee-for-Service	1265010920	1265010920	1	1	AZRENKASSIAN, SETRAK MANOUK	2/22/2025	207R00000X	NA	Other	026	PHYSICIANS	None	41	Internal Medicine	0	In state provider	M MD	7300 MEDICAL CENTER DR	None	WEST HILLS	CA	91307	1902	19	06037	34.20289797	-118.6294006	Los Angeles County
289064	Fee-for-Service	1528175395	1528175395	1	1	ALEXANDER, NICOLE K MD	6/29/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	81199	08	Family Practice	0	In state provider	None	7000 BOULDER AVE	None	HIGHLAND	CA	92346	3348	36	06071	34.12632952	-117.1956652	San Bernardino County
289079	Fee-for-Service	1700384708	1700384708	1	1	ADVENTIST HEALTH PHYSICIANS	8/20/2019	207X00000X	NA	Orthopedic Surgery	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	370 DEL NORTE AVE	STE 201	YUBA CITY	CA	95991	4142	51	06101	39.14466521	-121.6166961	Sutter County
289110	Fee-for-Service	1851958516	1851958516	1	1	ART OF HOSPICE INC	7/2/2020	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	6345 BALBOA BLVD	SUITE 195	ENCINO	CA	91316	1515	19	06037	34.18620241	-118.5011527	Los Angeles County
289127	Fee-for-Service	1841809365	1841809365	1	1	ALIVE HOSPICE CARE INC	9/1/2022	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	712 S MAIN STREET	SUITE A	BURBANK	CA	91506	2529	19	06037	34.16633234	-118.3130026	Los Angeles County
289156	Fee-for-Service	1679507909	1679507909	1	1	ASSIF, AHMED MD	4/9/2007	No Taxonomy Provided	NA	None	026	PHYSICIANS	91310	05	Anesthesiology	0	In state provider	None	6969 BROCKTON AVE	STE B	RIVERSIDE	CA	92506	3813	33	06065	33.94701	-117.396786	Riverside County
289198	Fee-for-Service	1386911337	1386911337	1	1	A&C HEALTHCARE INC	5/13/2014	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	None	20465 VALLEY BLVD	None	WALNUT	CA	91789	2729	19	06037	34.01102627	-117.8571285	Los Angeles County
289378	Fee-for-Service	1568694792	1568694792	1	1	AHI SOLUTIONS INCORPORATED	7/26/2010	247100000X	NA	Other	084	INDEPENDENT DIAGNOSTIC TESTING FACILITY XOVER PROV ONLY	-	-	NOT APPLICABLE	0	In state provider	None	400 29TH STREET	# 208	OAKLAND	CA	94609	3547	01	06001	37.81784861	-122.2652263	Alameda County
289404	Fee-for-Service	1043311160	1043311160	1	1	ANDRUSHENKO, IRINA OD	1/24/2008	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	26506 BOUQUET CANYON RD	None	SAUGUS	CA	91350	2300	19	06037	34.42742329	-118.5368396	Los Angeles County
289415	Fee-for-Service	1457452740	1457452740	1	1	ADAMS, MARIAN M	1/24/1996	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	72215	None	None	0	In state provider	None	725 WELCH RD	None	PALO ALTO	CA	94304	1601	43	06085	37.43721275	-122.1744449	Santa Clara County
289437	Fee-for-Service	1205384419	1205384419	1	2	AMIR PARVINCHI MD INC	5/13/2018	207R00000X	NA	Other	026	PHYSICIANS	None	08	Family Practice	0	In state provider	None	12737 GLENOAKS BLVD	# 26	SYLMAR	CA	91342	4776	19	06037	34.30181336	-118.4422626	Los Angeles County
289443	Fee-for-Service	1326437708	1326437708	1	1	ADVANCED RETINA CARE	6/23/2015	207W00000X	NA	Ophthalmology	026	PHYSICIANS	65668	18	Ophthalmology	0	In state provider	None	7145 N CHESTNUT AVE	STE 108	FRESNO	CA	93720	0359	10	06019	36.84050111	-119.7381232	Fresno County
289499	Fee-for-Service	1205840634	1205840634	1	1	ALVARADO PATHOLOGY ASSOC	1/1/1995	No Taxonomy Provided	NA	None	022	PHYSICIANS GROUP	-	None	None	0	In state provider	None	6655 ALVARADO RD	None	SAN DIEGO	CA	92120	5208	37	06073	32.77718098	-117.0571332	San Diego County
289519	Fee-for-Service	1013419076	1013419076	1	1	AHN, HANNAH G MD	6/2/2023	2085R0202X	NA	Mammography/MRI Provider	026	PHYSICIANS	185410	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
289580	Fee-for-Service	1073052262	1073052262	1	1	ADVANCED REGENERATIVE CELL	1/15/2019	193200000X	NA	Other	026	PHYSICIANS	70983	None	None	0	In state provider	None	7325 MEDICAL CENTER DR	STE 304	WEST HILLS	CA	91307	4115	19	06037	34.20369349	-118.629837	Los Angeles County
289637	Fee-for-Service	1811075450	1811075450	1	1	ALEXANDER, JONATHAN	8/2/2004	No Taxonomy Provided	NA	None	026	PHYSICIANS	80964	66	Emergency Medicine (Urgent Care)	0	In state provider	None	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	38	06075	37.7634502	-122.4579779	San Francisco County
289696	Fee-for-Service	1700171105	1700171105	1	1	AASTHA INC	4/11/2011	261QP2300X	NA	Other	026	PHYSICIANS	56443	None	None	0	In state provider	None	1920 N GAREY AVE	None	POMONA	CA	91767	2708	19	06037	34.08095869	-117.7526975	Los Angeles County
289729	Fee-for-Service	1568586162	1568586162	1	1	ALMEYDA PEREZ, JULIAN A	3/5/2009	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	41	Internal Medicine	1	Border provider	MD	1800 W CHARLESTON BLVD	None	LAS VEGAS	NV	89102	2329	00	None	36.1590063	-115.1674415	Clark County
289739	Fee-for-Service	1306919568	1306919568	1	1	ALIKPALA, AGNES Y MD	8/10/2011	No Taxonomy Provided	NA	None	026	PHYSICIANS	31317	40	Pediatrics	0	In state provider	None	350 RHODE ISLAND ST	None	SAN FRANCISCO	CA	94110	4506	38	06075	37.76542836	-122.4026384	San Francisco County
289775	Fee-for-Service	1730685983	1730685983	1	1	AKERS, BEATRICE S	12/1/2022	2084N0400X	NA	Neurology	026	PHYSICIANS	17896	None	None	0	In state provider	None	4860 Y ST	None	SACRAMENTO	CA	95817	2307	34	06067	38.552211	-121.449429	Sacramento County
289777	Fee-for-Service	1346554201	1346554201	1	1	AMEER, ADNAN MD	5/22/2018	No Taxonomy Provided	NA	None	026	PHYSICIANS	118254	10	Gastroenterology (M.D. only)	0	In state provider	None	300 WEST HUNTINGTON DR	None	ARCADIA	CA	91007	3402	19	06037	34.13489987	-118.0424069	Los Angeles County
289798	Fee-for-Service	1346309960	1346309960	1	1	ALLISON, ROBERT G MD	11/30/1995	208000000X	NA	Pediatric Primary Care	026	PHYSICIANS	31938	40	Pediatrics	0	In state provider	STE 201	11550 INDIAN HILLS RD	None	MISSION HILLS	CA	91345	1200	19	06037	34.28024575	-118.4588775	Los Angeles County
289858	Fee-for-Service	1699157396	1699157396	1	1	AJIBOLA, OMOWUNMI MD	2/1/2024	2085R0204X	NA	Other	026	PHYSICIANS	184618	None	None	0	In state provider	None	1150 INDIAN CANYON	None	PALM SPRINGS	CA	92262	4872	33	06065	33.838623	-116.542737	Riverside County
289897	Fee-for-Service	1386751741	1386751741	1	1	APPLEGATE, GREGORY R MD	4/27/2006	No Taxonomy Provided	NA	None	026	PHYSICIANS	57333	None	None	0	In state provider	None	2393 TOWNSGATE RD	STE 202	WESTLAKE VILLAGE	CA	91361	2517	56	06111	34.16103602	-118.834026	Ventura County
289916	Fee-for-Service	1457309270	1457309270	1	1	AVERA ST LUKES	4/30/2009	No Taxonomy Provided	NA	None	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	305 S STATE ST	None	ABERDEEN	SD	57401	4527	00	None	45.461403	-98.47929349	Brown County
289949	Fee-for-Service	1326668955	1326668955	1	1	ABBOTT, MICHAEL DO	3/19/2025	207L00000X	NA	Other	026	PHYSICIANS	-	05	Anesthesiology	1	Border provider	None	1093 ROYAL COURT	None	MEDFORD	OR	97504	8383	00	None	42.34017467	-122.8666022	Jackson County
289967	Fee-for-Service	1386176139	1386176139	1	1	ADESINA, ADEBUSOLA MD	3/3/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	163027	None	None	0	In state provider	None	975 SERENO DR	None	VALLEJO	CA	94589	2441	48	06095	38.12828446	-122.24821	Solano County
289976	Fee-for-Service	1528003787	1528003787	1	1	AMIN,DAVID J MD	4/1/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	69754	66	Emergency Medicine (Urgent Care)	0	In state provider	ATTN MGA OFFICE	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	19	06037	34.17030266	-118.5881699	Los Angeles County
289996	Fee-for-Service	1992751382	1992751382	1	1	ACCENTCARE HOME HEALTH	4/16/1993	251E00000X	NA	Other	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	OF CALIFORNIA, INC	2590 GOODWATER AVE	SUITE 100	REDDING	CA	96002	1550	45	06089	40.57100504	-122.3225892	Shasta County
290007	Fee-for-Service	1861409252	1861409252	1	1	AVERA MCKENNAN HOSPITAL	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	800 E 21ST ST	None	SIOUX FALLS	SD	57105	1016	00	None	43.534251	-96.7157055	Minnehaha County
290019	Fee-for-Service	1114188653	1114188653	1	1	ANSELMI, DANIEL A LMFT	10/23/2017	No Taxonomy Provided	NA	None	087	LICENSED PROFESSIONALS	101208	-	NOT APPLICABLE	0	In state provider	None	10529 SLATER AVE	STE 10505,10507,10537	FOUNTAIN VALLEY	CA	92708	7725	30	06059	33.70910384	-117.944985	Orange County
290020	Fee-for-Service	1528148681	1528148681	1	1	AFGHANI, BEHNOOSH MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	69511	77	Infectious Disease	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
290030	Fee-for-Service	1730830779	1730830779	1	1	ALVARADO, KRIS C LMFT	2/2/2022	106H00000X	NA	Mental Health Outpatient Services	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	3840 WOODRUFF AVE	STE 209	LONG BEACH	CA	90808	2149	19	06037	33.828786	-118.1165535	Los Angeles County
290041	Fee-for-Service	1780042002	1780042002	1	1	ANGER, ALEXANDRA C NP	2/7/2018	No Taxonomy Provided	NA	None	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	38	06075	37.76344756	-122.4581992	San Francisco County
290051	Fee-for-Service	1174511026	1174511026	1	1	ANTES, LISA M. MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	200 HAWKINS DR	None	IOWA CITY	IA	52242	1009	00	None	41.659929	-91.548099	Johnson County
290058	Fee-for-Service	1871574251	1871574251	1	1	ASSURANCE HOSPICE, INC	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	444 E HUNTINGTON DR	STE 103	ARCADIA	CA	91006	6257	19	06037	34.14015049	-118.021113	Los Angeles County
290079	Fee-for-Service	1528148681	1528148681	1	1	AFGHANI, BEHNOOSH MD	6/30/1993	No Taxonomy Provided	NA	None	026	PHYSICIANS	69511	40	Pediatrics	0	In state provider	None	101 THE CITY DR S	None	ORANGE	CA	92868	3201	30	06059	33.78674051	-117.8888713	Orange County
290118	Fee-for-Service	1871574251	1871574251	1	1	ASSURANCE HOSPICE, INC	4/1/2005	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	444 E HUNTINGTON DR	STE 103	ARCADIA	CA	91006	6257	19	06037	34.14015049	-118.021113	Los Angeles County
290141	Fee-for-Service	1265436281	1265436281	1	1	ANDERSON, L JEROME MD	2/8/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	-	None	None	4	Out of state provider - CA-MMIS Fiscal Intermediary (FI)	None	3433 NW 56TH ST STE 400	None	OKLAHOMA CITY	OK	73112	0000	00	None	35.52754846	-97.577361	Oklahoma County
290185	Fee-for-Service	1770889545	1770889545	1	1	ALIUDDIN KHAJA MD INC	10/15/2021	101YP2500X	NA	Other	010	GROUP CERTIFIED NURSE PRACTITIONER	-	-	NOT APPLICABLE	0	In state provider	ROUP	770 MAGNOLIA AVE	2F	CORONA	CA	92879	3122	33	06065	33.85936872	-117.5534605	Riverside County
290211	Fee-for-Service	1467780015	1467780015	1	1	ADAMS, LAURA	7/18/2024	235Z00000X	NA	Other	037	SPEECH THERAPISTS	-	-	NOT APPLICABLE	0	In state provider	None	760 POLHEMUS RD	None	SAN MATEO	CA	94402	3938	41	06081	37.52051982	-122.3386627	San Mateo County
290239	Fee-for-Service	1770889545	1770889545	1	1	ALIUDDIN KHAJA MD INC	10/22/2018	101YP2500X	NA	Other	078	MARRIAGE AND FAMILY THERAPIST GROUP	-	-	NOT APPLICABLE	0	In state provider	ROUP	770 MAGNOLIA AVE	2F	CORONA	CA	92879	3122	33	06065	33.85936872	-117.5534605	Riverside County
290292	Fee-for-Service	1770889545	1770889545	1	1	ALIUDDIN KHAJA MD INC	5/6/2016	193200000X	NA	Other	026	PHYSICIANS	92186	None	None	0	In state provider	ROUP	770 MAGNOLIA AVE	2F	CORONA	CA	92879	3122	33	06065	33.85936872	-117.5534605	Riverside County
290339	Fee-for-Service	1013338086	1013338086	1	1	AZARI, PARINAZ MD INC	7/21/2014	208VP0014X	NA	Other	026	PHYSICIANS	110947	01	General Practice	0	In state provider	None	191 LYNCH CREEK WAY	STE 101	PETALUMA	CA	94954	2389	49	06097	38.25172735	-122.6352381	Sonoma County
290341	Fee-for-Service	1770889545	1770889545	1	1	ALIUDDIN KHAJA MD INC	7/22/2021	101YP2500X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	ROUP	770 MAGNOLIA AVE	2F	CORONA	CA	92879	3122	33	06065	33.85936872	-117.5534605	Riverside County
290423	Fee-for-Service	1629497763	1629497763	1	1	AFSHAR, YALDA MD	5/6/2016	No Taxonomy Provided	NA	None	026	PHYSICIANS	128326	16	Obstetrics-Gynecology (M.D. Only) Neonatal	0	In state provider	None	200 UCLA MEDICAL PLAZA	SUITE 430	LOS ANGELES	CA	90095	0001	19	06037	34.065126	-118.446237	Los Angeles County
290426	Fee-for-Service	1831715838	1831715838	1	1	ADVENTIST HEALTH PHYSICIANS	8/17/2020	208000000X	NA	Pediatric Primary Care	045	CLINIC EXEMP FROM LICENSURE	-	-	NOT APPLICABLE	0	In state provider	NETWORK	1231 PLUMAS ST	None	YUBA CITY	CA	95991	3410	51	06101	39.14838521	-121.617531	Sutter County
290459	Fee-for-Service	1063000248	1063000248	1	1	AARON D. SMITH, PSY.D. A PSY	2/11/2022	261QM0801X	NA	Other	031	PSYCHOLOGISTS	-	None	None	0	In state provider	CHOLOGICAL CORPORATION	4160 TEMESCAL CANYON RD	SUITE 309	CORONA	CA	92883	4629	33	06065	33.81915655	-117.5075503	Riverside County
290495	Fee-for-Service	1578793337	1578793337	1	1	ALLEN, SHAREELA M LCSW	8/2/2019	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	954 WEST FOOTHILL BLVD	SUITE A	UPLAND	CA	91786	3782	36	06071	34.10675048	-117.6646365	San Bernardino County
290497	Fee-for-Service	1396350013	1396350013	1	1	APA HOSPICE CARE INC	4/5/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	501 W BROADWAY	SUITE 800	SAN DIEGO	CA	92101	3546	37	06073	32.71562254	-117.1677915	San Diego County
290532	Fee-for-Service	1235611518	1235611518	1	1	AZURE HEALTH CARE MANAGEMENT	8/13/2020	No Taxonomy Provided	NA	None	014	HOME HEALTH AGENCIES	-	-	NOT APPLICABLE	0	In state provider	INC	2130 ARROWHEAD AVE	STE 103C	SAN BERNARDINO	CA	92405	4023	36	06071	34.13450029	-117.289686	San Bernardino County
290538	Fee-for-Service	1396350013	1396350013	1	1	APA HOSPICE CARE INC	4/5/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	501 W BROADWAY	SUITE 800	SAN DIEGO	CA	92101	3546	37	06073	32.71562254	-117.1677915	San Diego County
290545	Fee-for-Service	1225328461	1225328461	1	1	AHMED, SAMEER MD	10/13/2017	No Taxonomy Provided	NA	None	026	PHYSICIANS	116526	04	Otology, Laryngology, Rhinology	0	In state provider	None	9333 IMPERIAL HIGHWAY	None	DOWNEY	CA	90242	2812	19	06037	33.918975	-118.1291985	Los Angeles County
290548	Fee-for-Service	1326546680	1326546680	1	1	ALCAUSIN, ALFREDO MD	4/29/2025	No Taxonomy Provided	NA	None	026	PHYSICIANS	192227	41	Internal Medicine	0	In state provider	None	9455 CLAIREMONT MESA BLV	None	SAN DIEGO	CA	92123	1297	37	06073	32.83133206	-117.1252363	San Diego County
290566	Fee-for-Service	1760007611	1760007611	1	1	AMERI HOSPICE CARE INC	11/5/2021	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	None	11145 TAMPA AVE	STE 1B	NORTHRIDGE	CA	91326	2215	19	06037	34.27373836	-118.5564202	Los Angeles County
290571	Fee-for-Service	1396957197	1396957197	1	1	AMERIHEALTH HOSPICE PROVIDER	1/1/2019	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	INC	1323 WEST COLTON AVE	SUITE 200	REDLANDS	CA	92374	2868	36	06071	34.0628555	-117.202599	San Bernardino County
290576	Fee-for-Service	1255412763	1255412763	1	1	AMERICAN BAPTIST HOMES OF	11/10/1972	314000000X	NA	Skilled Nursing Facility	017	LONG TERM CARE FACILITY	-	-	NOT APPLICABLE	0	In state provider	THE WEST	900 CALLE DE LOS AMIGOS	None	SANTA BARBARA	CA	93105	4435	42	06083	34.423569	-119.7507895	Santa Barbara County
290603	Fee-for-Service	1760007611	1760007611	1	1	AMERI HOSPICE CARE INC	11/5/2021	No Taxonomy Provided	NA	None	105	HOSPICE PROVIDERS FOR PALLIATIVE CARE SERVICES	-	-	NOT APPLICABLE	0	In state provider	None	11145 TAMPA AVE	STE 1B	NORTHRIDGE	CA	91326	2215	19	06037	34.27373836	-118.5564202	Los Angeles County
290607	Fee-for-Service	1396957197	1396957197	1	1	AMERIHEALTH HOSPICE PROVIDER	3/6/2013	No Taxonomy Provided	NA	None	039	CERTIFIED HOSPICE	-	-	NOT APPLICABLE	0	In state provider	INC	1323 WEST COLTON AVE	SUITE 200	REDLANDS	CA	92374	2868	36	06071	34.0628555	-117.202599	San Bernardino County
290624	Fee-for-Service	1619929494	1619929494	1	1	ANDERSON, SCOTT T MD	11/30/1992	No Taxonomy Provided	NA	None	026	PHYSICIANS	52090	01	General Practice	0	In state provider	None	2425 GEARY BLVD	None	SAN FRANCISCO	CA	94115	3358	38	06075	37.78272203	-122.4433297	San Francisco County
290658	Fee-for-Service	1689196099	1689196099	1	1	ACHILLES PROSTHETICS AND ORT	12/17/2024	335E00000X	NA	Other	029	PROSTHETISTS	-	-	NOT APPLICABLE	0	In state provider	HOTICS, INC	1435 STATE STREET	None	SANTA BARBARA	CA	93101	2511	42	06083	34.42603267	-119.7081699	Santa Barbara County
290671	Fee-for-Service	1407340409	1407340409	1	1	AMAR, JORDAN Y MD	8/14/2023	2084N0400X	NA	Neurology	026	PHYSICIANS	185408	None	None	0	In state provider	None	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	19	06037	34.06269295	-118.2030006	Los Angeles County
290692	Fee-for-Service	1053464495	1053464495	1	1	ALBEE, KATE N	10/25/2013	No Taxonomy Provided	NA	None	025	PHYSICAL THERAPISTS	-	None	None	0	In state provider	None	1200 EL CAMINO REAL	None	S SAN FRANCISCO	CA	94080	3208	41	06081	37.65894608	-122.440161	San Mateo County
290752	Fee-for-Service	1255609483	1255609483	1	1	ALFARO MCFIELD MEDICAL CLINI	6/6/2012	193200000X	NA	Other	022	PHYSICIANS GROUP	-	None	None	0	In state provider	CLINIC INC	1800 N WESTERN AVE	STE 305	SAN BERNARDINO	CA	92411	1354	36	06071	34.1315778	-117.3182453	San Bernardino County
290765	Fee-for-Service	1508285834	1508285834	1	1	AGUIRRE, JANELL MD	12/30/2019	207L00000X	NA	Other	026	PHYSICIANS	140757	05	Anesthesiology	0	In state provider	None	1600 EUREKA RD	None	ROSEVILLE	CA	95661	3027	31	06061	38.746836	-121.250529	Placer County
290801	Fee-for-Service	1851475859	1851475859	1	1	ARTZ, JONATHAN E MD	4/26/2001	No Taxonomy Provided	NA	None	026	PHYSICIANS	86054	13	Neurology (M.D. only)	0	In state provider	None	99 MONTECILLO RD	None	SAN RAFAEL	CA	94903	3308	21	06041	38.00450116	-122.5540001	Marin County
290877	Fee-for-Service	1245098821	1245098821	1	1	ALPASAN, KAYE S CNP	3/25/2024	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	2773 HARRIS ST	STE A & D	EUREKA	CA	95503	4866	12	06023	40.78052829	-124.1363953	Humboldt County
290898	Fee-for-Service	1114639275	1114639275	1	1	A BELOVED HOME OF DIAMOND	1/19/2023	No Taxonomy Provided	NA	None	092	RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE)	-	-	NOT APPLICABLE	0	In state provider	BAR LLC	454 S ROCK RIVER RD	None	DIAMOND BAR	CA	91765	1561	19	06037	34.01590739	-117.8194308	Los Angeles County
290904	Fee-for-Service	1437485646	1437485646	1	1	AVALOS, CARLA MSW LCSW	6/25/2021	1041C0700X	NA	Mental Health Outpatient Services	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	CES	1849 SAWTELLE BLVD	SUITE 610	CULVER CITY	CA	90025	7013	19	06037	34.04266851	-118.4451527	Los Angeles County
290917	Fee-for-Service	1477810497	1477810497	1	1	AROMIN, MELISSA J MD	7/17/2015	No Taxonomy Provided	NA	None	026	PHYSICIANS	131380	66	Emergency Medicine (Urgent Care)	0	In state provider	None	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	19	06037	34.09813032	-118.2901794	Los Angeles County
291057	Fee-for-Service	1073152112	1073152112	1	1	AGAPE DERMATOLOGY PC	4/10/2020	207N00000X	NA	Dermatology	022	PHYSICIANS GROUP	-	None	None	0	In state provider	S CENTER	18800 MAIN STREET	111	HUNTINGTON BEACH	CA	92648	1717	30	06059	33.68890364	-117.9949974	Orange County
291086	Fee-for-Service	1710597240	1710597240	1	1	AL KAWALLY, MARIAM G OD	8/19/2020	152WC0802X	NA	Other	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	1721 WESTWIND DR	STE B	BAKERSFIELD	CA	93301	3026	15	06029	35.37519935	-119.0425415	Kern County
291168	Fee-for-Service	1851344162	1851344162	1	1	ARMC, LP	5/1/2010	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	6250 HIGHWAY 83/84	None	ABILENE	TX	79606	5215	00	None	32.36672455	-99.74276583	Taylor County
291186	Fee-for-Service	1851344162	1851344162	1	1	ARMC, LP	5/18/2006	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	2	Out of state provider	None	6250 HIGHWAY 83/84	None	ABILENE	TX	79606	5215	00	None	32.36672455	-99.74276583	Taylor County
291214	Fee-for-Service	1154949451	1154949451	1	1	AUEYONG, ORADEE	12/6/2023	363L00000X	NA	Nurse Practitioner	007	CERTIFIED NURSE PRACTIONER	-	None	None	0	In state provider	None	9961 SIERRA AVE	None	FONTANA	CA	92335	6720	36	06071	34.072245	-117.4319685	San Bernardino County
291242	Fee-for-Service	1790778488	1790778488	1	1	ANAHEIM GLOBAL MEDICAL	3/8/2005	282N00000X	NA	Hospitals	016	COMMUNITY INPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	1025 S ANAHEIM BLVD	None	ANAHEIM	CA	92805	5806	30	06059	33.81994338	-117.9087416	Orange County
291255	Fee-for-Service	1790778488	1790778488	1	1	ANAHEIM GLOBAL MEDICAL	3/8/2005	282N00000X	NA	Hospitals	015	COMMUNITY OUTPATIENT HOSPITAL	-	-	NOT APPLICABLE	0	In state provider	CENTER INC	1025 S ANAHEIM BLVD	None	ANAHEIM	CA	92805	5806	30	06059	33.81994338	-117.9087416	Orange County
291282	Fee-for-Service	1205032067	1205032067	1	1	AHEARN-EDWARDS, KATHERINE C	5/31/2017	No Taxonomy Provided	NA	None	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	LCSW	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	37	06073	32.79293009	-117.0952438	San Diego County
291287	Fee-for-Service	1639707052	1639707052	1	1	AL-ANI, ISRAA MD	7/3/2023	207R00000X	NA	Other	026	PHYSICIANS	186388	None	None	0	In state provider	None	7300 N FRESNO	None	FRESNO	CA	93720	2941	10	06019	36.84133078	-119.7824983	Fresno County
291301	Fee-for-Service	1891753232	1891753232	1	1	ALLISON, JERRY A MD	8/1/2008	No Taxonomy Provided	NA	None	026	PHYSICIANS	103638	08	Family Practice	0	In state provider	None	1250 E ALMOND AVE	None	MADERA	CA	93637	5606	20	06039	36.94519024	-120.0420086	Madera County
291371	Fee-for-Service	1073090486	1073090486	1	1	ADAMS, JONATHAN DC	9/24/2020	111N00000X	NA	Other	006	CHIROPRACTORS	-	-	NOT APPLICABLE	0	In state provider	None	395 CIVIC DR	E	PLEASANT HILL	CA	94523	1949	07	06013	37.96218807	-122.0728145	Contra Costa County
291376	Fee-for-Service	1881631885	1881631885	1	1	ALENBAUGH, LARRY L OD	2/8/2015	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	2836-A E CHAPMAN AVE	None	ORANGE	CA	92869	3200	30	06059	33.78777048	-117.8229915	Orange County
291463	Fee-for-Service	1902383540	1902383540	1	1	ASIS, STEPHANIE L OD	11/19/2018	No Taxonomy Provided	NA	None	020	OPTOMETRISTS	-	-	NOT APPLICABLE	0	In state provider	None	7056 ARCHIBALD AVE	STE 107	CORONA	CA	92880	8714	33	06065	33.959457	-117.593014	Riverside County
291496	Fee-for-Service	1114188653	1114188653	1	2	ANSELMI, DANIEL A	9/10/2018	No Taxonomy Provided	NA	None	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	-	-	NOT APPLICABLE	0	In state provider	None	17111 BEACH BLVD	STE 205	HUNTINGTON BEACH	CA	92647	5947	30	06059	33.713937	-117.9892085	Orange County
291561	Non-Physician Medical Practitioner	None	1336748565	0	0	ASAD, AARON PA	7/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1207 E FLORIDA AVE	None	HEMET	CA	92543	4513	00	06000	33.74753552	-116.9593245	Riverside County
291577	Non-Physician Medical Practitioner	None	1225753841	0	0	AXIAK, KATHERINE PA-C	1/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1524 MCHENRY AVE	SUITES 550, 570	MODESTO	CA	95350	4500	00	06000	37.666233	-120.993933	Stanislaus County
291598	Non-Physician Medical Practitioner	None	1619370822	0	0	AYUEN, JACOB A PA	12/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4045 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2021	00	06000	35.3540847	-119.0536548	Kern County
291630	Non-Physician Medical Practitioner	None	1770717290	0	0	ALLIANCE HEALTHCARE SERVICES INC	7/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	00	06000	32.95809	-115.5537045	Imperial County
291642	Non-Physician Medical Practitioner	None	1518039536	0	0	ABERNETHY, KATHARINA PA-C	4/29/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6580 HEMBREE LANE	SUITE 270	WINDSOR	CA	95492	6885	00	06000	38.52650514	-122.7897518	Sonoma County
291680	Non-Physician Medical Practitioner	None	1730605486	0	0	ALLERS, JENNA C PA-C	12/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 E ROMIE LN	A	SALINAS	CA	93901	4031	00	06000	36.65998191	-121.6461895	Monterey County
291688	Non-Physician Medical Practitioner	None	1689291700	0	0	AUERBACH, THOMAS B PA-C	11/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	604 N MAGNOLIA AVE	100	CLOVIS	CA	93611	9204	00	06000	36.83939464	-119.6661479	Fresno County
291690	Non-Physician Medical Practitioner	None	1265803225	0	0	ABREA, CRISJUN S NP	7/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1250 EAST ALMOND AVENUE	None	MADERA	CA	93637	5606	00	06000	36.94519024	-120.0420086	Madera County
291694	Non-Physician Medical Practitioner	None	1326475724	0	0	ALFONSO, NATHALIE T NP	2/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 N EL CIELO RD	None	PALM SPRINGS	CA	92262	6972	00	06000	33.82736911	-116.5109632	Riverside County
291703	Non-Physician Medical Practitioner	None	1811558042	0	0	ABRAHAM, TABITHA E NP	8/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 EAST OCEAN AVE.	None	LOMPOC	CA	93436	7092	00	06000	34.63941491	-120.4393023	Santa Barbara County
291707	Non-Physician Medical Practitioner	None	1588060198	0	0	ALTAMIRANO-CARIAGA, MELANIE NP	3/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1260 15TH STREET	1501, 1502	SANTA MONICA	CA	90404	1150	00	06000	34.02648965	-118.4867439	Los Angeles County
291730	Non-Physician Medical Practitioner	None	1629474036	0	0	ARCA, ABEGAIL V NP	2/24/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1231 E 223RD ST	APT 32	CARSON	CA	90745	4211	00	06000	33.82436153	-118.2508245	Los Angeles County
291753	Non-Physician Medical Practitioner	None	1811179898	0	0	ALLEN, TENNILLE A NP	6/19/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8115 EL PASEO GRANDE	UNIT 10	LA JOLLA	CA	92037	3150	00	06000	32.854302	-117.255602	San Diego County
291771	Non-Physician Medical Practitioner	None	1942473632	0	0	ADKINS, DONNA MARIE	4/20/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	300 MERIDIAN CENTRE BLVD	None	ROCHESTER	NY	14618	3981	00	06000	43.101765	-77.581701	Monroe County
291779	Non-Physician Medical Practitioner	None	1750031647	0	0	ABREW, ALEXANDRA PA	10/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2251 N HARBOR BLVD	None	FULLERTON	CA	92835	2601	00	06000	33.89691672	-117.9291749	Orange County
291832	Non-Physician Medical Practitioner	None	1275541229	0	0	ARELLANO, JAMES PATRICK	12/12/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 MEDICAL PLAZA DR	SUITE 255	ROSEVILLE	CA	95661	3043	00	06000	38.76507948	-121.2477476	Placer County
291853	Non-Physician Medical Practitioner	None	1134470446	0	0	ALLARD, JILLIAN D	11/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6759 RYCROFT DR	None	RIVERSIDE	CA	92506	5316	00	06000	33.92897598	-117.34351	Riverside County
291863	Non-Physician Medical Practitioner	None	1184622862	0	0	ARENAS, MARCELINO	5/17/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1185 NOREEN COURT	None	UPLAND	CA	91784	1559	00	06000	34.13109455	-117.6695717	San Bernardino County
291883	Non-Physician Medical Practitioner	None	1740737634	0	0	ALLEN, KELSI D PA	4/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2309 ANTONIO AVE	None	CAMARILLO	CA	93010	1414	00	06000	34.24435917	-119.0191975	Ventura County
291938	Non-Physician Medical Practitioner	None	1619622479	0	0	ALEXANDER, NICOLE E NP	3/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3903 LONE TREE WAY	SUITE 104A	ANTIOCH	CA	94509	6249	00	06000	37.98216807	-121.8054744	Contra Costa County
291939	Non-Physician Medical Practitioner	None	1477850568	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	3/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1485 MAIN ST	SUITE 101	SAINT HELENA	CA	94574	1850	00	06000	38.50614525	-122.4718005	Napa County
291962	Non-Physician Medical Practitioner	None	1154480853	0	0	ALLEN, ALLYSON W	3/7/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4068 W 57TH STREET	None	LOS ANGELES	CA	90043	2242	00	06000	33.99011791	-118.3459575	Los Angeles County
291987	Non-Physician Medical Practitioner	None	1871837872	0	0	AMBROSIO, MELISSA H	10/8/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	828 COVENTRY AVE	None	CLOVIS	CA	93611	8538	00	06000	36.82038726	-119.6598741	Fresno County
292014	Non-Physician Medical Practitioner	None	1811709173	0	0	ARAMBEL, MICAELA A PA-C	2/27/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	309 WEST BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	00	06000	34.01597577	-118.1003516	Los Angeles County
292025	Non-Physician Medical Practitioner	None	1326585910	0	0	AKPENGBE, BERNADETTE N NP	9/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4990 ARLINGTON AVE	STE D	RIVERSIDE	CA	92504	2757	00	06000	33.94604554	-117.4117995	Riverside County
292045	Non-Physician Medical Practitioner	None	1215662101	0	0	ANAKOR, NKIRUKA C NP	11/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2131 ELKS	104	SAN BERNARDINO	CA	92404	5544	00	06000	34.13470788	-117.262434	San Bernardino County
292059	Non-Physician Medical Practitioner	None	1619242393	0	0	ALWATTAR, TARQUIN L NP	12/31/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10 YARMOUTH COURT	None	OAKLAND	CA	94619	2434	00	06000	37.80058658	-122.1725151	Alameda County
292088	Non-Physician Medical Practitioner	None	1295228799	0	0	ADAMO, ALESSANDRA M NP	11/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3300 E. SOUTH STREET	209	LAKEWOOD	CA	90805	4945	00	06000	33.86018093	-118.1537163	Los Angeles County
292112	Non-Physician Medical Practitioner	None	1124450788	0	0	ALEMAN-OCAMPO, JENNIFER V	2/9/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6331 SMOKY QUARTZ DR	None	BAKERSFIELD	CA	93313	5310	00	06000	35.28931674	-119.0737072	Kern County
292127	Non-Physician Medical Practitioner	None	1093221988	0	0	ALZUBAIDI, QAMMER PA	5/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 W MINERAL KING AVE	None	VISALIA	CA	93291	6263	00	06000	36.327888	-119.294919	Tulare County
292149	Non-Physician Medical Practitioner	None	1568234656	0	0	ALVARADO, RACHEL	1/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
292169	Non-Physician Medical Practitioner	None	1003230038	0	0	APLA HEALTH & WELLNESS	4/21/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	611 S KINGSLEY DR	None	LOS ANGELES	CA	90005	2319	00	06000	34.06305793	-118.3028813	Los Angeles County
292190	Non-Physician Medical Practitioner	None	1104215631	0	0	ANTI, MABEL NP	5/12/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	00	06000	33.12181055	-117.2840499	San Diego County
292216	Non-Physician Medical Practitioner	None	1649742362	0	0	AMIS, MARK PA-C	11/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	00	06000	33.49890392	-117.1612965	Riverside County
292250	Non-Physician Medical Practitioner	None	1942470315	0	0	ACEVEDO, LUCIANO	8/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1828 E CESAR E CHAVEZ AV	STE B-218	LOS ANGELES	CA	90033	2400	00	06000	34.05023174	-118.2154927	Los Angeles County
292255	Non-Physician Medical Practitioner	None	1538685334	0	0	AGRON, KATHERINE A C NP	1/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13501 CONTOUR DR	None	SHERMAN OAKS	CA	91423	4701	00	06000	34.14313105	-118.4274696	Los Angeles County
292290	Non-Physician Medical Practitioner	None	1578958047	0	0	ASPEN MEDICAL GROUP, INC.	9/7/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11441 HEACOCK ST	SUITE B-1	MORENO VALLEY	CA	92557	7907	00	06000	33.954858	-117.243978	Riverside County
292334	Non-Physician Medical Practitioner	None	1013308485	0	0	AMBATALI, REX B JR NP	3/23/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9779 COLLIE WAY	None	ELK GROVE	CA	95757	6223	00	06000	38.402406	-121.414572	Sacramento County
292340	Non-Physician Medical Practitioner	None	1396067500	0	0	AAA COMPREHENSIVE HEALTHCARE INC	4/30/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7451 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91605	2803	00	06000	34.20616081	-118.3878161	Los Angeles County
292361	Non-Physician Medical Practitioner	None	1801574934	0	0	ANDERSON, BRETT PA-C	5/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	00	06000	33.78034779	-117.8655767	Orange County
292371	Non-Physician Medical Practitioner	None	1760160691	0	0	ANDERSON, MEGAN PA	4/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 N HIGHLAND SPRINGS A	None	BANNING	CA	92220	3046	00	06000	33.9316595	-116.9468639	Riverside County
292400	Non-Physician Medical Practitioner	None	1144973249	0	0	AGUIRRE, IHOVANA NP	9/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1336 NATIVIDAD RD	None	SALINAS	CA	93906	3101	00	06000	36.69908763	-121.6352503	Monterey County
292401	Non-Physician Medical Practitioner	None	1518293331	0	0	AMADOR, LETICIA PA-C	3/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	631 S BROOKHURST ST	SUITE # 101	ANAHEIM	CA	92804	3510	00	06000	33.823647	-117.9589675	Orange County
292409	Non-Physician Medical Practitioner	None	1326277153	0	0	AULAKH, RAMANDEEP PA	7/16/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4770 W HERNDON AVE	STE 107	FRESNO	CA	93722	8401	00	06000	36.83717984	-119.8778388	Fresno County
292427	Non-Physician Medical Practitioner	None	1720125339	0	0	ASSL, HASSAN	3/6/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	792 MONO STREET	None	MANTECA	CA	95337	7826	00	06000	37.76608005	-121.2034969	San Joaquin County
292436	Non-Physician Medical Practitioner	None	1003915042	0	0	ARMSTRONG, BRUCE W.	3/22/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10666 N TORREY PINES RD	None	LA JOLLA	CA	92037	1027	00	06000	32.89687721	-117.2418677	San Diego County
292454	Non-Physician Medical Practitioner	None	1528101201	0	0	ADESIDA, ANDREW A	3/3/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	00	06000	34.0309884	-118.2642142	Los Angeles County
292462	Non-Physician Medical Practitioner	None	1700017712	0	0	AJMAL, MOHAMMAD NP	3/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4023 MARINE AVE	None	LAWNDALE	CA	90260	0000	00	06000	33.89468047	-118.344636	Los Angeles County
292466	Non-Physician Medical Practitioner	None	1407886070	0	0	ARNOLD, KAREN LEA	11/17/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	374 W OLIVE AVE	SUITE A	MERCED	CA	95348	3137	00	06000	37.31914092	-120.4749911	Merced County
292490	Non-Physician Medical Practitioner	None	1629178454	0	0	ANDERSON, SCOTT T	11/28/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	235 W 6TH ST	None	RENO	NV	89503	4548	00	06000	39.53165987	-119.8181899	Washoe County
292502	Non-Physician Medical Practitioner	None	1295821734	0	0	AGUILAR-MALAZNIK, MARIA ENGRACIA	4/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2885 KAISER DR.	BLD C	SANTA CLARA	CA	95051	0000	00	06000	37.34192094	-121.9780412	Santa Clara County
292518	Non-Physician Medical Practitioner	None	1194471508	0	0	ANARI, FATEMEH PA-C	3/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8628 RESEDA BLVD.	None	NORTHRIDGE	CA	91324	4032	00	06000	34.22722956	-118.5360495	Los Angeles County
292519	Non-Physician Medical Practitioner	None	1992044770	0	0	ANZO, JENNIFER T	4/11/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1024 14TH STREET	UNIT D	SANTA MONICA	CA	90403	7205	00	06000	34.02909185	-118.4915949	Los Angeles County
292522	Non-Physician Medical Practitioner	None	1952653818	0	0	ALEJANDRO, CARRIE	1/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2400 BAHAMAS DR	None	BAKERSFIELD	CA	93309	0745	00	06000	35.37485948	-119.0454927	Kern County
292563	Non-Physician Medical Practitioner	None	1427608751	0	0	ASAMAPHAND, MONIKA NP	3/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4275 S BURNHAM AVE	STE 230	LAS VEGAS	NV	89119	5400	00	06000	36.111699	-115.1238165	Clark County
292572	Non-Physician Medical Practitioner	None	1801202676	0	0	ANPHON CORPORATION	10/8/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	333 E NUTWOOD STREET	SUITE C	INGLEWOOD	CA	90301	9989	00	06000	33.96053226	-118.3506276	Los Angeles County
292578	Non-Physician Medical Practitioner	None	1629760525	0	0	ALEXANDER, CINDY NP	9/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	151 CLAYDELLE AVE	None	EL CAJON	CA	92020	4505	00	06000	32.794155	-116.958763	San Diego County
292643	Non-Physician Medical Practitioner	None	1891390951	0	0	AHMED, SYED PA	1/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	9300 W SUNSET RD	None	LAS VEGAS	NV	89148	4844	00	06000	36.072729	-115.295094	Clark County
292650	Non-Physician Medical Practitioner	None	1174051775	0	0	ALEXANDER, TIANITA PA-C	7/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1742 OREGON STREET	None	REDDING	CA	96001	1717	00	06000	40.5808265	-122.3932989	Shasta County
292683	Non-Physician Medical Practitioner	None	1528093069	0	0	AU, HELENE H PA-C	8/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1043 ELM AVENUE	104	LONG BEACH	CA	90813	3244	00	06000	33.779655	-118.1880065	Los Angeles County
292727	Non-Physician Medical Practitioner	None	1699503342	0	0	ARMENTA, GABRIELA A PA	12/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7101 MAGNOLIA AVE	A	RIVERSIDE	CA	92504	3843	00	06000	33.94582085	-117.4021968	Riverside County
292815	Non-Physician Medical Practitioner	None	1568140077	0	0	ADE, KELSEY S PA-C	11/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6501 COYLE AVENUE	None	CARMICHAEL	CA	95608	0306	00	06000	38.669562	-121.31379	Sacramento County
292864	Non-Physician Medical Practitioner	None	1013368315	0	0	ALEGRIA, ISABEL E PA-C	4/13/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9700 DE SOTO	None	CHATSWORTH	CA	91311	4409	00	06000	34.246692	-118.588543	Los Angeles County
292874	Non-Physician Medical Practitioner	None	1407500127	0	0	ALBERSTONE, LAUREN PA	3/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
292983	Non-Physician Medical Practitioner	None	1609147651	0	0	ABARE, KATHRYN H NP	4/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3932 JEWELL ST	APT N203	SAN DIEGO	CA	92109	6015	00	06000	32.79143171	-117.2363796	San Diego County
293027	Non-Physician Medical Practitioner	None	1891070686	0	0	ANUGOM, FELISTA NP	1/17/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2350 W WHITENDALE AVE	None	VISALIA	CA	93277	6136	00	06000	36.307377	-119.316285	Tulare County
293032	Non-Physician Medical Practitioner	None	1225670557	0	0	ALIAZIS, TRICIA M CNP	6/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3621 MARTIN LUTHER KING	STE 6	LYNWOOD	CA	90262	3512	00	06000	33.93082719	-118.2024698	Los Angeles County
293038	Non-Physician Medical Practitioner	None	1942569553	0	0	ARREDONDO, MARIA ELENA	6/3/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5712 COLDBROOK AVE	None	LAKEWOOD	CA	90713	1442	00	06000	33.85923158	-118.1223315	Los Angeles County
293041	Non-Physician Medical Practitioner	None	1649371642	0	0	ALLEN, ANDREW C PA-C	8/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	00	06000	33.763572	-116.4056895	Riverside County
293046	Non-Physician Medical Practitioner	None	1952588691	0	0	ALTAMED HEALTH SERVICES CORP.	1/5/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6901 ATLANTIC AVE	None	BELL	CA	90201	3646	00	06000	33.97291242	-118.1878808	Los Angeles County
293118	Non-Physician Medical Practitioner	None	1437540762	0	0	ABBOTT, ELIZABETH G PA-C	11/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11103 VENICE BLVD	None	LOS ANGELES	CA	90034	6914	00	06000	34.01379685	-118.4159354	Los Angeles County
293189	Non-Physician Medical Practitioner	None	1851157937	0	0	ABU-DOULEH, NADIA	1/30/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
293199	Non-Physician Medical Practitioner	None	1336856608	0	0	ALIMAM, LORETTA M NP	12/3/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	905 EAST WASHINGTON ST	None	PETALUMA	CA	94952	3385	00	06000	38.24451673	-122.6303052	Sonoma County
293214	Non-Physician Medical Practitioner	None	1528308806	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	5/23/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18990 COYOTE VALLEY RD	SUITE 10	HIDDEN VALLEY LAK	CA	95467	8337	00	06000	38.79462138	-122.5574782	Lake County
293215	Non-Physician Medical Practitioner	None	1841614575	0	0	AFVARI, MELODY	4/6/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5200 ETIWANDA AVE	None	TARZANA	CA	91356	4336	00	06000	34.16562059	-118.5307861	Los Angeles County
293223	Non-Physician Medical Practitioner	None	1518398031	0	0	ALL FOR HEALTH HEALTH FOR ALL INC	9/30/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1030 S GLENDALE AVE	SUITE 307	GLENDALE	CA	91205	5612	00	06000	34.13381535	-118.2519184	Los Angeles County
293236	Non-Physician Medical Practitioner	None	1881926939	0	0	ARANCIBIA, SERGIO G	10/13/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1011 E DEVONSHIRE AVE	SUITE 201	HEMET	CA	92543	3033	00	06000	33.75118151	-116.9615025	Riverside County
293241	Non-Physician Medical Practitioner	None	1154734069	0	0	ALMANI, NOEL PA-C	8/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 S. CENTRAL AVENUE	None	GLENDALE	CA	91204	2508	00	06000	34.12811155	-118.2577764	Los Angeles County
293242	Non-Physician Medical Practitioner	None	1659774560	0	0	AZUBUIKE, EZIOMA K	2/24/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 W 3RD ST	APT 137	LONG BEACH	CA	90802	3028	00	06000	33.77053272	-118.1944246	Los Angeles County
293299	Non-Physician Medical Practitioner	None	1669803003	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	11/25/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2256 DOCKERY AVE	SUITE #B	SELMA	CA	93662	3873	00	06000	36.566298	-119.6018135	Fresno County
293309	Non-Physician Medical Practitioner	None	1912075938	0	0	ASHTON, SARAH	9/30/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2345 FAIR OAKS BLVD	MEDICINE 6	SACRAMENTO	CA	95825	4708	00	06000	38.57535	-121.407633	Sacramento County
293312	Non-Physician Medical Practitioner	None	1740946862	0	0	AYON, MARCO F	1/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16850 BEAR VALLEY ROAD	None	VICTORVILLE	CA	92395	5794	00	06000	34.47092468	-117.2977236	San Bernardino County
293319	Non-Physician Medical Practitioner	None	1003589417	0	0	AVINO, HAYLEY	11/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2400 S AVENUE A	None	YUMA	AZ	85364	7127	00	06000	32.683167	-114.633459	Yuma County
293327	Non-Physician Medical Practitioner	None	1013441229	0	0	ABRAHA, TEKLEHAIMANOT S	6/2/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1140 D ST	UNIT 202	HAYWARD	CA	94541	4224	00	06000	37.67249529	-122.0783004	Alameda County
293354	Non-Physician Medical Practitioner	None	1366884199	0	0	AIDS HEALTHCARE FOUNDATION	9/4/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1414 S GRAND AVE	SUITE 485	LOS ANGELES	CA	90015	3067	00	06000	34.03661142	-118.2657227	Los Angeles County
293382	Non-Physician Medical Practitioner	None	1689756330	0	0	AVILA, ARTURO R	4/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3953 HARLAN RANCH BLVD	None	CLOVIS	CA	93619	5061	00	06000	36.86176884	-119.6366781	Fresno County
293394	Non-Physician Medical Practitioner	None	1225294754	0	0	ARBUTHNOT, MISHAEL Y	7/8/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31923 BIRCHWOOD DR	None	LAKE ELSINORE	CA	92532	2623	00	06000	33.6565369	-117.260944	Riverside County
293433	Non-Physician Medical Practitioner	None	1265402093	0	0	AYER, KRISTEN A CNM	8/16/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1010 CAPTAINS COURT	None	SANTA CRUZ	CA	95062	5704	00	06000	36.97237469	-121.993728	Santa Cruz County
293457	Non-Physician Medical Practitioner	None	1437402989	0	0	ALEXANDER, ALICIA A PA	3/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14901 RINALDI STREET	SUITE 200-201	MISSION HILLS	CA	91345	1254	00	06000	34.27903452	-118.457433	Los Angeles County
293460	Non-Physician Medical Practitioner	None	1780007302	0	0	ALLEN, KAMERON N	8/4/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24975 PROSPECT AVE	None	LOMA LINDA	CA	92354	2842	00	06000	34.05020686	-117.2594881	San Bernardino County
293477	Non-Physician Medical Practitioner	None	1558699819	0	0	ARGUELLO, LORI E	12/15/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6555 COYLE AVE	None	CARMICHAEL	CA	95608	0302	00	06000	38.66859	-121.3118055	Sacramento County
293532	Non-Physician Medical Practitioner	None	1376306217	0	0	ANDERSON, ANGEL NP	10/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39000 BOB HOPE DR	None	RANCHO MIRAGE	CA	92270	3221	00	06000	33.763572	-116.4056895	Riverside County
293543	Non-Physician Medical Practitioner	None	1881168714	0	0	AWAMLEH, CLAUDIA NP	8/12/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5 LOWER RAGSDALE DR	100	MONTEREY	CA	93940	5817	00	06000	36.57544273	-121.8164209	Monterey County
293582	Non-Physician Medical Practitioner	None	1063074904	0	0	ALLEN, JAELYNNE M NP	1/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	36243 INLAND VALLEY DR	STE 80	WILDOMAR	CA	92595	9547	00	06000	33.591528	-117.2393325	Riverside County
293584	Non-Physician Medical Practitioner	None	1780028811	0	0	ARCAY, JONATHAN	8/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
293590	Non-Physician Medical Practitioner	None	1619415528	0	0	AGBISIT, MICHAEL A NP	4/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	448 ORIOLE ROAD	None	SAN JACINTO	CA	92582	6965	00	06000	33.78321766	-117.0038094	Riverside County
293596	Non-Physician Medical Practitioner	None	1306961313	0	0	ASARO, AMANDA M PA	6/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
293603	Non-Physician Medical Practitioner	None	1306121652	0	0	ASHTON, JENNA M	7/20/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	978 WESTCREEK LANE	APT 148	WESTLAKE VILLAGE	CA	91362	5440	00	06000	34.17948182	-118.7879254	Ventura County
293609	Non-Physician Medical Practitioner	None	1104130236	0	0	AKEY, SHELLEY A NP	3/19/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
293610	Non-Physician Medical Practitioner	None	1619697125	0	0	ALVAREZ, DANIEL PA	1/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	594 EL CAMINO REAL	None	SANTA CLARA	CA	95050	4345	00	06000	37.35293214	-121.9385135	Santa Clara County
293645	Non-Physician Medical Practitioner	None	1629022389	0	0	ALMANZA, JULIANA CASILLAS	11/9/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2699 ATLANTIC AVE	None	LONG BEACH	CA	90806	2710	00	06000	33.805971	-118.1850555	Los Angeles County
293651	Non-Physician Medical Practitioner	None	1164181848	0	0	ALVAREZ-BAUTISTA, ALEJANDRO	8/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1505 MAIN ST	None	WATSONVILLE	CA	95076	3761	00	06000	36.91747129	-121.7773741	Santa Cruz County
293652	Non-Physician Medical Practitioner	None	1578011037	0	0	ARENALES, YVETTE NP	12/6/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13050 HEACOCK ST	None	MORENO VALLEY	CA	92553	3122	00	06000	33.931386	-117.243772	Riverside County
293742	Non-Physician Medical Practitioner	None	1073825519	0	0	ARTHINGTON, JASON W	8/31/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 FRANCIS ST	None	BAKERSFIELD	CA	93308	2355	00	06000	35.4220961	-119.0365186	Kern County
293776	Non-Physician Medical Practitioner	None	1255773966	0	0	AUDIRAC, COSETTE	3/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	941 SHOREPOINT CT	APT F106	ALAMEDA	CA	94501	5872	00	06000	37.76365087	-122.2699127	Alameda County
293778	Non-Physician Medical Practitioner	None	1841615895	0	0	ALMOJERA- DE LEUS, ANALINE NP	5/25/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2090 S EUCLID ST	SUITE 104	ANAHEIM	CA	92802	0000	00	06000	33.79616455	-117.9412293	Orange County
293806	Non-Physician Medical Practitioner	None	1699512905	0	0	ALCARAZ PELAYO, LAURA	10/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
293811	Non-Physician Medical Practitioner	None	1417108861	0	0	AYAZ, LAILA	3/10/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6023 E SUMMIT CT	None	ANAHEIM	CA	92807	4771	00	06000	33.84118793	-117.7787344	Orange County
293820	Non-Physician Medical Practitioner	None	1689197816	0	0	ALLENGER, LAWRENCE N NP	10/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	115 MALL DRIVE	None	HANFORD	CA	93230	5786	00	06000	36.32396253	-119.6688834	Kings County
293853	Non-Physician Medical Practitioner	None	1801332051	0	0	ANI, EBERECHI J NP	1/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	73700 DINAH SHORE DR	STE 106	PALM DESERT	CA	92211	0813	00	06000	33.79748917	-116.3786855	Riverside County
293897	Non-Physician Medical Practitioner	None	1699298190	0	0	AGUILAR-URREA, RUTH N	12/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2665 GENEVA AVE	305	DALY CITY	CA	94014	1571	00	06000	37.70719008	-122.4159784	San Mateo County
293901	Non-Physician Medical Practitioner	None	1063148419	0	0	ANUFORO, CHINWE J NP	11/30/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	162 N SANTA FE ST	None	HEMET	CA	92543	4451	00	06000	33.74923371	-116.9629676	Riverside County
293918	Non-Physician Medical Practitioner	None	1235116138	0	0	AYALA, ADELA YNIGUEZ	1/19/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	568 E HERNDON AVE STE 20	None	FRESNO	CA	93720	2989	00	06000	36.83752653	-119.7776433	Fresno County
293938	Non-Physician Medical Practitioner	None	1013785310	0	0	ALLEN, HANNAH PA	5/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
293975	Non-Physician Medical Practitioner	None	1689925935	0	0	ALI, NABILAH A	9/22/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3353 W BRADY AVE	None	ANAHEIM	CA	92804	4702	00	06000	33.8123586	-118.00735	Orange County
293999	Non-Physician Medical Practitioner	None	1306248703	0	0	ANH, SO Y NP	6/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	627 S GARDEN ST	C	VISALIA	CA	93277	2851	00	06000	36.322848	-119.29014	Tulare County
294035	Non-Physician Medical Practitioner	None	1912393448	0	0	ALVAREZ, KELLEY E PA	11/4/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	185 E 7TH AVE	STE A	CHICO	CA	95926	3356	00	06000	39.74473059	-121.8488381	Butte County
294090	Non-Physician Medical Practitioner	None	1184670374	0	0	ABT, FRANK G	4/26/1996	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27970 PERIWINKLE LANE	None	VALENCIA	CA	91354	1843	00	06000	34.44652015	-118.5630932	Los Angeles County
294103	Non-Physician Medical Practitioner	None	1114429909	0	0	AKPAN, GODFREY NP	9/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16279 WALNUT ST	None	HESPERIA	CA	92345	3622	00	06000	34.4213317	-117.3075694	San Bernardino County
294135	Non-Physician Medical Practitioner	None	1285931378	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	3/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6 WOODLAND RD	SUITE 302	SAINT HELENA	CA	94574	9501	00	06000	38.54297115	-122.4754501	Napa County
294155	Non-Physician Medical Practitioner	None	1003560442	0	0	ALI, AMANE PA-C	8/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1717 S MAIN STREET	None	MILPITAS	CA	95035	6756	00	06000	37.40594287	-121.9029593	Santa Clara County
294188	Non-Physician Medical Practitioner	None	1508952730	0	0	ATIENZA, JANET R NP	10/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5542 BUFFALO AVE	None	SHERMAN OAKS	CA	91423	5225	00	06000	34.17156193	-118.4301244	Los Angeles County
294225	Non-Physician Medical Practitioner	None	1497487722	0	0	AHDOUT, SARAH PA	9/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2010 EAST CARSON STREET	None	LONG BEACH	CA	90807	3040	00	06000	33.83242453	-118.16721	Los Angeles County
294232	Non-Physician Medical Practitioner	None	1093448300	0	0	ABBASI, RAMINA PA	11/20/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E 28TH ST	419	LONG BEACH	CA	90806	2775	00	06000	33.80803441	-118.1847137	Los Angeles County
294237	Non-Physician Medical Practitioner	None	1578860722	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	3/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18990 COYOTE VALLEY RD	SUITE 9	HIDDEN VALLEY LAK	CA	95467	8337	00	06000	38.79462138	-122.5574782	Lake County
294241	Non-Physician Medical Practitioner	None	1376134585	0	0	ABOAGYE, WENDI N PA	12/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
294286	Non-Physician Medical Practitioner	None	1073907689	0	0	ALL FOR HEALTH HEALTH FOR ALL INC	5/20/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	800 S CENTRAL AVE	SUITE 308	GLENDALE	CA	91204	4370	00	06000	34.13654729	-118.2578243	Los Angeles County
294297	Non-Physician Medical Practitioner	None	1174741714	0	0	AILANJIAN, SHELLEY NP	2/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1383 E HERNDON AVE	STE 101	FRESNO	CA	93720	3309	00	06000	36.83690167	-119.7635813	Fresno County
294299	Non-Physician Medical Practitioner	None	1861141327	0	0	ANYANWU, LOVELYN U NP	5/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12442 LIMONITE AVE	UNIT 104	EASTVALE	CA	91752	2467	00	06000	33.97511454	-117.5531895	Riverside County
294321	Non-Physician Medical Practitioner	None	1174206478	0	0	ANTUNEZ, VIVIANA	2/17/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
294341	Non-Physician Medical Practitioner	None	1063792240	0	0	AJMERA, ARCHANA NP	8/21/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
294345	Non-Physician Medical Practitioner	None	1114399334	0	0	ABBOUD, ANGELA A PA-C	5/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2725 MENDOCINO AVE	None	SANTA ROSA	CA	95403	2805	00	06000	38.46672	-122.720724	Sonoma County
294347	Non-Physician Medical Practitioner	None	1619987443	0	0	ARAUZ, ARIADNA D	8/7/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5340 BECKWORTH WAY	None	ANTELOPE	CA	95843	4663	00	06000	38.708532	-121.3394085	Sacramento County
294361	Non-Physician Medical Practitioner	None	1053555904	0	0	ALEXANDER, PATRICIA ANN	11/4/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	344 E. 4TH ST	None	MADERA	CA	93638	0000	00	06000	36.96542931	-120.0587612	Madera County
294389	Non-Physician Medical Practitioner	None	1205594678	0	0	ASPEL, MANDY E NP	12/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16143 KOKANEE RD	STE C	APPLE VALLEY	CA	92307	1355	00	06000	34.54439055	-117.2678905	San Bernardino County
294419	Non-Physician Medical Practitioner	None	1639540123	0	0	ANDERSON, MELANIE G PA-C	12/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17271 BROOKHURST ST	None	FOUNTAIN VALLEY	CA	92708	3701	00	06000	33.71228787	-117.9545597	Orange County
294449	Non-Physician Medical Practitioner	None	1922877133	0	0	ASHQAR, STEPHANIE PA	6/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17271 BROOKHURST ST	None	FOUNTAIN VALLEY	CA	92708	3701	00	06000	33.71228787	-117.9545597	Orange County
294474	Non-Physician Medical Practitioner	None	1275303570	0	0	AMIDON, ROBIN NP	4/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1010 W CHAPMAN AVE	None	ORANGE	CA	92868	2847	00	06000	33.78785047	-117.8631495	Orange County
294485	Non-Physician Medical Practitioner	None	1558594911	0	0	AQUINO, CATHERINE T	10/8/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5427 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4101	00	06000	34.01966132	-118.1536008	Los Angeles County
294487	Non-Physician Medical Practitioner	None	1750767083	0	0	AAROE, DANIELLA NP	12/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3188 SUMMIT RIDGE TER	None	CHICO	CA	95928	7383	00	06000	39.75987894	-121.7680401	Butte County
294538	Non-Physician Medical Practitioner	None	1750734893	0	0	AINSWORTH, DELISSA M	9/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12810 PAPAGO DR	None	POWAY	CA	92064	3713	00	06000	32.95889942	-117.0539448	San Diego County
294558	Non-Physician Medical Practitioner	None	1245803055	0	0	AKBAR, NEELA PA-C	11/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
294586	Non-Physician Medical Practitioner	None	1376052027	0	0	ANDRIANARIJAONA, IRINNA NP	3/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1208 FLOYD AVE	STE B8	MODESTO	CA	95350	2454	00	06000	37.67801219	-120.977686	Stanislaus County
294606	Non-Physician Medical Practitioner	None	1134763246	0	0	ABOUELJOUD, SARAH PA-C	4/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
294607	Non-Physician Medical Practitioner	None	1184804767	0	0	ANDERSON, KIMBERLY PA	7/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	729 SUNRISE AVE	SUITE 602	ROSEVILLE	CA	95661	4542	00	06000	38.73444822	-121.2720033	Placer County
294617	Non-Physician Medical Practitioner	None	1841415502	0	0	ACEVES, JOHANNA C	9/23/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12401 WASHINGTON BLVD	DEPT OF RADIOLOGY	WHITTIER	CA	90602	1006	00	06000	33.969141	-118.0489095	Los Angeles County
294638	Non-Physician Medical Practitioner	None	1063659985	0	0	ALTAMED HEALTH SERVICES CORP	4/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1814 W LINCOLN AVE	None	ANAHEIM	CA	92801	6730	00	06000	33.83241852	-117.946323	Orange County
294658	Non-Physician Medical Practitioner	None	1942844055	0	0	ALVAREZ BARAJAS, CECILIA PA-C	1/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3883 AIRWAY DR	SUITE 320	SANTA ROSA	CA	95403	1670	00	06000	38.483226	-122.739705	Sonoma County
294683	Non-Physician Medical Practitioner	None	1437275674	0	0	ALLERTON, EVE S	5/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3220 33RD ST	None	SAN DIEGO	CA	92104	4726	00	06000	32.73870441	-117.1230919	San Diego County
294699	Non-Physician Medical Practitioner	None	1659738516	0	0	ASIMUS, DEREK PA	5/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26777 AGOURA RD	STE 4	CALABASAS	CA	91302	2967	00	06000	34.13998921	-118.7070142	Los Angeles County
294741	Non-Physician Medical Practitioner	None	1598053381	0	0	A, DE J	12/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5904 W MODOC AVE	None	VISALIA	CA	93291	8532	00	06000	36.353178	-119.356812	Tulare County
294780	Non-Physician Medical Practitioner	None	1396830824	0	0	ADAIR, WARD D	11/9/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2222 NW LOVEJOY ST	SUITE 315	PORTLAND	OR	97210	5101	00	06000	45.52979363	-122.6969471	Multnomah County
294782	Non-Physician Medical Practitioner	None	1144334723	0	0	AGHABEGIAN, ARMEN	3/29/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2408 SYLVAN LANE	None	GLENDALE	CA	91208	2335	00	06000	34.1822871	-118.2271527	Los Angeles County
294799	Non-Physician Medical Practitioner	None	1891485033	0	0	ALI, ANA K PA	5/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	00	06000	37.7634502	-122.4579779	San Francisco County
294835	Non-Physician Medical Practitioner	None	1700146487	0	0	ARIMA, CATHERINE C M NP	4/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3124 EL PORTAL	None	ALAMEDA	CA	94502	6814	00	06000	37.73600929	-122.2440258	Alameda County
294884	Non-Physician Medical Practitioner	None	1881114486	0	0	AKOPYAN, ANI	4/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3535 BROOK ST	APT 22	LAFAYETTE	CA	94549	4336	00	06000	37.88823102	-122.1196896	Contra Costa County
294895	Non-Physician Medical Practitioner	None	1841802535	0	0	AH SUE, ROBERT T PA	11/18/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	115 MALL DRIVE	None	HANFORD	CA	93230	5786	00	06000	36.32396253	-119.6688834	Kings County
294901	Non-Physician Medical Practitioner	None	1205245255	0	0	ANDERSON, JACQUELINE E NP	7/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8911 LAKEWOOD DR	SUITE 13	WINDSOR	CA	95492	7857	00	06000	38.55034733	-122.8042316	Sonoma County
294906	Non-Physician Medical Practitioner	None	1881714277	0	0	AREFI, LAILA S.	10/31/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1310 W. STEWART DR.	SUITE 602	ORANGE	CA	92868	3854	00	06000	33.78236048	-117.8664975	Orange County
294978	Non-Physician Medical Practitioner	None	1174836993	0	0	AGUILLON-DOMS, CLARIZA L	7/23/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	632 W GIBSON RD	None	WOODLAND	CA	95695	5169	00	06000	38.66314048	-121.794696	Yolo County
294979	Non-Physician Medical Practitioner	None	1912254210	0	0	ABDALLA, NISREEN S NP	9/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1476 E 13TH ST	None	UPLAND	CA	91786	5953	00	06000	34.11058216	-117.6295241	San Bernardino County
294990	Non-Physician Medical Practitioner	None	1427620723	0	0	ASISTORES, CATHERINE R NP	1/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
295003	Non-Physician Medical Practitioner	None	1790272243	0	0	AIDELOJE, JOSEPHINE E NP	7/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16279 WALNUT ST	None	HESPERIA	CA	92345	3622	00	06000	34.4213317	-117.3075694	San Bernardino County
295007	Non-Physician Medical Practitioner	None	1417205683	0	0	ARREGUIN, MELISA E NP	11/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1415 S CONYER STREET	None	VISALIA	CA	93277	4624	00	06000	36.318096	-119.3011785	Tulare County
295032	Non-Physician Medical Practitioner	None	1619208832	0	0	AOYS, MAUREEN C	9/21/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22513 FRIAR STREET	None	WOODLAND HILLS	CA	91367	1716	00	06000	34.18556898	-118.6175735	Los Angeles County
295039	Non-Physician Medical Practitioner	None	1174329403	0	0	AGUSTO, STACYRAE NP	3/4/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 OLD RIVER RD	110	BAKERSFIELD	CA	93311	9504	00	06000	35.35127492	-119.1142991	Kern County
295052	Non-Physician Medical Practitioner	None	1912292285	0	0	APAIT HEALTH CENTER	8/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1730 W OLYMPIC BLVD	SUITE 300	LOS ANGELES	CA	90015	1019	00	06000	34.05007222	-118.2762421	Los Angeles County
295069	Non-Physician Medical Practitioner	None	1124496997	0	0	ARIETA, CHRISTINA M	11/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	420 HAMPTON COURT	None	SAN RAMON	CA	94583	2526	00	06000	37.75161526	-121.9537418	Contra Costa County
295110	Non-Physician Medical Practitioner	None	1750656641	0	0	AGENA, JOANNA C N NP	7/22/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	618 LANCASTER WAY	None	REDWOOD CITY	CA	94061	1222	00	06000	37.46855912	-122.2475202	San Mateo County
295136	Non-Physician Medical Practitioner	None	1679973267	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	12/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1701 E CESAR E CHAVEZ AV	#456	LOS ANGELES	CA	90033	2464	00	06000	34.05112725	-118.2173921	Los Angeles County
295163	Non-Physician Medical Practitioner	None	1689866998	0	0	ALEXANDER, LAUREN A NP	12/31/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	159 19TH AVENUE	APT 8	SAN FRANCISCO	CA	94121	1351	00	06000	37.78489956	-122.4786646	San Francisco County
295171	Non-Physician Medical Practitioner	None	1689613515	0	0	AMOANI, ALBERT N JR	9/16/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	37500 CITRON PLACE	None	PALMDALE	CA	91362	4930	00	06000	34.56468988	-118.177443	Los Angeles County
295196	Non-Physician Medical Practitioner	None	1417566043	0	0	ALBGAL, HAILA A NP	12/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 VAN NESS AVE	None	SAN FRANCISCO	CA	94109	6978	00	06000	37.78594176	-122.421322	San Francisco County
295231	Non-Physician Medical Practitioner	None	1205485646	0	0	ACEVEDO, KARINA V NP	5/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
295241	Non-Physician Medical Practitioner	None	1497495352	0	0	AUJLA, NAVPREET PA	8/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2905 TELEGRAPH AVE	None	BERKELEY	CA	94705	2063	00	06000	37.85736641	-122.2594952	Alameda County
295248	Non-Physician Medical Practitioner	None	1437785268	0	0	ANDRZEJEWSKI, DEREK F PA-C	6/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2525 ERRINGER RD.	None	SIMI VALLEY	CA	93065	2352	00	06000	34.280838	-118.7614975	Ventura County
295254	Non-Physician Medical Practitioner	None	1528440898	0	0	ADVENTIST HEALTH PHYSICIANS	4/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1934 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	3957	00	06000	34.02025007	-118.1199011	Los Angeles County
295262	Non-Physician Medical Practitioner	None	1356878136	0	0	AHOY, ALBERT	8/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2770 ACTON ST	None	BERKELEY	CA	94702	2334	00	06000	37.85584236	-122.2821858	Alameda County
295282	Non-Physician Medical Practitioner	None	1710420898	0	0	ADELMAN, WHITNEY M NP	3/17/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2107 AIRPARK DR	None	REDDING	CA	96001	2433	00	06000	40.57493327	-122.4048185	Shasta County
295340	Non-Physician Medical Practitioner	None	1144570508	0	0	AVERY, STEPHANIE B NP	4/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5635 NE GOING STREET	None	PORTLAND	OR	97218	2632	00	06000	45.55669706	-122.6050981	Multnomah County
295343	Non-Physician Medical Practitioner	None	1952867079	0	0	ARIF, NIDA PA-C	4/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1495 RIVER PARK DR	200	SACRAMENTO	CA	95815	4500	00	06000	38.599524	-121.437738	Sacramento County
295364	Non-Physician Medical Practitioner	None	1831593326	0	0	ALI, AYESHA A NP	6/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6234 WEST BIRCH AVENUE	None	FRESNO	CA	93722	2842	00	06000	36.84108565	-119.904591	Fresno County
295371	Non-Physician Medical Practitioner	None	1235340811	0	0	ASHIER, SAURABH D	3/4/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12618 CARAVEL ST	None	CERRITOS	CA	90703	7743	00	06000	33.86073676	-118.0628768	Los Angeles County
295374	Non-Physician Medical Practitioner	None	1235535998	0	0	ANDREWS, ELIZABETH L PA-C	5/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1870 20TH AVE	None	SAN FRANCISCO	CA	94122	4404	00	06000	37.75288478	-122.4774376	San Francisco County
295418	Non-Physician Medical Practitioner	None	1871519447	0	0	ABLIN, IDALIA CORTEZ	11/16/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3551 Q STREET	SUITE 100	BAKERSFIELD	CA	93301	0000	00	06000	35.392059	-119.010556	Kern County
295439	Non-Physician Medical Practitioner	None	1326644188	0	0	ARRIETA, KHRISTINE NP	11/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
295440	Non-Physician Medical Practitioner	None	1760774863	0	0	ARMEEN, GARY P	5/13/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	207 W LEGION RD	None	BRAWLEY	CA	92227	7780	00	06000	32.95809	-115.5537045	Imperial County
295498	Non-Physician Medical Practitioner	None	1578619813	0	0	ALZINA, MERICA-JONES S	12/9/1992	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5555 GROSSMONT CENTER DR	SHARP GROSSMONT HOSPITAL	LA MESA	CA	91942	3019	00	06000	32.781483	-117.007182	San Diego County
295499	Non-Physician Medical Practitioner	None	1972059921	0	0	AUSONIO, SALVATORE NP	1/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	32487 BERGAMO COURT	None	TEMECULA	CA	92592	3886	00	06000	33.49202573	-117.0917326	Riverside County
295501	Non-Physician Medical Practitioner	None	1912248378	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	6/17/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2750 SYCAMORE DR	SUITE 202	SIMI VALLEY	CA	93065	1502	00	06000	34.28529962	-118.7437672	Ventura County
295534	Non-Physician Medical Practitioner	None	1639508112	0	0	ADLAO, MARIROSE	11/19/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3580 SANTA ANITA AVE	#A	EL MONTE	CA	91731	2455	00	06000	34.07443832	-118.0414722	Los Angeles County
295580	Non-Physician Medical Practitioner	None	1124053483	0	0	ADELMAN, MARA L	10/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	945 WINDSOR ST	None	NAPA	CA	94558	3510	00	06000	38.31797541	-122.2930845	Napa County
295608	Non-Physician Medical Practitioner	None	1396592564	0	0	AKINSOLA, IBUKUN	9/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
295665	Non-Physician Medical Practitioner	None	1023780129	0	0	AL-ASADY, SARAH PA-C	3/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	720 E CARNEGIE DR.	STE 140	SAN BERNARDINO	CA	92408	3516	00	06000	34.06914052	-117.2695442	San Bernardino County
295669	Non-Physician Medical Practitioner	None	1891377081	0	0	ALARIBE, CALBETH	9/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	333 MERCY AVE	None	MERCED	CA	95340	8319	00	06000	37.33875148	-120.467457	Merced County
295671	Non-Physician Medical Practitioner	None	1215276258	0	0	AURELIO, MORGAN C CNM	10/24/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3838 CALIFORNIA ST .	SUITE 805	SAN FRANCISCO	CA	94118	1510	00	06000	37.78591809	-122.4575439	San Francisco County
295677	Non-Physician Medical Practitioner	None	1538154786	0	0	ADLER, JEREMY ANDREW	9/27/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	477 N EL CAMINO REAL	SUITE #B301	ENCINITAS	CA	92024	1328	00	06000	33.05700866	-117.262449	San Diego County
295724	Non-Physician Medical Practitioner	None	1780948869	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	6/17/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1130 W OLIVE AVE	None	BURBANK	CA	91506	2214	00	06000	34.1710823	-118.3191114	Los Angeles County
295799	Non-Physician Medical Practitioner	None	1104254952	0	0	ALLEN, TONYA L NP	11/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	475 EL RANCHO DRIVE	None	KINGMAN	AZ	86409	3516	00	06000	35.229618	-114.050538	Mohave County
295809	Non-Physician Medical Practitioner	None	1164617700	0	0	A, TORRES S	11/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	929 NEWMAN DR	None	S SAN FRANCISCO	CA	94080	1110	00	06000	37.66434057	-122.4577679	San Mateo County
295840	Non-Physician Medical Practitioner	None	1114046323	0	0	ARLAND, LESLEY	5/13/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	13123 E 16TH AVE	None	AURORA	CO	80045	7106	00	06000	39.742164	-104.8350375	Adams County
295842	Non-Physician Medical Practitioner	None	1437862968	0	0	ADEFRIS, SENAIT NP	9/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3500 WHITTIER BLVD	STE 107	LOS ANGELES	CA	90023	1746	00	06000	34.02656881	-118.1982818	Los Angeles County
295861	Non-Physician Medical Practitioner	None	1730788977	0	0	ALFONZO, REBECCA S NP	11/13/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15791 BEAR VALLEY RD.	None	HESPERIA	CA	92345	1746	00	06000	34.47063553	-117.3190095	San Bernardino County
295888	Non-Physician Medical Practitioner	None	1962978502	0	0	ATHERLY-BROWN, ALISHA PA-C	1/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	511 BATH ST	None	SANTA BARBARA	CA	93101	3403	00	06000	34.41386476	-119.6993335	Santa Barbara County
295921	Non-Physician Medical Practitioner	None	1396374799	0	0	ANDERSON, ROBERT M PA	9/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2975 N SYCAMORE DR	None	SIMI VALLEY	CA	93065	1201	00	06000	34.28924598	-118.7439214	Ventura County
295944	Non-Physician Medical Practitioner	None	1306285531	0	0	ANDERSON, MARGARET A NP	2/7/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9437 GENSLER CT	None	ELK GROVE	CA	95624	6053	00	06000	38.414313	-121.346973	Sacramento County
296001	Non-Physician Medical Practitioner	None	1689258659	0	0	ALIOTTI, ALEXANDRIA J	8/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	230 SAN JOSE STREET	None	SALINAS	CA	93901	3901	00	06000	36.65837657	-121.6469645	Monterey County
296055	Non-Physician Medical Practitioner	None	1861992141	0	0	AVELLONA, HARRY	12/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11333 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	1116	00	06000	34.27684353	-118.4684024	Los Angeles County
296059	Non-Physician Medical Practitioner	None	1841686623	0	0	AWA, TESSY K NP	11/3/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2359 AGUILAR PL	None	WOODLAND	CA	95776	5413	00	06000	38.64862708	-121.7377834	Yolo County
296085	Non-Physician Medical Practitioner	None	1639237613	0	0	AUYEUNG, VIKCY	4/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1201 FILLMORE ST	None	SAN FRANCISCO	CA	94115	4110	00	06000	37.78096742	-122.4322568	San Francisco County
296096	Non-Physician Medical Practitioner	None	1942857834	0	0	ATANESIAN, VARDAN NP	4/29/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4500 BROCKTON AVE	STE 319	RIVERSIDE	CA	92501	4090	00	06000	33.97785263	-117.3836152	Riverside County
296098	Non-Physician Medical Practitioner	None	1912159559	0	0	ARAGON-NAVARRETE, CRISTINA M	5/21/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1780 NEW YORK DRIVE	None	ALTADENA	CA	91001	3329	00	06000	34.17850553	-118.113867	Los Angeles County
296135	Non-Physician Medical Practitioner	None	1386403442	0	0	ALIGADA, IRISA CLAIRE	5/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	81715 DR CARREON BLVD	None	INDIO	CA	92201	5564	00	06000	33.7073825	-116.2385415	Riverside County
296152	Non-Physician Medical Practitioner	None	1104100619	0	0	ABEL, MEGAN D	3/12/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3252 LINCOLN AVENUE	None	ALTADENA	CA	91001	4142	00	06000	34.20140562	-118.1591085	Los Angeles County
296161	Non-Physician Medical Practitioner	None	1326349960	0	0	ABOVIAN, DAVID PA-C	2/11/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	191 S BUENA VISTA STREET	SUITE 200-240	BURBANK	CA	91505	4542	00	06000	34.15872557	-118.3283863	Los Angeles County
296175	Non-Physician Medical Practitioner	None	1386937035	0	0	AMANTE, HEATHER R NP	4/26/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	653 S CASITA STREET	None	ANAHEIM	CA	92805	4747	00	06000	33.83092959	-117.9052568	Orange County
296227	Non-Physician Medical Practitioner	None	1780929042	0	0	ANGELES, CONSTANCE	2/21/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST STE 20	None	LOS ANGELES	CA	90033	5322	00	06000	34.06269295	-118.2030006	Los Angeles County
296249	Non-Physician Medical Practitioner	None	1689849879	0	0	AVAKIAN, LANY S NP	5/11/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1469 N ROGERS AVE	None	CLOVIS	CA	93619	7677	00	06000	36.85649243	-119.703931	Fresno County
296259	Non-Physician Medical Practitioner	None	1356675037	0	0	ANAK-AGUNG-GEDE, ANGEL P PA-C	3/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	860 WEST VALLEY PKWY	STE 150	ESCONDIDO	CA	92025	2534	00	06000	33.1175634	-117.0952973	San Diego County
296301	Non-Physician Medical Practitioner	None	1326542424	0	0	ANDERSON, MALINDA B NP	10/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5671 BALBOA AVE	None	SAN DIEGO	CA	92111	2705	00	06000	32.82010691	-117.1788026	San Diego County
296309	Non-Physician Medical Practitioner	None	1295162899	0	0	ANDERSON, KRISTINA A	11/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1208 ANTHONY ST	None	REDLANDS	CA	92374	3938	00	06000	34.068276	-117.1508545	San Bernardino County
296317	Non-Physician Medical Practitioner	None	1124675095	0	0	AULAKH, AMBER K PA-C	5/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5600 CALIFORNIA AVE	STE 101	BAKERSFIELD	CA	93309	1614	00	06000	35.356203	-119.0612695	Kern County
296386	Non-Physician Medical Practitioner	None	1538446448	0	0	AYALA, MIGUEL ANGEL	5/30/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6001 NORRIS CANYON RD	None	SAN RAMON	CA	94583	5400	00	06000	37.7755858	-121.958923	Contra Costa County
296389	Non-Physician Medical Practitioner	None	1972599272	0	0	AHMADZAI, ARIAN A	8/23/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5177 MEDINA RD	None	WOODLAND HILLS	CA	91364	1912	00	06000	34.16291555	-118.5997543	Los Angeles County
296408	Non-Physician Medical Practitioner	None	1972954410	0	0	ACKER, LINDA M NP	9/26/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	700 BOGUE ROAD	APT 44	YUBA CITY	CA	95991	9218	00	06000	39.0996516	-121.620095	Sutter County
296415	Non-Physician Medical Practitioner	None	1700274354	0	0	AGNEW, DANIELA PA-C	10/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	49617 CESAR CHAVEZ ST	SUITE B	COACHELLA	CA	92236	1535	00	06000	33.68797107	-116.1818005	Riverside County
296418	Non-Physician Medical Practitioner	None	1134103625	0	0	ADAMEK, LISA M NP	4/15/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3344 SIERRA SPRINGS COUR	None	PENRYN	CA	95663	9303	00	06000	38.83043889	-121.1607733	Placer County
296426	Non-Physician Medical Practitioner	None	1245579879	0	0	AMOAKO, SAMUEL NP	10/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2372 STERLING AVE	None	SAN BERNARDINO	CA	92404	4624	00	06000	34.13682	-117.243687	San Bernardino County
296452	Non-Physician Medical Practitioner	None	1831775071	0	0	ALONSO ODUARDO, OSCAR NP	9/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
296483	Non-Physician Medical Practitioner	None	1417423856	0	0	ALZAMORA MONDRAGON, ANA	9/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2210 E ILLINOIS	STE 406	FRESNO	CA	93701	2167	00	06000	36.74500687	-119.7846885	Fresno County
296493	Non-Physician Medical Practitioner	None	1669186581	0	0	ARANTOWICZ, KAYLA PA-C	10/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3434 MIDWAY DRIVE	SUITE 2001	SAN DIEGO	CA	92110	4924	00	06000	32.75065153	-117.2126147	San Diego County
296497	Non-Physician Medical Practitioner	None	1770619751	0	0	ANDAYA, JAYE C	11/10/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1640 HOPE DR	APT 1014	SANTA CLARA	CA	95054	1753	00	06000	37.397934	-121.955598	Santa Clara County
296503	Non-Physician Medical Practitioner	None	1356563167	0	0	AAMOT, CRISTINA M NP	11/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	00	06000	33.12181055	-117.2840499	San Diego County
296585	Non-Physician Medical Practitioner	None	1982602397	0	0	ARENAS, JESSICA LEE	11/16/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 S GRAND AVE STE 200	None	GLENDORA	CA	91741	4205	00	06000	34.133859	-117.872523	Los Angeles County
296586	Non-Physician Medical Practitioner	None	1255820759	0	0	ALLEN, JORDAN A PA-C	7/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4647 ZION AVE	None	SAN DIEGO	CA	92120	2507	00	06000	32.79293009	-117.0952438	San Diego County
296589	Non-Physician Medical Practitioner	None	1124746318	0	0	ARJOMANDI, SHAHRZAD PA-C	11/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19671 BEACH BLVD,	SUITE 215	HUNTINGTON BEACH	CA	92648	7101	00	06000	33.67718578	-117.9887516	Orange County
296607	Non-Physician Medical Practitioner	None	1972630291	0	0	ANDERSON, DENISE M	2/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26977 HAYWARD BLVD	None	HAYWARD	CA	94566	6754	00	06000	37.65539215	-122.0459892	Alameda County
296674	Non-Physician Medical Practitioner	None	1588282149	0	0	ALVAREZ, ARMANDA L NP	9/17/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	44054 MARGARITA RD STE 1	None	TEMECULA	CA	92592	2737	00	06000	33.48386484	-117.102706	Riverside County
296683	Non-Physician Medical Practitioner	None	1093019051	0	0	ALL-INCLUSIVE COMMUNITY HEALTH CENTER	6/9/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1311 N SAN FERNANDO BLVD	None	BURBANK	CA	91504	4236	00	06000	34.18947282	-118.3206362	Los Angeles County
296688	Non-Physician Medical Practitioner	None	1831592286	0	0	ADEGBE, ROSETTE J NP	4/22/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1084 FLAGER RANCH ROAD	None	CORONA	CA	92881	4730	00	06000	33.82006329	-117.5597967	Riverside County
296705	Non-Physician Medical Practitioner	None	1477194215	0	0	AGUINIGA, ARMANDO PA-C	10/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12401 WASHINGTON BLVD	None	WHITTIER	CA	90602	1006	00	06000	33.969141	-118.0489095	Los Angeles County
296706	Non-Physician Medical Practitioner	None	1578101374	0	0	ALVAREZ, JESSICA J PA	11/3/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
296754	Non-Physician Medical Practitioner	None	1821302027	0	0	ARROYO VISTA FAMILY HEALTH FOUNDATION	6/29/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4837 HUNTINGTON DR N	SUITE 1	LOS ANGELES	CA	90032	1981	00	06000	34.0860874	-118.1788432	Los Angeles County
296757	Non-Physician Medical Practitioner	None	1215205091	0	0	ANDERSON, TERESA M	9/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3296 WRIGHTWOOD DR	None	STUDIO CITY	CA	91604	3936	00	06000	34.13124131	-118.3747875	Los Angeles County
296793	Non-Physician Medical Practitioner	None	1225526395	0	0	ABINA, OLUWATOSIN PA-C	9/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4001 J STREET	None	SACRAMENTO	CA	95819	3626	00	06000	38.570526	-121.4521695	Sacramento County
296810	Non-Physician Medical Practitioner	None	1235435587	0	0	ANDERSON, RACHEL A	7/27/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	930 VIA MIL CUMBRES	UNIT 148	SOLANA BEACH	CA	92075	2609	00	06000	32.99638741	-117.2515318	San Diego County
296843	Non-Physician Medical Practitioner	None	1275077877	0	0	ADELMAN, ARIELLA NP	5/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5224 CORTEEN PL	APT 2	VALLEY VILLAGE	CA	91607	4267	00	06000	34.16560527	-118.4019544	Los Angeles County
296849	Non-Physician Medical Practitioner	None	1538456090	0	0	AGAHI, LOPEZ F	7/14/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3301 C ST	BLDG 550	SACRAMENTO	CA	95816	3300	00	06000	38.579877	-121.456143	Sacramento County
296906	Non-Physician Medical Practitioner	None	1962537852	0	0	ADAMS, JARED L	2/27/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2860 HOLLAND AVE	None	CLOVIS	CA	93611	3965	00	06000	36.79792152	-119.658204	Fresno County
296910	Non-Physician Medical Practitioner	None	1134473564	0	0	ALLEN, SHEENA L	7/10/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27940 SOLAMINT RD	APT 14206	CANYON COUNTRY	CA	91387	2000	00	06000	34.41902556	-118.4523631	Los Angeles County
296916	Non-Physician Medical Practitioner	None	1023596400	0	0	ARCIAGA, KIM NP	3/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26800 CROWN VALLEY PKWY	STE 305, 315, 325, 330	MISSION VIEJO	CA	92691	8033	00	06000	33.56286021	-117.6673449	Orange County
296924	Non-Physician Medical Practitioner	None	1902413404	0	0	AFRICA, WARRICK M NP	10/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
297017	Non-Physician Medical Practitioner	None	1437718731	0	0	ALEXANDER, BAYLEE PA-C	10/31/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5411 ETIWANDA AVENUE	200	TARZANA	CA	91356	3648	00	06000	34.169112	-118.530837	Los Angeles County
297027	Non-Physician Medical Practitioner	None	1801319306	0	0	ARCANGEL, ANGEL I NP	9/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7910 FROST ST	None	SAN DIEGO	CA	92123	2771	00	06000	32.80027449	-117.153846	San Diego County
297062	Non-Physician Medical Practitioner	None	1922642784	0	0	ANGELLE-CARGILL, MARY NP	11/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1552 COFFEE ROAD	SUITE 200	MODESTO	CA	95355	3122	00	06000	37.666872	-120.975684	Stanislaus County
297116	Non-Physician Medical Practitioner	None	1437620366	0	0	ARZATE, ADRIANA PA-C	9/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	115 MALL DRIVE	None	HANFORD	CA	93230	5786	00	06000	36.32396253	-119.6688834	Kings County
297175	Non-Physician Medical Practitioner	None	1396577391	0	0	ARENAS VELASQUEZ, JULIANA PA-C	9/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	910 CAMPISI WAY	STE 2A	CAMPBELL	CA	95008	2340	00	06000	37.29090718	-121.9337266	Santa Clara County
297198	Non-Physician Medical Practitioner	None	1285197350	0	0	ANDREWS, KATHLEEN	7/24/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	508 GISON DRIVE	SUITE 150	ROSEVILLE	CA	95650	1234	00	06000	38.77866166	-121.2745528	Placer County
297203	Non-Physician Medical Practitioner	None	1376276782	0	0	ALVO, EMILY G PA-C	12/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	969 S. SANTA FE AVE	A	VISTA	CA	92083	6910	00	06000	33.1927833	-117.2316819	San Diego County
297240	Non-Physician Medical Practitioner	None	1215753124	0	0	AZZOPARDI, OLIVIA K	2/12/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	296 H ST	303	CHULA VISTA	CA	91910	4779	00	06000	32.63445985	-117.0769184	San Diego County
297265	Non-Physician Medical Practitioner	None	1952589459	0	0	ALI, MAY MAJIED	9/3/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 E VALENCIA MESA DR	SUITE 311	FULLERTON	CA	92835	3813	00	06000	33.89343304	-117.9279349	Orange County
297278	Non-Physician Medical Practitioner	None	1710318878	0	0	ALL FOR HEALTH HEALTH FOR ALL INC	9/30/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8134 FOOTHILL BLVD	None	SUNLAND	CA	91040	2941	00	06000	34.25963611	-118.3103495	Los Angeles County
297282	Non-Physician Medical Practitioner	None	1568010304	0	0	APPEL, JAIME L NP	8/25/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
297283	Non-Physician Medical Practitioner	None	1326175316	0	0	ALEXANDER-BANYS, BAMBI NP	1/10/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 WAYNE CT EAST	None	REDWOOD CITY	CA	94063	4428	00	06000	37.48032005	-122.1860892	San Mateo County
297294	Non-Physician Medical Practitioner	None	1306015425	0	0	ALTAMED HEALTH SERVICES CORP	2/13/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8041 NEWMAN AVE	None	HUNTINGTON BEACH	CA	92647	7034	00	06000	33.70481104	-117.9882948	Orange County
297310	Non-Physician Medical Practitioner	None	1407022163	0	0	AMPUDIA, MARIA T	10/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20620 CAMINO DE LOS CANT	None	YORBA LINDA	CA	92886	4699	00	06000	33.88935762	-117.7721858	Orange County
297325	Non-Physician Medical Practitioner	None	1134492937	0	0	ALTAMED HEALTH SERVICES CORP	6/29/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2219 E 1ST ST	None	LOS ANGELES	CA	90033	3901	00	06000	34.04452444	-118.2114844	Los Angeles County
297329	Non-Physician Medical Practitioner	None	1396148326	0	0	ANDAZOLA, JIMMY F PA	5/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	00	06000	37.7634502	-122.4579779	San Francisco County
297330	Non-Physician Medical Practitioner	None	1043439813	0	0	ANYAOHA, AMAKA L NP	11/14/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23035 FRIGATE AVE	None	CARSON	CA	90745	0000	00	06000	33.81599043	-118.2778237	Los Angeles County
297340	Non-Physician Medical Practitioner	None	1306526041	0	0	ABIY, TIRSIT	8/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
297360	Non-Physician Medical Practitioner	None	1194073692	0	0	AMUNDSON, JOY L NP	2/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2151 HARBOR BLVD	STE 3100	FULLERTON	CA	92835	3820	00	06000	33.89443025	-117.9288328	Orange County
297364	Non-Physician Medical Practitioner	None	1679244503	0	0	ASHDOWN, AUBREE C PA-C	3/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 FIVEPOINT	None	IRVINE	CA	92618	2377	00	06000	33.65251244	-117.7317885	Orange County
297367	Non-Physician Medical Practitioner	None	1508501883	0	0	AUSTIN, GARRETT J PA	7/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	6019	00	06000	37.97026329	-121.2890849	San Joaquin County
297379	Non-Physician Medical Practitioner	None	1366907461	0	0	AVINA, ELIZABETH C NP	8/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
297394	Non-Physician Medical Practitioner	None	1063421386	0	0	A, CAPUTO J	1/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5525 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3009	00	06000	32.781195	-117.0070695	San Diego County
297400	Non-Physician Medical Practitioner	None	1851598254	0	0	ALONGI, ANNA D	1/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23752 SUNSET CROSSING RD	None	DIAMOND BAR	CA	91765	1350	00	06000	34.03323386	-117.8049699	Los Angeles County
297449	Non-Physician Medical Practitioner	None	1184480626	0	0	AMOUR, ALEXANDRIA M PA	1/16/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
297464	Non-Physician Medical Practitioner	None	1104229483	0	0	ADAIR, RACHAEL N CNM	9/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1682 CLARA AVE	None	FORTUNA	CA	95540	3814	00	06000	40.566852	-124.1327355	Humboldt County
297473	Non-Physician Medical Practitioner	None	1699371773	0	0	ALVAREZ, ASTRID M PA-C	12/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	00	06000	34.04805253	-117.249534	San Bernardino County
297552	Non-Physician Medical Practitioner	None	1609491158	0	0	AQUINO, KAITLIN E PA-C	10/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	855 E ANAHEIM ST	None	LONG BEACH	CA	90813	3550	00	06000	33.78263447	-118.1827035	Los Angeles County
297579	Non-Physician Medical Practitioner	None	1417409954	0	0	ARNOLD, JEANNE F NP	11/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	302 NORTH KENTON CT	None	VISALIA	CA	93291	2633	00	06000	36.332244	-119.361591	Tulare County
297602	Non-Physician Medical Practitioner	None	1770697690	0	0	APPEL, MYRLEE C	7/7/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1603 TUSTIN AVE	None	COSTA MESA	CA	92627	3209	00	06000	33.62815704	-117.9146898	Orange County
297612	Non-Physician Medical Practitioner	None	1154321651	0	0	ATOIAN, ARPINE	1/13/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 N FRESNO ST	SUITE 101	FRESNO	CA	93703	1124	00	06000	36.77828036	-119.7815087	Fresno County
297621	Non-Physician Medical Practitioner	None	1174700710	0	0	ALTAMED HEALTH SERVICES CORP	4/28/1997	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5427 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4101	00	06000	34.01966132	-118.1536008	Los Angeles County
297659	Non-Physician Medical Practitioner	None	1598292476	0	0	ARONSON, LINDSAY M PA	8/9/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3883 AIRWAY DR	STE 220	SANTA ROSA	CA	95403	1671	00	06000	38.483226	-122.739705	Sonoma County
297701	Non-Physician Medical Practitioner	None	1295707743	0	0	ANQUE, VICENTA C NP	10/31/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1172 CABANA ST	None	CALEXICO	CA	92231	4405	00	06000	32.69000651	-115.4793555	Imperial County
297740	Non-Physician Medical Practitioner	None	1477975324	0	0	ALTAMED HEALTH SERVICES CORP	9/25/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	535 S 2ND AVE	None	COVINA	CA	91723	3013	00	06000	34.08008204	-117.8879145	Los Angeles County
297767	Non-Physician Medical Practitioner	None	1932425303	0	0	ANDRES, PHILIP A NP	11/10/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	208 VILLAGE WAY SOUTH	None	SAN FRANCISCO	CA	94080	4737	00	06000	37.65322857	-122.4103308	San Mateo County
297775	Non-Physician Medical Practitioner	None	1861056475	0	0	ANSARI, RYAN G PA	4/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4000 CIVIC CENTER DRIVE	206	SAN RAFAEL	CA	94903	4171	00	06000	38.0041783	-122.538861	Marin County
297824	Non-Physician Medical Practitioner	None	1205815248	0	0	ALTAMIRA, JENNIFER L NP	3/16/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	141 HYDE PARK	None	IRVINE	CA	92606	1914	00	06000	33.70579927	-117.8004897	Orange County
297848	Non-Physician Medical Practitioner	None	1710180260	0	0	AMAJOYI AGUNENYE, CECILIA O PA	3/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	00	06000	34.1010559	-117.6369445	San Bernardino County
297852	Non-Physician Medical Practitioner	None	1346992138	0	0	ADLER, DAVID J PA-C	8/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1098 FOSTER CITY BLVD	A 104	FOSTER CITY	CA	94404	2300	00	06000	37.5537827	-122.2558392	San Mateo County
297854	Non-Physician Medical Practitioner	None	1578327086	0	0	ALVARADO, EDDIE A PA	1/22/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 VETERANS BLVD	None	REDWOOD CITY	CA	94603	2037	00	06000	37.48948529	-122.2232468	San Mateo County
297880	Non-Physician Medical Practitioner	None	1184605396	0	0	ANDERSON, PAUL ROGER	7/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 N TRACY BLVD	None	TRACY	CA	95376	3451	00	06000	37.744011	-121.4349725	San Joaquin County
297929	Non-Physician Medical Practitioner	None	1962828863	0	0	ALVIZ, AMANDA	3/27/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5671 BALBOA AVE	None	SAN DIEGO	CA	92111	2705	00	06000	32.82010691	-117.1788026	San Diego County
297943	Non-Physician Medical Practitioner	None	1780963413	0	0	AUSTRIA, JOHANA V S NP	11/20/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3801 E PACIFIC COAST HWY	APT 102	LONG BEACH	CA	90804	2025	00	06000	33.78988405	-118.147383	Los Angeles County
297949	Non-Physician Medical Practitioner	None	1659563849	0	0	ALBUJAR, ROSEMARY	10/23/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9 PARK CREST COURT	APT B	NOVATO	CA	94947	4759	00	06000	38.08694148	-122.5562025	Marin County
298010	Non-Physician Medical Practitioner	None	1609161132	0	0	ARIELLA, JESSEL	12/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5501 CLAREMONT AVE APT B	None	OAKLAND	CA	94618	1181	00	06000	37.84369382	-122.2569232	Alameda County
298014	Non-Physician Medical Practitioner	None	1346682028	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	11/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1142 ROSE AVE	SUITE A	SELMA	CA	93662	3251	00	06000	36.56886527	-119.5983853	Fresno County
298016	Non-Physician Medical Practitioner	None	1417248337	0	0	ARRIAGA, PAULA ADRIANA	10/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2645 OCEAN AVE	#303	SAN FRANCISCO	CA	94132	1633	00	06000	37.73199657	-122.4739936	San Francisco County
298026	Non-Physician Medical Practitioner	None	1164083812	0	0	ACEVES, BRENDA I NP	10/7/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11234 ANDERSON ST	STE 1617	LOMA LINDA	CA	92354	2804	00	06000	34.049547	-117.264078	San Bernardino County
298034	Non-Physician Medical Practitioner	None	1477091445	0	0	AL-KHAWALDEH, AMJAD I NP	12/3/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 TECHEVAH DRIVE	None	PALM SPRINGS	CA	92262	5750	00	06000	33.83753681	-116.5424435	Riverside County
298039	Non-Physician Medical Practitioner	None	1831612589	0	0	ALTMAN, ANGELA NP	6/19/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15107 VANOWEN STREET	None	VAN NUYS	CA	91405	4542	00	06000	34.19395645	-118.463265	Los Angeles County
298045	Non-Physician Medical Practitioner	None	1760779433	0	0	AGUILAR, OLIVIA M NP	12/16/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2365 MEDLAR RD	None	TUSTIN	CA	92780	6820	00	06000	33.72318194	-117.8068513	Orange County
298055	Non-Physician Medical Practitioner	None	1669046843	0	0	ALLORO-LICHTENSTEIN, PAULA J NP	7/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2140 PROFESSIONAL DRIVE	SUITE 210 OFFICE G	ROSEVILLE	CA	95661	3776	00	06000	38.74231476	-121.2482109	Placer County
298064	Non-Physician Medical Practitioner	None	1902120421	0	0	AYELE, MAHOGANY A CNP	9/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
298098	Non-Physician Medical Practitioner	None	1578328043	0	0	ADIL, ZULHUMAR PA	4/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	100 E VALENCIA MESA DR	None	FULLERTON	CA	92835	3813	00	06000	33.89343304	-117.9279349	Orange County
298133	Non-Physician Medical Practitioner	None	1285017335	0	0	ARAUJO, JOHN G	4/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4440 SEPULVEDA BLVD	UNIT 418	SHERMAN OAKS	CA	91403	3943	00	06000	34.15090698	-118.4673232	Los Angeles County
298146	Non-Physician Medical Practitioner	None	1346260221	0	0	ARIEL, DJINA	10/27/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	632 W GIBSON RD	None	WOODLAND	CA	95616	0000	00	06000	38.66314048	-121.794696	Yolo County
298163	Non-Physician Medical Practitioner	None	1477092625	0	0	ANGERS, ALEXIS	2/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1420 S. CENTRAL AVENUE	None	GLENDALE	CA	91204	2508	00	06000	34.12811155	-118.2577764	Los Angeles County
298179	Non-Physician Medical Practitioner	None	1629307947	0	0	ABDULIAN, MARI T	4/21/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6311 MIRROR LAKE DRIVE	None	LOS ANGELES	CA	90068	1636	00	06000	34.12491279	-118.3281018	Los Angeles County
298212	Non-Physician Medical Practitioner	None	1306884598	0	0	ANDERSON, MAUDE L	11/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26859 NEW DOBBEL AVE	None	HAYWARD	CA	94542	2355	00	06000	37.65474746	-122.0488891	Alameda County
298221	Non-Physician Medical Practitioner	None	1326171273	0	0	AROCHE, MAYRA L PA-C	11/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1701 E CESAR E CHAVEZ AV	STE 230	LOS ANGELES	CA	90033	2496	00	06000	34.05112725	-118.2173921	Los Angeles County
298230	Non-Physician Medical Practitioner	None	1740526730	0	0	ANYANWU, ELIZABETH NP	9/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	73700 DINAH SHORE DR	STE 106	PALM DESERT	CA	92211	0813	00	06000	33.79748917	-116.3786855	Riverside County
298239	Non-Physician Medical Practitioner	None	1669550802	0	0	A, VERANO W	4/8/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8488 NEY AVENUE	None	OAKLAND	CA	94605	4129	00	06000	37.7621936	-122.1578665	Alameda County
298267	Non-Physician Medical Practitioner	None	1801949698	0	0	AYALA, ELDER ORLANDO	9/9/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2109 VENICE BLVD	None	LOS ANGELES	CA	90006	5224	00	06000	34.04363351	-118.302876	Los Angeles County
298281	Non-Physician Medical Practitioner	None	1427124098	0	0	ALHADHRAMI, GABULL MOHAMED	7/27/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2200 OFARRELL ST	SECOND FLOOR	SAN FRANCISCO	CA	94115	3357	00	06000	37.78224789	-122.4412946	San Francisco County
298285	Non-Physician Medical Practitioner	None	1932555323	0	0	ACOSTA, ZOILEMMA	10/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1400 BARTON ROAD	# 1016	REDLANDS	CA	92373	5455	00	06000	34.049079	-117.205767	San Bernardino County
298297	Non-Physician Medical Practitioner	None	1437441524	0	0	AKPENGBE, TONY A NP	2/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	255 N D ST	STE 400	SAN BERNARDINO	CA	92401	1715	00	06000	34.1036709	-117.291874	San Bernardino County
298306	Non-Physician Medical Practitioner	None	1053562090	0	0	ALIMI, NICOLE L	2/6/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 S BURNSIDE AVE	APT 5L	LOS ANGELES	CA	90036	5373	00	06000	34.06710047	-118.352169	Los Angeles County
298308	Non-Physician Medical Practitioner	None	1043427065	0	0	ADAMS, ELIZABETH O NP	4/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3165 ERLE ROAD	None	MARYSVILLE	CA	95901	9775	00	06000	39.102818	-121.5021088	Yuba County
298328	Non-Physician Medical Practitioner	None	1124233176	0	0	ALMARIO, ANDRELYN CALALANG	10/11/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2200 RIVER PLAZA DR	None	SACRAMENTO	CA	95833	4134	00	06000	38.605527	-121.5182925	Sacramento County
298334	Non-Physician Medical Practitioner	None	1023366515	0	0	ALVAREZ, ELIEZER L	1/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1522 N SAFFORD AVENUE	None	FRESNO	CA	93720	1640	00	06000	36.76349868	-119.8096882	Fresno County
298365	Non-Physician Medical Practitioner	None	1013348507	0	0	AJIDUAH, VALERIE O	12/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3069 DELTA TULE WAY	None	SACRAMENTO	CA	95834	1092	00	06000	38.636991	-121.5269235	Sacramento County
298378	Non-Physician Medical Practitioner	None	1306196316	0	0	ARMSTRONG, ANDREW R PA-C	2/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3525 LOMA VISTA RD	STE A	VENTURA	CA	93003	3101	00	06000	34.27680789	-119.2480851	Ventura County
298383	Non-Physician Medical Practitioner	None	1417294265	0	0	AIYVAZIAN, TALAR O	6/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7112 QUARTZ AVE	None	WINNETKA	CA	91306	3636	00	06000	34.19960199	-118.5644371	Los Angeles County
298390	Non-Physician Medical Practitioner	None	1811656549	0	0	ABHAR, SOLANGE NP	1/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1845 CHICAGO AVE	B	RIVERSIDE	CA	92507	2366	00	06000	33.994269	-117.3485375	Riverside County
298393	Non-Physician Medical Practitioner	None	1962711838	0	0	ALESSI, MARY A	3/22/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2431 GRAND CANAL	None	IRVINE	CA	92620	1899	00	06000	33.69176417	-117.7598273	Orange County
298422	Non-Physician Medical Practitioner	None	1033694302	0	0	ALHAKIM, MARIAM	1/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1110 W LA PALMA AVENUE	SUITE 1	ANAHEIM	CA	92801	2822	00	06000	33.84712953	-117.9320355	Orange County
298423	Non-Physician Medical Practitioner	None	1275057051	0	0	ALICEA, RAUL C PA-C	9/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3633 CAMINO DEL RIO S	STE 300	SAN DIEGO	CA	92108	4014	00	06000	32.77798059	-117.1163142	San Diego County
298467	Non-Physician Medical Practitioner	None	1629229745	0	0	ANTHONIA, OKEANI	4/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6279 SANDHILL CT	None	RANCHO CUCAMONGA	CA	91739	6279	00	06000	34.13996192	-117.5395671	San Bernardino County
298484	Non-Physician Medical Practitioner	None	1205215795	0	0	APPLE TREE DENTAL CALIFORNIA, INC.	9/18/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	430 N EL CAMINO REAL	None	SAN MATEO	CA	94401	3710	00	06000	37.57029119	-122.3360886	San Mateo County
298487	Non-Physician Medical Practitioner	None	1447531801	0	0	ALFARO, JESUS M JR NP	7/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	227 HILLCREST DR	None	DALY CITY	CA	94014	1028	00	06000	37.70675857	-122.4674156	San Mateo County
298518	Non-Physician Medical Practitioner	None	1417365909	0	0	ARRIGONI, JOSEFINA G NP	2/10/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13984 BLACK ROCK CIRCLE	None	MOORPARK	CA	93021	5025	00	06000	34.29561693	-118.8680125	Ventura County
298521	Non-Physician Medical Practitioner	None	1306394952	0	0	ABAD, MARIA KATRINA NP	9/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	00	06000	37.51438187	-122.2607682	San Mateo County
298530	Non-Physician Medical Practitioner	None	1982646386	0	0	AGUDELO, ELIANA Z	3/20/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1533 A 11TH AVE	None	SAN FRANCISCO	CA	94122	3614	00	06000	37.75952814	-122.4681818	San Francisco County
298534	Non-Physician Medical Practitioner	None	1104123264	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	3/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	784 N LEMOORE AVE	None	LEMOORE	CA	93245	2329	00	06000	36.306675	-119.780783	Kings County
298539	Non-Physician Medical Practitioner	None	1760723647	0	0	ABRAHAM, KYLE K PA	4/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 ESPLANADE	SUITE C	CHICO	CA	95926	3369	00	06000	39.74352822	-121.8495394	Butte County
298552	Non-Physician Medical Practitioner	None	1366811622	0	0	ABSTON, ERIN R	3/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25971 NEWPORT AVENUE	None	LOMA LINDA	CA	92354	3881	00	06000	34.04764888	-117.2377553	San Bernardino County
298588	Non-Physician Medical Practitioner	None	1427399583	0	0	ANYIKAM, CLARIBELL R	2/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2900 E LINCOLN AVE	APT 264	ANAHEIM	CA	92806	4046	00	06000	33.83622434	-117.8666225	Orange County
298669	Non-Physician Medical Practitioner	None	1750388997	0	0	APEDAILE, YOLANDA P NP	4/5/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	PO BOX 45	None	AMADOR CITY	CA	95601	0045	00	06000	0	0	None
298683	Non-Physician Medical Practitioner	None	1619587540	0	0	ABRAHAM, JOSEY	11/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
298693	Non-Physician Medical Practitioner	None	1114416773	0	0	ANDRADE, ALINA V PA	12/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 N JACKSON AVE	None	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
298705	Non-Physician Medical Practitioner	None	1215473640	0	0	AKINKUNLE, OLUKAYODE NP	2/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	610 EUCLID AVE	200	NATIONAL CITY	CA	91950	2951	00	06000	32.68419388	-117.0829524	San Diego County
298709	Non-Physician Medical Practitioner	None	1275574709	0	0	ANDERSON, ANASTASIA M	11/9/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 OCEAN AVE	SUITE 114	SANTA MONICA	CA	90402	2653	00	06000	34.02243976	-118.5077012	Los Angeles County
298711	Non-Physician Medical Practitioner	None	1447566781	0	0	ABANOBI, CHIZOMAM M NP	7/22/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	166 PANORMAMA CT	None	BREA	CA	92821	3438	00	06000	33.92998159	-117.8931481	Orange County
298745	Non-Physician Medical Practitioner	None	1104292267	0	0	ANDERSON, AMANDA L	11/30/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	550 E 8TH AVE	None	ESCONDIDO	CA	92025	5121	00	06000	33.11811065	-117.0715523	San Diego County
298797	Non-Physician Medical Practitioner	None	1154664241	0	0	ARCHENBRONN, SARAH R NP	1/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
298809	Non-Physician Medical Practitioner	None	1265664411	0	0	ALLING, SARAH ANN	12/24/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 PARNASSUS AVE	SUITE 101	SAN FRANCISCO	CA	94143	2202	00	06000	37.76344756	-122.4581992	San Francisco County
298816	Non-Physician Medical Practitioner	None	1407278393	0	0	ALTAMED HEALTH SERVICES CORP	8/7/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1776 E CENTURY BLVD	None	LOS ANGELES	CA	90002	3050	00	06000	33.94556113	-118.2413137	Los Angeles County
298838	Non-Physician Medical Practitioner	None	1528799145	0	0	ABAYA, HONEYLYNN C NP	7/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22555 ALESSANDRO BLVD	STE B	MORENO VALLEY	CA	92553	8533	00	06000	33.9169235	-117.2693745	Riverside County
298845	Non-Physician Medical Practitioner	None	1316327182	0	0	ADVENTIST HEALTH PHYSICIANS	4/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1560 E CHEVY CHASE DRIVE	SUITE 430	GLENDALE	CA	91206	4140	00	06000	34.15290734	-118.2302295	Los Angeles County
298892	Non-Physician Medical Practitioner	None	1992032940	0	0	ARMSTRONG, LYNN M NP	3/8/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26353 BELLE PORTE AVE	None	HARBOR CITY	CA	90710	3737	00	06000	33.78209179	-118.3021069	Los Angeles County
298906	Non-Physician Medical Practitioner	None	1790114668	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	11/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1419 N ACACIA AVE	#101	REEDLEY	CA	93654	2197	00	06000	36.60886182	-119.4510442	Fresno County
298936	Non-Physician Medical Practitioner	None	1871172361	0	0	ARASHEBEN, SUZAN P PA-C	8/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8631 W THIRD STREET	None	LOS ANGELES	CA	90048	5901	00	06000	34.07361928	-118.3803143	Los Angeles County
298953	Non-Physician Medical Practitioner	None	1013686286	0	0	ANDREASEN, BAILEY A NP	8/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 N. WESTERN AVE	SUITE 204	SAN BERNARDINO	CA	92411	1353	00	06000	34.1315778	-117.3182453	San Bernardino County
298971	Non-Physician Medical Practitioner	None	1992170567	0	0	ALIMAGNO, MARIA ANGELICA F NP	6/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	123 ATLANTIC AVENUE	None	LONG BEACH	CA	90802	5121	00	06000	33.7685184	-118.1850803	Los Angeles County
299039	Non-Physician Medical Practitioner	None	1982319109	0	0	ANDERSON, CHRISTINE PA	10/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2704 E WILLOW ST	None	SIGNAL HILL	CA	90755	2217	00	06000	33.80432955	-118.1594295	Los Angeles County
299055	Non-Physician Medical Practitioner	None	1922490960	0	0	AGHABY COMPREHENSIVE COMMUNITY HEALTH CENTER	8/17/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	349 W COMPTON BLVD	None	COMPTON	CA	90220	3110	00	06000	33.89598014	-118.2276822	Los Angeles County
299065	Non-Physician Medical Practitioner	None	1487239133	0	0	ALEXANDER, AMANDA NP	11/5/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2216 BUENAVENTURA BLVD	SUITE B	REDDING	CA	96001	3838	00	06000	40.55453352	-122.3904825	Shasta County
299094	Non-Physician Medical Practitioner	None	1922811207	0	0	ALVAREZ, MICHAEL PA	4/1/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	345 N RIVERSIDE AVE	None	RIALTO	CA	92376	5925	00	06000	34.10524305	-117.3702612	San Bernardino County
299106	Non-Physician Medical Practitioner	None	1700015153	0	0	AKINPELU, KARIMA Q NP	2/11/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2456 W MICHIGAN STREET	None	MILWAUKEE	WI	53233	1809	00	06000	43.03754374	-87.94466343	Milwaukee County
299117	Non-Physician Medical Practitioner	None	1497176705	0	0	APIKYAN, LUSINE NP	4/7/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	733 N HELIOTROPE DR	None	LOS ANGELES	CA	90029	2522	00	06000	34.08458643	-118.2949852	Los Angeles County
299134	Non-Physician Medical Practitioner	None	1871261271	0	0	ALARCON, TIMOTHY	3/30/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 S GRANDE AVE	None	LOS ANGELES	CA	90015	3010	00	06000	34.03719097	-118.2654105	Los Angeles County
299150	Non-Physician Medical Practitioner	None	1306884846	0	0	AMORDE, CONNIE L	8/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	553 ARROWHEAD DRIVE	None	LAFAYETTE	CA	94549	5501	00	06000	37.86313011	-122.0900376	Contra Costa County
299152	Non-Physician Medical Practitioner	None	1700391190	0	0	ALAMARES, GAMIEL NP	10/29/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23181 VERDUGO DR STE 103	None	LAGUNA HILLS	CA	92653	1313	00	06000	33.62609529	-117.7293191	Orange County
299184	Non-Physician Medical Practitioner	None	1154736429	0	0	AVENAL COMMUNITY HEALTH CENTER	9/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3554 W. MT. WHITNEY AVEN	None	RIVERDALE	CA	93656	0000	00	06000	36.43083157	-119.8619557	Fresno County
299198	Non-Physician Medical Practitioner	None	1235576190	0	0	ANDREWS, REBECCA D NP	1/30/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1 SCRIPPS DRIVE	STE 102	SACRAMENTO	CA	95825	6206	00	06000	38.573181	-121.4118135	Sacramento County
299236	Non-Physician Medical Practitioner	None	1811194491	0	0	AMSBAUGH, NICOLE L PA-C	6/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	101 CIVIC CTR LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	06000	34.480224	-114.3390555	Mohave County
299239	Non-Physician Medical Practitioner	None	1043660749	0	0	ANDREW, LAURA	2/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	37275 IRONWOOD DR	None	YUCAIPA	CA	92399	9782	00	06000	34.00838081	-116.9900866	San Bernardino County
299257	Non-Physician Medical Practitioner	None	1467198960	0	0	ANUGOM, GEORGIANA	11/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	00	06000	33.51993406	-117.1641955	Riverside County
299274	Non-Physician Medical Practitioner	None	1730481318	0	0	ALTAMED HEALTH SERVICES CORP	12/14/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1300 SOUTH SUNSET AVENUE	None	WEST COVINA	CA	91790	3342	00	06000	34.0601054	-117.9474205	Los Angeles County
299290	Non-Physician Medical Practitioner	None	1871245688	0	0	ATANGAN, RICHARD ERIC O NP	3/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3660 PARK SIERRA DR	208	RIVERSIDE	CA	92501	1768	00	06000	33.90330693	-117.4707039	Riverside County
299305	Non-Physician Medical Practitioner	None	1538228267	0	0	ALTMAN, GREG G	3/20/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13037 SNOWDROP ST	None	EASTVALE	CA	92880	3170	00	06000	33.96771126	-117.5678401	Riverside County
299327	Non-Physician Medical Practitioner	None	1952081408	0	0	ABENOJAR, SHAINA GARCIA NP	9/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1880 N ORANGE GROVE AVE	None	POMONA	CA	91767	3006	00	06000	34.07803211	-117.74833	Los Angeles County
299337	Non-Physician Medical Practitioner	None	1578029187	0	0	ANCHETA, BELINDA F CNP	11/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
299338	Non-Physician Medical Practitioner	None	1881613669	0	0	AMPLA HEALTH	2/8/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	236 W EAST AVE	None	CHICO	CA	95926	7235	00	06000	39.75480717	-121.864654	Butte County
299348	Non-Physician Medical Practitioner	None	1467529214	0	0	ALDERSON, JENNIFER C	3/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9 E YALE LOOP	None	IRVINE	CA	92604	3365	00	06000	33.68379939	-117.7900629	Orange County
299367	Non-Physician Medical Practitioner	None	1073868527	0	0	AVENAL COMMUNITY HEALTH CENTER	8/29/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	140 C ST	None	LEMOORE	CA	93245	2929	00	06000	36.30111141	-119.7823533	Kings County
299390	Non-Physician Medical Practitioner	None	1366226862	0	0	ARREDONDO, ALONDRA PA-C	2/8/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	498 W 4TH ST	None	PERRIS	CA	92570	2070	00	06000	33.78237192	-117.2367068	Riverside County
299399	Non-Physician Medical Practitioner	None	1760969562	0	0	ADENIJI, CHRYSTANYA A NP	4/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1809 W. REDLANDS BLVD	# 234	REDLANDS	CA	92373	8054	00	06000	34.06288379	-117.2156673	San Bernardino County
299409	Non-Physician Medical Practitioner	None	1790080182	0	0	AVERY, JAMES L PA	11/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1801 E MARCH LN	STE D460	STOCKTON	CA	95210	6680	00	06000	38.00315652	-121.2868715	San Joaquin County
299435	Non-Physician Medical Practitioner	None	1043716186	0	0	ABDALIAN, SHAHRIN A NP	2/11/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1398 THUNDERBIRD AVE	None	SUNNYVALE	CA	94087	3733	00	06000	37.34882371	-122.0006453	Santa Clara County
299436	Non-Physician Medical Practitioner	None	1932294279	0	0	ASTOURIAN, PATRICK C	6/4/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5565 GROSSMONT CENTER DR	BUILDING 3 SUITE 256	LA MESA	CA	91942	3020	00	06000	32.77978322	-117.0094766	San Diego County
299438	Non-Physician Medical Practitioner	None	1891000857	0	0	ANN, ROGERS L	3/29/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	401 RAILROAD ST W	None	MISSOULA	MT	59802	4109	00	06000	46.877157	-113.9963625	Missoula County
299459	Non-Physician Medical Practitioner	None	1538506134	0	0	ADAIR, NATALIE A	7/22/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	511 1/2 ORCHID AVENUE	None	CORONA DEL MAR	CA	92625	2471	00	06000	33.59616012	-117.8671775	Orange County
299498	Non-Physician Medical Practitioner	None	1376763698	0	0	AFNAN, JIA X PA-C	8/8/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3200 KEARNEY ST	None	FREMONT	CA	94538	2299	00	06000	37.54866156	-121.9750739	Alameda County
299561	Non-Physician Medical Practitioner	None	1033524384	0	0	AIKIN, JESSICA J	4/5/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2400 PACIFIC AVENUE	APT 409	SAN FRANCISCO	CA	94115	1267	00	06000	37.79334592	-122.435035	San Francisco County
299601	Non-Physician Medical Practitioner	None	1588132435	0	0	ARAUZA, TRACY L CNP	2/25/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	00	06000	39.506454	-121.5412785	Butte County
299618	Non-Physician Medical Practitioner	None	1275146110	0	0	ACDAN, GRACE NP	4/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3625 E THOUSAND OAKS BLV	SUITE #232	WESTLAKE VILLAGE	CA	91362	6932	00	06000	34.16480359	-118.8299997	Ventura County
299620	Non-Physician Medical Practitioner	None	1548334584	0	0	AO, JOVILIA V	4/22/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	729 FILBERT ST	None	SAN FRANCISCO	CA	94133	2760	00	06000	37.80103613	-122.4119083	San Francisco County
299639	Non-Physician Medical Practitioner	None	1750655353	0	0	ABU, OGBANEDI J PA	1/14/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8151 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	2300	00	06000	38.461554	-121.4167635	Sacramento County
299655	Non-Physician Medical Practitioner	None	1578579702	0	0	AUSTIN, CLAIRE A	7/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4172 CHESA LANE	None	CLOVIS	CA	93619	5129	00	06000	36.86226583	-119.6311623	Fresno County
299656	Non-Physician Medical Practitioner	None	1235641986	0	0	ANGELES, GERRALD C	6/18/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 E SECOND ST	STE 5	POMONA	CA	91766	2020	00	06000	34.05845654	-117.7423951	Los Angeles County
299684	Non-Physician Medical Practitioner	None	1336135490	0	0	ADAMS-PLESCIA, ROBIN N NP	8/3/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2945 FRANKLIN BLVD	None	SACRAMENTO	CA	95818	3515	00	06000	38.551266	-121.4754345	Sacramento County
299692	Non-Physician Medical Practitioner	None	1528308004	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	5/23/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18990 COYOTE VALLEY RD	SUITE 5	HIDDEN VALLEY LAK	CA	95467	8337	00	06000	38.79462138	-122.5574782	Lake County
299726	Non-Physician Medical Practitioner	None	1962488528	0	0	ARANDA, FRANK	4/2/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 CANAL ST	None	KING CITY	CA	93930	3458	00	06000	36.20592899	-121.1314287	Monterey County
299742	Non-Physician Medical Practitioner	None	1003134545	0	0	ASIAN HEALTH SERVICES	6/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	250 E 18TH ST FL 2	None	OAKLAND	CA	94606	1729	00	06000	37.79999844	-122.2527149	Alameda County
299752	Non-Physician Medical Practitioner	None	1598713943	0	0	AUDRAIN, ERIN B	3/26/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5112 BUTTERWOOD CIRCLE	None	ORANGEVALE	CA	95662	5606	00	06000	38.662641	-121.2043905	Sacramento County
299754	Non-Physician Medical Practitioner	None	1841692449	0	0	AMIR HASSEN, SOFIAN M NP	9/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	856 PURDUE COURT	None	MERCED	CA	95348	2143	00	06000	37.33520238	-120.482322	Merced County
299773	Non-Physician Medical Practitioner	None	1629705777	0	0	ARKALGUD, SAHANA M PA-C	11/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2335 E KASHIAN LANE	STE 220	FRESNO	CA	93701	2234	00	06000	36.74333844	-119.7831874	Fresno County
299778	Non-Physician Medical Practitioner	None	1588214795	0	0	ACEVEDO, VERONICA L NP	4/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	00	06000	34.06169385	-118.2044698	Los Angeles County
299784	Non-Physician Medical Practitioner	None	1396059606	0	0	ANDEREGG, KIMBERLY C NP	2/25/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2233 W DIVISION ST	None	CHICAGO	IL	60622	8151	00	06000	41.90303229	-87.6832947	Cook County
299785	Non-Physician Medical Practitioner	None	1578169389	0	0	ASKARI, AROOB PA	6/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
299794	Non-Physician Medical Practitioner	None	1548551997	0	0	ALAMEDA HEALTH SYSTEM	10/10/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1411 E 31ST ST	KORET BUIDLING, 6TH FLOO	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
299813	Non-Physician Medical Practitioner	None	1194376152	0	0	AHMED, WAFA H PA	1/23/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2615 CHESTER AVENUE	None	BAKERSFIELD	CA	93301	2014	00	06000	35.38333823	-119.0188872	Kern County
299826	Non-Physician Medical Practitioner	None	1679326383	0	0	AMANTE, PHILIP V NP	7/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
299827	Non-Physician Medical Practitioner	None	1710973862	0	0	ACEVES, MARIA G	6/22/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15725 POMERADO RD	SUITE 107	POWAY	CA	92064	2068	00	06000	33.00037882	-117.0580735	San Diego County
299833	Non-Physician Medical Practitioner	None	1487329413	0	0	ASAMAPHAND, CHARLES PA-C	3/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	00	06000	33.49890392	-117.1612965	Riverside County
299902	Non-Physician Medical Practitioner	None	1750661641	0	0	AMER-DAVIS, STACY KATHRYN	7/27/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2400 E 4TH ST	None	NATIONAL CITY	CA	91950	2026	00	06000	32.68637926	-117.0828839	San Diego County
299910	Non-Physician Medical Practitioner	None	1407520810	0	0	ARENDALL, MICHELLE N	7/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	350 30TH ST	100	OAKLAND	CA	94609	3422	00	06000	37.81892183	-122.2640154	Alameda County
299933	Non-Physician Medical Practitioner	None	1275084089	0	0	AHSAN, ROSMARIE H	12/10/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1610 W EDINGER AVE	STE B	SANTA ANA	CA	92704	4339	00	06000	33.72718149	-117.889506	Orange County
299991	Non-Physician Medical Practitioner	None	1124446158	0	0	ALAMEDA HEALTH SYSTEM	5/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 S SHORE CTR W	SUITE A-F	ALAMEDA	CA	94501	5762	00	06000	37.75884896	-122.2528366	Alameda County
299993	Non-Physician Medical Practitioner	None	1962963140	0	0	ALANIZ, IRENE E NP	9/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11602 HAWTHORNE BLVD	STE A	HAWTHORNE	CA	90250	3832	00	06000	33.928776	-118.3524545	Los Angeles County
300010	Non-Physician Medical Practitioner	None	1104872845	0	0	ANSORGE, MICHELE A	11/26/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	4053 TAYLOR RD	SUITE N	CHESAPEAKE	VA	23321	5537	00	06000	36.86201638	-76.40504997	Chesapeake city
300025	Non-Physician Medical Practitioner	None	1952848137	0	0	ABAD, CHELSEA M NP	8/10/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
300029	Non-Physician Medical Practitioner	None	1912297268	0	0	ALBERTONI, MICHELLE MIKA	1/11/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 WEST MACARTHUR	None	OAKLAND	CA	94611	5641	00	06000	37.82397231	-122.2578822	Alameda County
300045	Non-Physician Medical Practitioner	None	1972658607	0	0	AMEZCUA, IGNACIO S	8/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	802 LINDA COURT	None	WALNUT	CA	91789	4344	00	06000	34.02785428	-117.8741403	Los Angeles County
300078	Non-Physician Medical Practitioner	None	1376798413	0	0	ASIAN AND PACIFIC ISLANDER WELLNESS CENTER, INC.	6/2/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	726 POLK ST	4TH FLOOR	SAN FRANCISCO	CA	94109	0000	00	06000	37.78379532	-122.4192766	San Francisco County
300090	Non-Physician Medical Practitioner	None	1780270595	0	0	ALMARIO, PAMELA Y NP	5/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4312 WOODMAN AVENUE	SUITE 102	SHERMAN OAKS	CA	91423	5546	00	06000	34.148637	-118.4312035	Los Angeles County
300095	Non-Physician Medical Practitioner	None	1720231368	0	0	AHANONU, CECILIA	9/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
300102	Non-Physician Medical Practitioner	None	1700572393	0	0	ATTIOGBE-AGBEMADON, DEDE	6/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
300112	Non-Physician Medical Practitioner	None	1669932588	0	0	ABED, FARZANA NP	4/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2025 SOQUEL AVE	None	SANTA CRUZ	CA	95062	1323	00	06000	36.98191238	-121.9975767	Santa Cruz County
300154	Non-Physician Medical Practitioner	None	1588835953	0	0	ALVARADO, LIZEL	6/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	15504 95TH STREET	None	FLORISSANT	MO	63034	2157	00	06000	38.82798878	-90.30245775	St. Louis County
300160	Non-Physician Medical Practitioner	None	1083352397	0	0	ANDREWS, STEVEN R PA-C	6/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1400 EAST CHURCH ST	None	SANTA MARIA	CA	93454	5906	00	06000	34.95203385	-120.4131707	Santa Barbara County
300169	Non-Physician Medical Practitioner	None	1124766852	0	0	ASHRAF, FATIMA NP	9/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	800 S MAIN ST	None	CORONA	CA	92882	3420	00	06000	33.872958	-117.568359	Riverside County
300188	Non-Physician Medical Practitioner	None	1730355173	0	0	ABBONDANZA, TARA NP	9/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	289 W HUNTINGTON DR	SUITE 410	ARCADIA	CA	91007	3495	00	06000	34.13549119	-118.0419175	Los Angeles County
300198	Non-Physician Medical Practitioner	None	1457766107	0	0	ABBOTT, COREY M NP	1/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5353 G STREET	None	CHINO	CA	91710	5249	00	06000	34.00987149	-117.6880905	San Bernardino County
300210	Non-Physician Medical Practitioner	None	1699127316	0	0	ADVENTIST HEALTH PHYSICIANS	11/23/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	515 S FAIRMONT AVENUE	None	LODI	CA	95240	3834	00	06000	38.12786821	-121.2859247	San Joaquin County
300250	Non-Physician Medical Practitioner	None	1811329899	0	0	AMPLA HEALTH	12/5/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7981 HIGHWAY 99E	None	LOS MOLINOS	CA	96055	9782	00	06000	40.02757963	-122.0999188	Tehama County
300270	Non-Physician Medical Practitioner	None	1285798298	0	0	ABOLFAZLI, ALI NP	3/24/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2235A MARKET ST	None	SAN FRANCISCO	CA	94114	1612	00	06000	37.76515224	-122.4317011	San Francisco County
300299	Non-Physician Medical Practitioner	None	1619435815	0	0	ALICBUSAN, JENNIFER C NP	2/19/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1100 TRANCAS ST	SUITE 201	NAPA	CA	94558	2904	00	06000	38.32316569	-122.2981938	Napa County
300347	Non-Physician Medical Practitioner	None	1528731403	0	0	ANDREW, SHIRLEY A NP	8/18/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	838 NORDAHL ROAD	STE 300	SAN MARCOS	CA	92069	3595	00	06000	33.13569751	-117.1191477	San Diego County
300366	Non-Physician Medical Practitioner	None	1538173745	0	0	AVELAR, LILIANA PA	1/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	00	06000	33.78673844	-118.2965289	Los Angeles County
300390	Non-Physician Medical Practitioner	None	1992328975	0	0	AMANO, JOSHUA E PA-C	7/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39141 CIVIC CENTER DR	STE 335	FREMONT	CA	94538	5831	00	06000	37.55436307	-121.9764708	Alameda County
300414	Non-Physician Medical Practitioner	None	1376136770	0	0	AGUILAR, JIRA JANE B NP	7/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8001 FROST STREET	None	SAN DIEGO	CA	92123	2746	00	06000	32.802147	-117.151371	San Diego County
300422	Non-Physician Medical Practitioner	None	1093178261	0	0	ABAO, PAMELA JOY R NP	9/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27201 TOURNEY RD	STE 200D	VALENCIA	CA	91381	1016	00	06000	34.41741018	-118.5770409	Los Angeles County
300444	Non-Physician Medical Practitioner	None	1720611650	0	0	ALDRED, JENNIFER NP	3/16/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2725 CAPITOL AVE	None	SACRAMENTO	CA	95816	6004	00	06000	38.571084	-121.471074	Sacramento County
300448	Non-Physician Medical Practitioner	None	1760521728	0	0	ADAMS, ERIN J	11/21/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	47 LONG LOTS ROAD	None	WESTPORT	CT	06880	3800	00	06000	41.144355	-73.3322115	Western Connecticut Planning Region
300471	Non-Physician Medical Practitioner	None	1750399796	0	0	ALLIANCE MEDICAL CENTER	4/24/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1381 UNIVERSITY AVE	None	HEALDSBURG	CA	95448	3314	00	06000	38.62757555	-122.8638141	Sonoma County
300528	Non-Physician Medical Practitioner	None	1770058349	0	0	ANDERSON, TARA L PA-C	4/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 FIVEPOINT	None	IRVINE	CA	92618	2377	00	06000	33.65251244	-117.7317885	Orange County
300542	Non-Physician Medical Practitioner	None	1689139396	0	0	ARVIZU, PALOMA NP	9/24/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	760 OTAY LAKES RD	None	CHULA VISTA	CA	91910	6915	00	06000	32.64603447	-117.0015068	San Diego County
300553	Non-Physician Medical Practitioner	None	1073103594	0	0	ALCAZAR, ASHLENE NP	8/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	888 LAKESIDE VILLAGE COM	None	CHICO	CA	95926	2281	00	06000	39.750084	-121.7934327	Butte County
300561	Non-Physician Medical Practitioner	None	1427793835	0	0	ABREU, ALEXIS A NP	4/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9481 PITTSBURGH AVE	200	RANCHO CUCAMONGA	CA	91730	9021	00	06000	34.08094188	-117.5559944	San Bernardino County
300571	Non-Physician Medical Practitioner	None	1346617594	0	0	AKHIMIEN, PATIENCE R NP	7/21/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8710 MONROE CT	SUITE 150	RANCHO CUCAMONGA	CA	91730	4883	00	06000	34.09544496	-117.5747968	San Bernardino County
300577	Non-Physician Medical Practitioner	None	1730653866	0	0	AMIS, JOSEPH P PA-C	7/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3525 LOMA VISTA ROAD	SUITE A	VENTURA	CA	93003	3165	00	06000	34.27680789	-119.2480851	Ventura County
300597	Non-Physician Medical Practitioner	None	1922625409	0	0	ARITA, BRIAN S PA-C	3/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 MT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
300606	Non-Physician Medical Practitioner	None	1891716080	0	0	AURIGEMMA, RONDA	9/7/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	100 MARIO CAPECCHI DR	None	SALT LAKE CITY	UT	84113	1103	00	06000	40.77048596	-111.8394574	Salt Lake County
300633	Non-Physician Medical Practitioner	None	1003891649	0	0	ANCONA, JOHN L	5/31/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4819 I ST	None	SACRAMENTO	CA	95819	3541	00	06000	38.568834	-121.4421795	Sacramento County
300681	Non-Physician Medical Practitioner	None	1770271280	0	0	ADENEYE, OMOROGIUWA NP	7/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3625 E THOUSAND OAKS BLV	SUITE #232	WESTLAKE VILLAGE	CA	91362	6932	00	06000	34.16480359	-118.8299997	Ventura County
300720	Non-Physician Medical Practitioner	None	1023011632	0	0	ALTURA CENTERS FOR HEALTH	6/6/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1101 N CHERRY ST	None	TULARE	CA	93274	2231	00	06000	36.22333808	-119.337575	Tulare County
300727	Non-Physician Medical Practitioner	None	1477153252	0	0	ANCHETA, DIANE NP	2/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2203 17TH ST	None	BAKERSFIELD	CA	93301	3604	00	06000	35.37431634	-119.0272969	Kern County
300732	Non-Physician Medical Practitioner	None	1053777342	0	0	ACOSTA, KELLIE M	4/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	275 N CHORRO	APT E	SAN LUIS OBISPO	CA	93405	3320	00	06000	35.29577642	-120.6723389	San Luis Obispo County
300735	Non-Physician Medical Practitioner	None	1508008129	0	0	AVERIA-SUBOC, MONICA	7/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 EASTLAKE AVE	NOR8302E	LOS ANGELES	CA	90089	0112	00	06000	34.06169385	-118.2044698	Los Angeles County
300737	Non-Physician Medical Practitioner	None	1346759875	0	0	ALESSI, ANDREA L	5/2/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5568 TABLE TOP LANE	None	LAS VEGAS	NV	89135	4052	00	06000	36.08729939	-115.3173968	Clark County
300756	Non-Physician Medical Practitioner	None	1588961676	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	3/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15322 LAKESHORE DR	SUITE 201	CLEARLAKE	CA	95422	9814	00	06000	38.95045805	-122.6255271	Lake County
300759	Non-Physician Medical Practitioner	None	1447927538	0	0	AVILA, ANGELICA NP	11/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8150 HAGEMAN RD	None	BAKERSFIELD	CA	93312	1959	00	06000	35.40166449	-119.0933415	Kern County
300769	Non-Physician Medical Practitioner	None	1356901821	0	0	ANDERSON, NICOLE M NP	7/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22555 ALESSANDRO BLVD	STE B	MORENO VALLEY	CA	92553	8533	00	06000	33.9169235	-117.2693745	Riverside County
300778	Non-Physician Medical Practitioner	None	1518427129	0	0	ANZULOVIC, RADOVAN PA	12/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 E OCEAN AVE	None	LOMPOC	CA	93436	7092	00	06000	34.63941491	-120.4393023	Santa Barbara County
300796	Non-Physician Medical Practitioner	None	1891200614	0	0	AMEZQUITA, CLARISSA NP	4/23/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
300822	Non-Physician Medical Practitioner	None	1013445774	0	0	ARKFELD, JOELLE M PA-C	8/24/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2101 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4836	00	06000	34.13502	-117.2758635	San Bernardino County
300830	Non-Physician Medical Practitioner	None	1235403775	0	0	ALLINA, EMILY K	4/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5079 BAYARD ST	None	SAN DIEGO	CA	92109	1702	00	06000	32.80700952	-117.2562551	San Diego County
300868	Non-Physician Medical Practitioner	None	1407101447	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	6/17/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 S CHEVY CHASE DR	SUITE #105	GLENDALE	CA	91205	4431	00	06000	34.136757	-118.2396195	Los Angeles County
300880	Non-Physician Medical Practitioner	None	1699954628	0	0	ADNEY, RACHEL LEIGH	3/4/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	730 WELCH RD	None	PALO ALTO	CA	94304	1503	00	06000	37.43731858	-122.1746139	Santa Clara County
300882	Non-Physician Medical Practitioner	None	1952875957	0	0	ABRAHAM, MICHELLE R	2/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6009 FALLING RAIN CT	None	ELK GROVE	CA	95757	8338	00	06000	38.406186	-121.433139	Sacramento County
300903	Non-Physician Medical Practitioner	None	1831559848	0	0	ALDACO, CARLA M NP	11/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13516 PERRY DRIVE	None	VISALIA	CA	93292	9348	00	06000	36.36666551	-119.272113	Tulare County
300912	Non-Physician Medical Practitioner	None	1467752626	0	0	ALL CARE ONE COMMUNITY HEALTH CENTER	2/10/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7300 SANTA FE AVE.	None	HUNTINGTON PARK	CA	90255	7531	00	06000	33.97358236	-118.2302503	Los Angeles County
300928	Non-Physician Medical Practitioner	None	1780460832	0	0	ALCARAZ CERVANTES, VIVIAN T	10/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9610 STOCKDALE HWY	UNIT B	BAKERSFIELD	CA	93311	3626	00	06000	35.35454145	-119.1097215	Kern County
301017	Non-Physician Medical Practitioner	None	1235562224	0	0	AVENAL COMMUNITY HEALTH CENTER	3/11/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 SKYLINE BLVD	None	AVENAL	CA	93204	1850	00	06000	36.00790722	-120.1216067	Kings County
301039	Non-Physician Medical Practitioner	None	1992807796	0	0	ANGEL, AUDREY M NP	7/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9243 TURNER LN	None	DURHAM	CA	95938	9634	00	06000	39.64003133	-121.8123759	Butte County
301043	Non-Physician Medical Practitioner	None	1023672342	0	0	ADDUCCI, JOSEPH PA-C	2/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2455 JEFFERSON BLVD	STE 100	WEST SACRAMENTO	CA	95691	5313	00	06000	38.55304251	-121.5367185	Yolo County
301050	Non-Physician Medical Practitioner	None	1295145712	0	0	ANDERSON, SCOTT L	1/15/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	305 TERRY LYNN AVENUE	None	MOUNT SHASTA	CA	96067	2039	00	06000	41.32256953	-122.3079075	Siskiyou County
301073	Non-Physician Medical Practitioner	None	1235376047	0	0	ALTAMED HEALTH SERVICES CORP	4/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1820 W LINCOLN AVE	None	ANAHEIM	CA	92801	6730	00	06000	33.83242148	-117.946809	Orange County
301074	Non-Physician Medical Practitioner	None	1487033213	0	0	ABRAMIAN, ARIN V NP	6/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8350 POOLE AVENUE	None	SUN VALLEY	CA	91352	3556	00	06000	34.22292057	-118.3628405	Los Angeles County
301087	Non-Physician Medical Practitioner	None	1982350385	0	0	AUSTIN, MAGDALENA M NP	6/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	123 ATLANTIC AVENUE	None	LONG BEACH	CA	90802	5121	00	06000	33.7685184	-118.1850803	Los Angeles County
301089	Non-Physician Medical Practitioner	None	1023821972	0	0	ARNOLD, LUKE PA-C	4/11/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1640 NEWPORT BLVD	SUITE 210	COSTA MESA	CA	92627	3786	00	06000	33.63437128	-117.9221659	Orange County
301104	Non-Physician Medical Practitioner	None	1518364405	0	0	ATHAVALE, ANITA A	6/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15271 OAK RIDGE WAY	None	LOS GATOS	CA	95030	2323	00	06000	37.24654383	-121.9696767	Santa Clara County
301127	Non-Physician Medical Practitioner	None	1225387616	0	0	AVENAL COMMUNITY HEALTH CENTER	1/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 SKYLINE BLVD	MOBILE UNIT 1	AVENAL	CA	93204	1850	00	06000	36.00790722	-120.1216067	Kings County
301136	Non-Physician Medical Practitioner	None	1932758596	0	0	ALLEN, SAMANTHA M NP	10/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
301137	Non-Physician Medical Practitioner	None	1245438118	0	0	APARICIO, JUAN C	4/6/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1805 WARWICK AVE	None	SANTA MONICA	CA	90404	5036	00	06000	34.02919514	-118.4583931	Los Angeles County
301145	Non-Physician Medical Practitioner	None	1225251135	0	0	ANDERSEN, ERIN	8/18/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1600 DIVISADERO ST # 166	UCSF EMPLOYEE AND OCCUPA	SAN FRANCISCO	CA	94115	3010	00	06000	37.78475261	-122.43973	San Francisco County
301187	Non-Physician Medical Practitioner	None	1134353121	0	0	ALTERMAN, DIANE L	6/19/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2012 HIGHLAND AVE	None	MANHATTAN BEACH	CA	90266	4562	00	06000	33.89090062	-118.4130707	Los Angeles County
301203	Non-Physician Medical Practitioner	None	1639299647	0	0	AGUIRRE, AURELIO T	10/3/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1316 CORDON DRIVE	None	LOS ANGELES	CA	90063	3203	00	06000	34.05424565	-118.1748426	Los Angeles County
301204	Non-Physician Medical Practitioner	None	1467231829	0	0	AVILA, MERCEDES NP	12/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1223 16TH STREET 3RD FLO	SUITE 3100 PODS A AND B	SANTA MONICA	CA	90404	1275	00	06000	34.02773198	-118.4862675	Los Angeles County
301216	Non-Physician Medical Practitioner	None	1174073886	0	0	AFRAH-BOATENG, ALICIA A PA	1/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10243 GENETIC CENTER DR	None	SAN DIEGO	CA	92121	6310	00	06000	32.90618683	-117.1814064	San Diego County
301223	Non-Physician Medical Practitioner	None	1174554414	0	0	ALVAREZ, JUAN A	10/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6583 E CETTI AVE	None	FRESNO	CA	93727	5883	00	06000	36.72517985	-119.6711542	Fresno County
301231	Non-Physician Medical Practitioner	None	1760901763	0	0	ALIBRANDO, KAITLYN PA	8/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
301340	Non-Physician Medical Practitioner	None	1093586067	0	0	ARMIJO, ETIENNE PA-C	3/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1401 GARCES HWY	None	DELANO	CA	93215	3660	00	06000	35.76144847	-119.238912	Kern County
301423	Non-Physician Medical Practitioner	None	1568693265	0	0	APPLEGATE, CHAD LEE	5/25/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	615 W CHERRY COURT	None	VISALIA	CA	93277	6679	00	06000	36.307728	-119.297853	Tulare County
301452	Non-Physician Medical Practitioner	None	1972998649	0	0	APARICIO, SYLVIA A NP	11/23/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25 RALL AVENUE	None	CLOVIS	CA	93612	4493	00	06000	36.80414222	-119.7085217	Fresno County
301471	Non-Physician Medical Practitioner	None	1407397672	0	0	ADEDIPE, ADEKEMI T NP	2/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	00	06000	33.12181055	-117.2840499	San Diego County
301476	Non-Physician Medical Practitioner	None	1093887622	0	0	ADAMS, NOHRA REBECCA	11/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5440 THORNWOOD DR	None	SAN JOSE	CA	95123	1217	00	06000	37.25346406	-121.8609675	Santa Clara County
301499	Non-Physician Medical Practitioner	None	1477191062	0	0	ATKINS, JUSTIN D NP	6/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12740 HESPERIA	SUITE A	VICTORVILLE	CA	92395	8306	00	06000	34.48256788	-117.2905361	San Bernardino County
301513	Non-Physician Medical Practitioner	None	1104360627	0	0	ABDELSAMIE, NISRIN E NP	8/8/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5671 HARMONY DR	None	EASTVALE	CA	91752	7604	00	06000	33.985035	-117.5567855	Riverside County
301518	Non-Physician Medical Practitioner	None	1174814289	0	0	AJAYI, IJEOMA C	8/6/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	919 HERITAGE DR	APT 28	RIDGECREST	CA	93555	5547	00	06000	35.63815199	-117.6759425	Kern County
301522	Non-Physician Medical Practitioner	None	1417136664	0	0	ALEXANDER, NANCY L PA	11/23/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13438 ROGUE RIVER DR	None	RANCHO CUCAMONGA	CA	91739	2060	00	06000	34.12686961	-117.5115485	San Bernardino County
301557	Non-Physician Medical Practitioner	None	1861908238	0	0	ANDERSON, ALLISON RN CPNP	8/11/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2303 CAMINO RAMON	SUITE 150	SAN RAMON	CA	94583	1392	00	06000	37.77552084	-121.9658366	Contra Costa County
301565	Non-Physician Medical Practitioner	None	1053821553	0	0	ADAMS, KIMBERLY B NP	4/2/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	260 SAN JOSE ST	None	SALINAS	CA	93901	3901	00	06000	36.65808446	-121.6456618	Monterey County
301596	Non-Physician Medical Practitioner	None	1003488214	0	0	ADHAM, SHIVA	8/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	5437 KIETZKE LANE	None	RENO	NV	89511	1088	00	06000	39.46515231	-119.7902663	Washoe County
301604	Non-Physician Medical Practitioner	None	1710430129	0	0	ASSEFA, BETELHEM	3/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
301632	Non-Physician Medical Practitioner	None	1083348494	0	0	ABELIAN, KATRIN PA-C	3/17/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8635 W 3RD ST	STE 485W	LOS ANGELES	CA	90048	6121	00	06000	34.07361928	-118.3803143	Los Angeles County
301654	Non-Physician Medical Practitioner	None	1346559440	0	0	ANDERSEN, GRETCHEN J	2/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14650 AVIATION BLVD	STE 210	HAWTHORNE	CA	90250	6688	00	06000	33.898788	-118.3786825	Los Angeles County
301661	Non-Physician Medical Practitioner	None	1215371745	0	0	ALLEN, LINDSAY E	1/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	805 PAGE ST	None	SAN FRANCISCO	CA	94117	2342	00	06000	37.77255057	-122.4343289	San Francisco County
301671	Non-Physician Medical Practitioner	None	1205543758	0	0	ANNUNZIATA, CASSANDRA F PA-C	3/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	799 MAIN ST	STE D	HALF MOON BAY	CA	94019	1996	00	06000	37.45841679	-122.4300072	San Mateo County
301680	Non-Physician Medical Practitioner	None	1780650028	0	0	ADAIR, THOMAS GLENN	4/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5160 N FRESNO ST	None	FRESNO	CA	93710	6825	00	06000	36.811512	-119.7813445	Fresno County
301697	Non-Physician Medical Practitioner	None	1487921037	0	0	ANDRES, GERMAINE BLAS	7/19/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	ROOM B-220	WEST HOLLYWOOD	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
301728	Non-Physician Medical Practitioner	None	1437583259	0	0	ANDERSON, JENNIFER X NP	5/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4111 TROUT GULCH ROAD	None	APTOS	CA	95003	2661	00	06000	37.02180054	-121.884297	Santa Cruz County
301753	Non-Physician Medical Practitioner	None	1114991825	0	0	AGNEW, ROBYN M CNM	6/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	641 LOMA DRIVE	None	HERMOSA BEACH	CA	90254	5011	00	06000	33.85893328	-118.3962866	Los Angeles County
301772	Non-Physician Medical Practitioner	None	1609249994	0	0	AXIS COMMUNITY HEALTH INC	5/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5925 W LAS POSITAS BLVD	STE 100	PLEASANTON	CA	94588	6239	00	06000	37.68360997	-121.8990082	Alameda County
301793	Non-Physician Medical Practitioner	None	1700491644	0	0	ALDINOV, KYRA PA-C	6/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16850 BEAR VALLEY RD	None	VICTORVILLE	CA	92395	5794	00	06000	34.47092468	-117.2977236	San Bernardino County
301812	Non-Physician Medical Practitioner	None	1245774793	0	0	AFROOKHTEH, MAHSA PA	2/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6440 PLATT AVE	None	WEST HILLS	CA	91307	3216	00	06000	34.18784988	-118.6427021	Los Angeles County
301825	Non-Physician Medical Practitioner	None	1518276161	0	0	APOSTLE, JODIE L	11/25/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	348 PINE AVE	APT A10	CARLSBAD	CA	92008	3187	00	06000	33.1566067	-117.3483892	San Diego County
301830	Non-Physician Medical Practitioner	None	1982229563	0	0	ALLEN, DELROY C PA-C	3/4/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
301838	Non-Physician Medical Practitioner	None	1669880787	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	12/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 E CESAR E CHAVEZ AV	#3000	LOS ANGELES	CA	90033	2424	00	06000	34.05101259	-118.217259	Los Angeles County
301843	Non-Physician Medical Practitioner	None	1780280594	0	0	ADKISON, SARA K PA-C	1/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1150 MAIN ST	STE 3	WATSONVILLE	CA	95076	3760	00	06000	36.9163164	-121.7698107	Santa Cruz County
301845	Non-Physician Medical Practitioner	None	1508079906	0	0	AMINI, TARA	2/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	912 S POMELO WAY	None	FULLERTON	CA	92832	2647	00	06000	33.86320654	-117.9400545	Orange County
301867	Non-Physician Medical Practitioner	None	1336335611	0	0	ALBANO, ANABEL	5/29/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	167 FREDERICK ST	None	SANTA CRUZ	CA	95062	3470	00	06000	36.97200754	-122.0026416	Santa Cruz County
301919	Non-Physician Medical Practitioner	None	1932964822	0	0	ABDELMESEH, MOURAD PA	9/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10880 WILSHIRE BLVD	1101	LOS ANGELES	CA	90024	4112	00	06000	34.05897499	-118.4431123	Los Angeles County
301941	Non-Physician Medical Practitioner	None	1720647225	0	0	ARNOPOLE, DAVID M	1/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4900 COMMERCE DR	None	BAKERSFIELD	CA	93309	0418	00	06000	35.3696013	-119.0558857	Kern County
301951	Non-Physician Medical Practitioner	None	1023524691	0	0	AZIZ, SHARARAH NP	5/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2433 CENTRAL AVENUE	SUITE A	ALAMEDA	CA	94501	4564	00	06000	37.76358675	-122.2413153	Alameda County
301956	Non-Physician Medical Practitioner	None	1992137970	0	0	ADIBE, CHRISTINA	6/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 LIGHTHOUSE AVE	None	MONTEREY	CA	93940	1439	00	06000	36.61275747	-121.9010674	Monterey County
302050	Non-Physician Medical Practitioner	None	1740427657	0	0	ALTAMED HEALTH SERVICES CORP	4/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1400 N MAIN ST	None	SANTA ANA	CA	92701	2304	00	06000	33.75688822	-117.8676134	Orange County
302071	Non-Physician Medical Practitioner	None	1437412905	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	11/8/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 S CHEVY CHASE DR	SUITE #102	GLENDALE	CA	91205	4431	00	06000	34.136757	-118.2396195	Los Angeles County
302098	Non-Physician Medical Practitioner	None	1083976294	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	11/8/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1560 E CHEVY CHASE DR	SUITE#245	GLENDALE	CA	91206	4197	00	06000	34.15290734	-118.2302295	Los Angeles County
302118	Non-Physician Medical Practitioner	None	1982358602	0	0	ARELLANO, JACQUELINE	7/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3186 S MARYLAND PKWY	None	LAS VEGAS	NV	89109	2317	00	06000	36.132948	-115.136874	Clark County
302135	Non-Physician Medical Practitioner	None	1457617755	0	0	ALTAMED HEALTH SERVICES CORP	5/11/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2321 W WHITTIER BLVD	None	MONTEBELLO	CA	90640	3006	00	06000	34.01365821	-118.1257857	Los Angeles County
302137	Non-Physician Medical Practitioner	None	1033380761	0	0	ARLU, MORALES S	8/12/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4211 AVALON BLVD	SUITE A	LOS ANGELES	CA	90011	5622	00	06000	34.007238	-118.2653065	Los Angeles County
302154	Non-Physician Medical Practitioner	None	1609059062	0	0	AGUARISTI, MARICELA E	12/24/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1530 MISSION AVENIDA	None	MORGAN HILL	CA	95123	3928	00	06000	37.1574285	-121.6443663	Santa Clara County
302184	Non-Physician Medical Practitioner	None	1013286939	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	11/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9330 STOCKDALE HWY	SUITE 400	BAKERSFIELD	CA	93311	3614	00	06000	35.35452946	-119.106351	Kern County
302190	Non-Physician Medical Practitioner	None	1598284648	0	0	ANDERSON, JOCELYN R PA-C	3/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1155 MILL ST	None	RENO	NV	89502	1576	00	06000	39.52483792	-119.7968314	Washoe County
302207	Non-Physician Medical Practitioner	None	1922837624	0	0	AVALOS, ERICA NP	1/30/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2898 LINDEN AVE	None	LONG BEACH	CA	90806	1627	00	06000	33.809688	-118.1868115	Los Angeles County
302225	Non-Physician Medical Practitioner	None	1205522083	0	0	AGUILAR, SHERLITA NP	3/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8260 MIRA MESA BLVD	SUITE A	SAN DIEGO	CA	92126	2662	00	06000	32.91277002	-117.1459433	San Diego County
302232	Non-Physician Medical Practitioner	None	1639409048	0	0	ABRAHAMS, MARLIE J	4/15/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1331 W CENTRAL AVE	STE 69	SANTA ANA	CA	92704	5778	00	06000	33.71315829	-117.8871056	Orange County
302267	Non-Physician Medical Practitioner	None	1417644121	0	0	ALVES, MYA A PA-C	11/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	00	06000	40.78355148	-124.1420294	Humboldt County
302283	Non-Physician Medical Practitioner	None	1023085560	0	0	ALVA, WENDY M NP	2/24/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2845 ECHO VALLEY ROAD	None	JAMUL	CA	91935	3027	00	06000	32.70445985	-116.9019527	San Diego County
302287	Non-Physician Medical Practitioner	None	1699134254	0	0	AHMED, FARZANA A PA-C	3/26/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
302294	Non-Physician Medical Practitioner	None	1134648595	0	0	ALLEN, TYCHELLE NP	1/7/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1465 65TH STREET	None	EMERYVILLE	CA	94608	1167	00	06000	37.84647527	-122.2928393	Alameda County
302295	Non-Physician Medical Practitioner	None	1952792467	0	0	AHINASI, SONNIA NP	10/3/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	540 W BASELINE RD	SUITE 3	CLAREMONT	CA	91711	1612	00	06000	34.12158153	-117.723276	Los Angeles County
302300	Non-Physician Medical Practitioner	None	1548514888	0	0	ADLER-CHAI, SARAH E NP	11/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	00	06000	37.592811	-122.382351	San Mateo County
302319	Non-Physician Medical Practitioner	None	1306068473	0	0	ALEXANDER, DAVID HASHIMY	12/27/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2080 CENTURY PARK E. #12	None	LOS ANGELES	CA	90067	0000	00	06000	34.05887194	-118.4122914	Los Angeles County
302334	Non-Physician Medical Practitioner	None	1629653761	0	0	ACEBEDO, ETHELYNE J NP	10/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8120 TIMBERLAKE WAY	SUITE 107	SACRAMENTO	CA	95823	5413	00	06000	38.461023	-121.41414	Sacramento County
302350	Non-Physician Medical Practitioner	None	1891168118	0	0	AMAYA, OLIVIA	3/19/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
302380	Non-Physician Medical Practitioner	None	1891083804	0	0	AHN, KATHLEEN G NP	5/4/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3233 MINNESOTA AVE	None	COSTA MESA	CA	92626	2212	00	06000	33.68858568	-117.9313411	Orange County
302384	Non-Physician Medical Practitioner	None	1003080318	0	0	AVECILLA, ERRILL C	2/3/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	123 CANNES CT	None	FAIRFIELD	CA	94534	7518	00	06000	38.27949008	-122.0669605	Solano County
302397	Non-Physician Medical Practitioner	None	1700490661	0	0	AVELLAN, MICHAEL PA-C	11/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
302418	Non-Physician Medical Practitioner	None	1144569534	0	0	ARMENTA, MAYA L	9/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	268 EAST SECOND AVE	None	CHICO	CA	95926	3391	00	06000	39.73988167	-121.8441066	Butte County
302432	Non-Physician Medical Practitioner	None	1376722884	0	0	ANTENORCRUZ, ANTHONY JAMES	5/14/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	585 N MOUNTAIN AVE	SUITE A	UPLAND	CA	91786	8516	00	06000	34.10114204	-117.6702497	San Bernardino County
302435	Non-Physician Medical Practitioner	None	1598239881	0	0	ABRAMSON, SHELBY NP	1/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2440 FENTON ST	STE 100	CHULA VISTA	CA	91914	3516	00	06000	32.65165623	-116.9555131	San Diego County
302459	Non-Physician Medical Practitioner	None	1346783974	0	0	AINZA, CHRISTINE M NP	1/3/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	45 CASTRO ST	175A	SAN FRANCISCO	CA	94114	1010	00	06000	37.76829732	-122.4357056	San Francisco County
302462	Non-Physician Medical Practitioner	None	1871036772	0	0	ASRAT, ALEMSEGED A	1/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2946 N APRICOT AVE	None	FRESNO	CA	93727	8674	00	06000	36.77833599	-119.6689028	Fresno County
302492	Non-Physician Medical Practitioner	None	1992002083	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	3/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15322 LAKESHORE DR	SUITE 102	CLEARLAKE	CA	95422	9814	00	06000	38.95045805	-122.6255271	Lake County
302508	Non-Physician Medical Practitioner	None	1205996386	0	0	ANDERSON, PATRICIA N NP	6/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23053 WINDOM ST	APT K2017	PALYA DEL REY	CA	90293	8371	00	06000	0	0	None
302515	Non-Physician Medical Practitioner	None	1770963589	0	0	ALLEN, MATTHEW G	8/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3380 HARDING STREET	APT 23	CARLSBAD	CA	92008	2461	00	06000	33.15803882	-117.3413549	San Diego County
302542	Non-Physician Medical Practitioner	None	1467851147	0	0	AGATEP, ELOISA F NP	8/21/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	77160 CALIFORNIA DRIVE	None	PALM DESERT	CA	92211	7870	00	06000	33.73562559	-116.3179649	Riverside County
302544	Non-Physician Medical Practitioner	None	1346715307	0	0	ADMASSIE, BIRHANU Z NP	11/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4059 LOST CANYON CT	None	ANTIOCH	CA	94531	8280	00	06000	37.96754804	-121.8028684	Contra Costa County
302569	Non-Physician Medical Practitioner	None	1427310648	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	11/8/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 S CHEVY CHASE DR	SUITE #200	GLENDALE	CA	91205	4431	00	06000	34.136757	-118.2396195	Los Angeles County
302592	Non-Physician Medical Practitioner	None	1487924007	0	0	ANDERSON, JUSTIN B	3/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8912 BELLSHIRE DR	None	HUNTINGTON BEACH	CA	92646	4617	00	06000	33.67066712	-117.972302	Orange County
302607	Non-Physician Medical Practitioner	None	1770920787	0	0	ALLAN HANCOCK COLLEGE	12/23/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	800 S COLLEGE DR	None	SANTA MARIA	CA	93454	6399	00	06000	34.94385	-120.421485	Santa Barbara County
302614	Non-Physician Medical Practitioner	None	1407323322	0	0	ALBU, LUCIA PA-C	3/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7551 MADISON AVE	None	CITRUS HEIGHTS	CA	95610	7449	00	06000	38.664333	-121.2879735	Sacramento County
302622	Non-Physician Medical Practitioner	None	1962868844	0	0	ADVINCULA, SAMUEL C NP	3/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1002 MCCALL DR	None	CORONA	CA	92881	8451	00	06000	33.82832534	-117.5604	Riverside County
302627	Non-Physician Medical Practitioner	None	1316523319	0	0	ACEVEDO CARRASCO, ANGEL PA	8/29/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	251 COHASSET	None	CHICO	CA	95926	2241	00	06000	39.75090044	-121.8522609	Butte County
302643	Non-Physician Medical Practitioner	None	1861256117	0	0	ALONSO, ANTHONY ALLAN PA-C	10/15/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18225 BROOKHURST STREET	SUITE 5	FOUNTAIN VALLEY	CA	92708	6719	00	06000	33.69890502	-117.9544165	Orange County
302673	Non-Physician Medical Practitioner	None	1811087232	0	0	ANTONIO, ANNA MB NP	11/19/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	267 JOYCE DRIVE	None	VACAVILLE	CA	95687	7625	00	06000	38.33357152	-121.9402935	Solano County
302680	Non-Physician Medical Practitioner	None	1689925984	0	0	ALBERT, JESSICA K	5/18/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2231 ARCHWAY	None	IRVINE	CA	92618	8823	00	06000	33.69534323	-117.714053	Orange County
302682	Non-Physician Medical Practitioner	None	1477318558	0	0	ARROGANTE, CATHERINE L NP	2/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	330 W RAMSEY ST	None	BANNING	CA	92220	4823	00	06000	33.92540549	-116.8802908	Riverside County
302705	Non-Physician Medical Practitioner	None	1235653148	0	0	ALBRIGHT, KELSEY A PA	7/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
302748	Non-Physician Medical Practitioner	None	1548366461	0	0	ANDERSON, LAURIE	6/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	0000	00	06000	34.129683	-117.970857	Los Angeles County
302761	Non-Physician Medical Practitioner	None	1528510542	0	0	ARTILES, MARCELA D NP	1/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	FIVE MEDICAL PLAZA	STE 190	ROSEVILLE	CA	95661	2865	00	06000	38.76523677	-121.2493453	Placer County
302767	Non-Physician Medical Practitioner	None	1760651814	0	0	ALTAMED HEALTH SERVICES CORP	4/9/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2720 S BRISTOL ST	SUITE 110	SANTA ANA	CA	92704	6207	00	06000	33.710463	-117.8854565	Orange County
302850	Non-Physician Medical Practitioner	None	1023340379	0	0	AGRAWAL, ANJALI	9/8/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11208 FREER ST	None	ARCADIA	CA	91006	5922	00	06000	34.10120262	-118.0246175	Los Angeles County
302871	Non-Physician Medical Practitioner	None	1285913970	0	0	ADAMS, JONATHAN T	4/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1355 EAST ST	SUITE 200	REDDING	CA	96001	0801	00	06000	40.58628506	-122.3887911	Shasta County
302880	Non-Physician Medical Practitioner	None	1821358375	0	0	ACEVES, THADEO J PA-C	1/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	00	06000	37.66508443	-120.9962589	Stanislaus County
302901	Non-Physician Medical Practitioner	None	1952612368	0	0	ALLEN, KELLIE A NP	4/28/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2847 FALCON RIDGE DR	None	SPARKS	NV	89436	7044	00	06000	39.59668027	-119.6912725	Washoe County
302925	Non-Physician Medical Practitioner	None	1306491121	0	0	ALI, SAMI A PA-C	10/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 E CESAR E CHAVEZ AV	SUITE 2500	LOS ANGELES	CA	90033	2434	00	06000	34.05101259	-118.217259	Los Angeles County
302976	Non-Physician Medical Practitioner	None	1851472021	0	0	AKABA, MIMI T NP	1/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4050 DUBLIN BLVD	None	DUBLIN	CA	94568	3112	00	06000	37.70554251	-121.873005	Alameda County
303033	Non-Physician Medical Practitioner	None	1407451065	0	0	AMOR, RONALYN M NP	3/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10 SANTA ROSA ST	STE 201	SAN LUIS OBISPO	CA	93405	5825	00	06000	35.29325417	-120.667547	San Luis Obispo County
303078	Non-Physician Medical Practitioner	None	1003851593	0	0	ANDERSON, LISA C	11/10/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 W FERN AVE	None	REDLANDS	CA	92373	5916	00	06000	34.05016907	-117.1793443	San Bernardino County
303086	Non-Physician Medical Practitioner	None	1912785049	0	0	ASSUMMA, COURTNEY PA-C	11/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28780 SINGLE OAK DRIVE	SUITE 160	TEMECULA	CA	92590	5528	00	06000	33.49890392	-117.1612965	Riverside County
303102	Non-Physician Medical Practitioner	None	1528636891	0	0	AZAROV, MARIYA S NP	9/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	515 MICHIGAN BLVD	None	WEST SACRAMENTO	CA	95691	2705	00	06000	38.58298316	-121.5265736	Yolo County
303168	Non-Physician Medical Practitioner	None	1770503708	0	0	ANGELA, BOGETTI-DUMLAO	11/24/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2315 STOCKTON BLVD	HOUSESTAFF BLDG., RM 101	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
303189	Non-Physician Medical Practitioner	None	1760021026	0	0	ALVAREZ-HUGHES, AMANDA	3/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
303190	Non-Physician Medical Practitioner	None	1093256828	0	0	ADAMS, BRIAN J NP	5/4/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1591 MIDNIGHT SUN DR	None	BEAUMONT	CA	92223	8441	00	06000	33.9446473	-116.9503756	Riverside County
303212	Non-Physician Medical Practitioner	None	1942586623	0	0	ALONZO, SILVIA	6/24/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2019 E CHERRY HILL COURT	None	ONTARIO	CA	91761	6427	00	06000	34.027785	-117.607923	San Bernardino County
303224	Non-Physician Medical Practitioner	None	1962745554	0	0	ANTONIO, CYNTHIA NP	9/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 S ANAHEIM BLVD	UNIT 1	ANAHEIM	CA	92805	7715	00	06000	33.83195477	-117.9128052	Orange County
303239	Non-Physician Medical Practitioner	None	1144880790	0	0	ATTAR, ASHLEY J PA-C	10/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3000 Q STREET	3RD FLOOR	SACRAMENTO	CA	95816	7058	00	06000	38.564991	-121.4696565	Sacramento County
303276	Non-Physician Medical Practitioner	None	1295799021	0	0	ARABIAN, VAHE	2/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1121 GRAYNOLD AVE	None	GLENDALE	CA	91202	2018	00	06000	34.16355394	-118.2777402	Los Angeles County
303290	Non-Physician Medical Practitioner	None	1538409818	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	5/23/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18990 COYOTE VALLEY RD	SUITE 8	HIDDEN VALLEY LAK	CA	95467	8337	00	06000	38.79462138	-122.5574782	Lake County
303293	Non-Physician Medical Practitioner	None	1407385149	0	0	AGYEMANG-BOAKYE, GILBERT NP	1/17/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6079 N FRESNO ST	SUITE 101	FRESNO	CA	93710	5276	00	06000	36.824301	-119.781437	Fresno County
303309	Non-Physician Medical Practitioner	None	1891276630	0	0	ANDREW, BRIAN P PA-C	3/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	101 CIVIC CTR LN	None	LAKE HAVASU CITY	AZ	86403	5607	00	06000	34.480224	-114.3390555	Mohave County
303314	Non-Physician Medical Practitioner	None	1205333135	0	0	ARYAL, DIKSHYA CNM	10/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	77 CADILLAC DR	STE 230	SACRAMENTO	CA	95825	5453	00	06000	38.572551	-121.4181585	Sacramento County
303332	Non-Physician Medical Practitioner	None	1942507009	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	3/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	470 GREENFIELD AVE	SUITE #202	HANFORD	CA	93230	3576	00	06000	36.32996137	-119.6580167	Kings County
303334	Non-Physician Medical Practitioner	None	1831188028	0	0	ANDREW, ROSEMARY BERNADETTE	11/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2615 E CLINTON AVE	VA MEDICAL CENTER SURGIC	FRESNO	CA	93703	2223	00	06000	36.77230594	-119.7792767	Fresno County
303381	Non-Physician Medical Practitioner	None	1851898209	0	0	ANTWI, ELVI A NP	3/30/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1332 W HERNDON AVE	STE 101	FRESNO	CA	93711	7118	00	06000	36.83737137	-119.8148304	Fresno County
303387	Non-Physician Medical Practitioner	None	1861851958	0	0	ACKERMAN, MARY ALICE NP	11/5/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8536 WILSHIRE BLVD	None	BEVERLY HILLS	CA	90211	3103	00	06000	34.06550726	-118.3775199	Los Angeles County
303391	Non-Physician Medical Practitioner	None	1104451541	0	0	AKOTO, LYNDA S NP	5/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15434 W SAGE ST	None	VICTORVILLE	CA	92395	3965	00	06000	34.51210263	-117.3272335	San Bernardino County
303406	Non-Physician Medical Practitioner	None	1154348829	0	0	A, KREIFELDT K	1/1/2000	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4561 DICKEY DR	None	LA MESA	CA	91941	5735	00	06000	32.761873	-116.9695045	San Diego County
303420	Non-Physician Medical Practitioner	None	1710513064	0	0	AYERS, KELSEY C PA	1/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
303470	Non-Physician Medical Practitioner	None	1902175623	0	0	A, ASFAHANI L PA-C	2/8/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25455 BARTON RD	STE 204-B	LOMA LINDA	CA	92354	3128	00	06000	34.04805253	-117.249534	San Bernardino County
303521	Non-Physician Medical Practitioner	None	1336717487	0	0	AMBRIZ, SONYA RN PNP	8/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3203 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	5831	00	06000	33.97264641	-118.2101997	Los Angeles County
303538	Non-Physician Medical Practitioner	None	1659428621	0	0	ASKINS, KISHLA ANNE	11/26/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	34800 BOB WILSON DR	NMCSD	SAN DIEGO	CA	92134	1098	00	06000	32.724567	-117.145467	San Diego County
303552	Non-Physician Medical Practitioner	None	1710425392	0	0	ANAND, SARABJIT S NP	7/18/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20540 E ARROW HWY	B	COVINA	CA	91724	1208	00	06000	34.10659351	-117.853677	Los Angeles County
303569	Non-Physician Medical Practitioner	None	1710199674	0	0	ANTELOPE VALLEY COMMUNITY CLINIC	8/6/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	45104 10TH ST W	None	LANCASTER	CA	93534	2310	00	06000	34.702929	-118.1480935	Los Angeles County
303597	Non-Physician Medical Practitioner	None	1982854865	0	0	AMEZCUA, WENDY J PA-C	2/8/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7774 CHERRY AVE	None	FONTANA	CA	92336	4014	00	06000	34.11281482	-117.488717	San Bernardino County
303601	Non-Physician Medical Practitioner	None	1093469413	0	0	ASHIQ, NAZIA PA	9/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	555 EAST HARDY STREET	None	INGLEWOOD	CA	90301	4011	00	06000	33.94909549	-118.3481595	Los Angeles County
303602	Non-Physician Medical Practitioner	None	1427235027	0	0	AQUINO, SUSAN G.	7/29/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1177 N PARK AVE	None	POMONA	CA	91768	3028	00	06000	34.06950662	-117.7549507	Los Angeles County
303608	Non-Physician Medical Practitioner	None	1477611549	0	0	ASH, PATRICIA NP	10/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1247 UPLAND HILLS DR S	None	UPLAND	CA	91786	2440	00	06000	34.11991526	-117.633377	San Bernardino County
303619	Non-Physician Medical Practitioner	None	1689067290	0	0	ARIZMENDI-HOLGUIN, WANDA D NP	10/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1140 N STEPHORA AVE	None	COVINA	CA	91724	1628	00	06000	34.1003885	-117.8523607	Los Angeles County
303621	Non-Physician Medical Practitioner	None	1457087892	0	0	AWOSIKA, OLUMIDE O NP	12/7/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5838 EDISON PL	None	CARLSBAD	CA	92008	5520	00	06000	33.12181055	-117.2840499	San Diego County
303708	Non-Physician Medical Practitioner	None	1124403993	0	0	ALVARADO, LIZA P T NP	10/19/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	37763 KINGBIRD PLACE	None	MURRIETA	CA	92563	7918	00	06000	33.57082664	-117.1566131	Riverside County
303726	Non-Physician Medical Practitioner	None	1174552020	0	0	ARDELEAN, RHONDA SUE	10/22/2003	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	704 GOLD HILL RD	SUITE 1200	FORT MILL	SC	29715	8906	00	06000	35.06096921	-80.95402504	York County
303731	Non-Physician Medical Practitioner	None	1033954128	0	0	ADKINS, LAUREN	8/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6969 BROCKTON AVE	SUITE A-B	RIVERSIDE	CA	92506	3809	00	06000	33.94701	-117.396786	Riverside County
303787	Non-Physician Medical Practitioner	None	1962045922	0	0	ALARAN, YASMIN A PA	12/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9850 GENESEE AVE	SUITE 440	SAN DIEGO	CA	92037	1212	00	06000	32.882913	-117.226341	San Diego County
303794	Non-Physician Medical Practitioner	None	1396999777	0	0	ANSARI, MITRA	6/13/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	962 APPALACHIAN	None	CLAREMONT	CA	91711	8306	00	06000	34.14827239	-117.699685	Los Angeles County
303810	Non-Physician Medical Practitioner	None	1639875982	0	0	AGUILAR, BRENDA E NP	5/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	955 W IMPERIAL HWY	SUITE 110	BREA	CA	92821	3812	00	06000	33.91745451	-117.9133065	Orange County
303838	Non-Physician Medical Practitioner	None	1902813710	0	0	ATEN, MARGARET J	12/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26917 COLUMBIA WAY	None	TEHACHAPI	CA	93561	9235	00	06000	35.16347908	-118.6064784	Kern County
303842	Non-Physician Medical Practitioner	None	1114104858	0	0	ALTAMED HEALTH SERVICES CORP	4/28/1997	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10454 E VALLEY BLVD	None	EL MONTE	CA	91731	0000	00	06000	34.07636122	-118.0447845	Los Angeles County
303858	Non-Physician Medical Practitioner	None	1376947648	0	0	AMADEO, MICHAEL A NP	12/18/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	45196 AVENIDA MANESSA	None	OCEANSIDE	CA	92057	7746	00	06000	33.22175893	-117.2979209	San Diego County
303861	Non-Physician Medical Practitioner	None	1336925254	0	0	ANUCHA, KRISTEN E NP	9/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3941 SAN DIMAS STREET	BLDG 104	BAKERSFIELD	CA	93301	5734	00	06000	35.39552345	-119.0082184	Kern County
303872	Non-Physician Medical Practitioner	None	1144789538	0	0	ACEVEDO, VIVIAN PA-C	6/11/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26520 CACTUS AVE	None	MORENO VALLEY	CA	92555	3927	00	06000	33.912117	-117.195849	Riverside County
303890	Non-Physician Medical Practitioner	None	1003046061	0	0	ALLWARDT, RACHELLE C NP	2/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2248 QUARRY WY	None	ROCKLIN	CA	95765	4292	00	06000	38.79765237	-121.2734437	Placer County
303923	Non-Physician Medical Practitioner	None	1871948133	0	0	ANASIS, MARIA NP	11/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 CORPORATE POINTE	STE 465	CULVER CITY	CA	90230	8706	00	06000	33.98867148	-118.3837334	Los Angeles County
303938	Non-Physician Medical Practitioner	None	1316504541	0	0	ANTON, NESREN A NP	11/28/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2400 BALFOUR RD	STE 302	BRENTWOOD	CA	94513	4955	00	06000	37.92519383	-121.734461	Contra Costa County
303940	Non-Physician Medical Practitioner	None	1467726380	0	0	ANTONIO, LANI D II	6/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4672 PRAIRIE FALCON WAY	None	TURLOCK	CA	95382	7468	00	06000	37.53574795	-120.8283497	Stanislaus County
303969	Non-Physician Medical Practitioner	None	1598938284	0	0	AVECILLA, ERRILL C	11/6/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	123 CANNES CT	None	FAIRFIELD	CA	94534	7518	00	06000	38.27949008	-122.0669605	Solano County
303993	Non-Physician Medical Practitioner	None	1437414190	0	0	ALTAMED HEALTH SERVICES CORP	8/17/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1300 N VERMONT AVE	PATIENT TOWER, FIRST FLO	LOS ANGELES	CA	90027	6005	00	06000	34.0956033	-118.2916918	Los Angeles County
303996	Non-Physician Medical Practitioner	None	1528658531	0	0	ANDERSON, ZULFIA PA	2/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	847 W CHILDS AVE	None	MERCED	CA	95341	6805	00	06000	37.28825369	-120.4963159	Merced County
304014	Non-Physician Medical Practitioner	None	1851419220	0	0	ASTORGA, ALEJANDRA CRUZ	9/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1855 N FAIR OAKS AVE STE	None	PASADENA	CA	91103	1620	00	06000	34.177806	-118.1507985	Los Angeles County
304021	Non-Physician Medical Practitioner	None	1902924814	0	0	ASTRID, SIDARTA	11/6/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2601 W ALAMEDA AVE	SUITE 101	BURBANK	CA	91505	4800	00	06000	34.15783817	-118.3293969	Los Angeles County
304051	Non-Physician Medical Practitioner	None	1811130370	0	0	ABDOU, CANDICE E	9/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	993 TENNESSEE ST	UNIT 10	SAN FRANCISCO	CA	94107	3092	00	06000	37.75966139	-122.3893993	San Francisco County
304062	Non-Physician Medical Practitioner	None	1891167029	0	0	ADAMS, NICOLE E NP	6/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1037 BOULDER PLACE	None	OCEANSIDE	CA	92057	1957	00	06000	33.27293088	-117.2951593	San Diego County
304095	Non-Physician Medical Practitioner	None	1225096738	0	0	ADAMS, JOY L NP	2/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2632 N MOONEY BLVD	None	VISALIA	CA	93291	2459	00	06000	36.353412	-119.314035	Tulare County
304101	Non-Physician Medical Practitioner	None	1881214237	0	0	ABIDO, KIMBERLY N NP	12/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 THE CITY DR S	STE 1A	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
304171	Non-Physician Medical Practitioner	None	1548654916	0	0	ABCEDE, EMILY A NP	4/14/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
304191	Non-Physician Medical Practitioner	None	1295449171	0	0	AN, RACHEL	8/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
304197	Non-Physician Medical Practitioner	None	1316287055	0	0	ASPER, KARIZZA B NP	3/22/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	982 HISSE DRIVE	None	SAN JACINTO	CA	92583	2037	00	06000	33.76667067	-116.9441447	Riverside County
304200	Non-Physician Medical Practitioner	None	1548449572	0	0	AGBO, OKWII G NP	11/13/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3543 N 60TH ST	None	LOS ANGELES	CA	90043	3015	00	06000	33.98539751	-118.3345065	Los Angeles County
304201	Non-Physician Medical Practitioner	None	1174613624	0	0	AUSTIN, ADRIANA M NP	9/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1260 15TH STREET	1501, 1502	SANTA MONICA	CA	90404	1150	00	06000	34.02648965	-118.4867439	Los Angeles County
304259	Non-Physician Medical Practitioner	None	1609504745	0	0	AWUAH OTCHERE, PRINCESS NP	1/20/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6079 N FRESNO ST	SUITE 101	FRESNO	CA	93710	5276	00	06000	36.824301	-119.781437	Fresno County
304266	Non-Physician Medical Practitioner	None	1700815958	0	0	AXTELL-KELLY, CARYN J PA-C	10/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	802 MAGNOLIA AVE	SUITE 206	CORONA	CA	92879	3104	00	06000	33.8596449	-117.5529774	Riverside County
304315	Non-Physician Medical Practitioner	None	1033307343	0	0	ADELMAN, TRAVIS B.	2/13/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7512 MORRO ROAD	None	ATASCADERO	CA	93422	4404	00	06000	35.47716258	-120.6674786	San Luis Obispo County
304329	Non-Physician Medical Practitioner	None	1083810766	0	0	ADINOLFI, NANCY	6/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1006 KIWI COURT	None	MERCED	CA	95348	1960	00	06000	37.33770844	-120.4593964	Merced County
304338	Non-Physician Medical Practitioner	None	1265444582	0	0	AUSTIN, HEATHER J PA-C	1/9/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	212 SAN JOSE ST	STE 301	SALINAS	CA	93901	3928	00	06000	36.65853377	-121.6476066	Monterey County
304352	Non-Physician Medical Practitioner	None	1316128754	0	0	AUER, DAVID PA-C	1/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	760 OTAY LAKES RD	None	CHULA VISTA	CA	91910	6915	00	06000	32.64603447	-117.0015068	San Diego County
304353	Non-Physician Medical Practitioner	None	1821478231	0	0	ARANAS, JAI-AR R NP	12/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	308 W WEEPING WILLOW	None	ORANGE	CA	92865	1089	00	06000	33.84023538	-117.8567937	Orange County
304365	Non-Physician Medical Practitioner	None	1366734220	0	0	A, CLAYTON J	6/11/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4589 DAUER AVENUE	None	LA MESA	CA	91942	8771	00	06000	32.762187	-117.0412105	San Diego County
304394	Non-Physician Medical Practitioner	None	1134964372	0	0	ADIDALA, VETZREL PA-C	9/6/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
304408	Non-Physician Medical Practitioner	None	1568706232	0	0	APARICIO, JOHANNA NP	2/26/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2712 MANHATTAN AVE	UNIT A	MANHATTAN BEACH	CA	90266	2171	00	06000	33.89476327	-118.4162801	Los Angeles County
304433	Non-Physician Medical Practitioner	None	1639277254	0	0	ALINO, JANETTE CUNANAN	9/14/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	17163 BIG OAK LN	None	YORBA LINDA	CA	92886	6229	00	06000	33.91221592	-117.8343125	Orange County
304443	Non-Physician Medical Practitioner	None	1780930867	0	0	ASMUTH, KATHERINE E NP	5/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	95 THIRD ST	None	SAN FRANCISCO	CA	94103	3103	00	06000	37.78653271	-122.402286	San Francisco County
304448	Non-Physician Medical Practitioner	None	1275535221	0	0	AUGUST-SCHWARTZ, SUZANNE LORRAINE	3/12/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3466 MT DIABLO BLVD	STE C100	LAFAYETTE	CA	94549	3952	00	06000	37.89256947	-122.1150289	Contra Costa County
304449	Non-Physician Medical Practitioner	None	1164793279	0	0	AGAHI, MAHSHID NP	12/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 E HARDY ST	STE 200	INGLEWOOD	CA	90301	4057	00	06000	33.9491005	-118.348857	Los Angeles County
304454	Non-Physician Medical Practitioner	None	1992392898	0	0	ASEFIRAD, ANAHITA P PA-C	4/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3851 SOTO STREET	None	VERNON	CA	90058	1718	00	06000	34.00717527	-118.2197322	Los Angeles County
304475	Non-Physician Medical Practitioner	None	1427598267	0	0	ABEYTA, JOSETTE M CNP	3/10/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10775 PIONEER TRL	STE 215	TRUCKEE	CA	96161	0234	00	06000	39.33573744	-120.180872	Nevada County
304487	Non-Physician Medical Practitioner	None	1578828604	0	0	ARAYA, NATALIE L PA	3/30/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	911 MORAGA RD STE 200	None	LAFAYETTE	CA	94549	4500	00	06000	37.88758326	-122.1181419	Contra Costa County
304519	Non-Physician Medical Practitioner	None	1558462515	0	0	AKBARI, MOHAMMAD A	12/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26115 STALLION ROAD	None	MORENO VALLEY	CA	92555	3309	00	06000	33.87988272	-117.2081917	Riverside County
304528	Non-Physician Medical Practitioner	None	1609988344	0	0	AMPIE, DAN	1/15/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	36442 TORREY PINES DRIVE	None	BEAUMONT	CA	92223	8016	00	06000	33.95110217	-117.023389	Riverside County
304543	Non-Physician Medical Practitioner	None	1265128953	0	0	ARIF, SARAH PA	8/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9508 STOCKDALE HWY	SUITE 150	BAKERSFIELD	CA	93311	3622	00	06000	35.35453237	-119.1086014	Kern County
304576	Non-Physician Medical Practitioner	None	1265016489	0	0	AHMAD, SHABANA CNP	5/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14114 BUSINESS CENTER DR	STE A	MORENO VALLEY	CA	92553	9113	00	06000	33.9148002	-117.2714647	Riverside County
304602	Non-Physician Medical Practitioner	None	1689936692	0	0	ARELLANO, DENA C NP	5/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1549 CARMEL CT	None	REDLANDS	CA	92374	2716	00	06000	34.07479468	-117.140293	San Bernardino County
304604	Non-Physician Medical Practitioner	None	1962769109	0	0	ASSUMMA, LORRAINE NP	2/26/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41880 KALMIA ST	SUITE 100	MURRIETA	CA	92562	8835	00	06000	33.55740114	-117.2157733	Riverside County
304623	Non-Physician Medical Practitioner	None	1932376209	0	0	ALISHARAN, CALLIE HALL	1/25/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3100 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	3866	00	06000	38.74399612	-121.2349547	Placer County
304644	Non-Physician Medical Practitioner	None	1558051946	0	0	AH SUE, JEREMY J PA-C	10/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	372 W CYPRESS AVE	None	REEDLEY	CA	93654	2113	00	06000	36.60784193	-119.4520057	Fresno County
304647	Non-Physician Medical Practitioner	None	1083940712	0	0	ABERNATHY, LATOYA DENISE	4/22/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	8399 ALMEDA RD	SUITE L	HOUSTON	TX	77054	7119	00	06000	29.68608704	-95.39109133	Harris County
304656	Non-Physician Medical Practitioner	None	1780142752	0	0	ASAI, MACKENZI K NP	11/9/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1131 WILSHIRE BLVD	100	SANTA MONICA	CA	90401	2072	00	06000	34.02509887	-118.4909994	Los Angeles County
304666	Non-Physician Medical Practitioner	None	1619193208	0	0	AVINA, NORMA E NP	2/2/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	241 LOUISIANA PL	None	OXNARD	CA	93036	1210	00	06000	34.24100923	-119.1701775	Ventura County
304680	Non-Physician Medical Practitioner	None	1588752026	0	0	ATKINSON, ALLISON L	1/8/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10993 CAMPBELL AVE	None	RIVERSIDE	CA	92505	2439	00	06000	33.93301975	-117.4938239	Riverside County
304681	Non-Physician Medical Practitioner	None	1932793270	0	0	AGUILAR, MICHELLE I NP	5/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1000 E LATHAM AVE	None	HEMET	CA	92543	4409	00	06000	33.74942449	-116.961741	Riverside County
304724	Non-Physician Medical Practitioner	None	1730284332	0	0	AYERS, KAREN JANE	6/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2700 DOLBEER ST	None	EUREKA	CA	95501	4736	00	06000	40.78355148	-124.1420294	Humboldt County
304756	Non-Physician Medical Practitioner	None	1598078230	0	0	ASHTON, ANDREA	2/27/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15733 WHITTIER BLVD	None	WHITTIER	CA	90603	2312	00	06000	33.94402086	-117.9922473	Los Angeles County
304770	Non-Physician Medical Practitioner	None	1679242143	0	0	ARMENDARIZ, AMANDA A PA-C	8/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11822 FLORAL DR	None	WHITTIER	CA	90601	2900	00	06000	33.99172377	-118.0495187	Los Angeles County
304845	Non-Physician Medical Practitioner	None	1235899766	0	0	ARASTU, NAAZNEEN S PA	3/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15855 POMONA RINCON RD	BLDG 4	CHINO HILLS	CA	91709	3162	00	06000	33.96437546	-117.6900161	San Bernardino County
304846	Non-Physician Medical Practitioner	None	1902288277	0	0	ADVENTIST HEALTH PHYSICIANS	4/11/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 S VIRGIL AVE	SUITE 300	LOS ANGELES	CA	90020	1406	00	06000	34.064883	-118.287086	Los Angeles County
304869	Non-Physician Medical Practitioner	None	1437620283	0	0	ACOSTA, JOANNA PA-C	7/6/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	236 W COLLEGE ST	None	COVINA	CA	91723	1902	00	06000	34.08746822	-117.8933488	Los Angeles County
304873	Non-Physician Medical Practitioner	None	1902667819	0	0	ARELLANO, ANGELICA M PA	9/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2335 E KASHIAN LANE	SUITE 280	FRESNO	CA	93701	2211	00	06000	36.74333844	-119.7831874	Fresno County
304878	Non-Physician Medical Practitioner	None	1710412499	0	0	AZMI, HALA M PA-C	1/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27640 EUCALYPTUS AVE	None	MORENO VALLEY	CA	92555	4557	00	06000	33.93749258	-117.1807371	Riverside County
304897	Non-Physician Medical Practitioner	None	1154949451	0	0	AUEYONG, ORADEE B NP	5/27/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18564 US HWY 18	104	APPLE VALLEY	CA	92307	2321	00	06000	34.53926652	-117.2592564	San Bernardino County
304921	Non-Physician Medical Practitioner	None	1124186614	0	0	AGUILAR, DENISE	3/17/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	522 E TEAGUE AVE	None	FRESNO	CA	93720	1700	00	06000	36.8591883	-119.7734836	Fresno County
304924	Non-Physician Medical Practitioner	None	1457633364	0	0	ALL FOR HEALTH HEALTH FOR ALL INC	7/8/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	520 E BROADWAY	None	GLENDALE	CA	91205	4926	00	06000	34.14630672	-118.2492813	Los Angeles County
304969	Non-Physician Medical Practitioner	None	1548849631	0	0	AVAKIAN, ARMINE NP	4/8/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	601 S WESTMORELAND AVE	None	LOS ANGELES	CA	90005	3999	00	06000	34.06348495	-118.28845	Los Angeles County
304971	Non-Physician Medical Practitioner	None	1134398043	0	0	ALTAMED HEALTH SERVICES CORP	2/13/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2223 W 1ST ST	None	SANTA ANA	CA	92703	3505	00	06000	33.7453773	-117.8990221	Orange County
304982	Non-Physician Medical Practitioner	None	1689277527	0	0	ABEDI, HOVIK NP	10/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	801 S CHEVY CHASE DR	STE 101	GLENDALE	CA	91205	4437	00	06000	34.136757	-118.2396195	Los Angeles County
304999	Non-Physician Medical Practitioner	None	1790319796	0	0	AGUILAR, AMY L NP	7/19/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1901 TOWN AND COUNTRY DR	SUITE 104	NORCO	CA	92860	3611	00	06000	33.92721419	-117.561448	Riverside County
305014	Non-Physician Medical Practitioner	None	1083210017	0	0	ALGAZZALI, AHLAM M PA-C	2/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20101 LAKE CHABOT RD	1ST FLOOR	CASTRO VALLEY	CA	94546	5305	00	06000	37.69819004	-122.0873124	Alameda County
305016	Non-Physician Medical Practitioner	None	1841428042	0	0	ALKASS, SAM PA-C	3/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1740 ROSECRANS ST	None	SAN DIEGO	CA	92106	1928	00	06000	32.72903913	-117.2254885	San Diego County
305023	Non-Physician Medical Practitioner	None	1487254850	0	0	AJAMI, ROLA	10/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
305102	Non-Physician Medical Practitioner	None	1831491091	0	0	AUSTIN, ROSA M NP	1/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2256 HEAVENLY WAY	None	LODI	CA	95242	4490	00	06000	38.10604805	-121.3004294	San Joaquin County
305115	Non-Physician Medical Practitioner	None	1174820344	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	3/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3727 BUCHANAN ST	SUITE. 310	SAN FRANCISCO	CA	94123	5410	00	06000	37.80442377	-122.4336192	San Francisco County
305191	Non-Physician Medical Practitioner	None	1164960167	0	0	AHN, JI H NP	11/28/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2030 DRISCOLL DR	None	RENO	NV	89509	3070	00	06000	39.50112107	-119.8468383	Washoe County
305222	Non-Physician Medical Practitioner	None	1780033084	0	0	ADVENTIST HEALTH PHYSICIANS	11/23/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 S FAIRMONT AVENUE	SUITE 100	LODI	CA	95240	5140	00	06000	38.1206163	-121.2858323	San Joaquin County
305226	Non-Physician Medical Practitioner	None	1437647732	0	0	ADABIE, NANA EFUA D NP	5/19/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
305251	Non-Physician Medical Practitioner	None	1689656928	0	0	ASHLEY, LISA MARIE	7/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2516 STOCKTON BLVD	TICON LL	SACRAMENTO	CA	95817	2208	00	06000	38.552409	-121.456647	Sacramento County
305299	Non-Physician Medical Practitioner	None	1487136909	0	0	AKOPYAN, NELLI NP	5/8/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18133 VENTURA BLVD	200 2ND FLOOR	TARZANA	CA	91356	3616	00	06000	34.1657808	-118.5283188	Los Angeles County
305311	Non-Physician Medical Practitioner	None	1497415715	0	0	ALMERO, MARYANN C NP	2/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1845 CHICAGO AVE	B	RIVERSIDE	CA	92507	2366	00	06000	33.994269	-117.3485375	Riverside County
305371	Non-Physician Medical Practitioner	None	1881081339	0	0	ANTHONY, HENRY A NP	9/27/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	341 BUENA VISTA DR	None	COALINGA	CA	93210	9252	00	06000	36.15505586	-120.3493024	Fresno County
305419	Non-Physician Medical Practitioner	None	1033744040	0	0	AVELAR-RIOS, CLAUDIA PA-C	9/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
305430	Non-Physician Medical Practitioner	None	1437672722	0	0	AQUINO, MARGIE BELINDA N NP	6/28/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
305439	Non-Physician Medical Practitioner	None	1619566254	0	0	AMBRIZ, NATALIE PA-C	3/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	333 HEGENBERGER RD	STE 100	OAKLAND	CA	94621	1452	00	06000	37.7350428	-122.1976624	Alameda County
305449	Non-Physician Medical Practitioner	None	1104354455	0	0	AMBERS, ASHLEY C	9/22/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5830 GREEN VALLEY CIR	None	CULVER CITY	CA	90054	0679	00	06000	33.98312161	-118.3886943	Los Angeles County
305484	Non-Physician Medical Practitioner	None	1093220998	0	0	ALIX, CHRISTOPHER S NP	1/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2615 CHESTER AVENUE	None	BAKERSFIELD	CA	93301	2014	00	06000	35.38333823	-119.0188872	Kern County
305488	Non-Physician Medical Practitioner	None	1124563366	0	0	ANAND, MANMIT K NP	1/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20540 E ARROW HWY	B	COVINA	CA	91724	1208	00	06000	34.10659351	-117.853677	Los Angeles County
305504	Non-Physician Medical Practitioner	None	1154929503	0	0	AREEPRACHAPIROM, ALYSSA M NP	4/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
305517	Non-Physician Medical Practitioner	None	1518992841	0	0	ARMSTRONG, ELIZABETH NP	1/11/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29525 CANWOOD ST	250	AGOURA HILLS	CA	91301	4233	00	06000	34.14724223	-118.7675471	Los Angeles County
305527	Non-Physician Medical Practitioner	None	1659583607	0	0	ALVA, KIMBERLY	8/4/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8635 W 3RD ST	SUITE 590W	LOS ANGELES	CA	90048	6101	00	06000	34.07361928	-118.3803143	Los Angeles County
305619	Non-Physician Medical Practitioner	None	1952919839	0	0	ARMBRUSTER, JOEL M PA-C	1/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
305626	Non-Physician Medical Practitioner	None	1285747964	0	0	ABDALI HAJIABADI, ABDOL HAMID	9/24/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1617 E 1ST ST	SUITE A	SANTA ANA	CA	92701	6385	00	06000	33.74616534	-117.8462414	Orange County
305665	Non-Physician Medical Practitioner	None	1467295618	0	0	ARNOTT, THOMAS C PA	9/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	75 NIELSON ST	None	WATSONVILLE	CA	95076	2468	00	06000	36.9282117	-121.7937089	Santa Cruz County
305697	Non-Physician Medical Practitioner	None	1740838994	0	0	ALVAREZ, FRANCISCO NP	3/12/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9300 VALLEY CHILRENS PL	None	MADERA	CA	93638	8761	00	06000	36.88437894	-119.8003484	Madera County
305709	Non-Physician Medical Practitioner	None	1407593577	0	0	AMIRKHANI, ERIC PA-C	12/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1162 MONTGOMERY DR	SUITE 200 & 300	SANTA ROSA	CA	95405	4802	00	06000	38.442978	-122.6999565	Sonoma County
305720	Non-Physician Medical Practitioner	None	1922359272	0	0	ARCENAS, RICHARD A NP	6/15/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	7614 HEAVENLY PEAK ST	None	LAS VEGAS	NV	89166	5202	00	06000	36.29988211	-115.3165058	Clark County
305783	Non-Physician Medical Practitioner	None	1104205871	0	0	AKIN, RACHEL E NP	10/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	112 DUDLEY AVENUE	APT A	VENICE	CA	90291	5219	00	06000	33.99508074	-118.4773288	Los Angeles County
305820	Non-Physician Medical Practitioner	None	1053744870	0	0	ARAULLO, PAUL P NP	9/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12611 ARTESIA BLVD	None	CERRITOS	CA	90703	8677	00	06000	33.87326963	-118.0632209	Los Angeles County
305846	Non-Physician Medical Practitioner	None	1962872200	0	0	AHEARN, THOMAS J	11/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7624 SANDSTONE CIR	UNIT 104	HUNTINGTON BEACH	CA	92648	5885	00	06000	33.65917192	-117.9938546	Orange County
305869	Non-Physician Medical Practitioner	None	1669535258	0	0	ALDERISIO, KRISTINA	7/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	768 POMONA AVENUE	None	EL CERRITO	CA	94530	3261	00	06000	37.91058567	-122.2977196	Contra Costa County
305902	Non-Physician Medical Practitioner	None	1265049472	0	0	AGRICOLA, CHELSEA RN PNP	9/25/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1919 E THOMAS RD	None	PHOENIX	AZ	85016	7710	00	06000	33.478749	-112.0426515	Maricopa County
305905	Non-Physician Medical Practitioner	None	1871158832	0	0	ARNOTT, SIERRA PA-C	1/16/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 N TUSTIN AVE	None	SANTA ANA	CA	92705	3807	00	06000	33.746805	-117.834147	Orange County
305910	Non-Physician Medical Practitioner	None	1891710661	0	0	ATMAR, FARIHA PA	3/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	726 4TH ST	None	MARYSVILLE	CA	95901	5656	00	06000	39.13872267	-121.5944372	Yuba County
305945	Non-Physician Medical Practitioner	None	1093497778	0	0	ARTOUNIAN MILAGERDI, RITA PA	3/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25455 BARTON RD	STE 108A	LOMA LINDA	CA	92354	3129	00	06000	34.04805253	-117.249534	San Bernardino County
306001	Non-Physician Medical Practitioner	None	1639754062	0	0	AGUILA, BIANCA A NP	2/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	00	06000	37.55769729	-121.9808861	Alameda County
306002	Non-Physician Medical Practitioner	None	1720414196	0	0	ATIENZA, SHARON D	2/23/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10843 CAMINITO ARCADA	None	SAN DIEGO	CA	92131	3666	00	06000	32.9318386	-117.0959262	San Diego County
306006	Non-Physician Medical Practitioner	None	1720602709	0	0	ASTANI, HELENA PA	8/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2545 W HAMMER LN	None	STOCKTON	CA	95209	2839	00	06000	38.0214303	-121.3461515	San Joaquin County
306009	Non-Physician Medical Practitioner	None	1548098932	0	0	AGUIRRE-PEREZ, NORMA Y NP	8/5/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5293 N FIRST STREET	None	FRESNO	CA	93710	7007	00	06000	36.81400939	-119.7725216	Fresno County
306077	Non-Physician Medical Practitioner	None	1972072528	0	0	AVEDIAN, LARA A PA-C	4/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	760 OTAY LAKES RD	None	CHULA VISTA	CA	91910	6915	00	06000	32.64603447	-117.0015068	San Diego County
306089	Non-Physician Medical Practitioner	None	1902890114	0	0	ALKIRE, JACQUELINE OLEARY	5/2/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1425 S MAIN ST	None	WALNUT CREEK	CA	94596	5318	00	06000	37.89189148	-122.057999	Contra Costa County
306104	Non-Physician Medical Practitioner	None	1447677174	0	0	AMADOR, JODI N NP	5/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3020 CHILDREN'S WAY	MC 5069	SAN DIEGO	CA	92123	4223	00	06000	32.798691	-117.150829	San Diego County
306116	Non-Physician Medical Practitioner	None	1487746772	0	0	ALLEN, CATHERINE ANN	4/7/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	260 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	00	06000	37.24047903	-121.7998157	Santa Clara County
306163	Non-Physician Medical Practitioner	None	1316106271	0	0	ANEJA, BEENU	12/19/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	584 N SUNRISE AVE	SUITE 100	ROSEVILLE	CA	95661	3035	00	06000	38.75842021	-121.2528302	Placer County
306170	Non-Physician Medical Practitioner	None	1366834400	0	0	ALTAMED HEALTH SERVICES CORP	5/19/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1155 W CENTRAL AVE	SUITES 104-107	SANTA ANA	CA	92707	3165	00	06000	33.71259106	-117.8843848	Orange County
306253	Non-Physician Medical Practitioner	None	1922451772	0	0	ALMASIAN, SARA NP	11/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1501 TROUSDALE DR	None	BURLINGAME	CA	94010	4506	00	06000	37.592811	-122.382351	San Mateo County
306284	Non-Physician Medical Practitioner	None	1497292411	0	0	ARIAS, ERIKA NP	10/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
306298	Non-Physician Medical Practitioner	None	1922269521	0	0	ADAM, JORY J PA	8/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15611 POMERADO RD	STE 400	POWAY	CA	92064	2437	00	06000	32.99706	-117.05544	San Diego County
306346	Non-Physician Medical Practitioner	None	1487243994	0	0	ADAMS, STEPHANIE J NP	4/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2652 EL CAMINO REAL	None	SANTA CLARA	CA	95051	3041	00	06000	37.35228637	-121.9754073	Santa Clara County
306350	Non-Physician Medical Practitioner	None	1639717218	0	0	ANDERSON, SHAUNTE NP	12/29/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3670 DEGNAN BLVD	None	LOS ANGELES	CA	90018	4015	00	06000	34.02110503	-118.329693	Los Angeles County
306351	Non-Physician Medical Practitioner	None	1831114636	0	0	ANG, LEE BOON NP	12/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6555 COYLE	SUITE 220	CARMICHAEL	CA	95608	0303	00	06000	38.66859	-121.3118055	Sacramento County
306389	Non-Physician Medical Practitioner	None	1013020809	0	0	ALBAKOVA, BELLA	2/9/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9850 GENESEE AVE	SUITE 560	LA JOLLA	CA	92037	1224	00	06000	32.882913	-117.226341	San Diego County
306396	Non-Physician Medical Practitioner	None	1861785180	0	0	AXELROD, IRINA PA-C	4/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
306409	Non-Physician Medical Practitioner	None	1982009007	0	0	ABANOBI, NKEIRUKA I M NP	4/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	166 PANORAMA CT	None	BREA	CA	92821	6209	00	06000	33.92998159	-117.8931481	Orange County
306415	Non-Physician Medical Practitioner	None	1174265730	0	0	AGUILAR, JEAN CASSANDRA B	6/14/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	36485 INLAND VALLEY DR	None	WILDOMAR	CA	92595	9681	00	06000	33.591699	-117.2368285	Riverside County
306435	Non-Physician Medical Practitioner	None	1760096812	0	0	ANDREW, MELISSA K PA	8/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	250 PROSPECT PL	None	CORONADO	CA	92118	1943	00	06000	32.69409033	-117.1680508	San Diego County
306436	Non-Physician Medical Practitioner	None	1770928822	0	0	ANGEL, WONG M	7/7/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	260 TILTON AVE	None	MORGAN HILL	CA	95037	2546	00	06000	37.15218822	-121.6798059	Santa Clara County
306459	Non-Physician Medical Practitioner	None	1700994597	0	0	AGUIRRE, ALVARO R	4/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1208 HALIDON WAY	None	FOLSOM	CA	95630	8541	00	06000	38.654451	-121.140936	Sacramento County
306464	Non-Physician Medical Practitioner	None	1619600608	0	0	ALARCON, GABRIEL PA	10/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15107 VANOWEN ST	None	VAN NUYS	CA	91405	4542	00	06000	34.19395645	-118.463265	Los Angeles County
306473	Non-Physician Medical Practitioner	None	1487906715	0	0	ANH, ENGLISH M	9/20/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1610 W EDINGER AVE	SUITE B	SANTA ANA	CA	92704	4339	00	06000	33.72718149	-117.889506	Orange County
306478	Non-Physician Medical Practitioner	None	1497151575	0	0	ALFARO, ANISSA M RN	5/27/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	596 E BOXWOOD LANE	None	AZUSA	CA	91702	6900	00	06000	34.14352933	-117.8997823	Los Angeles County
306500	Non-Physician Medical Practitioner	None	1962976712	0	0	ALTOUMAH, SHAHER PA	5/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
306505	Non-Physician Medical Practitioner	None	1386991677	0	0	ADELMAN, NICOLE	10/16/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
306543	Non-Physician Medical Practitioner	None	1598916884	0	0	AMACKER, PAULA A	4/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22515 OLD ALTURAS ROAD	None	BELLA VISTA	CA	96008	9804	00	06000	40.63678054	-122.2393528	Shasta County
306546	Non-Physician Medical Practitioner	None	1649777061	0	0	ANDERSON, JILL NP	12/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
306555	Non-Physician Medical Practitioner	None	1548560451	0	0	AMUNDSEN, TONI MARIE	4/16/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2016 N D ST	None	SAN BERNARDINO	CA	92405	3914	00	06000	34.134039	-117.2919395	San Bernardino County
306602	Non-Physician Medical Practitioner	None	1518664879	0	0	AZIZ, BASSAM E NP	11/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24329 CRENSHAW BLVD	STE. A	TORRANCE	CA	90505	5334	00	06000	33.804612	-118.327997	Los Angeles County
306610	Non-Physician Medical Practitioner	None	1912982539	0	0	ANGELICA, CAMARGO-LOWTHERS	3/30/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7910 FROST ST	SUITE 220	SAN DIEGO	CA	92123	2771	00	06000	32.80027449	-117.153846	San Diego County
306673	Non-Physician Medical Practitioner	None	1730531468	0	0	ADVENTIST HEALTH PHYSICIANS	11/23/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 S FAIRMONT AVENUE	SUITE 125	LODI	CA	95240	5141	00	06000	38.1206163	-121.2858323	San Joaquin County
306674	Non-Physician Medical Practitioner	None	1972674174	0	0	ARAUJO, SUSAN M NP	1/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	499 W BLUFF AVE	None	FRESNO	CA	93711	6917	00	06000	36.8557539	-119.8016033	Fresno County
306703	Non-Physician Medical Practitioner	None	1356407951	0	0	ALLEN, DAVID E	5/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	40 LAKESIDE DR	None	CORTE MADERA	CA	94925	1036	00	06000	37.92931395	-122.5205764	Marin County
306720	Non-Physician Medical Practitioner	None	1316125263	0	0	ALBANO, ALANA M	6/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3360 MAGUIRE WAY	None	DUBLIN	CA	94568	8500	00	06000	37.70620119	-121.8620433	Alameda County
306724	Non-Physician Medical Practitioner	None	1417178526	0	0	ARBET, KAREN M	8/16/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 W 3RD ST	None	LONG BEACH	CA	90802	3005	00	06000	33.77053272	-118.1944246	Los Angeles County
306727	Non-Physician Medical Practitioner	None	1679027577	0	0	ALARCON, JEAN NP	5/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2101 STONE	SUITE 100	WEST SACRAMENTO	CA	95691	4056	00	06000	38.56318049	-121.5379228	Yolo County
306763	Non-Physician Medical Practitioner	None	1851842009	0	0	ALVEY, CHRISTOPHER F	3/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1550 SPRINGFIELD	APT 14	CHICO	CA	95928	6307	00	06000	39.73191691	-121.8090551	Butte County
306766	Non-Physician Medical Practitioner	None	1215089040	0	0	ABREGO, MARIO A M	7/29/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9151 DINSDALE ST	None	DOWNEY	CA	90240	3549	00	06000	33.94665074	-118.1125744	Los Angeles County
306768	Non-Physician Medical Practitioner	None	1487741294	0	0	A, LENZ C	1/7/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1020 29 TH ST	#570B	SACRAMENTO	CA	95816	0000	00	06000	38.572803	-121.4685	Sacramento County
306782	Non-Physician Medical Practitioner	None	1982062808	0	0	ABRAAMYAN, ABRAHAM PA-C	5/11/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5601 DE SOTO AVE	None	WOODLAND HILLS	CA	91367	6701	00	06000	34.17030266	-118.5881699	Los Angeles County
306786	Non-Physician Medical Practitioner	None	1912083924	0	0	ABRAHIM, SHOKOOR A	11/1/1999	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6914 BEECHFIELD DRIVE	None	RANCHO PALOS VERD	CA	90275	2910	00	06000	33.78130481	-118.4006681	Los Angeles County
306810	Non-Physician Medical Practitioner	None	1639414139	0	0	APLA HEALTH & WELLNESS	10/5/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3743 S. LABREA AVE.	None	LOS ANGELES	CA	90016	5309	00	06000	34.01991	-118.355626	Los Angeles County
306820	Non-Physician Medical Practitioner	None	1124556857	0	0	ARANETA, MARIA M PA	6/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	441 N LAKEVIEW AVE	None	ANAHEIM	CA	92807	3028	00	06000	33.85429563	-117.8166478	Orange County
306833	Non-Physician Medical Practitioner	None	1164718334	0	0	ALBA, CAYO KAWEAH	3/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	973 SEQUOIA AVE	None	LINDSAY	CA	93247	1426	00	06000	36.2151862	-119.0961292	Tulare County
306882	Non-Physician Medical Practitioner	None	1225504301	0	0	ALFRED, AMGAD PA	11/22/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 SAN BERNARDINO RD	None	UPLAND	CA	91786	4920	00	06000	34.1010559	-117.6369445	San Bernardino County
306890	Non-Physician Medical Practitioner	None	1689903155	0	0	AVILA, MICHAEL A	7/11/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26951 CIMARRON CANYON DR	None	MORENO VALLEY	CA	92555	4992	00	06000	33.89083549	-117.1926052	Riverside County
306892	Non-Physician Medical Practitioner	None	1568488195	0	0	ARMENDARIZ, ARTURO A	12/5/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	462 FIRST AVE	None	CHULA VISTA	CA	91910	4935	00	06000	32.63802778	-117.0695963	San Diego County
306901	Non-Physician Medical Practitioner	None	1467022269	0	0	ANAMURO, BRYAN E PA	3/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	757 WESTWOOD PLZ	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
306910	Non-Physician Medical Practitioner	None	1144526484	0	0	ALLEGRETTO, REBECCA CONTE	5/16/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10833 LE CONTE AVE	62-182	LOS ANGELES	CA	90095	3075	00	06000	34.06373445	-118.443537	Los Angeles County
306915	Non-Physician Medical Practitioner	None	1891911038	0	0	ANASTASIU, DANIELLE-ZENOVIE PA	12/12/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1400 S. GRAND AVE	SUITE 707	LOS ANGELES	CA	90015	2881	00	06000	34.03692236	-118.2655238	Los Angeles County
306924	Non-Physician Medical Practitioner	None	1629723101	0	0	AKIMPAYE, LILIANE	8/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
306944	Non-Physician Medical Practitioner	None	1285383117	0	0	ANUGOM, JUDITH NP	5/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27349 JEFFERSON AVE	SUITE 111	TEMECULA	CA	92590	5634	00	06000	33.51993406	-117.1641955	Riverside County
306958	Non-Physician Medical Practitioner	None	1508318874	0	0	AULAKH, HARDEEP NP	2/9/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2905 TELEGRAPH AVE	None	BERKELEY	CA	94705	2063	00	06000	37.85736641	-122.2594952	Alameda County
306965	Non-Physician Medical Practitioner	None	1992812283	0	0	AYALA, ELISEO	7/1/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8225 LONG BEACH BLVD	None	SOUTH GATE	CA	90280	0000	00	06000	33.96371607	-118.2251842	Los Angeles County
306981	Non-Physician Medical Practitioner	None	1124712492	0	0	AGUIRRE, JOCELYN	8/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	657 N TOWN CENTER DR	None	LAS VEGAS	NV	89144	6367	00	06000	36.180999	-115.3174815	Clark County
306983	Non-Physician Medical Practitioner	None	1730851601	0	0	ABDUL, ZENET NP	11/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12746 W JEFFERSON BLVD	FL 2-4	LOS ANGELES	CA	90094	2885	00	06000	33.97751255	-118.417598	Los Angeles County
306990	Non-Physician Medical Practitioner	None	1477936391	0	0	AZIZ, ZOHRA	12/14/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	175 ELAINE DR	None	PLEASANT HILL	CA	94523	3907	00	06000	37.94357385	-122.053296	Contra Costa County
307007	Non-Physician Medical Practitioner	None	1952347502	0	0	ANGELES, VANCE S	7/19/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1506 CAVALIER CT	None	CERES	CA	95307	7004	00	06000	37.608696	-120.928731	Stanislaus County
307039	Non-Physician Medical Practitioner	None	1598094286	0	0	ABRAHAM, ANCY NP	10/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4920 S CENTINELA	None	LOS ANGELES	CA	90066	6822	00	06000	33.98803852	-118.4171701	Los Angeles County
307043	Non-Physician Medical Practitioner	None	1922424217	0	0	AZWELL, ELIZABETH R A NP	10/23/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2383 CORONADO COURT	None	FAIRFIELD	CA	94533	5826	00	06000	38.24173904	-122.0747019	Solano County
307054	Non-Physician Medical Practitioner	None	1982134078	0	0	ANG, SAMANTHA PA	10/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2131 WEST THIRD STREET	None	LOS ANGELES	CA	90057	7992	00	06000	34.06324759	-118.2737045	Los Angeles County
307093	Non-Physician Medical Practitioner	None	1710452826	0	0	ALTIVEROS, ARNOLD I NP	11/30/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	525 WEST ACACIA STREET	None	STOCKTON	CA	95203	2405	00	06000	37.9611947	-121.3009489	San Joaquin County
307113	Non-Physician Medical Practitioner	None	1992511943	0	0	ACHARYA, PARITOSH NP	2/9/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3000 Q STREET	2ND FLOOR	SACRAMENTO	CA	95816	7058	00	06000	38.564991	-121.4696565	Sacramento County
307133	Non-Physician Medical Practitioner	None	1043999808	0	0	ALHEIT, ANDREA M NP	10/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	550 S GREEN VALLEY RD	None	WATSONVILLE	CA	95076	3053	00	06000	36.92586689	-121.7796602	Santa Cruz County
307194	Non-Physician Medical Practitioner	None	1508201856	0	0	ALVAREZ, LUPITA N	5/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11922 BERMUDA ST	None	VISALIA	CA	93291	8932	00	06000	36.37374702	-119.305341	Tulare County
307200	Non-Physician Medical Practitioner	None	1285244525	0	0	ABDOU, AMIR PA-C	4/2/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15031 RINALDI ST	None	MISSION HILLS	CA	91345	1207	00	06000	34.27904453	-118.459944	Los Angeles County
307210	Non-Physician Medical Practitioner	None	1326259888	0	0	AYELE, TSEDEY PA-C	9/21/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
307221	Non-Physician Medical Practitioner	None	1194249110	0	0	ARPAIA, JOSEPH E PA-C	7/29/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD	None	WEST HOLLYWOOD	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
307233	Non-Physician Medical Practitioner	None	1508118472	0	0	ALDRIDGE, TAYLOR A	4/6/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	551 ORTEGA	APT 12	MOUNTAIN VIEW	CA	94040	1533	00	06000	37.39869476	-122.1057163	Santa Clara County
307276	Non-Physician Medical Practitioner	None	1508370875	0	0	AKINS, MELANIE NP	1/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	752 MEDICAL CENTER CT	SUITE 302	CHULA VISTA	CA	91911	6661	00	06000	32.61800405	-117.0232585	San Diego County
307283	Non-Physician Medical Practitioner	None	1740378470	0	0	AMARA, CHRISTINE M	5/20/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	795 EL CAMINO REAL	None	PALO ALTO	CA	94301	2302	00	06000	37.43920432	-122.162109	Santa Clara County
307297	Non-Physician Medical Practitioner	None	1710658505	0	0	ANDES, JENNIFFER GIELYN PA	7/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2200 OFARRELL ST	None	SAN FRANCISCO	CA	94115	3357	00	06000	37.78224789	-122.4412946	San Francisco County
307302	Non-Physician Medical Practitioner	None	1730423930	0	0	ARAGON, ORALIA EDITH	7/18/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	SUITE 1000	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
307348	Non-Physician Medical Practitioner	None	1366456170	0	0	AOKI DIABETES RESEARCH INSTITUTE	7/13/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3100 O ST	None	SACRAMENTO	CA	95816	6519	00	06000	38.566953	-121.4675595	Sacramento County
307352	Non-Physician Medical Practitioner	None	1851578595	0	0	ALTAMED HEALTH SERVICES CORP	4/28/1997	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9436 SLAUSON AVE	None	PICO RIVERA	CA	90660	4748	00	06000	33.96800305	-118.0956362	Los Angeles County
307354	Non-Physician Medical Practitioner	None	1568827210	0	0	ALTURA CENTERS FOR HEALTH	5/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 W TULARE DRIVE	None	TULARE	CA	93274	2233	00	06000	36.20637928	-119.3688387	Tulare County
307390	Non-Physician Medical Practitioner	None	1811317001	0	0	ALDALUR, MAYDOLE L NP	7/14/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7931 WESTERA LN	None	LA PALMA	CA	90623	1844	00	06000	33.84730084	-118.0325355	Orange County
307416	Non-Physician Medical Practitioner	None	1356994321	0	0	ADAMES, JACQUELINE NP	2/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2271 E PALMDALE BLVD	SUITE E	PALMDALE	CA	93550	1340	00	06000	34.58021047	-118.087218	Los Angeles County
307418	Non-Physician Medical Practitioner	None	1639859077	0	0	ALI, SINA NP	12/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8170 LAGUNA BLVD	STE 304	ELK GROVE	CA	95758	7903	00	06000	38.421054	-121.405365	Sacramento County
307433	Non-Physician Medical Practitioner	None	1528442977	0	0	ANDERSON, MEGAN L	9/28/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	34095 CASTLE PINES DR	None	YUCAIPA	CA	92399	6903	00	06000	34.03913527	-117.0608156	San Bernardino County
307434	Non-Physician Medical Practitioner	None	1841431392	0	0	AVALOS, JORGE	10/14/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3057 CELEBRATION DR	None	LODI	CA	95242	9723	00	06000	38.13194886	-121.3152526	San Joaquin County
307440	Non-Physician Medical Practitioner	None	1003499575	0	0	ANGHEL, BRITTANY D PA	10/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4225 TWEEDY BLVD	STE B	SOUTH GATE	CA	90280	6217	00	06000	33.94330446	-118.1970199	Los Angeles County
307444	Non-Physician Medical Practitioner	None	1407581630	0	0	AZLING, BAILEY PA	7/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10880 WILSHIRE BLVD	1101	LOS ANGELES	CA	90024	4112	00	06000	34.05897499	-118.4431123	Los Angeles County
307450	Non-Physician Medical Practitioner	None	1235690397	0	0	ADEDAYO, TOLULOPE T NP	9/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	461 TENNESSEE ST	SUITE C	REDLANDS	CA	92373	8161	00	06000	34.058745	-117.2000975	San Bernardino County
307457	Non-Physician Medical Practitioner	None	1811270226	0	0	ARTIGAS, CHRISTOPHER F	12/12/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	553 ARTOLA ST	None	LAS VEGAS	NV	89144	4517	00	06000	36.16873651	-115.3344012	Clark County
307514	Non-Physician Medical Practitioner	None	1508877382	0	0	ALLEN, ROBERTA R	12/29/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2020 SUTTER PL	SUITE 101	DAVIS	CA	95616	6201	00	06000	38.56287659	-121.7715536	Yolo County
307590	Non-Physician Medical Practitioner	None	1043748288	0	0	AGUILAR NIETO, JOSE A PA-C	9/12/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2900 WHIPPLE AVE	SUITE 225	REDWOOD CITY	CA	94065	2851	00	06000	37.4783072	-122.2551089	San Mateo County
307599	Non-Physician Medical Practitioner	None	1891242293	0	0	ALEJANDRO, JOHN A N NP	4/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	112 LAUREL AVE	None	BREA	CA	92821	4910	00	06000	33.91883561	-117.8942657	Orange County
307607	Non-Physician Medical Practitioner	None	1518171016	0	0	ALTAMED HEALTH SERVICES CORP	1/5/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6901 ATLANTIC AVE	None	BELL	CA	90201	3646	00	06000	33.97291242	-118.1878808	Los Angeles County
307616	Non-Physician Medical Practitioner	None	1083917439	0	0	ASAMOAH, YAW O	8/25/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6309 CAMEL BACK LN	None	FONTANA	CA	92336	5830	00	06000	34.13934938	-117.4502004	San Bernardino County
307618	Non-Physician Medical Practitioner	None	1417342916	0	0	ARMBRUSTER, KRYSTLE NP	2/10/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2216 BUENAVENTURA BLVD	SUITE B	REDDING	CA	96001	3838	00	06000	40.55453352	-122.3904825	Shasta County
307629	Non-Physician Medical Practitioner	None	1437459880	0	0	AMARAL, CHRISTOPHER T	1/18/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	351 S JASMINE STREET	None	DENVER	CO	80224	1233	00	06000	39.71001692	-104.9187803	Denver County
307639	Non-Physician Medical Practitioner	None	1861974925	0	0	ACEVEDO, KAREN A NP	11/2/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2687 CALIFORNIA ST	None	SAN FRANCISCO	CA	94115	2617	00	06000	37.78828723	-122.4385799	San Francisco County
307668	Non-Physician Medical Practitioner	None	1316771298	0	0	ABRANTES, BROOKE E PA-C	4/12/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4140 JADE STREET	SUITE 100	CAPITOLA	CA	95010	3956	00	06000	36.97026148	-121.9638195	Santa Cruz County
307680	Non-Physician Medical Practitioner	None	1215099494	0	0	ALVA, KATHLEEN C	2/26/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31001 RANCHO VIEJO RD.	SUITE 200	SAN JUAN CAPISTRA	CA	92675	0000	00	06000	33.50974262	-117.6596065	Orange County
307695	Non-Physician Medical Practitioner	None	1124697388	0	0	ALEMNJI, EDITH E NP	7/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3700 H ST,	None	SACRAMENTO	CA	95816	4611	00	06000	38.572137	-121.4562375	Sacramento County
307760	Non-Physician Medical Practitioner	None	1952468639	0	0	ARNOUX, LENORE ELLEN	5/10/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3779 PIEDMONT AVE	None	OAKLAND	CA	94611	5347	00	06000	37.82384659	-122.2558913	Alameda County
307781	Non-Physician Medical Practitioner	None	1114516150	0	0	ANJUM, AZEEM NP	10/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	610 EUCLID AVE	200	NATIONAL CITY	CA	91950	2951	00	06000	32.68419388	-117.0829524	San Diego County
307807	Non-Physician Medical Practitioner	None	1477867893	0	0	AMARGO, FIDELINO J PA-C	1/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	29955 TECHNOLOGY DR	SUITE 111	MURRIETA	CA	92563	2637	00	06000	33.56063993	-117.1379703	Riverside County
307828	Non-Physician Medical Practitioner	None	1952848236	0	0	ALONZO, NATALIE	5/19/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19270 SONOMA HIGHWAY 12	None	SONOMA	CA	95476	5414	00	06000	38.29871411	-122.4751509	Sonoma County
307843	Non-Physician Medical Practitioner	None	1265918502	0	0	ATILANO, MARINA PA	3/13/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	480B TESCONI CIR	None	SANTA ROSA	CA	95401	4691	00	06000	38.44950583	-122.7351601	Sonoma County
307852	Non-Physician Medical Practitioner	None	1740565936	0	0	A, THEURET D	11/1/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	712 JAY ST	None	FOSSIL	OR	97830	8371	00	06000	44.99823432	-120.2123854	Wheeler County
307895	Non-Physician Medical Practitioner	None	1376053413	0	0	AJALA-STAATS, CATHERINE N NP	3/4/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24060 FIR AVE	SUITE A	MORENO VALLEY	CA	92553	2895	00	06000	33.93543049	-117.242604	Riverside County
307919	Non-Physician Medical Practitioner	None	1912349291	0	0	ARBO, MA ANA LEON NP	4/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4092 ST TROPEZ CT	None	MERCED	CA	95348	9539	00	06000	37.34330414	-120.4931427	Merced County
307922	Non-Physician Medical Practitioner	None	1730684655	0	0	ARANZASO, MARISSA NP	4/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	558 ABBOTT ST	A	SALINAS	CA	93901	4326	00	06000	36.66276002	-121.6420145	Monterey County
307928	Non-Physician Medical Practitioner	None	1679352629	0	0	ASHTON, JONATHAN NP	7/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3389 G ST	STE B	MERCED	CA	95340	0964	00	06000	37.32623805	-120.4692747	Merced County
307970	Non-Physician Medical Practitioner	None	1073670238	0	0	ARSALANE, SAID PAUL	10/26/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 EL CAMINO REAL	None	SOUTH SAN FRANCIS	CA	94080	2170	00	06000	37.65894608	-122.440161	San Mateo County
307991	Non-Physician Medical Practitioner	None	1891963419	0	0	ALLEN, JASON I	4/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3118 E PIRU LANE	None	BREA	CA	92821	9105	00	06000	33.92625566	-117.8548914	Orange County
308005	Non-Physician Medical Practitioner	None	1386042182	0	0	ATIYEH, JOSHUA M	1/3/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	3012 WATERVIEW DRIVE	None	LAS VEGAS	NV	89117	2323	00	06000	36.13716036	-115.2931018	Clark County
308022	Non-Physician Medical Practitioner	None	1265661110	0	0	ARVIZU, ELIZABETH E NP	4/28/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4801 CHRISTMAS TREE LN	None	BAKERSFIELD	CA	93306	1767	00	06000	35.40764407	-118.940026	Kern County
308023	Non-Physician Medical Practitioner	None	1952566499	0	0	ANSON, ELAINE EKBERG	6/7/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	12605 E 16TH AVE	None	AURORA	CO	80045	2545	00	06000	39.742182	-104.8408515	Adams County
308046	Non-Physician Medical Practitioner	None	1912153131	0	0	ASATRIAN, NAIRA	3/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9168 N PRICE AVE	None	FRESNO	CA	93720	4112	00	06000	36.8691776	-119.7470866	Fresno County
308048	Non-Physician Medical Practitioner	None	1316117682	0	0	ANAYA, LAURA H PA	2/12/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4000 DUBLIN BLVD	None	DUBLIN	CA	94568	3113	00	06000	37.70553949	-121.872609	Alameda County
308090	Non-Physician Medical Practitioner	None	1346450103	0	0	ALTAMED HEALTH SERVICES CORP	9/26/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1701 ZONAL AVE.	None	LOS ANGELES	CA	90033	1065	00	06000	34.06219051	-118.2106555	Los Angeles County
308123	Non-Physician Medical Practitioner	None	1992207062	0	0	AHMADI, MOHAMAD E NP	2/4/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10309 AZUAGA ST	SUITE 35	SAN DIEGO	CA	92129	4086	00	06000	32.96122118	-117.1017824	San Diego County
308126	Non-Physician Medical Practitioner	None	1306194105	0	0	AMH COMPREHENSIVE MEDICAL CENTERS	9/4/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	711 NORTH ALVARADO ST. S	None	LOS ANGELES	CA	90026	4016	00	06000	34.05620486	-118.2770255	Los Angeles County
308130	Non-Physician Medical Practitioner	None	1316116221	0	0	ALTAMED HEALTH SERVICES CORP	2/13/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4010 E CHAPMAN AVE	None	ORANGE	CA	92869	3990	00	06000	33.7877325	-117.8109675	Orange County
308142	Non-Physician Medical Practitioner	None	1548600117	0	0	AMORUSO, JULIE A NP	2/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8220 WYMARK DRIVE	STE 200	ELK GROVE	CA	95757	6298	00	06000	38.406888	-121.4100495	Sacramento County
308146	Non-Physician Medical Practitioner	None	1093060386	0	0	ASHBY, MARK B	10/15/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4310 GREENBUSH AVE	None	SHERMAN OAKS	CA	91423	3911	00	06000	34.14924075	-118.425927	Los Angeles County
308183	Non-Physician Medical Practitioner	None	1780654624	0	0	ADORADOR, ANITA C	9/23/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	26494 ANTONIO CIRCLE	None	LOMA LINDA	CA	92354	6752	00	06000	34.03978214	-117.22689	San Bernardino County
308200	Non-Physician Medical Practitioner	None	1447300314	0	0	ABN00SIAN, JILBERT	12/1/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	831 GRAYNOLD AVE	None	GLENDALE	CA	91202	2607	00	06000	34.16131098	-118.2800257	Los Angeles County
308240	Non-Physician Medical Practitioner	None	1952902140	0	0	ANSELMIN, DOMINIQUE	6/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
308244	Non-Physician Medical Practitioner	None	1174918585	0	0	ADEIZA, JOHN D NP	7/30/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15725 POMERADO RD	#105	POWAY	CA	92064	2057	00	06000	33.00037882	-117.0580735	San Diego County
308247	Non-Physician Medical Practitioner	None	1609271485	0	0	APHAILEE, VICTORIA L CNM	2/17/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1975 MAXWELL AVENUE	APT 114C	WOODLAND	CA	95776	5173	00	06000	38.66874845	-121.730247	Yolo County
308254	Non-Physician Medical Practitioner	None	1447223276	0	0	ADLER, NEIL S	11/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	816 17TH AVE	None	MENLO PARK	CA	94025	2043	00	06000	37.4756439	-122.1891694	San Mateo County
308256	Non-Physician Medical Practitioner	None	1790035780	0	0	ANSON, RYAN C NP	4/20/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
308269	Non-Physician Medical Practitioner	None	1629124920	0	0	APPAUH, DONYINA KWAKU	3/3/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	115 E WASHINGTON BLVD	None	LOS ANGELES	CA	90015	3606	00	06000	34.0309884	-118.2642142	Los Angeles County
308292	Non-Physician Medical Practitioner	None	1821137274	0	0	ASIAN MEDICAL CLINIC FREMONT INC	8/15/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	46356 WARM SPRINGS BLVD	SUITE 872	FREMONT	CA	94539	7021	00	06000	37.49302608	-121.9312288	Alameda County
308311	Non-Physician Medical Practitioner	None	1518186949	0	0	ALCANTARA, ROSALIE	3/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4347 SLAUSON AVE	None	MAYWOOD	CA	90270	2837	00	06000	33.98746892	-118.1884749	Los Angeles County
308353	Non-Physician Medical Practitioner	None	1174996177	0	0	ALL-INCLUSIVE COMMUNITY HEAL	2/21/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3920 EAGLE ROCK BLVD	SUITE A	LOS ANGELES	CA	90065	3606	00	06000	34.11936223	-118.230111	Los Angeles County
308369	Non-Physician Medical Practitioner	None	1356873715	0	0	AHMADI, SHIVA B	12/16/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1307 WEST SIXTH STREET	105	CORONA	CA	92882	3294	00	06000	33.87790309	-117.589666	Riverside County
308388	Non-Physician Medical Practitioner	None	1801633805	0	0	APOSTOL, ANNE GAIL	11/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
308405	Non-Physician Medical Practitioner	None	1881012193	0	0	ADLAO, GLADELYNN L NP	12/19/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	490 DESERT WILLOW ROAD	None	AZUSA	CA	91702	1418	00	06000	34.14596357	-117.9028492	Los Angeles County
308445	Non-Physician Medical Practitioner	None	1649754292	0	0	ADEYEYE, SUNDAY NP	11/19/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	PO BOX 62	None	LOMA LINDA	CA	92354	0062	00	06000	0	0	None
308463	Non-Physician Medical Practitioner	None	1356766414	0	0	APLA HEALTH & WELLNESS	3/4/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1741 E 120TH ST	None	LOS ANGELES	CA	90059	3051	00	06000	33.92464326	-118.2427028	Los Angeles County
308471	Non-Physician Medical Practitioner	None	1073071684	0	0	ANEKE, RACHEAL E NP	10/30/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2372 STERLING AVE	None	SAN BERNARDINO	CA	92404	4624	00	06000	34.13682	-117.243687	San Bernardino County
308503	Non-Physician Medical Practitioner	None	1164598280	0	0	ANAKWENZE, EBERE H	3/20/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10 SADDLE RD	None	RANCHO PALOS VERD	CA	90275	6510	00	06000	33.76068955	-118.3190439	Los Angeles County
308509	Non-Physician Medical Practitioner	None	1508398132	0	0	ALVAREZ, KATHERINE A PA-C	2/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2950 RESEARCH PARK DR	None	SOQUEL	CA	95073	2000	00	06000	36.98692657	-121.9685264	Santa Cruz County
308516	Non-Physician Medical Practitioner	None	1699460097	0	0	ATSEGBUA, AJARA E	3/31/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
308548	Non-Physician Medical Practitioner	None	1366105074	0	0	ANDERSON, JUSTIN M PA	2/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 CHILDREN'S WAY	None	SAN DIEGO	CA	92123	4232	00	06000	32.798889	-117.150826	San Diego County
308568	Non-Physician Medical Practitioner	None	1235862210	0	0	ALEXOPOULOS, CHRISTINE PA	9/23/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1231 N AVALON BLVD	None	WILMINGTON	CA	90744	2601	00	06000	33.78765728	-118.2630655	Los Angeles County
308593	Non-Physician Medical Practitioner	None	1962848374	0	0	AUSTIN, KIRK J PA	7/15/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3600 POWER INN RD	STE G	SACRAMENTO	CA	95826	3826	00	06000	38.541726	-121.4096355	Sacramento County
308616	Non-Physician Medical Practitioner	None	1083851992	0	0	ALTAMED HEALTH SERVICES CORP	4/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12751 HARBOR BLVD	None	GARDEN GROVE	CA	92840	5800	00	06000	33.77746612	-117.9151381	Orange County
308626	Non-Physician Medical Practitioner	None	1023400082	0	0	AGYEMANG, ALBERTA A NP	4/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
308642	Non-Physician Medical Practitioner	None	1558733451	0	0	AMBROSINO, ANTHONY J	2/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2273 11TH AVE	None	SACRAMENTO	CA	95818	4326	00	06000	38.543409	-121.4882505	Sacramento County
308651	Non-Physician Medical Practitioner	None	1902591381	0	0	AGGIO, JULIAN PA-C	8/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2767 OLIVE HWY	None	OROVILLE	CA	95966	6118	00	06000	39.506454	-121.5412785	Butte County
308679	Non-Physician Medical Practitioner	None	1356092274	0	0	ALCARAZ, AMBER L PA-C	11/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1700 E CESAR E CHAVEZ AV	SUITE 2500	LOS ANGELES	CA	90033	2434	00	06000	34.05101259	-118.217259	Los Angeles County
308700	Non-Physician Medical Practitioner	None	1871197087	0	0	ASUMBRADO, JOEY C NP	4/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2100 5TH AVE	STE 200	SAN DIEGO	CA	92101	2102	00	06000	32.727474	-117.1602985	San Diego County
308702	Non-Physician Medical Practitioner	None	1669846002	0	0	ALVAREZ, MELISSA M NP	4/29/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	337 WEST 78TH STREET	None	LOS ANGELES	CA	90003	2413	00	06000	33.96887885	-118.2795452	Los Angeles County
308713	Non-Physician Medical Practitioner	None	1467117127	0	0	AZEVEDO, ALYSSA N NP	6/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
308714	Non-Physician Medical Practitioner	None	1083995427	0	0	ALVAREZ-FERNANDEZ, MOISES	11/2/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	835 W STEVENS AVE	14	SANTA ANA	CA	92707	5033	00	06000	33.69448473	-117.8803733	Orange County
308728	Non-Physician Medical Practitioner	None	1700507571	0	0	ACEVEDO, DANIEL F PA-C	7/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
308753	Non-Physician Medical Practitioner	None	1699230953	0	0	ABDELFATTAH, HANAN B PA	4/9/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
308774	Non-Physician Medical Practitioner	None	1578939153	0	0	AGATEP, JAMES E NP	3/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12351 CHASE STREET	None	GARDEN GROVE	CA	92845	2109	00	06000	33.78295327	-118.0282699	Orange County
308801	Non-Physician Medical Practitioner	None	1407242118	0	0	ALVAREZ, JULIAN	3/11/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
308819	Non-Physician Medical Practitioner	None	1215063268	0	0	ANTONOWICH-JONSSON, ANNA M	4/2/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	534 EAST LEMON AVE	None	MONROVIA	CA	91016	2929	00	06000	34.14706835	-117.9921926	Los Angeles County
308821	Non-Physician Medical Practitioner	None	1043592512	0	0	AZIZ, SABRINA PA-C	3/24/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
308863	Non-Physician Medical Practitioner	None	1184910598	0	0	ALLER, JANET B NP	10/6/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3369 UNION SPRINGS WAY	None	SACRAMENTO	CA	95827	2715	00	06000	38.565108	-121.3326045	Sacramento County
308869	Non-Physician Medical Practitioner	None	1932529047	0	0	AQUINO-BAUTISTA, JENNIFER E	12/21/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11 COTTONTAIL DR	None	PHILLIPS RANCH	CA	91766	4844	00	06000	34.0364966	-117.7791486	Los Angeles County
308882	Non-Physician Medical Practitioner	None	1457065179	0	0	AVALOS, YESENIA PA-C	10/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2833	00	06000	37.37715796	-122.0651926	Santa Clara County
308898	Non-Physician Medical Practitioner	None	1134496490	0	0	ARTHUR, ANDREA NP	7/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18660 OUTER HWY 18	None	APPLE VALLEY	CA	92307	2316	00	06000	34.53882192	-117.2572076	San Bernardino County
308903	Non-Physician Medical Practitioner	None	1477505014	0	0	AMATO, KIMBERLY JEAN	4/20/2004	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	250 S GRAND AVE	None	GLENDORA	CA	91741	4218	00	06000	34.132842	-117.872523	Los Angeles County
308952	Non-Physician Medical Practitioner	None	1205461100	0	0	ABOUCHEDID, TIANA C PA	12/27/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1055 EAST COLORADO BLVD	None	PASADENA	CA	91188	2375	00	06000	34.14595648	-118.1287575	Los Angeles County
308972	Non-Physician Medical Practitioner	None	1609827708	0	0	ADAMS, AMY E	2/1/2002	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4608 GLENCOE AVE	APT 4	MARINA DEL REY	CA	90292	6347	00	06000	33.98434949	-118.4333711	Los Angeles County
309025	Non-Physician Medical Practitioner	None	1528331485	0	0	ACORDA REECE, MARIE K NP	1/5/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28602 PIETRO DR	None	VALENCIA	CA	91354	2698	00	06000	34.45803016	-118.557523	Los Angeles County
309029	Non-Physician Medical Practitioner	None	1356775878	0	0	ALTAMED HEALTH SERVICES CORP	11/15/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6336 S. PASSONS BLVD	None	PICO RIVERA	CA	90660	3355	00	06000	33.98515856	-118.0862644	Los Angeles County
309038	Non-Physician Medical Practitioner	None	1215488226	0	0	ACQUISTAPACE, MARIAN E CNM	12/30/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	608 14TH AVE	None	SANTA CRUZ	CA	95062	4065	00	06000	36.96489904	-121.9909994	Santa Cruz County
309115	Non-Physician Medical Practitioner	None	1568109494	0	0	ALVARADO, AUDREE A NP	6/6/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	165 N CLARK ST	None	FRESNO	CA	93701	2108	00	06000	36.74454278	-119.786043	Fresno County
309154	Non-Physician Medical Practitioner	None	1346802543	0	0	AHN, JULIE K PA-C	9/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	800 S MAIN ST	None	CORONA	CA	92882	3420	00	06000	33.872958	-117.568359	Riverside County
309155	Non-Physician Medical Practitioner	None	1053476416	0	0	AHN, LAURA Y NP	7/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6682 ABERDALE CIRCLE	None	SAN RAMON	CA	94582	3007	00	06000	37.74848423	-121.9006674	Contra Costa County
309179	Non-Physician Medical Practitioner	None	1023183282	0	0	ALVAREZ, CARLOS	9/20/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 OLD RIVER RD	SUITE 105	BAKERSFIELD	CA	93311	9503	00	06000	35.352648	-119.1122505	Kern County
309223	Non-Physician Medical Practitioner	None	1346777695	0	0	ANTIGUA, FRANCIS D NP	9/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	201 N COLLEGE DR	101	SANTA MARIA	CA	93454	4614	00	06000	34.954461	-120.424836	Santa Barbara County
309229	Non-Physician Medical Practitioner	None	1689011637	0	0	ALTURA CENTERS FOR HEALTH	9/17/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3035 E BARDSLEY AVE	None	TULARE	CA	93274	6122	00	06000	36.19647282	-119.302504	Tulare County
309233	Non-Physician Medical Practitioner	None	1477859205	0	0	ADLER, LAUREN R	7/13/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3313 FERNSIDE BLVD	UNIT A	ALAMEDA	CA	94501	1772	00	06000	37.76068201	-122.2256012	Alameda County
309261	Non-Physician Medical Practitioner	None	1619263597	0	0	ALTAMED HEALTH SERVICES CORP	8/25/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10418 VALLEY BLVD	None	EL MONTE	CA	91731	3600	00	06000	34.07647884	-118.0458956	Los Angeles County
309276	Non-Physician Medical Practitioner	None	1164477683	0	0	AMADOR, KELLIE JEAN	8/14/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 FLORIDA AVENUE	None	MODESTO	CA	95350	0000	00	06000	37.66508443	-120.9962589	Stanislaus County
309277	Non-Physician Medical Practitioner	None	1720733967	0	0	ABILA, ANGELINA F NP	3/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9939 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3528	00	06000	33.91571158	-117.4549231	Riverside County
309287	Non-Physician Medical Practitioner	None	1326470279	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	11/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1142 ROSE AVE	SUIT # C	SELMA	CA	93662	3251	00	06000	36.56886527	-119.5983853	Fresno County
309289	Non-Physician Medical Practitioner	None	1588986459	0	0	ASIAN PACIFIC HEALTH CARE VENTURE, INC.	3/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	180 UNION PLACE	None	LOS ANGELES	CA	90026	0000	00	06000	34.06186536	-118.2653898	Los Angeles County
309309	Non-Physician Medical Practitioner	None	1932529831	0	0	ALTURA CENTERS FOR HEALTH	7/30/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16686 ROAD 168	None	WOODVILLE	CA	93257	0000	00	06000	36.092772	-119.1967015	Tulare County
309367	Non-Physician Medical Practitioner	None	1942971304	0	0	ADAMS, ARLINE N PA-C	9/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9375 SAN FERNANDO RD	None	SUN VALLEY	CA	91352	1418	00	06000	34.2395322	-118.3939944	Los Angeles County
309380	Non-Physician Medical Practitioner	None	1780871400	0	0	AGUILAR HOUCK, LAURA K	4/18/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	916 SUNSET HILLS LANE	None	REDLANDS	CA	92373	6963	00	06000	34.01906399	-117.1705858	San Bernardino County
309398	Non-Physician Medical Practitioner	None	1699828913	0	0	ARGUELLES, ROBIN S NP	12/23/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3385 G STREET	SUITE A	MERCED	CA	95340	0964	00	06000	37.325943	-120.469278	Merced County
309417	Non-Physician Medical Practitioner	None	1740758416	0	0	ALVAREZ, SILVERIO PA-C	7/26/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	552 S PASEO DOROTEA	STE 2	PALM SPRINGS	CA	92264	1437	00	06000	33.81460283	-116.5017722	Riverside County
309437	Non-Physician Medical Practitioner	None	1811464811	0	0	ALJUNDI, OMAR NP	8/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	00	06000	37.51438187	-122.2607682	San Mateo County
309469	Non-Physician Medical Practitioner	None	1760989834	0	0	ANYANACHO, NGOZI NP	6/19/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2372 STERLING AVE	None	SAN BERNARDINO	CA	92404	4624	00	06000	34.13682	-117.243687	San Bernardino County
309516	Non-Physician Medical Practitioner	None	1457839581	0	0	AUNG, AYE NP	1/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1900 SULLIVAN AVE	None	DALY CITY	CA	94015	2200	00	06000	37.67984327	-122.4730264	San Mateo County
309533	Non-Physician Medical Practitioner	None	1922367028	0	0	AGUINALDO, PATRICIA	5/21/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6316 HOLMES AVE	None	LOS ANGELES	CA	90001	1824	00	06000	33.982263	-118.2411845	Los Angeles County
309560	Non-Physician Medical Practitioner	None	1255314928	0	0	AMIN, ANASTACIA K	8/31/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	991 CHAPMAN STREET	None	SAN JOSE	CA	95126	1403	00	06000	37.33985392	-121.9283267	Santa Clara County
309593	Non-Physician Medical Practitioner	None	1194067728	0	0	ADRIAN, NEIL C	6/21/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1339 DONNA COURT	None	MERCED	CA	95340	0776	00	06000	37.32853845	-120.4522801	Merced County
309596	Non-Physician Medical Practitioner	None	1861821407	0	0	ATASHROO, MEGAN E NP	8/21/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1252 CANADA ROAD	None	WOODSIDE	CA	94062	3511	00	06000	37.436103	-122.2629075	San Mateo County
309602	Non-Physician Medical Practitioner	None	1528560810	0	0	AKAHOSHI, LAUREN PA	4/9/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	160 E ARTESIA STREET	SUITE 310	POMONA	CA	91767	2922	00	06000	34.07556833	-117.7507835	Los Angeles County
309617	Non-Physician Medical Practitioner	None	1316341324	0	0	AVENDANO, NANCY NP	11/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27924 SECO CANYON RD	None	SANTA CLARITA	CA	91350	3870	00	06000	34.4588501	-118.5343405	Los Angeles County
309687	Non-Physician Medical Practitioner	None	1730578238	0	0	ASPEYTIA, AMANDA J NP	3/7/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3133 SWEETWATER SPRINGS	None	SPRING VALLEY	CA	91978	1566	00	06000	32.735349	-116.9714919	San Diego County
309692	Non-Physician Medical Practitioner	None	1184481152	0	0	ABDUL-RAHMAN, AHMED Q NP	9/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
309739	Non-Physician Medical Practitioner	None	1609147743	0	0	ASIAN PACIFIC HEALTH CARE VENTURE, INC.	1/14/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9960 BALDWIN PL	None	EL MONTE	CA	91731	2204	00	06000	34.07140294	-118.0516061	Los Angeles County
309759	Non-Physician Medical Practitioner	None	1366078065	0	0	ALBERTSON, NICOLE PA-C	4/24/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 LINCOLN BLVD	None	MARINA DEL REY	CA	90292	6306	00	06000	33.98160766	-118.4400667	Los Angeles County
309772	Non-Physician Medical Practitioner	None	1669058137	0	0	ASHIQ, FATIMA NP	3/31/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	940 N WESTERN AVE	A	SAN PEDRO	CA	90732	2403	00	06000	33.75111361	-118.3090432	Los Angeles County
309780	Non-Physician Medical Practitioner	None	1770359754	0	0	ARMSTRONG, ALYSSA CNM	4/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	31170 TEMECULA PKWY	STE 201	TEMECULA	CA	92592	2914	00	06000	33.47598766	-117.1199967	Riverside County
309803	Non-Physician Medical Practitioner	None	1437303310	0	0	ANTIS, DANIEL J Z	4/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	450 ARMSTRONG DRIVE	None	PLACENTIA	CA	92870	2407	00	06000	33.89196105	-117.8718364	Orange County
309808	Non-Physician Medical Practitioner	None	1841444791	0	0	ALLEN, ANDREW H PA-C	8/31/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	170 COLUMBUS AVE	SUITE 110	SAN FRANCISCO	CA	94133	5160	00	06000	37.79680499	-122.4050031	San Francisco County
309864	Non-Physician Medical Practitioner	None	1326649930	0	0	ARDAYA, AMY M PA-C	2/24/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
309872	Non-Physician Medical Practitioner	None	1568567220	0	0	ALL FOR HEALTH HEALTH FOR ALL INC	7/8/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	519 E BROADWAY	None	GLENDALE	CA	91205	1110	00	06000	34.14636593	-118.2492244	Los Angeles County
309899	Non-Physician Medical Practitioner	None	1487326617	0	0	AYERZA, JOSHUA D PA-C	9/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1313 E HERNDON AVE	101B/203-206	FRESNO	CA	93720	3306	00	06000	36.834984	-119.7641925	Fresno County
309903	Non-Physician Medical Practitioner	None	1609499763	0	0	AGNEW, JORDAN D PA	2/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4560 ADMIRALTY WAY	SUITE 105	MARINA DEL REY	CA	90292	5423	00	06000	33.98364904	-118.4449069	Los Angeles County
309955	Non-Physician Medical Practitioner	None	1063689990	0	0	ALLEN, CARLA C NP	10/24/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7908 E SAFFRON	None	ANAHEIM HILLS	CA	92808	2217	00	06000	33.86169557	-117.751808	Orange County
309966	Non-Physician Medical Practitioner	None	1912312273	0	0	AVENAL COMMUNITY HEALTH CENTER	7/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	148 E KINGS ST	None	AVENAL	CA	93204	1529	00	06000	36.00249425	-120.1366109	Kings County
309972	Non-Physician Medical Practitioner	None	1790105559	0	0	ALTURA CENTERS FOR HEALTH	7/29/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	600 N CHERRY ST	None	TULARE	CA	93274	2978	00	06000	36.21679761	-119.3375929	Tulare County
309978	Non-Physician Medical Practitioner	None	1679294466	0	0	ALECXIH, ELIZABETH M PA-C	1/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
310005	Non-Physician Medical Practitioner	None	1457688699	0	0	AMANFO, ARTHUR N	6/24/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7770 WESTSIDE DR	APT 101	SAN DIEGO	CA	92108	1212	00	06000	32.77655848	-117.1528895	San Diego County
310017	Non-Physician Medical Practitioner	None	1811616311	0	0	ALVAREZ, RYAN C PA-C	11/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
310073	Non-Physician Medical Practitioner	None	1124189618	0	0	ALVES, JEANETTE S	10/26/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1300 SIERRA OAK LANE	None	COLFAX	CA	95713	9541	00	06000	39.09049481	-120.9744639	Placer County
310087	Non-Physician Medical Practitioner	None	1629311543	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	6/17/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1687 ERRINGER RD	SUITE 104	SIMI VALLEY	CA	93065	6508	00	06000	34.268886	-118.761426	Ventura County
310112	Non-Physician Medical Practitioner	None	1215673918	0	0	ANTALEK, BOBBY J NP	7/8/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
310123	Non-Physician Medical Practitioner	None	1184372047	0	0	ABDULQADIR, SHABANA A NP	4/26/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	315 MERCY AVE	STE 400	MERCED	CA	95340	8363	00	06000	37.33874349	-120.467493	Merced County
310136	Non-Physician Medical Practitioner	None	1003280892	0	0	ADENIJI, JOHN NP	10/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12555 CENTRAL AVE	STE C	CHINO	CA	91710	3569	00	06000	34.025247	-117.6892645	San Bernardino County
310142	Non-Physician Medical Practitioner	None	1700582871	0	0	AVENO, MARJORIE NP	6/12/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	123 ATLANTIC AVENUE	None	LONG BEACH	CA	90802	5121	00	06000	33.7685184	-118.1850803	Los Angeles County
310153	Non-Physician Medical Practitioner	None	1013065952	0	0	AFSHAR, MICHELE R	2/27/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2065 PORT BRISTOL	None	NEWPORT BEACH	CA	92660	5414	00	06000	33.62599689	-117.8507918	Orange County
310170	Non-Physician Medical Practitioner	None	1073824413	0	0	ADIARTE, JAMIE	4/2/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	DEPT. 148	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
310181	Non-Physician Medical Practitioner	None	1902260334	0	0	AGHILI, NELLY S NP	6/15/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1485 RIVER PARK DR	STE 200	SACRAMENTO	CA	95815	4501	00	06000	38.599614	-121.438728	Sacramento County
310242	Non-Physician Medical Practitioner	None	1003113192	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	3/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6 WOODLAND RD	SUITE 102	SAINT HELENA	CA	94574	9501	00	06000	38.54297115	-122.4754501	Napa County
310264	Non-Physician Medical Practitioner	None	1720144785	0	0	ABELLERA, EMMELINE DUMUK	5/2/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7373 WEST LN	None	STOCKTON	CA	95210	3377	00	06000	38.017701	-121.297869	San Joaquin County
310275	Non-Physician Medical Practitioner	None	1013794411	0	0	ARRIAGA, ALEX PA-C	1/22/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2081 BRONZE STAR DR	None	WOODLAND	CA	95776	5423	00	06000	38.67049812	-121.7238394	Yolo County
310281	Non-Physician Medical Practitioner	None	1740467174	0	0	ALDAZ, JESSICA	4/26/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3200 KEARNEY ST	URGENT CARE CENTER	FREMONT	CA	94538	2299	00	06000	37.54866156	-121.9750739	Alameda County
310282	Non-Physician Medical Practitioner	None	1548417801	0	0	ANSARY, MIR SAMIM A	11/17/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1019 CABERNET CT	None	VACAVILLE	CA	95688	2805	00	06000	38.36062463	-121.9843297	Solano County
310286	Non-Physician Medical Practitioner	None	1982131660	0	0	ALEKSANI, EMIN PA	5/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	191 S BUENA VISTA STREET	SUITE 150	BURBANK	CA	91505	4522	00	06000	34.15872557	-118.3283863	Los Angeles County
310291	Non-Physician Medical Practitioner	None	1497582209	0	0	ALOMARI, NUHA PA-C	11/12/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18112 OUTER HWY 18	STE 101	APPLE VALLEY	CA	92307	0840	00	06000	34.54079736	-117.2688963	San Bernardino County
310313	Non-Physician Medical Practitioner	None	1346645595	0	0	ANDERSON, KAITLIN R NP	4/21/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	210 CANAL ST	None	KING CITY	CA	93930	3432	00	06000	36.20731142	-121.1325532	Monterey County
310322	Non-Physician Medical Practitioner	None	1629180708	0	0	AMOS, DANIEL	7/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1626 W TEMPLE ST	None	LOS ANGELES	CA	90026	5027	00	06000	34.06828822	-118.2617899	Los Angeles County
310334	Non-Physician Medical Practitioner	None	1639845993	0	0	AMAYUN, IRA V NP	10/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39141 CIVIC CENTER DR	STE 335	FREMONT	CA	94538	5831	00	06000	37.55436307	-121.9764708	Alameda County
310349	Non-Physician Medical Practitioner	None	1639225154	0	0	ALI, KANEEZ	3/22/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	215 W 4TH ST	None	PERRIS	CA	92570	2010	00	06000	33.78233553	-117.2305035	Riverside County
310360	Non-Physician Medical Practitioner	None	1114156759	0	0	ASTURIAS, SHERI	11/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27260 LOS ALTOS APT 931	None	MISSION VIEJO	CA	92691	8501	00	06000	33.56692945	-117.6674609	Orange County
310399	Non-Physician Medical Practitioner	None	1124637368	0	0	ANDERSON, GWENDOLYN	8/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
310413	Non-Physician Medical Practitioner	None	1457695132	0	0	ABRIAM, SHERELL S NP	1/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9396 STONE SPRINGS DR	None	ELK GROVE	CA	95624	3959	00	06000	38.41974	-121.3486605	Sacramento County
310420	Non-Physician Medical Practitioner	None	1861465940	0	0	ALAMSHAHI, MARY C NP	10/28/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1312 LONGFELLOW CIRCLE	None	ROSEVILLE	CA	95747	6886	00	06000	38.77096697	-121.3319962	Placer County
310440	Non-Physician Medical Practitioner	None	1225695869	0	0	ABRAHAMSON, LAUREN E CNM	10/28/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	112 LA CASA VIA	SUITE 300	WALNUT CREEK	CA	94598	3059	00	06000	37.91229899	-122.0423696	Contra Costa County
310449	Non-Physician Medical Practitioner	None	1699016030	0	0	AL-SAEEDI, AMINAH	5/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	222 W 39TH AVE	None	SAN MATEO	CA	94403	4364	00	06000	37.53039072	-122.2987772	San Mateo County
310488	Non-Physician Medical Practitioner	None	1023316668	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	3/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1530 RAILROAD AVE	None	ST. HELENA	CA	94574	1107	00	06000	38.50733846	-122.4714652	Napa County
310500	Non-Physician Medical Practitioner	None	1235645391	0	0	AUDU, JONATHAN NP	11/13/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11942 PARAMOUNT BLVD	STE B	DOWNEY	CA	90242	2306	00	06000	33.93374098	-118.1445557	Los Angeles County
310532	Non-Physician Medical Practitioner	None	1407023757	0	0	ARRUDA, TERI L NP	7/2/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	328 QUINCY AVE	None	LONG BEACH	CA	90814	3059	00	06000	33.769197	-118.139373	Los Angeles County
310559	Non-Physician Medical Practitioner	None	1275902280	0	0	ANDERSON, MATTHEW C	5/9/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	30137 STERLING CIRCLE	None	MENIFEE	CA	92584	6947	00	06000	33.68257657	-117.1489197	Riverside County
310590	Non-Physician Medical Practitioner	None	1194142570	0	0	ANDOLINA, SARA	2/28/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1991 WILLOWRIDGE DRIVE	None	VISTA	CA	92081	7301	00	06000	33.16078571	-117.2551824	San Diego County
310600	Non-Physician Medical Practitioner	None	1124754254	0	0	ABADIES, LEA DOMINIQUE M PA	4/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1095 IRVINE BLVD	None	TUSTIN	CA	92780	3526	00	06000	33.74821163	-117.8097851	Orange County
310650	Non-Physician Medical Practitioner	None	1912475542	0	0	AQUI, THERESA NP	4/28/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3111 CAMINO DEL RIO	STE 625	SAN DIEGO	CA	92108	5718	00	06000	32.77510996	-117.1277427	San Diego County
310678	Non-Physician Medical Practitioner	None	1295972321	0	0	ARANA, BRIANNA PA-C	2/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	00	06000	37.51438187	-122.2607682	San Mateo County
310744	Non-Physician Medical Practitioner	None	1225009319	0	0	ALLEN, MELISSA B NP	2/10/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1882 GRANADA AVE	None	CONCORD	CA	94519	1330	00	06000	37.98507723	-122.0088679	Contra Costa County
310749	Non-Physician Medical Practitioner	None	1851456214	0	0	ARELLANO, TERESA	6/11/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3475 CLARINGTON AVE	302	LOS ANGELES	CA	90034	3891	00	06000	34.02870451	-118.4051086	Los Angeles County
310782	Non-Physician Medical Practitioner	None	1871172445	0	0	AKUBUILO, NJIDEKA NP	10/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11942 PARAMOUNT BLVD	STE B	DOWNEY	CA	90242	2306	00	06000	33.93374098	-118.1445557	Los Angeles County
310793	Non-Physician Medical Practitioner	None	1083063598	0	0	ALBERSON, ANDREA L PA-C	1/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
310824	Non-Physician Medical Practitioner	None	1487842621	0	0	ASLI, FARAH G	3/9/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	552 N BELLFLOWER BLVD	UNIT 318	LONG BEACH	CA	90814	4365	00	06000	33.7716168	-118.1209043	Los Angeles County
310894	Non-Physician Medical Practitioner	None	1275158305	0	0	ANDERSON, CARLEY M PA	11/12/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2 W FERN AVE	None	REDLANDS	CA	92373	5916	00	06000	34.05016907	-117.1793443	San Bernardino County
310896	Non-Physician Medical Practitioner	None	1538264817	0	0	ANDERSON, ERIN N NP	4/24/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1820 GOSHEN AVENUE	None	CLOVIS	CA	93611	6661	00	06000	36.84965235	-119.683494	Fresno County
310899	Non-Physician Medical Practitioner	None	1043382666	0	0	ABOLHASSANI-BLOOMER, TINA NP	5/3/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19171 JASPER HILL ROAD	None	TRABUCO CANYON	CA	92679	1121	00	06000	33.68350166	-117.6356199	Orange County
310943	Non-Physician Medical Practitioner	None	1710284963	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	3/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	913 WASHINGTON ST	None	CALISTOGA	CA	94515	1433	00	06000	38.57812737	-122.5772111	Napa County
310949	Non-Physician Medical Practitioner	None	1124325220	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	3/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18990 COYOTE VALLEY RD	SUITE 8	HIDDEN VALLEY LAK	CA	95467	8337	00	06000	38.79462138	-122.5574782	Lake County
310951	Non-Physician Medical Practitioner	None	1326165853	0	0	AREND, WILLIAM H PA-C	8/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
310967	Non-Physician Medical Practitioner	None	1871914309	0	0	ALLEN, ROBERT C	1/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2549 VIA LA SELVA	None	PALOS VERDES	CA	90274	1019	00	06000	33.80368398	-118.3858001	Los Angeles County
310979	Non-Physician Medical Practitioner	None	1033847918	0	0	AMURAO, JASON B NP	11/18/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1280 S VICTORIA AVE	250	VENTURA	CA	93003	6521	00	06000	34.26344767	-119.2119344	Ventura County
311071	Non-Physician Medical Practitioner	None	1982086278	0	0	AVALOS, JOSE A NP	12/23/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10522 BISBY ST	None	EL MONTE	CA	91731	1910	00	06000	34.08473767	-118.0414953	Los Angeles County
311092	Non-Physician Medical Practitioner	None	1144915661	0	0	AUSTRIA, DIONNE MELODY S NP	11/9/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	317 WEST PUEBLO ST	None	SANTA BARBARA	CA	93105	4365	00	06000	34.42967671	-119.7228362	Santa Barbara County
311141	Non-Physician Medical Practitioner	None	1609236512	0	0	AL-ALI, BAYAN K	8/15/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12760 MILLENIUM DR	STE 302	PLAYA VISTA	CA	90094	2915	00	06000	33.97572635	-118.4168134	Los Angeles County
311171	Non-Physician Medical Practitioner	None	1366926388	0	0	ADAMS, MICHELLE Y PA-C	10/23/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1515 NEWHALL STREET	None	SANTA CLARA	CA	95050	6114	00	06000	37.33979844	-121.9336503	Santa Clara County
311174	Non-Physician Medical Practitioner	None	1972976744	0	0	AIELLO, CHRISTIE D NP	3/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2501 E CHAPMAN AVE	None	ORANGE	CA	92869	3204	00	06000	33.78785649	-117.8276715	Orange County
311190	Non-Physician Medical Practitioner	None	1770085862	0	0	ALMERAZ, ANDREA NP	11/7/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 N. WESTERN AVE	SUITE 204	SAN BERNARDINO	CA	92411	1353	00	06000	34.1315778	-117.3182453	San Bernardino County
311196	Non-Physician Medical Practitioner	None	1154471514	0	0	ALFONSO, JUDY VO	5/11/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7955 WESTMINSTER BLVD	None	WESTMINSTER	CA	92683	4001	00	06000	33.75932839	-117.9902744	Orange County
311198	Non-Physician Medical Practitioner	None	1013188838	0	0	ABBA, PATRICIA NP	4/1/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	22110 ROSCOE BLVD	STE 201	CANOGA PARK	CA	91304	3861	00	06000	34.21957849	-118.6082685	Los Angeles County
311220	Non-Physician Medical Practitioner	None	1922305010	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	3/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10 WOODLAND RD	SUITE 502	ST. HELENA	CA	94574	0000	00	06000	38.54196972	-122.4751787	Napa County
311229	Non-Physician Medical Practitioner	None	1457879488	0	0	ALTAMIMI, LAITH M NP	10/13/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	785 MEDICAL CENTER	203	CLOVIS	CA	93611	6878	00	06000	36.84377271	-119.6609536	Fresno County
311240	Non-Physician Medical Practitioner	None	1497351597	0	0	ALEXANDER, JULIE E PA-C	12/4/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	28212 KELLY JOHNSON PKWY	SUITE 245	VALENCIA	CA	91355	5084	00	06000	34.44856821	-118.5794922	Los Angeles County
311283	Non-Physician Medical Practitioner	None	1225282403	0	0	AGLIPAY, IRMA OROZCO	6/24/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3308 ANGELICO CT	None	SAN JOSE	CA	95135	1772	00	06000	37.31347222	-121.7663865	Santa Clara County
311364	Non-Physician Medical Practitioner	None	1699187849	0	0	AMOS, TESSA D NP	12/16/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1994 ARROWHEAD AVE	None	SOUTH LAKE TAHOE	CA	96150	5238	00	06000	38.85383468	-120.0209053	El Dorado County
311365	Non-Physician Medical Practitioner	None	1629240049	0	0	ALICAR, AGNES TAGORDA	4/18/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1801 E MARCH	STE C-320	STOCKTON	CA	95210	6676	00	06000	38.00315652	-121.2868715	San Joaquin County
311403	Non-Physician Medical Practitioner	None	1902340276	0	0	ANTHONY, HANNAH L NP	7/14/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1742 SAND HILL RD	APT 406	PALO ALTO	CA	94304	2116	00	06000	37.43069002	-122.1876006	Santa Clara County
311480	Non-Physician Medical Practitioner	None	1538498415	0	0	ALLIANCE HEALTHCARE SERVICES INC	7/3/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	406 SUNRISE AVE	None	ROSEVILLE	CA	95661	4106	00	06000	38.73944898	-121.2720559	Placer County
311482	Non-Physician Medical Practitioner	None	1962781351	0	0	AL-SAAD, MAGDALENA M NP	9/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23316 EAGLE RIDGE	None	MISSION VIEJO	CA	92692	1694	00	06000	33.62340449	-117.6278175	Orange County
311499	Non-Physician Medical Practitioner	None	1013435783	0	0	ADEN, AMANDA PA	7/21/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9353 IMPERIAL HWY	None	DOWNEY	CA	90242	2812	00	06000	33.9171603	-118.1288418	Los Angeles County
311514	Non-Physician Medical Practitioner	None	1013006477	0	0	ALVERO, ERNESTO M	4/23/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14125 VEREDA DEL PORTAL	None	SALINAS	CA	93908	9323	00	06000	36.56169343	-121.7238998	Monterey County
311534	Non-Physician Medical Practitioner	None	1861637274	0	0	AGUSTIN, JASON K	7/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	136 BRIDGE STREET	None	SAN GABRIEL	CA	91775	2720	00	06000	34.1034865	-118.1123463	Los Angeles County
311543	Non-Physician Medical Practitioner	None	1194995563	0	0	ALDRICH, KATHERINE M NP	12/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1445 BAIRD ROAD	None	SANTA ROSA	CA	95409	2512	00	06000	38.488383	-122.6681505	Sonoma County
311545	Non-Physician Medical Practitioner	None	1457372542	0	0	AYVAZYAN, CHRISTINE	5/31/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 S CENTRAL AVE	SUITE 221	GLENDALE	CA	91204	2530	00	06000	34.12736888	-118.257777	Los Angeles County
311552	Non-Physician Medical Practitioner	None	1366451627	0	0	ARTHUR, CORPUS	2/8/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	525 3RD AVE	None	CHULA VISTA	CA	91910	5616	00	06000	32.63367609	-117.0769202	San Diego County
311562	Non-Physician Medical Practitioner	None	1700131679	0	0	ALL FOR HEALTH HEALTH FOR ALL INC	6/27/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 S GLENOAKS BLVD STE	None	BURBANK	CA	91502	2707	00	06000	34.18077992	-118.3029503	Los Angeles County
311600	Non-Physician Medical Practitioner	None	1164432969	0	0	ANDERSON, JON K NP	5/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	39532 S LILLEY WAY	None	COARSEGOLD	CA	93614	9202	00	06000	37.17783609	-119.8290316	Madera County
311608	Non-Physician Medical Practitioner	None	1407393903	0	0	ADUBA, LYNDA N NP	6/23/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16229 WOODRUFF AVE	APT 2	BELLFLOWER	CA	90706	4940	00	06000	33.88683429	-118.1173813	Los Angeles County
311617	Non-Physician Medical Practitioner	None	1588698112	0	0	ALPER, MIKHAIL PA-C	2/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7121 N WHITNEY AVE	None	FRESNO	CA	93720	0151	00	06000	36.83923029	-119.7423444	Fresno County
311651	Non-Physician Medical Practitioner	None	1922739135	0	0	AMIN, PAYAL NP	11/6/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4849 VAN NUYS BLVD	211	SHERMAN OAKS	CA	91403	2110	00	06000	34.159113	-118.4487465	Los Angeles County
311664	Non-Physician Medical Practitioner	None	1336201482	0	0	A GRACE E HWANG	4/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	835 SEQUOIA AVE	None	LINDSAY	CA	93247	1424	00	06000	36.21351337	-119.0961199	Tulare County
311682	Non-Physician Medical Practitioner	None	1578858916	0	0	ANDERSON, BRITTNEY K NP	8/4/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10001 CLIFF DRIVE	None	HUNTINGTON BEACH	CA	92646	6604	00	06000	33.66154833	-117.9534091	Orange County
311694	Non-Physician Medical Practitioner	None	1235214750	0	0	AVALOS, ROBIN M	2/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	16069 NEST EVANS DR	None	SURPRISE	AZ	85379	5104	00	06000	33.616089	-112.406292	Maricopa County
311724	Non-Physician Medical Practitioner	None	1700853165	0	0	ALMGREN, CHRISTINA MARGUERITE	9/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	751 S BASCOM AVE	PEDIATRICS DEPT	SAN JOSE	CA	95128	2604	00	06000	37.313433	-121.9318385	Santa Clara County
311755	Non-Physician Medical Practitioner	None	1922018993	0	0	ARIAS, EDWARD J PA-C	6/28/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7600 HOSPITAL DR	STE G	SACRAMENTO	CA	95823	5406	00	06000	38.463876	-121.414698	Sacramento County
311810	Non-Physician Medical Practitioner	None	1942455464	0	0	ATIENZA, ASHIKA SHANKAR	7/8/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 LAWRENCE EXPY	DEPT 148	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
311825	Non-Physician Medical Practitioner	None	1821110925	0	0	ADONA, LOLITA NP	1/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20 ALLEN ST	None	MARTINEZ	CA	94553	2681	00	06000	38.00771973	-122.1331484	Contra Costa County
311877	Non-Physician Medical Practitioner	None	1558943662	0	0	ATMOJO, MAYA PA-C	11/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2811 WILSHIRE BLVD	STE 930	SANTA MONICA	CA	90403	4809	00	06000	34.03785224	-118.4752132	Los Angeles County
311909	Non-Physician Medical Practitioner	None	1114517919	0	0	ANTONE, STACY	1/6/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
311915	Non-Physician Medical Practitioner	None	1902192875	0	0	ALTAMED HEALTH SERVICES CORP	8/25/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12130 PARAMOUNT BLVD	None	DOWNEY	CA	90242	2339	00	06000	33.93100421	-118.1466676	Los Angeles County
311920	Non-Physician Medical Practitioner	None	1023765377	0	0	ARMSTRONG, REBECCA R PA-C	2/22/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1144 65TH ST STE F	None	OAKLAND	CA	94608	1053	00	06000	37.84779018	-122.2868874	Alameda County
311927	Non-Physician Medical Practitioner	None	1578390456	0	0	ABDUL, NILUFAR PA-C	2/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2221 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1418	00	06000	38.556288	-121.458474	Sacramento County
311931	Non-Physician Medical Practitioner	None	1134867864	0	0	ANDERSEN, WYATT J PA-C	8/7/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
311948	Non-Physician Medical Practitioner	None	1659775708	0	0	AGORRILLA, MARIA S NP	10/24/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	44274 GEORGE CUSHMAN CT	212	TEMECULA	CA	92592	5945	00	06000	33.48313254	-117.0888293	Riverside County
311970	Non-Physician Medical Practitioner	None	1306359146	0	0	ADDIS, CHALICE A NP	9/6/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	23181 VERDUGO DR STE 103	None	LAGUNA HILLS	CA	92653	1313	00	06000	33.62609529	-117.7293191	Orange County
311973	Non-Physician Medical Practitioner	None	1831462068	0	0	ANTES, JAMES E	4/9/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	134 WEST JAVIS	None	RIDGECREST	CA	93555	3031	00	06000	35.57886569	-117.6719929	Kern County
311995	Non-Physician Medical Practitioner	None	1528510419	0	0	ALBANO, MICHELLE M NP	4/1/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1417 DRAGON ROCK DRIVE	None	HENDERSON	NV	89052	4042	00	06000	35.9769102	-115.1278355	Clark County
312004	Non-Physician Medical Practitioner	None	1518049659	0	0	ALVAREZ, JUANA ROSA	2/2/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19304 KAY AVENUE	None	CERRITOS	CA	90703	7338	00	06000	33.85545639	-118.0505129	Los Angeles County
312074	Non-Physician Medical Practitioner	None	1396466876	0	0	ASHLEY-WHITE, QUIANNA PA	5/1/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	1821	00	06000	37.7634502	-122.4579779	San Francisco County
312081	Non-Physician Medical Practitioner	None	1619938180	0	0	A, MCVEY B	5/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	309 W BEVERLY BLVD	None	MONTEBELLO	CA	90640	4308	00	06000	34.01597577	-118.1003516	Los Angeles County
312126	Non-Physician Medical Practitioner	None	1992993000	0	0	ANGIOI, ELENA	5/5/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	57445 29 PALMS HWY	SUITE 301	YUCCA VALLEY	CA	92284	2947	00	06000	34.12434696	-116.4111216	San Bernardino County
312130	Non-Physician Medical Practitioner	None	1033832191	0	0	ATILLO, FRANCISE FAITH B NP	12/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	225 NORTH JACKSON	None	SAN JOSE	CA	95116	1603	00	06000	37.36217918	-121.8472051	Santa Clara County
312154	Non-Physician Medical Practitioner	None	1841367547	0	0	ADDISON-SOREY, ANDREA J	8/31/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	310 MYLNAR AVE	None	MANTECA	CA	95336	4111	00	06000	37.8014544	-121.201171	San Joaquin County
312159	Non-Physician Medical Practitioner	None	1841365202	0	0	ANTHONY, DAVID MICHAEL	6/27/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	00	06000	36.84133078	-119.7824983	Fresno County
312172	Non-Physician Medical Practitioner	None	1780267336	0	0	ARROYO, ARIANNA PA-C	3/20/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25150 HANCOCK AVENUE	SUITE 210	MURRIETA	CA	92562	5989	00	06000	33.56635084	-117.1823956	Riverside County
312187	Non-Physician Medical Practitioner	None	1295063527	0	0	ALLEN, BLAINE J NP	10/16/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	10169 EASTVIEW ST	None	FIRESTONE	CO	80504	0000	00	06000	40.14807212	-104.9332614	Weld County
312225	Non-Physician Medical Practitioner	None	1912519299	0	0	ALOKOZAI, ARIA PA-C	2/20/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
312238	Non-Physician Medical Practitioner	None	1154962199	0	0	ARAJ, AILEEN NP	8/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2299 MOWRY AVE	STE 3C	FREMONT	CA	94538	1621	00	06000	37.55671415	-121.9817758	Alameda County
312240	Non-Physician Medical Practitioner	None	1942365648	0	0	ALFARO, IVONE LUCILA	11/16/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8781 VAN NUYS BLVD	None	PANORAMA CITY	CA	91402	2406	00	06000	34.22960628	-118.4502708	Los Angeles County
312245	Non-Physician Medical Practitioner	None	1255542601	0	0	ALTAMED HEALTH SERVICES CORP	1/5/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3945 E. WHITTIER BLVD	None	LOS ANGELES	CA	90023	2440	00	06000	34.02394552	-118.187748	Los Angeles County
312265	Non-Physician Medical Practitioner	None	1649718990	0	0	AGUILAR, EUGENE T	6/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16745 W BERNARDO DR	STE 240	SAN DIEGO	CA	92127	1907	00	06000	33.01539521	-117.0824934	San Diego County
312273	Non-Physician Medical Practitioner	None	1639323355	0	0	ALPHA PREGNANCY HELP CENTER	1/18/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	645 W OLIVE AVE	SUITE 321	MERCED	CA	95348	2433	00	06000	37.31939934	-120.4804685	Merced County
312283	Non-Physician Medical Practitioner	None	1912673039	0	0	ALVES, REBECCA M PA-C	3/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2755 HERNDON AVE	None	CLOVIS	CA	93611	6800	00	06000	36.83745149	-119.6604315	Fresno County
312308	Non-Physician Medical Practitioner	None	1760623854	0	0	AVILA, MELDY Y	4/1/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10835 NEW STREET	None	DOWNEY	CA	90241	0000	00	06000	33.94342419	-118.1318514	Los Angeles County
312318	Non-Physician Medical Practitioner	None	1770577603	0	0	AUSTIN, JILL PA	2/27/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	505 PARNASSUS AVE	None	SAN FRANCISCO	CA	94143	2204	00	06000	37.7634502	-122.4579779	San Francisco County
312350	Non-Physician Medical Practitioner	None	1376065490	0	0	AGBATEKWE, EUGINIA	4/17/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
312368	Non-Physician Medical Practitioner	None	1396264925	0	0	AW, MUN Y PA-C	10/18/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	220 S 1ST ST	None	ALHAMBRA	CA	91801	3893	00	06000	34.09192598	-118.1259775	Los Angeles County
312373	Non-Physician Medical Practitioner	None	1366611774	0	0	ANDERSON, SHERRI N PA-C	7/10/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	215 W JANSS RD	None	THOUSAND OAKS	CA	91360	1847	00	06000	34.2064445	-118.8824085	Ventura County
312378	Non-Physician Medical Practitioner	None	1467759415	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	3/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	935 TRANCAS ST	4B	NAPA	CA	94558	2932	00	06000	38.32367324	-122.294977	Napa County
312380	Non-Physician Medical Practitioner	None	1245414085	0	0	ASANOVA, ELENA	10/7/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12157 VICTORY BLVD	None	NORTH HOLLYWOOD	CA	91606	3204	00	06000	34.18669745	-118.3985415	Los Angeles County
312386	Non-Physician Medical Practitioner	None	1932415957	0	0	ALBIDRES, DIANA NP	1/19/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2265 W 236TH PLACE	None	TORRANCE	CA	90501	5950	00	06000	33.81058163	-118.3222363	Los Angeles County
312411	Non-Physician Medical Practitioner	None	1578208534	0	0	ANDRIC, PATRICIA E NP	11/10/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2600 VIA DE LA VALLE	SUITE 200	DEL MAR	CA	92014	1192	00	06000	32.98053969	-117.2508471	San Diego County
312434	Non-Physician Medical Practitioner	None	1902294085	0	0	ALTAVAS, DARRYL CHRISTIAN NP	2/27/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	515 W GRANGEVILLE BLVD	B	HANFORD	CA	93230	2861	00	06000	36.3426505	-119.652795	Kings County
312436	Non-Physician Medical Practitioner	None	1104273309	0	0	ANKER, YEN K NP	7/5/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	84 PRAIRIE FALCON	None	ALISO VIEJO	CA	92656	1717	00	06000	33.60303237	-117.7382142	Orange County
312468	Non-Physician Medical Practitioner	None	1053589713	0	0	AVILA, DAWN M NP	9/15/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	446 S 2ND ST	None	KERMAN	CA	93630	1354	00	06000	36.7290862	-120.0639237	Fresno County
312487	Non-Physician Medical Practitioner	None	1104481704	0	0	ABERGAS, MARIBELLE B NP	8/1/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	21300 SHERMAN WAY STE 3	None	CANOGA PARK	CA	91303	3672	00	06000	34.20095853	-118.5957675	Los Angeles County
312507	Non-Physician Medical Practitioner	None	1023225281	0	0	ARAYA, ELEN G NP	7/16/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1013 S SEDONA LN	None	ANAHEIM	CA	92808	1652	00	06000	33.85752987	-117.7260942	Orange County
312511	Non-Physician Medical Practitioner	None	1053796136	0	0	ALKAFARNA, NIDAL A PA	8/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
312557	Non-Physician Medical Practitioner	None	1740848050	0	0	AHMED, SANA A PA-C	8/13/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	101 CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
312571	Non-Physician Medical Practitioner	None	1073834065	0	0	AVILA, ESTHER	2/25/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7278 ELSA COURT	None	FONTANA	CA	92336	5756	00	06000	34.12212049	-117.4645347	San Bernardino County
312575	Non-Physician Medical Practitioner	None	1710218409	0	0	ALLIANCE MEDICAL CENTER	4/28/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8465 OLD REDWOOD HWY STE	None	WINDSOR	CA	95492	9244	00	06000	38.5435006	-122.8006981	Sonoma County
312593	Non-Physician Medical Practitioner	None	1548867666	0	0	AL-SHOUBAKI, HEBA M PA-C	1/6/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1313 E HERNDON AVE	101B/203-206	FRESNO	CA	93720	3306	00	06000	36.834984	-119.7641925	Fresno County
312606	Non-Physician Medical Practitioner	None	1043258239	0	0	ANDERSON, CHAD H	10/4/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1063 VERONA AVENUE	None	LIVERMORE	CA	94550	5423	00	06000	37.67213853	-121.7821905	Alameda County
312607	Non-Physician Medical Practitioner	None	1396959060	0	0	ALTAMED HEALTH SERVICES CORP	6/29/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5427 EAST WHITTIER BLVD	None	E. LOS ANGELES	CA	90022	4101	00	06000	34.01966132	-118.1536008	Los Angeles County
312621	Non-Physician Medical Practitioner	None	1851479372	0	0	AGUEY, OMAR J PA-C	11/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	41880 KALMIA ST	SUITE 100	MURRIETA	CA	92562	8835	00	06000	33.55740114	-117.2157733	Riverside County
312630	Non-Physician Medical Practitioner	None	1124079702	0	0	ARMENTA, CELESTE L	2/17/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1860 HORSESHOE CT	None	IMPERIAL	CA	92251	9523	00	06000	32.86768242	-115.5682354	Imperial County
312664	Non-Physician Medical Practitioner	None	1649901943	0	0	AZHAND, SHEILA PA	11/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 EASTLAKE AVE	None	LOS ANGELES	CA	90089	0177	00	06000	34.06169385	-118.2044698	Los Angeles County
312699	Non-Physician Medical Practitioner	None	1568951440	0	0	ACEVEDO, LUZ D PA-C	12/3/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2075 SAN JOAQUIN HILLS R	None	NEWPORT BEACH	CA	92660	6505	00	06000	33.61676129	-117.869325	Orange County
312708	Non-Physician Medical Practitioner	None	1740597921	0	0	AMALYA, DALTORIO	8/3/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 SUPERIOR AVE	160	NEWPORT BEACH	CA	92663	3663	00	06000	33.63017269	-117.929499	Orange County
312720	Non-Physician Medical Practitioner	None	1174774368	0	0	ANDERSON, DEBORAH LOUISE	6/9/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13010 HESPERIA RD	SUITE 200	VICTORVILLE	CA	92395	5837	00	06000	34.48843676	-117.2909745	San Bernardino County
312742	Non-Physician Medical Practitioner	None	1487323200	0	0	AGUILAR MARROQUIN, ERIKA NP	3/2/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1701 E CESAR E CHAVEZ AV	SUITE 356	LOS ANGELES	CA	90033	2425	00	06000	34.05112725	-118.2173921	Los Angeles County
312743	Non-Physician Medical Practitioner	None	1902327075	0	0	ANJO, BENJAMIN NP	11/5/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
312758	Non-Physician Medical Practitioner	None	1730270828	0	0	AFSHARI, PARVANEH NP	10/13/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	311 S CITRUS AVENUE	None	LOS ANGELES	CA	90036	3035	00	06000	34.06843716	-118.3397083	Los Angeles County
312770	Non-Physician Medical Practitioner	None	1619423233	0	0	AKILA, AROUS	3/19/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2100 MAMMOTH LN	None	CORONA	CA	92879	5983	00	06000	33.89242767	-117.5294175	Riverside County
312814	Non-Physician Medical Practitioner	None	1689324253	0	0	ALINAGHI, BAHAREH NP	7/11/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
312821	Non-Physician Medical Practitioner	None	1083712764	0	0	AULETTO, ROXELLEN A NP	9/14/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	921 SIERRA AVE	None	CLOVIS	CA	93612	1259	00	06000	36.83037495	-119.697429	Fresno County
312851	Non-Physician Medical Practitioner	None	1760035992	0	0	ARREOLA, ALEXIS L NP	9/1/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 W ARBOR DR	None	SAN DIEGO	CA	92103	9001	00	06000	32.7537975	-117.1658298	San Diego County
312882	Non-Physician Medical Practitioner	None	1679801955	0	0	ARIEAS, ERIN T NP	12/15/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1308 7TH AVENUE	None	SACRAMENTO	CA	95818	3747	00	06000	38.549664	-121.502475	Sacramento County
312909	Non-Physician Medical Practitioner	None	1992986731	0	0	ADEAGBO, GRACE O NP	7/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2372 STERLING AVE	None	SAN BERNARDINO	CA	92404	4624	00	06000	34.13682	-117.243687	San Bernardino County
312935	Non-Physician Medical Practitioner	None	1952719882	0	0	ARAGON, GILBERT D	10/1/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	821 ALVARADO AVE	None	SUNNYVALE	CA	94085	3403	00	06000	37.39238183	-122.0078351	Santa Clara County
312939	Non-Physician Medical Practitioner	None	1972748689	0	0	ARLIEN, JONATHAN EDWARD	2/23/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	1600 MEDICAL PKWY	None	CARSON CITY	NV	89703	4625	00	06000	39.202263	-119.7841095	Consolidated Municipality of Carson City
312944	Non-Physician Medical Practitioner	None	1467969485	0	0	ASAFA, OLUSOLA M	8/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5446 JAMESPORT WY	None	SACRAMENTO	CA	95835	2464	00	06000	38.67687	-121.5365535	Sacramento County
312951	Non-Physician Medical Practitioner	None	1174035885	0	0	ABAS, ARCELYN V NP	7/30/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16229 WOODRUFF AVE	51	BELLFLOWER	CA	90706	4943	00	06000	33.88683429	-118.1173813	Los Angeles County
312987	Non-Physician Medical Practitioner	None	1174147581	0	0	ARMAS, STEPHANIE M NP	2/23/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	150 LAGUNA RD	STE A	FULLERTON	CA	92835	3614	00	06000	33.89367364	-117.9302191	Orange County
312988	Non-Physician Medical Practitioner	None	1790177582	0	0	ALTAMED HEALTH SERVICES CORP	10/29/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1900 E SLAUSON AVE	None	HUNTINGTON PARK	CA	90255	2725	00	06000	33.9891357	-118.2389609	Los Angeles County
313008	Non-Physician Medical Practitioner	None	1770865016	0	0	AUBREE, WATKINS	3/17/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
313037	Non-Physician Medical Practitioner	None	1982154324	0	0	ALLEN, EVERETT PA	10/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1742 OREGON STREET	None	REDDING	CA	96001	1717	00	06000	40.5808265	-122.3932989	Shasta County
313041	Non-Physician Medical Practitioner	None	1700335924	0	0	ADEYEMO, OLUMIDE	1/10/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
313068	Non-Physician Medical Practitioner	None	1437574720	0	0	AAMER, MUHAMMAD NP	8/9/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2652 SOUTH PALOMA	None	YUMA	AZ	85365	8907	00	06000	32.680773	-114.488703	Yuma County
313073	Non-Physician Medical Practitioner	None	1902181381	0	0	APGAR, AUTUMN RENEE	5/23/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	925 TAHOE BLVD	SUITE 105	INCLINE VILLAGE	NV	89451	9566	00	06000	39.24951683	-119.9492358	Washoe County
313108	Non-Physician Medical Practitioner	None	1982990859	0	0	ALTAMED HEALTH SERVICES CORP	8/25/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3820 MARTIN LUTHER KING	None	LYNWOOD	CA	90262	3625	00	06000	33.92760854	-118.1976943	Los Angeles County
313119	Non-Physician Medical Practitioner	None	1134229149	0	0	A, WALLRICH P	12/4/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9394 BIG HORN BLVD	None	ELK GROVE	CA	95758	7977	00	06000	38.420028	-121.40712	Sacramento County
313134	Non-Physician Medical Practitioner	None	1649044876	0	0	ALCANTAR, SARA E NP	4/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 SAN PABLO ST	None	LOS ANGELES	CA	90033	5313	00	06000	34.06238259	-118.2030986	Los Angeles County
313169	Non-Physician Medical Practitioner	None	1558031054	0	0	ALMONTE, WENDY P NP	4/25/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5400 W HILLSDALE AVE	None	VISALIA	CA	93291	6238	00	06000	36.330327	-119.351943	Tulare County
313185	Non-Physician Medical Practitioner	None	1003379306	0	0	ANTONY, TREESA NP	10/16/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	421 NUT TREE RD	None	VACAVILLE	CA	95687	3508	00	06000	38.36441975	-121.9525909	Solano County
313200	Non-Physician Medical Practitioner	None	1316281314	0	0	ALFANDY, FNU NP	9/20/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
313218	Non-Physician Medical Practitioner	None	1992720726	0	0	ATTALLA, RAAFAT E	5/23/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5013 W 136TH ST	None	HAWTHORNE	CA	90250	5635	00	06000	33.90862158	-118.3660441	Los Angeles County
313232	Non-Physician Medical Practitioner	None	1033416136	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	3/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18990 COYOTE VALLEY RD	STE. 5	HIDDEN VALLEY LAK	CA	95467	8337	00	06000	38.79462138	-122.5574782	Lake County
313254	Non-Physician Medical Practitioner	None	1922276328	0	0	ALTAMED HEALTH SERVICES CORP	1/5/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3945 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2440	00	06000	34.02394552	-118.187748	Los Angeles County
313284	Non-Physician Medical Practitioner	None	1083118970	0	0	ACHARYA, PRATIKSHYA NP	1/30/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3000 Q STREET	2ND FLOOR	SACRAMENTO	CA	95816	7058	00	06000	38.564991	-121.4696565	Sacramento County
313288	Non-Physician Medical Practitioner	None	1215593074	0	0	AHMED, ROMA NP	6/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1110 W LA PALMA AVE	STE 4	ANAHEIM	CA	92801	2823	00	06000	33.84712953	-117.9320355	Orange County
313296	Non-Physician Medical Practitioner	None	1073022935	0	0	ANAYA, VANESSA I	4/17/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	925 THE ALAMEDA	UNIT 304	SAN JOSE	CA	95126	3137	00	06000	37.33175652	-121.9080358	Santa Clara County
313311	Non-Physician Medical Practitioner	None	1083496988	0	0	AVAGYAN, HOVHANNES NP	3/3/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3030 W OLYMPIC BLVD	STE 217	LOS ANGELES	CA	90006	6507	00	06000	34.05260995	-118.3015825	Los Angeles County
313328	Non-Physician Medical Practitioner	None	1437600350	0	0	ANGLE, LESLEY N PA-C	5/5/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7325 MEDICAL CENTER DR	STE 200	WEST HILLS	CA	91307	4108	00	06000	34.20369349	-118.629837	Los Angeles County
313333	Non-Physician Medical Practitioner	None	1679028658	0	0	APPIS, JULIA I NP	4/28/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
313371	Non-Physician Medical Practitioner	None	1063149946	0	0	ALLAHYARIAN, LINDA NP	11/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 MEDICAL PLAZA	265	LOS ANGELES	CA	90095	0001	00	06000	34.06527974	-118.4462792	Los Angeles County
313394	Non-Physician Medical Practitioner	None	1538783873	0	0	ALEXANDER, MIYOSHI NP	8/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	710 EUCLID ST	203	ANAHEIM	CA	92801	4122	00	06000	33.8420837	-117.9415765	Orange County
313413	Non-Physician Medical Practitioner	None	1669107082	0	0	ASH, TAYLOR PA-C	9/3/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1187 E HERNDON AVE	SUITE 101	FRESNO	CA	93720	3166	00	06000	36.83640179	-119.7674647	Fresno County
313465	Non-Physician Medical Practitioner	None	1417733627	0	0	ARRIZON, SAMANTHA P PA	4/18/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
313490	Non-Physician Medical Practitioner	None	1982870291	0	0	ALWANI, SHIREEN	7/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20530 ANZA AVE	APT 172	TORRANCE	CA	90503	2943	00	06000	33.844194	-118.3623445	Los Angeles County
313572	Non-Physician Medical Practitioner	None	1427274141	0	0	AKOTIA, BHAVANA PA	12/14/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25150 HANCOCK AVE	STE 206	MURRIETA	CA	92562	5989	00	06000	33.56635084	-117.1823956	Riverside County
313585	Non-Physician Medical Practitioner	None	1811034283	0	0	AVANT ORTIZ, KENDRA	7/19/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9710 BRIMHALL ROAD	None	BAKERSFIELD	CA	93312	2779	00	06000	35.3687456	-119.1106561	Kern County
313616	Non-Physician Medical Practitioner	None	1346747391	0	0	ATILLO, RONALD MAR T NP	10/22/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	None	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
313634	Non-Physician Medical Practitioner	None	1700896727	0	0	ARYAFAR, PARASTOO NP	11/30/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	37200 STRATFORD	None	INDIO	CA	92203	4507	00	06000	33.77885847	-116.2727584	Riverside County
313641	Non-Physician Medical Practitioner	None	1487002218	0	0	ABDALLAH, FATIMEH PA	3/2/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2055 KELLOGG AVE	None	CORONA	CA	92879	3111	00	06000	33.85626255	-117.5559289	Riverside County
313643	Non-Physician Medical Practitioner	None	1629392469	0	0	ALLEN, J BRIAN	3/31/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	250 SOUTH MAIN STREET	None	EUREKA	NV	89316	0347	00	06000	39.51066246	-115.9605456	Eureka County
313670	Non-Physician Medical Practitioner	None	1215644232	0	0	AGUIRRE, ANDREW C NP	6/28/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	43839 15TH ST W	None	LANCASTER	CA	93534	4756	00	06000	34.678791	-118.156867	Los Angeles County
313690	Non-Physician Medical Practitioner	None	1346480985	0	0	AXIS COMMUNITY HEALTH, INC.	4/28/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6666 OWENS DR	None	PLEASANTON	CA	94588	3334	00	06000	37.69743706	-121.9098578	Alameda County
313696	Non-Physician Medical Practitioner	None	1124203872	0	0	ALLDREDGE, JUSTIN M	6/12/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2129 TAMY LANE	None	SANTA ANA	CA	92706	2456	00	06000	33.76457343	-117.8901321	Orange County
313706	Non-Physician Medical Practitioner	None	1780674069	0	0	ARCE, KATHARINE	9/26/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3801 KATELLA AVE	STE 330	LOS ALAMITOS	CA	90720	6900	00	06000	33.80318951	-118.066068	Orange County
313732	Non-Physician Medical Practitioner	None	1003434275	0	0	ABRAHAM, ANTONIOUS PA-C	7/10/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1713 W KATELLA AVE	None	ANAHEIM	CA	92804	6450	00	06000	33.8033013	-117.9419025	Orange County
313739	Non-Physician Medical Practitioner	None	1801961958	0	0	ALOMARI, ELIZABETH NP	2/20/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9211 CROSS WATER DR	None	BAKERSFIELD	CA	93312	6262	00	06000	35.41777301	-119.1048153	Kern County
313807	Non-Physician Medical Practitioner	None	1902263015	0	0	ALL FOR HEALTH, HEALTH FOR A	7/28/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	5855 CAPISTRANO AVE	SUITE D	ATASCADERO	CA	93422	8853	00	06000	35.48988121	-120.6645004	San Luis Obispo County
313833	Non-Physician Medical Practitioner	None	1912233438	0	0	ADAMS, WESLEY CHARLES	9/1/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2220 CLARK AVE	None	LONG BEACH	CA	90815	2521	00	06000	33.79772674	-118.1338339	Los Angeles County
313840	Non-Physician Medical Practitioner	None	1164752515	0	0	ANAIZI, NADINE PA-C	5/17/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
313847	Non-Physician Medical Practitioner	None	1396173621	0	0	ABANIEL, REA E C	6/20/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	944 BLUE HERON	None	SEAL BEACH	CA	90740	5612	00	06000	33.75149896	-118.0904096	Orange County
313862	Non-Physician Medical Practitioner	None	1164037024	0	0	AW, AMINATA NP	11/22/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1800 N CALIFORNIA ST	None	STOCKTON	CA	95204	0001	00	06000	37.97026329	-121.2890849	San Joaquin County
313872	Non-Physician Medical Practitioner	None	1184870537	0	0	ANURAN-TORRES, JHOANNA J NP	4/30/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1606 21ST STREET	None	MANHATTAN BEACH	CA	90266	4041	00	06000	33.89256825	-118.3848129	Los Angeles County
313879	Non-Physician Medical Practitioner	None	1023889672	0	0	AFNAN, MINA PA	5/8/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 WEST HOSPITAL RD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
313881	Non-Physician Medical Practitioner	None	1184269540	0	0	ASCHRAFNIA, MADINA PA	8/14/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2010 EAST CARSON STREET	None	LONG BEACH	CA	90807	3040	00	06000	33.83242453	-118.16721	Los Angeles County
313886	Non-Physician Medical Practitioner	None	1962577841	0	0	ARELLANO, CLEDDHY R NP	4/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3527 SPENCER STREET	None	TORRANCE	CA	90503	3619	00	06000	33.84502417	-118.3480412	Los Angeles County
313912	Non-Physician Medical Practitioner	None	1780399162	0	0	ARCANGELI, MARGARET J NP	6/5/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1595 SOQUEL DR	STE 400	SANTA CRUZ	CA	95065	1724	00	06000	36.98879599	-121.9826354	Santa Cruz County
313922	Non-Physician Medical Practitioner	None	1023565314	0	0	ANSLINGER, CHRISTOPHE T	12/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2488 N CALIFORNIA ST	None	STOCKTON	CA	95204	3494	00	06000	37.97587328	-121.2911856	San Joaquin County
313985	Non-Physician Medical Practitioner	None	1124737903	0	0	AGRA, JONAH PA	11/18/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	13365 W WASHINGTON BLVD	None	CULVER CITY	CA	90066	5134	00	06000	33.99238471	-118.4439832	Los Angeles County
314015	Non-Physician Medical Practitioner	None	1376840462	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	3/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	999 ADAMS ST	SUITE 500	SAINT HELENA	CA	94574	1148	00	06000	38.5071543	-122.4685546	Napa County
314031	Non-Physician Medical Practitioner	None	1629367172	0	0	ALZAATRA, MYKEISHA Q	2/27/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14711 BORA DRIVE	None	LA MIRADA	CA	90638	3836	00	06000	33.90119808	-118.0173991	Los Angeles County
314033	Non-Physician Medical Practitioner	None	1306412754	0	0	ALI, ANDREA N PA	1/1/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	11370 ANDERSON ST	STE B-100	LOMA LINDA	CA	92354	3450	00	06000	34.047153	-117.2611485	San Bernardino County
314044	Non-Physician Medical Practitioner	None	1598482515	0	0	ARAKELYAN, LAURA NP	7/13/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2210 E ILLINOIS	STE 406	FRESNO	CA	93701	2167	00	06000	36.74500687	-119.7846885	Fresno County
314090	Non-Physician Medical Practitioner	None	1669170528	0	0	ADESINA, MAYOWA NP	5/25/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	73700 DINAH SHORE DR	STE 106	PALM DESERT	CA	92211	0813	00	06000	33.79748917	-116.3786855	Riverside County
314095	Non-Physician Medical Practitioner	None	1487030656	0	0	AMADI, ADAMMA NP	6/21/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1025 W OLYMPIC BLVD	None	LOS ANGELES	CA	90015	1329	00	06000	34.04624254	-118.267606	Los Angeles County
314100	Non-Physician Medical Practitioner	None	1689142580	0	0	ABBAS, AMEL T PA-C	9/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1180 N INDIAN CANYON DR	SUITE E205	PALM SPRINGS	CA	92262	4402	00	06000	33.839505	-116.5455735	Riverside County
314148	Non-Physician Medical Practitioner	None	1003401035	0	0	ARANDIA, RUBIROSA C NP	2/10/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3389 G ST	STE B	MERCED	CA	95340	0964	00	06000	37.32623805	-120.4692747	Merced County
314160	Non-Physician Medical Practitioner	None	1598081820	0	0	ARGOUD, MARIA ANA	1/13/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	855 3RD AVE	None	CHULA VISTA	CA	91911	1354	00	06000	32.62197574	-117.0723222	San Diego County
314219	Non-Physician Medical Practitioner	None	1508379389	0	0	ALFONSO, HOPE C NP	9/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10200 SEPULVEDA BLVD	STE 200	MISSION HILLS	CA	91345	2657	00	06000	34.25572562	-118.4673156	Los Angeles County
314243	Non-Physician Medical Practitioner	None	1932537610	0	0	ALLEN, LAUREN E PA-C	10/2/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	3941 SAN DIMAS ST	101	BAKERSFIELD	CA	93301	5711	00	06000	35.39552345	-119.0082184	Kern County
314244	Non-Physician Medical Practitioner	None	1417511437	0	0	ARANDIA, PHILAMER S NP	10/14/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	725 WELCH RD	None	PALO ALTO	CA	94304	1601	00	06000	37.43721275	-122.1744449	Santa Clara County
314255	Non-Physician Medical Practitioner	None	1528655438	0	0	ANDREWS, JAMES	4/7/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	35800 BOB HOPE DRIVE	#240	RANCHO MIRAGE	CA	92270	1740	00	06000	33.790527	-116.4058645	Riverside County
314265	Non-Physician Medical Practitioner	None	1649577354	0	0	ABERNETHY, ERIK I PA-C	5/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6580 HEMBREE LANE	SUITE 270	WINDSOR	CA	95492	6885	00	06000	38.52650514	-122.7897518	Sonoma County
314271	Non-Physician Medical Practitioner	None	1114429719	0	0	ADIMORAH, ADAOBI M NP	5/2/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1007 E COOLEY DR	STE 111	COLTON	CA	92324	3901	00	06000	34.05461152	-117.310599	San Bernardino County
314278	Non-Physician Medical Practitioner	None	1962256750	0	0	ANDRADA, KATHLYN NP	7/29/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	729 SUNRISE AVE	SUITE 602	ROSEVILLE	CA	95661	4542	00	06000	38.73444822	-121.2720033	Placer County
314296	Non-Physician Medical Practitioner	None	1285116020	0	0	ANDERSON, PAIGE E PA-C	7/30/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2850 TELEGRAPH AVE	130	BERKELEY	CA	94705	1159	00	06000	37.85808554	-122.2594469	Alameda County
314343	Non-Physician Medical Practitioner	None	1407494735	0	0	ADEGBITE, ADEKUNLE S NP	5/19/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
314353	Non-Physician Medical Practitioner	None	1629405980	0	0	ALCANTARA, AILEEN J NP	10/9/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6919 BALCOM AVE	None	RESEDA	CA	91335	4804	00	06000	34.19620974	-118.5206655	Los Angeles County
314377	Non-Physician Medical Practitioner	None	1710191283	0	0	ALTAMED HEALTH SERVICES CORP	4/28/1997	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	9436 SLAUSON AVE.	None	PICO RIVERA	CA	90660	4748	00	06000	33.96800305	-118.0956362	Los Angeles County
314394	Non-Physician Medical Practitioner	None	1801962345	0	0	ADVANCED WOMENS HEALTH CENTER	6/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4850 COMMERCE DR	None	BAKERSFIELD	CA	93309	0415	00	06000	35.3701588	-119.0556274	Kern County
314438	Non-Physician Medical Practitioner	None	1730647991	0	0	AGUDAH, VICTORIA NP	6/23/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2960 CAMINO DIABLO	105	WALNUT CREEK	CA	94597	3988	00	06000	37.89859467	-122.0843018	Contra Costa County
314440	Non-Physician Medical Practitioner	None	1306128822	0	0	ALL FOR HEALTH HEALTH FOR ALL INC	11/16/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	437 S PACIFIC AVE	None	GLENDALE	CA	91204	1441	00	06000	34.140231	-118.264439	Los Angeles County
314487	Non-Physician Medical Practitioner	None	1225398316	0	0	ABRUTE, VILIJA NP	3/11/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4860 Y ST	None	SACRAMENTO	CA	95817	2307	00	06000	38.552211	-121.449429	Sacramento County
314493	Non-Physician Medical Practitioner	None	1689216020	0	0	AHMAD, ZEESHAN	1/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	14860 ROSCOE BLVD	#200	PANORAMA CITY	CA	91402	4683	00	06000	34.2214515	-118.4573205	Los Angeles County
314510	Non-Physician Medical Practitioner	None	1801289939	0	0	ARDA, CARMENCITA B NP	5/8/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	12643 BELLFLOWER LANE	None	MORENO VALLEY	CA	92555	2250	00	06000	33.93712017	-117.2046223	Riverside County
314535	Non-Physician Medical Practitioner	None	1205922630	0	0	ARBIZU, CHERI L	12/21/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1776 YGNACIO VALLEY RD 2	LN 2:	WALNUT CREEK	CA	94598	3125	00	06000	37.91657746	-122.0403263	Contra Costa County
314594	Non-Physician Medical Practitioner	None	1831449040	0	0	AQEEL, NOUR PA-C	10/28/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8101 NEWMAN AVE	STE B	HUNTINGTON BEACH	CA	92647	7042	00	06000	33.70483151	-117.987264	Orange County
314598	Non-Physician Medical Practitioner	None	1720482110	0	0	ATASHBAR, MARYAM NP	8/7/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 HILLMONT AVE	None	VENTURA	CA	93003	3099	00	06000	34.27771547	-119.2540344	Ventura County
314608	Non-Physician Medical Practitioner	None	1205598455	0	0	AGBAYANI, KYLA K PA	2/15/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
314692	Non-Physician Medical Practitioner	None	1992176267	0	0	AVENAL COMMUNITY HEALTH CENT	9/18/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	20326 MAIN STREET	None	STRATFORD	CA	93266	9742	00	06000	36.18962048	-119.822823	Kings County
314694	Non-Physician Medical Practitioner	None	1427276799	0	0	AGUILAR H, MARIA E	5/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1705 PILGRIM WAY	None	MONROVIA	CA	91016	4429	00	06000	34.13347426	-118.0139634	Los Angeles County
314702	Non-Physician Medical Practitioner	None	1346361888	0	0	AGUILAR, RIVELLINO A	5/18/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8524 SUVA ST	None	DOWNEY	CA	90240	3347	00	06000	33.95373583	-118.1176329	Los Angeles County
314733	Non-Physician Medical Practitioner	None	1538183686	0	0	ANZIANO, DEBRA BETH	8/17/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2100 WEBSTER ST	SUITE 309	SAN FRANCISCO	CA	94115	2373	00	06000	37.7904826	-122.4324477	San Francisco County
314814	Non-Physician Medical Practitioner	None	1275918674	0	0	AVENAL COMMUNITY HEALTH CENT	6/22/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	304 BECKY PEASE STREET	None	KETTTLEMAN CITY	CA	93239	0000	00	06000	36.009459	-119.9602025	Kings County
314841	Non-Physician Medical Practitioner	None	1003938556	0	0	ALAAN, YBELYNN CARANDANG	2/9/2006	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	16323 CLARK AVE	None	BELLFLOWER	CA	90706	5209	00	06000	33.885693	-118.1339975	Los Angeles County
314843	Non-Physician Medical Practitioner	None	1710386370	0	0	ATTERBURY, CODY T	3/16/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6942 E COUNTRY CLUB LANE	None	ANAHEIM HILLS	CA	92807	4412	00	06000	33.84280779	-117.7579811	Orange County
314906	Non-Physician Medical Practitioner	None	1679090393	0	0	ABELOE, JENNA NP	9/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1131 WILSHIRE BLVD	100	SANTA MONICA	CA	90401	2072	00	06000	34.02509887	-118.4909994	Los Angeles County
314909	Non-Physician Medical Practitioner	None	1578042214	0	0	ADERINTO, IFEOLUWA J NP	6/19/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	501 S BUENA VISTA ST	None	BURBANK	CA	91505	4809	00	06000	34.15729818	-118.3277073	Los Angeles County
314910	Non-Physician Medical Practitioner	None	1194122234	0	0	ABEJUELA, KRISTOFER R P	2/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2158 DERRINGER LANE	None	DIAMOND BAR	CA	91765	3333	00	06000	33.98609006	-117.8019222	Los Angeles County
314925	Non-Physician Medical Practitioner	None	1306212717	0	0	ANN, CECILIA NP	3/22/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10174 MASON AVE	None	CHATSWORTH	CA	91311	3301	00	06000	34.255611	-118.5798115	Los Angeles County
314927	Non-Physician Medical Practitioner	None	1871832360	0	0	ANDERSEN, MARCELA M NP	6/27/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2650 S BRISTOL ST	STE 101-103	SANTA ANA	CA	92704	5751	00	06000	33.71118647	-117.885452	Orange County
314949	Non-Physician Medical Practitioner	None	1396175758	0	0	AJCA, MARTHA C	11/2/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1481 ALMOND DR	None	PERRIS	CA	92571	3912	00	06000	33.798942	-117.214552	Riverside County
314961	Non-Physician Medical Practitioner	None	1588602247	0	0	ANWAR, YASMIN	10/10/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	32686 VINE ST	None	TEMECULA	CA	92592	3330	00	06000	33.45210066	-117.0881008	Riverside County
314975	Non-Physician Medical Practitioner	None	1013507300	0	0	ADDISH, FERID PA-C	2/25/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10441 LAKEWOOD BLVD.	SUITE E	DOWNEY	CA	90241	2744	00	06000	33.94358034	-118.1193714	Los Angeles County
314976	Non-Physician Medical Practitioner	None	1659424190	0	0	ARCHER, VERONIKA	9/22/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	325 WALNUT ST	None	SAN FRANCISCO	CA	94118	2014	00	06000	37.7884455	-122.4487882	San Francisco County
314982	Non-Physician Medical Practitioner	None	1396089397	0	0	AGUILAR, GABRIEL R	9/1/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4326 REINHARDT DR	None	OAKLAND	CA	94619	2245	00	06000	37.79282441	-122.1842582	Alameda County
314989	Non-Physician Medical Practitioner	None	1558995084	0	0	ATIENZA, NEO NP	7/24/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 VICTORIA STREET	None	COSTA MESA	CA	92627	1995	00	06000	33.65258952	-117.9121545	Orange County
314994	Non-Physician Medical Practitioner	None	1306349352	0	0	ALAMILLO, SARAH V PA-C	9/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	301 INDUSTRIAL ROAD	None	SAN CARLOS	CA	94070	2603	00	06000	37.51438187	-122.2607682	San Mateo County
314999	Non-Physician Medical Practitioner	None	1114300449	0	0	AVETISYAN, EMMA NP	7/12/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6064 HAGLEHURST PLACE	#1	NORTH HOLLYWOOD	CA	91606	0000	00	06000	34.18100649	-118.3865112	Los Angeles County
315011	Non-Physician Medical Practitioner	None	1093117079	0	0	ARTSRUNYAN, INESSA NP	9/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4607 LAKEVIEW CANYON RD	567	WESTLAKE VILLAGE	CA	91361	4028	00	06000	34.14829414	-118.8192603	Los Angeles County
315032	Non-Physician Medical Practitioner	None	1023663507	0	0	ANGILA, ELIZA N NP	1/10/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2018 MISSION ST	None	SANTA CRUZ	CA	95060	5218	00	06000	36.962588	-122.0439201	Santa Cruz County
315054	Non-Physician Medical Practitioner	None	1114160967	0	0	ABDELWAHHAB, EANAS	8/12/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
315059	Non-Physician Medical Practitioner	None	1275346116	0	0	AMIS, BRIDGETT NP	4/16/2025	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	18002 WIKA RD	None	APPLE VALLEY	CA	92307	2125	00	06000	34.54046469	-117.2712424	San Bernardino County
315064	Non-Physician Medical Practitioner	None	1275961609	0	0	ALLOCCO, DIANA M NP	2/26/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1825 GALINDO ST	APT 331	CONCORD	CA	94520	2785	00	06000	37.97563582	-122.0348991	Contra Costa County
315074	Non-Physician Medical Practitioner	None	1285844282	0	0	ARMES, BOBBIE D PA-C	1/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	403 W F ST	None	ONTARIO	CA	91762	3207	00	06000	34.069293	-117.655065	San Bernardino County
315098	Non-Physician Medical Practitioner	None	1154628105	0	0	AMBROSIO, JOEL P PA	10/4/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1200 B GALE WILSON BLVD	None	FAIRFIELD	CA	94533	3552	00	06000	38.26109552	-122.0470245	Solano County
315108	Non-Physician Medical Practitioner	None	1306173869	0	0	ABDINOR, EMILY W	12/26/2012	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1006 FOXHALL WAY	None	SACRAMENTO	CA	95831	1709	00	06000	38.509965	-121.5200475	Sacramento County
315169	Non-Physician Medical Practitioner	None	1174704845	0	0	AGUSTIN, JOHNNY V NP	12/3/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 OLD RIVER RD	250	BAKERSFIELD	CA	93311	9515	00	06000	35.35127492	-119.1142991	Kern County
315196	Non-Physician Medical Practitioner	None	1548003379	0	0	ALMOUAZZEN, ADNAN NP	8/28/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	811 E 11TH ST	STE 102	UPLAND	CA	91786	7274	00	06000	34.1034335	-117.6398415	San Bernardino County
315206	Non-Physician Medical Practitioner	None	1740607167	0	0	AVILA, SHANE L C NP	9/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	24603 RAVENNA AVE	None	CARSON	CA	90745	6439	00	06000	33.8021391	-118.2689823	Los Angeles County
315214	Non-Physician Medical Practitioner	None	1225186133	0	0	ADIGWE-MOZIA, MARTHA N	6/16/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1611 CRENSHAW BLVD	SUITE 131	TORRANCE	CA	90501	3123	00	06000	33.832557	-118.328659	Los Angeles County
315277	Non-Physician Medical Practitioner	None	1114067006	0	0	AMBROSINI, THOMAS	1/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1325 COTTONWOOD ST	None	WOODLAND	CA	95695	5131	00	06000	38.664027	-121.7933505	Yolo County
315281	Non-Physician Medical Practitioner	None	1336895580	0	0	ARDESSI, AMANDA NP	3/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2150 N WATERMAN AVE	None	SAN BERNARDINO	CA	92404	4811	00	06000	34.134705	-117.2787865	San Bernardino County
315320	Non-Physician Medical Practitioner	None	1659584308	0	0	AREZOU, MANSOURIAN	3/15/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
315342	Non-Physician Medical Practitioner	None	1902060361	0	0	ALEXANDRIA, ARIAS I	7/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1850 E WASHINGTON ST	None	COLTON	CA	92324	4621	00	06000	34.0483915	-117.295902	San Bernardino County
315399	Non-Physician Medical Practitioner	None	1154066025	0	0	AGHAZARIAN, ANI T PA-C	7/11/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
315402	Non-Physician Medical Practitioner	None	1245697713	0	0	AUGUSTINE, STEVEN B	9/29/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 REDWOOD BLVD	APT 60	REDDING	CA	96003	1923	00	06000	40.61844616	-122.3760065	Shasta County
315403	Non-Physician Medical Practitioner	None	1437517489	0	0	ADDO, BELINDA A NP	8/25/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	19416 MT WASATCH DR	None	RIVERSIDE	CA	92508	3278	00	06000	33.89304308	-117.3225272	Riverside County
315417	Non-Physician Medical Practitioner	None	1649893660	0	0	ANDAYA, STACYANN F NP	10/1/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2637 SHADELANDS DR	None	WALNUT CREEK	CA	94598	2512	00	06000	37.925712	-122.021856	Contra Costa County
315423	Non-Physician Medical Practitioner	None	1760180970	0	0	ALVIZO, DIANA G PA-C	5/17/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	520 W 17TH ST	1	SANTA ANA	CA	92706	3614	00	06000	33.75995252	-117.873378	Orange County
315428	Non-Physician Medical Practitioner	None	1689976789	0	0	ANDREAS, DONNA K.	2/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	2400 S AVE A	None	YUMA	AZ	85364	7127	00	06000	32.683167	-114.633459	Yuma County
315429	Non-Physician Medical Practitioner	None	1669202776	0	0	ALFONSO GONZALEZ, ANAIVIS NP	11/25/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	7965 SIERRA AVE	STE E	FONTANA	CA	92336	3329	00	06000	34.109001	-117.4357835	San Bernardino County
315431	Non-Physician Medical Practitioner	None	1699220491	0	0	ADJEI, PHYLLIS E NP	2/16/2017	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	900 SILVER OAK DRIVE	None	BAKERSFIELD	CA	93312	4046	00	06000	35.36624482	-119.1019472	Kern County
315448	Non-Physician Medical Practitioner	None	1790082832	0	0	ADVENTIST HEALTH PHYSICIANS NETWORK	3/30/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2701 CHESTER AVE	None	BAKERSFIELD	CA	93301	2016	00	06000	35.384166	-119.0188765	Kern County
315459	Non-Physician Medical Practitioner	None	1649768920	0	0	AIKENS, MALCOLM N NP	3/19/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4650 LINCOLN BLVD	None	MARINA DEL REY	CA	90292	6306	00	06000	33.98160766	-118.4400667	Los Angeles County
315470	Non-Physician Medical Practitioner	None	1811956501	0	0	ARAKI, JOANNE M	12/26/2007	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	2	Out of state provider	n/a	213 S WHITACRE ST	None	YERINGTON	NV	89447	2561	00	06000	38.9840412	-119.1668041	Lyon County
315471	Non-Physician Medical Practitioner	None	1942400528	0	0	ARAM, GUYUMJIAN	2/4/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1457 RAYMOND AVE	None	GLENDALE	CA	91201	1277	00	06000	34.18032888	-118.2817326	Los Angeles County
315487	Non-Physician Medical Practitioner	None	1497461040	0	0	ANWARZAI, ABDELLA PA	3/16/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2823 FRESNO ST	None	FRESNO	CA	93721	1324	00	06000	36.7423511	-119.7834688	Fresno County
315493	Non-Physician Medical Practitioner	None	1740588359	0	0	ABIGAIL, GOETZ	3/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2000 MOWRY AVE	None	FREMONT	CA	94538	1716	00	06000	37.55769729	-121.9808861	Alameda County
315503	Non-Physician Medical Practitioner	None	1407910763	0	0	ADEWALE, DEBRA CARDELL	3/1/2001	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1141 W REDONDO BCH BLVD	SUITE 307	GARDENA	CA	90247	0000	00	06000	33.89247036	-118.2941482	Los Angeles County
315533	Non-Physician Medical Practitioner	None	1811430820	0	0	ALBANO, RIZALINA NP	6/4/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8851 CENTER DR	STE 505	LA MESA	CA	91942	3032	00	06000	32.78189749	-117.0075062	San Diego County
315542	Non-Physician Medical Practitioner	None	1184898488	0	0	AGUILAR, ANTONIO PA-C	6/7/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27700 MEDICAL CENTER	None	MISSION VIEJO	CA	92691	6426	00	06000	33.56008604	-117.6657795	Orange County
315571	Non-Physician Medical Practitioner	None	1831487958	0	0	ANDERSON, FIONA G NP	10/1/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	25471 ENGLEWOOD DR	None	LAGUNA NIGUEL	CA	92677	1445	00	06000	33.54761321	-117.6856253	Orange County
315602	Non-Physician Medical Practitioner	None	1225002710	0	0	ANDROY, LAURA S PA	10/5/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
315623	Non-Physician Medical Practitioner	None	1497265706	0	0	ARENAS, ANA C NP	1/24/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	400 N PEPPER AVE	None	COLTON	CA	92324	1801	00	06000	34.073505	-117.3505995	San Bernardino County
315696	Non-Physician Medical Practitioner	None	1740783455	0	0	ANOSIKE, NNAEMEKA G NP	7/24/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	508 GISON DRIVE	SUITE 150	ROSEVILLE	CA	95650	1234	00	06000	38.77866166	-121.2745528	Placer County
315715	Non-Physician Medical Practitioner	None	1821635467	0	0	ASHBAUGH, SHANE PA-C	7/9/2021	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	38690 STIVERS	None	FREMONT	CA	94536	5279	00	06000	37.55724607	-121.9830866	Alameda County
315721	Non-Physician Medical Practitioner	None	1952513517	0	0	ACOSTA, ANGELICA N	8/24/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1627 LAVENDER COURT	None	CARPINTERIA	CA	93013	3364	00	06000	34.40194315	-119.5228441	Santa Barbara County
315725	Non-Physician Medical Practitioner	None	1154523496	0	0	AKKINAPALLI, NEELIMA	4/1/2010	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	27200 CALAROGA AVE	None	HAYWARD	CA	94545	4339	00	06000	37.63347961	-122.0897735	Alameda County
315732	Non-Physician Medical Practitioner	None	1801082946	0	0	AMADOR, CORY PA	5/25/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	10607 HEATHER ST	None	RANCHO CUCAMONGA	CA	91737	4408	00	06000	34.13372345	-117.5736415	San Bernardino County
315734	Non-Physician Medical Practitioner	None	1427425172	0	0	AGONCILLO, STEPHANIE E	10/6/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6152 SHERATON PL	None	APTOS	CA	95003	3190	00	06000	36.98879472	-121.9334376	Santa Cruz County
315744	Non-Physician Medical Practitioner	None	1811909955	0	0	AHMADIAN, MARYAM	6/20/2011	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	200 N ROBERTSON BLVD	None	BEVERLY HILLS	CA	90211	1769	00	06000	34.069509	-118.383743	Los Angeles County
315759	Non-Physician Medical Practitioner	None	1366594277	0	0	ANSLINGER, DAVID	1/18/2005	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	15810 S HARLAN RD	SUITE A	LATHROP	CA	95330	8719	00	06000	37.81877638	-121.292417	San Joaquin County
315777	Non-Physician Medical Practitioner	None	1104327881	0	0	ALLEN, RACHEL W NP	3/20/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	44241 15TH ST W	SUITE 303	LANCASTER	CA	93534	5502	00	06000	34.68712999	-118.1569096	Los Angeles County
315784	Non-Physician Medical Practitioner	None	1932505260	0	0	AXTEN, STEVEN J	1/1/2015	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	2450 PETROGLYPH ST	None	REDDING	CA	96002	2851	00	06000	40.55681551	-122.327451	Shasta County
315793	Non-Physician Medical Practitioner	None	1891957783	0	0	ARTEAGA, LIESL A NP	9/22/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	701 N FIRST AVENUE	None	ARCADIA	CA	91006	2528	00	06000	34.14757894	-118.0285212	Los Angeles County
315825	Non-Physician Medical Practitioner	None	1790151405	0	0	AHN, ALICE NP	7/1/2018	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1500 E DUARTE RD	None	DUARTE	CA	91010	3012	00	06000	34.129683	-117.970857	Los Angeles County
315827	Non-Physician Medical Practitioner	None	1447233358	0	0	AIDS HEALTHCARE FOUNDATION	8/6/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8263 GROVE AVE	None	RANCHO CUCAMONGA	CA	91730	0000	00	06000	34.10436536	-117.6285141	San Bernardino County
315828	Non-Physician Medical Practitioner	None	1295900280	0	0	ABIEMO, ADELAIDE PA-C	6/21/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	425 DIAMOND DRIVE	SUITE 104-105	LAKE ELSINORE	CA	92530	4495	00	06000	33.65802263	-117.3002985	Riverside County
315845	Non-Physician Medical Practitioner	None	1649303165	0	0	ANDERSON, DAVID C	8/13/2008	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1428 PHILLIPS LN	SUITE 203	SAN LUIS OBISPO	CA	93401	2537	00	06000	35.28794905	-120.6574321	San Luis Obispo County
315849	Non-Physician Medical Practitioner	None	1659786242	0	0	AMADOR, CHARLES A	11/3/2014	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	4126 NORMAL AVENUE	None	LOS ANGELES	CA	90029	2907	00	06000	34.0866064	-118.2852751	Los Angeles County
315859	Non-Physician Medical Practitioner	None	1366064800	0	0	AYODELE, NAOMI PA-C	3/13/2024	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	300 PASTEUR DR	None	STANFORD	CA	94305	2200	00	06000	37.43304542	-122.1759654	Santa Clara County
315882	Non-Physician Medical Practitioner	None	1265549349	0	0	ABARAY, MAUREEN S NP	12/15/2020	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	500 W HOSPITAL ROAD	None	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
315917	Non-Physician Medical Practitioner	None	1194079004	0	0	ADKINS, MAURICE A	12/7/2016	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	740 N SIAVOHN DRIVE	None	ORANGE	CA	92869	2588	00	06000	33.79946999	-117.8156358	Orange County
315940	Non-Physician Medical Practitioner	None	1699467761	0	0	ANDERSON, NATASHA PA-C	12/15/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1441 FLORIDA AVE	None	MODESTO	CA	95350	4405	00	06000	37.66508443	-120.9962589	Stanislaus County
315962	Non-Physician Medical Practitioner	None	1003585928	0	0	ATTIKU, ALEX PA-C	5/3/2023	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	119 S LOCUST ST	STE B	VISALIA	CA	93291	6251	00	06000	36.329382	-119.2937355	Tulare County
315980	Non-Physician Medical Practitioner	None	1811129091	0	0	ASIAN PACIFIC HEALTH CARE VENTURE, INC.	6/6/2013	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	180 UNION PL	None	LOS ANGELES	CA	90026	5715	00	06000	34.06186536	-118.2653898	Los Angeles County
315981	Non-Physician Medical Practitioner	None	1902239668	0	0	ACEVEDO, ANGELICA M NP	8/23/2019	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1141 ROSE AVE	None	SELMA	CA	93662	3241	00	06000	36.56881144	-119.5985344	Fresno County
315991	Non-Physician Medical Practitioner	None	1104567932	0	0	AMPARO, CAMILLE A PA-C	9/12/2022	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	1520 SAN PABLO ST	None	LOS ANGELES	CA	90033	5310	00	06000	34.06269295	-118.2030006	Los Angeles County
316034	Non-Physician Medical Practitioner	None	1487781043	0	0	AKINLOYE, SONGOLAYE	5/1/1999	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	8700 BEVERLY BLVD.	None	LOS ANGELES	CA	90048	1865	00	06000	34.07671715	-118.3799413	Los Angeles County
316046	Non-Physician Medical Practitioner	None	1417197831	0	0	ADRANEDA, ALDRINE ALBA	7/7/2009	Taxonomy not applicable	NA	n/a	n/a	n/a	n/a	n/a	n/a	0	In state provider	n/a	6629 IRVINE AVE	None	NORTH HOLLYWOOD	CA	91606	1746	00	06000	34.19121533	-118.3856338	Los Angeles County
316060	Ordering, Referring, Prescribing	N/A	1003010141	0	0	ACHUFF, SUSAN F LMFT	2/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT24776	N/A	N/A	N/A	N/A	N/A	820 E. GILBERT ST.	None	SAN BERNARDINO	CA	92415	0928	00	06000	34.1268333	-117.2687417	San Bernardino County
316104	Ordering, Referring, Prescribing	N/A	1003123076	0	0	ARZAGA, WENDY PA-C	10/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	21143	N/A	N/A	N/A	N/A	N/A	781 N SEQUOIA AVE	STE 3	LINDSAY	CA	93247	1448	00	06000	36.21240571	-119.0961081	Tulare County
316107	Ordering, Referring, Prescribing	N/A	1003126632	0	0	ALCARIA, RIZZA PHARMD	8/15/2023	Taxonomy not applicable	NA	n/a	000	Unknown	72298	N/A	N/A	N/A	N/A	N/A	3495 SONOMA BLVD	SUITE K	VALLEJO	CA	94590	2983	00	06000	38.12158398	-122.2552773	Solano County
316122	Ordering, Referring, Prescribing	N/A	1003145707	0	0	ALVAREZ, MAYRA LCSW	4/14/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW60761	N/A	N/A	N/A	N/A	N/A	204 E BEACH ST	None	WATSONVILLE	CA	95076	4809	00	06000	36.91224802	-121.7541363	Santa Cruz County
316128	Ordering, Referring, Prescribing	N/A	1003152927	0	0	AGUIRRE, MARIXA LMFT	7/29/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT127206	N/A	N/A	N/A	N/A	N/A	265 SAN JACINTO RIVER RD	None	LAKE ELSINORE	CA	92530	4400	00	06000	33.66201142	-117.3001906	Riverside County
316133	Ordering, Referring, Prescribing	N/A	1003164302	0	0	ANDREWS, JOHN S MD	4/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G71080	N/A	N/A	N/A	N/A	N/A	1501 IMPERIAL AVE	None	SAN DIEGO	CA	92101	7638	00	06000	32.70625742	-117.1498948	San Diego County
316158	Ordering, Referring, Prescribing	N/A	1003194879	0	0	ARLINGTON, LORRAINE A OT	3/19/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	764	N/A	N/A	N/A	N/A	N/A	17800 HIGHWAY 18	None	APPLE VALLEY	CA	92307	0000	00	06000	34.54007429	-117.2744761	San Bernardino County
316163	Ordering, Referring, Prescribing	N/A	1003199860	0	0	ARMENDARIZ, KARINA H LMFT	8/11/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT91179	N/A	N/A	N/A	N/A	N/A	1300 17TH ST	CITY CENTRE BLDG	BAKERSFIELD	CA	93301	4504	00	06000	35.37476047	-119.016774	Kern County
316179	Ordering, Referring, Prescribing	N/A	1003216268	0	0	AIKEN, LAUREN LMFT	8/2/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT127252	N/A	N/A	N/A	N/A	N/A	200 24TH ST	None	RICHMOND	CA	94804	1804	00	06000	37.93439778	-122.3465322	Contra Costa County
316187	Ordering, Referring, Prescribing	N/A	1003227653	0	0	AN, SUEJIN LMFT	1/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103640	N/A	N/A	N/A	N/A	N/A	520 S LA FAYETTE PARK PL	None	LOS ANGELES	CA	90057	5400	00	06000	34.06392003	-118.2826062	Los Angeles County
316199	Ordering, Referring, Prescribing	N/A	1003248717	0	0	ARMSTRONG, LAUREN R PSYD	11/30/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	31166	N/A	N/A	N/A	N/A	N/A	1722 S LEWIS RD	None	CAMARILLO	CA	93012	8520	00	06000	34.18921316	-119.0340743	Ventura County
316206	Ordering, Referring, Prescribing	N/A	1003261454	0	0	ASHLEY, JACQUELINE S LCSW	10/2/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	70676	N/A	N/A	N/A	N/A	N/A	7140 INDIANA AVE	None	RIVERSIDE	CA	92504	4544	00	06000	33.93890182	-117.3977958	Riverside County
316229	Ordering, Referring, Prescribing	N/A	1003284951	0	0	ALANIZ, SANDRA LMFT	3/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125150	N/A	N/A	N/A	N/A	N/A	429 N SAN ANTONIO RD	None	SANTA BARBARA	CA	93110	1399	00	06000	34.44573228	-119.7804008	Santa Barbara County
316240	Ordering, Referring, Prescribing	N/A	1003302282	0	0	ALONZO, ANA NP	10/10/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022803	N/A	N/A	N/A	N/A	N/A	1019 AMALIA AVE	None	LOS ANGELES	CA	90022	4016	00	06000	34.01745145	-118.1572366	Los Angeles County
316253	Ordering, Referring, Prescribing	N/A	1003328899	0	0	APPLING, CHERISH PHARMD	7/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75821	N/A	N/A	N/A	N/A	N/A	5504 BALBOA AVE	None	SAN DIEGO	CA	92111	2704	00	06000	32.81973233	-117.1810836	San Diego County
316269	Ordering, Referring, Prescribing	N/A	1003347808	0	0	ACOSTABERRIOS, JAIME MD	3/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166142	N/A	N/A	N/A	N/A	N/A	1745 N BROADWAY	STE 101	SANTA MARIA	CA	93454	1927	00	06000	34.971759	-120.4356175	Santa Barbara County
316289	Ordering, Referring, Prescribing	N/A	1003372459	0	0	AUJLA, SONIA S PHARMD	1/12/2020	Taxonomy not applicable	NA	n/a	000	Unknown	79954	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	0000	00	06000	38.36981229	-120.8002806	Amador County
316361	Ordering, Referring, Prescribing	N/A	1003472309	0	0	ADAGBADA, YEKEEN NP	11/13/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011775	N/A	N/A	N/A	N/A	N/A	4448 YORK BOULEVARD	None	LOS ANGELES	CA	90041	3328	00	06000	34.12374025	-118.2188529	Los Angeles County
316418	Ordering, Referring, Prescribing	N/A	1003682493	0	0	ALONZO, STACEY LMFT	12/17/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	152096	N/A	N/A	N/A	N/A	N/A	700 FREDERICK STREET	103	SANTA CRUZ	CA	95062	2239	00	06000	36.98031434	-122.004438	Santa Cruz County
316429	Ordering, Referring, Prescribing	N/A	1003891482	0	0	AUSTIN, KATHERINE C MD	3/10/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C176875	N/A	N/A	N/A	N/A	N/A	2017 FIRST AVENUE	SUITE 100	SAN DIEGO	CA	92101	0000	00	06000	32.72646147	-117.1638767	San Diego County
316448	Ordering, Referring, Prescribing	N/A	1003938556	0	0	ALAAN, YBELYNN C NP	9/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	15587	N/A	N/A	N/A	N/A	N/A	1873 COMMERCENTER W	None	SAN BERNARDINO	CA	92408	3303	00	06000	34.067781	-117.286122	San Bernardino County
316454	Ordering, Referring, Prescribing	N/A	1003944984	0	0	AMIAL-COTA, YADIRA	1/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44051	N/A	N/A	N/A	N/A	N/A	460 KINGS COUNTY DR	101	HANFORD	CA	93230	5953	00	06000	36.32980315	-119.668609	Kings County
316484	Ordering, Referring, Prescribing	N/A	1013006477	0	0	ALVERO, ERNESTO M	4/30/2023	Taxonomy not applicable	NA	n/a	000	Unknown	11393	N/A	N/A	N/A	N/A	N/A	351 FELICE DR	None	HOLLISTER	CA	95023	3361	00	06000	36.85325269	-121.4170104	San Benito County
316486	Ordering, Referring, Prescribing	N/A	1013005842	0	0	ASLI, AZIN PHD	3/22/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY15233	N/A	N/A	N/A	N/A	N/A	500 CITY PKWY W	SUITE 200	ORANGE	CA	92868	2941	00	06000	33.78299346	-117.895788	Orange County
316488	Ordering, Referring, Prescribing	N/A	1013009513	0	0	ALEGRE, ELMER E MD	12/6/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	9380	N/A	N/A	N/A	N/A	N/A	1559 WATASHEAMU RD	None	GARDNERVILLE	NV	89460	7455	00	06000	38.90016089	-119.7157447	Douglas County
316549	Ordering, Referring, Prescribing	N/A	1013126143	0	0	AFSARI, PETER F DO	11/29/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A12976	N/A	N/A	N/A	N/A	N/A	1039 MURRAY AVENUE	None	SAN LUIS OBISPO	CA	93422	3991	00	06000	35.29091981	-120.665741	San Luis Obispo County
316563	Ordering, Referring, Prescribing	N/A	1013159060	0	0	ANDERSON, JOHN R LMFT	1/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	14455	N/A	N/A	N/A	N/A	N/A	720 WOOD ST	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
316585	Ordering, Referring, Prescribing	N/A	1013200617	0	0	ALVAREZ, DIANA LCSW	4/9/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81025	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
316609	Ordering, Referring, Prescribing	N/A	1013225739	0	0	AUDE, ROBERT M LMFT	6/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	35529	N/A	N/A	N/A	N/A	N/A	4892 SAN PABLO DAM RD	None	EL SOBRANTE	CA	94803	3222	00	06000	37.96337568	-122.2929195	Contra Costa County
316659	Ordering, Referring, Prescribing	N/A	1013313840	0	0	ALLEY, KATHARINE LCSW	6/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	84926	N/A	N/A	N/A	N/A	N/A	4025 W 226TH ST	None	TORRANCE	CA	90505	2340	00	06000	33.82360754	-118.3560922	Los Angeles County
316664	Ordering, Referring, Prescribing	N/A	1013320720	0	0	ARMENTA-BELEN, KRISTA LMFT	7/18/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	80289	N/A	N/A	N/A	N/A	N/A	4141 STATE STREET	None	SANTA BARBARA	CA	93110	1851	00	06000	34.4404695	-119.7612045	Santa Barbara County
316678	Ordering, Referring, Prescribing	N/A	1013343789	0	0	ARAGON, ALEXIS M LMFT	8/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	88605	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	None	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
316682	Ordering, Referring, Prescribing	N/A	1013348507	0	0	AJIDUAH, VALERIE PA	12/7/2022	Taxonomy not applicable	NA	n/a	000	Unknown	51325	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
316707	Ordering, Referring, Prescribing	N/A	1013384742	0	0	ARELLANO, CARLA M LMFT	6/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT119401	N/A	N/A	N/A	N/A	N/A	727 SHASTA ST	None	REDWOOD CITY	CA	94063	2124	00	06000	37.47945362	-122.2230493	San Mateo County
316716	Ordering, Referring, Prescribing	N/A	1013394311	0	0	ABOYE, REDIEAT A MD	9/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150890	N/A	N/A	N/A	N/A	N/A	5256 MISSION BLVD	None	RIVERSIDE	CA	92509	4624	00	06000	33.99261717	-117.3987262	Riverside County
316717	Ordering, Referring, Prescribing	N/A	1013394980	0	0	ABDELNABI, MAI MD	9/23/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A175016	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON STREET	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
316721	Ordering, Referring, Prescribing	N/A	1013393503	0	0	AKERS, ELAINE R PHN	8/25/2015	Taxonomy not applicable	NA	n/a	000	Unknown	280062	N/A	N/A	N/A	N/A	N/A	701 SOUTH MT VERNON	None	SAN BERNARDINO	CA	92395	5852	00	06000	34.08892704	-117.3137698	San Bernardino County
316740	Ordering, Referring, Prescribing	N/A	1013435023	0	0	AHN, ALICE M DDS PC	5/20/2018	Taxonomy not applicable	NA	n/a	000	Unknown	100616	N/A	N/A	N/A	N/A	N/A	15206 PARTHENIA ST	None	NORTH HILLS	CA	91343	5305	00	06000	34.22817313	-118.4636497	Los Angeles County
316762	Ordering, Referring, Prescribing	N/A	1013466630	0	0	AGUIRRE, SAMANTHA R	10/21/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	100831	N/A	N/A	N/A	N/A	N/A	740 SOLANO ST	None	CORNING	CA	96021	3352	00	06000	39.92792649	-122.175513	Tehama County
316826	Ordering, Referring, Prescribing	N/A	1013615186	0	0	ALLEN-CARRASQUILLO, SHALONTE NP	6/4/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030375	N/A	N/A	N/A	N/A	N/A	9300 N LOOP BLVD	STE. C	CALIFORNIA CITY	CA	93505	2269	00	06000	35.13321511	-117.9623345	Kern County
316860	Ordering, Referring, Prescribing	N/A	1013947910	0	0	ADRIAN0-NOGRA, ROSAFEL R NP	10/6/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	580191	N/A	N/A	N/A	N/A	N/A	25555 HESPERIAN BLVD	None	HAYWARD	CA	94545	2447	00	06000	37.64243568	-122.1038935	Alameda County
316899	Ordering, Referring, Prescribing	N/A	1023132610	0	0	ANDRADE, LINDA A LMFT	10/26/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51728	N/A	N/A	N/A	N/A	N/A	12300 WASHINGTON BLVD	C	WHITTIER	CA	90606	2584	00	06000	33.96733395	-118.051096	Los Angeles County
316904	Ordering, Referring, Prescribing	N/A	1023134038	0	0	ARBITER, LINDA N LMFT	12/2/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45100	N/A	N/A	N/A	N/A	N/A	12450 VAN NUYS BLVD	100	PACOIMA	CA	91331	1392	00	06000	34.27894489	-118.4044363	Los Angeles County
316956	Ordering, Referring, Prescribing	N/A	1023238219	0	0	AMERINE, STEVEN A LMFT	1/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT42731	N/A	N/A	N/A	N/A	N/A	1393 BAILEY DRIVE	None	HANFORD	CA	93230	5922	00	06000	36.32726257	-119.6663418	Kings County
316986	Ordering, Referring, Prescribing	N/A	1023307642	0	0	ARANDA, VON ZIEGFRID S PHARMD	3/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65026	N/A	N/A	N/A	N/A	N/A	845 S MAIN ST	None	WILLITS	CA	95490	3915	00	06000	39.40290364	-123.3506795	Mendocino County
316992	Ordering, Referring, Prescribing	N/A	1023324951	0	0	AREVALO SALAS, MYRNA J LMFT	11/1/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	89467	N/A	N/A	N/A	N/A	N/A	3919 MACDONALD AVE	None	RICHMOND	CA	94805	2229	00	06000	37.93356754	-122.3320315	Contra Costa County
317053	Ordering, Referring, Prescribing	N/A	1023431194	0	0	AVILA, ASHLEY B PHARMD	4/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61610	N/A	N/A	N/A	N/A	N/A	3801 PELANDALE AVE	None	MODESTO	CA	95356	8300	00	06000	37.70013907	-121.0663275	Stanislaus County
317098	Ordering, Referring, Prescribing	N/A	1023496726	0	0	AKUSHE, ODIRI O NP	6/16/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014753	N/A	N/A	N/A	N/A	N/A	1855 N FAIR OAKS AVE	None	PASADENA	CA	91103	1620	00	06000	34.177806	-118.1507985	Los Angeles County
317099	Ordering, Referring, Prescribing	N/A	1023502259	0	0	ABADA, LOUISA	3/5/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW121398	N/A	N/A	N/A	N/A	N/A	1727 MLK JR WAY	None	OAKLAND	CA	94612	1327	00	06000	37.80868384	-122.2744362	Alameda County
317101	Ordering, Referring, Prescribing	N/A	1023503307	0	0	ALFANO, ANGELO J	9/6/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009941	N/A	N/A	N/A	N/A	N/A	925 BEVINS CT	None	LAKEPORT	CA	95453	9754	00	06000	39.03772106	-122.9223338	Lake County
317129	Ordering, Referring, Prescribing	N/A	1023544202	0	0	A. GUZMAN, PATRICIA LMFT	6/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112646	N/A	N/A	N/A	N/A	N/A	2200 W ORANGEWOOD AVE	STE. 212	ORANGE	CA	92868	1945	00	06000	33.79576054	-117.875655	Orange County
317154	Ordering, Referring, Prescribing	N/A	1023590551	0	0	AMBROZ, JESSICA C LCSW	9/6/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28010	N/A	N/A	N/A	N/A	N/A	401 N FAIRVIEW AVE	None	GOLETA	CA	93117	1732	00	06000	34.44743077	-119.8307072	Santa Barbara County
317164	Ordering, Referring, Prescribing	N/A	1023596962	0	0	ALVAREZ, MARIA D LCSW	8/3/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW102905	N/A	N/A	N/A	N/A	N/A	2035 E BALL RD	200	ANAHEIM	CA	92806	5159	00	06000	33.81812448	-117.8880075	Orange County
317174	Ordering, Referring, Prescribing	N/A	1023635919	0	0	AMITAI, DAHLIA M PHARMD	5/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH82536	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DRIVE	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
317184	Ordering, Referring, Prescribing	N/A	1023658614	0	0	AREVALO, YESSENIA E LCSW	12/13/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	112981	N/A	N/A	N/A	N/A	N/A	954 N VERMONT AVE	None	LOS ANGELES	CA	90029	3529	00	06000	34.08896256	-118.2917211	Los Angeles County
317199	Ordering, Referring, Prescribing	N/A	1023691623	0	0	AVILA, NOEMI NP	8/19/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022305	N/A	N/A	N/A	N/A	N/A	11980 MOUNT VERNON AVENU	None	GRAND TERRACE	CA	92313	5172	00	06000	34.036353	-117.3136565	San Bernardino County
317209	Ordering, Referring, Prescribing	N/A	1023734357	0	0	AHMADIAN, NATASHA	4/26/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020774	N/A	N/A	N/A	N/A	N/A	760 RENZ LN	None	GILROY	CA	95020	9584	00	06000	37.00466254	-121.5555242	Santa Clara County
317249	Ordering, Referring, Prescribing	N/A	1033120787	0	0	ANANIAN, CHARLES E DPM	10/24/2017	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	4582	N/A	N/A	N/A	N/A	N/A	1828 E CESAR E CHAVEZ AV	STE 4600	LOS ANGELES	CA	90033	2577	00	06000	34.05023174	-118.2154927	Los Angeles County
317265	Ordering, Referring, Prescribing	N/A	1033180898	0	0	ABRAHAM, MOTOKO DO	8/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A16948	N/A	N/A	N/A	N/A	N/A	5580 CALLE REAL	None	GOLETA	CA	93111	1646	00	06000	34.44131559	-119.8184752	Santa Barbara County
317285	Ordering, Referring, Prescribing	N/A	1033235692	0	0	ALLAN, TAMMY C LMFT	11/19/2017	Taxonomy not applicable	NA	n/a	000	Unknown	22271	N/A	N/A	N/A	N/A	N/A	29632 HWY 299 EAST	None	ROUND MOUNTAIN	CA	96084	0228	00	06000	40.80385331	-121.9397745	Shasta County
317336	Ordering, Referring, Prescribing	N/A	1033312988	0	0	ARRINGTON, JERRICA T LMFT	4/7/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132189	N/A	N/A	N/A	N/A	N/A	5080 CALIFORNIA AVE	STE 460	BAKERSFIELD	CA	93309	1698	00	06000	35.36158575	-119.0598492	Kern County
317372	Ordering, Referring, Prescribing	N/A	1033380001	0	0	ACOSTA, YESSICA LMFT	2/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111189	N/A	N/A	N/A	N/A	N/A	4452 E. CESAR CHAVEZ BLV	None	FRESNO	CA	93702	3605	00	06000	36.7358051	-119.7545078	Fresno County
317379	Ordering, Referring, Prescribing	N/A	1033405584	0	0	ANGERT, DAVID	11/26/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A131722	N/A	N/A	N/A	N/A	N/A	2333 S MOONEY BLVD	None	VISALIA	CA	93277	6228	00	06000	36.308682	-119.3154255	Tulare County
317414	Ordering, Referring, Prescribing	N/A	1033454210	0	0	AZUA-VALDEZ, ROSIO E LCSW	4/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93881	N/A	N/A	N/A	N/A	N/A	1311 11TH ST	None	REEDLEY	CA	93654	2926	00	06000	36.59910168	-119.4469399	Fresno County
317415	Ordering, Referring, Prescribing	N/A	1033461207	0	0	AVILA, MAGDALENA LCSW	12/8/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	112502	N/A	N/A	N/A	N/A	N/A	2719 N AIR FRESNO DR	None	FRESNO	CA	93727	1547	00	06000	36.77448139	-119.7281325	Fresno County
317443	Ordering, Referring, Prescribing	N/A	1033491493	0	0	ABRAMOWICZ, PAMELA M NP	1/19/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018658	N/A	N/A	N/A	N/A	N/A	124 CARMEN LN	STE A	SANTA MARIA	CA	93458	7768	00	06000	34.92479644	-120.4377807	Santa Barbara County
317468	Ordering, Referring, Prescribing	N/A	1033510995	0	0	AGUILAR, ANA L LCSW	2/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93470	N/A	N/A	N/A	N/A	N/A	1515 S BON VIEW AVE	None	ONTARIO	CA	91761	4408	00	06000	34.045335	-117.636444	San Bernardino County
317474	Ordering, Referring, Prescribing	N/A	1033524475	0	0	ALONZO, ALYSSA K LMFT	8/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121176	N/A	N/A	N/A	N/A	N/A	370 W. CRENSHAW BLVD	E-100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
317482	Ordering, Referring, Prescribing	N/A	1033544507	0	0	ALHADI, FATIN PSYD	4/10/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY29942	N/A	N/A	N/A	N/A	N/A	3810 ROSIN CT SUITE 180	None	SACRAMENTO	CA	95834	1658	00	06000	38.637702	-121.474773	Sacramento County
317596	Ordering, Referring, Prescribing	N/A	1033718580	0	0	ALLIEU, JOHN S NP	1/27/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015714	N/A	N/A	N/A	N/A	N/A	2951 FULTON AVE	None	SACRAMENTO	CA	95821	4909	00	06000	38.618991	-121.402692	Sacramento County
317613	Ordering, Referring, Prescribing	N/A	1033763677	0	0	AGUILAR, ASHLEY D LMFT	6/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115824	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR.	210	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
317644	Ordering, Referring, Prescribing	N/A	1033867353	0	0	ARASHAZARI, EILNAZ	7/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84607	N/A	N/A	N/A	N/A	N/A	2000 PORTOLA AVE	None	LIVERMORE	CA	94550	1762	00	06000	37.69125899	-121.7746983	Alameda County
317651	Ordering, Referring, Prescribing	N/A	1033952353	0	0	AHMED NAIEM, FNU MD	6/13/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A196901	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
317664	Ordering, Referring, Prescribing	N/A	1043047483	0	0	AQUINO, MONICA A DDS	9/18/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110803	N/A	N/A	N/A	N/A	N/A	137 N VIRGIL AVE	None	LOS ANGELES	CA	90004	4811	00	06000	34.07457287	-118.2868414	Los Angeles County
317670	Ordering, Referring, Prescribing	N/A	1043203466	0	0	AMADOR, ARTHUR MD	4/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C52414	N/A	N/A	N/A	N/A	N/A	769 W BLAINE ST	None	RIVERSIDE	CA	92507	3970	00	06000	33.98300646	-117.327555	Riverside County
317675	Ordering, Referring, Prescribing	N/A	1043237787	0	0	ATHAR-MACDONALD, HUMA A PSYD	12/10/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY17573	N/A	N/A	N/A	N/A	N/A	14140 BEACH BLVD	155	WESTMINSTER	CA	92683	4453	00	06000	33.756966	-117.9894915	Orange County
317713	Ordering, Referring, Prescribing	N/A	1043356850	0	0	AHMAD, BUSHRA F MD	4/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A73057	N/A	N/A	N/A	N/A	N/A	202 N 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
317731	Ordering, Referring, Prescribing	N/A	1043399462	0	0	ALBERT, DENISE MD	2/27/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A81724	N/A	N/A	N/A	N/A	N/A	999 BAKER WAY	420	SAN MATEO	CA	94404	1582	00	06000	37.56022167	-122.286255	San Mateo County
317749	Ordering, Referring, Prescribing	N/A	1043426919	0	0	AL-NAQBI, ABEER M MD	8/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	A148617	N/A	N/A	N/A	N/A	N/A	5925 W LAS POSITAS BLVD	100	PLEASANTON	CA	94588	8537	00	06000	37.68360997	-121.8990082	Alameda County
317753	Ordering, Referring, Prescribing	N/A	1043439813	0	0	ANYAOHA, AMAKA L CNP	5/22/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	23402	N/A	N/A	N/A	N/A	N/A	6001 E WASHINGTON BLVD	None	COMMERCE	CA	90040	2414	00	06000	33.99703164	-118.1499826	Los Angeles County
317762	Ordering, Referring, Prescribing	N/A	1043447345	0	0	ADAMS, BRUCE LMFT	4/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	80838	N/A	N/A	N/A	N/A	N/A	1108 S EL CAMINO REAL	None	SAN MATEO	CA	94402	2804	00	06000	37.55635875	-122.3187345	San Mateo County
317772	Ordering, Referring, Prescribing	N/A	1043478563	0	0	ALCALA, ANNA B LMFT	6/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84636	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	STE. 210	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
317774	Ordering, Referring, Prescribing	N/A	1043479280	0	0	ARAI, SCOTT G PSYD	7/13/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	27133	N/A	N/A	N/A	N/A	N/A	1326 4TH AVE	None	SAN FRANCISCO	CA	94122	2616	00	06000	37.76379697	-122.4609136	San Francisco County
317810	Ordering, Referring, Prescribing	N/A	1043560287	0	0	ADUSEI, MICHAEL MD	9/22/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C171898	N/A	N/A	N/A	N/A	N/A	30 SHELBURNE RD	None	STAMFORD	CT	06902	1640	00	06000	41.054958	-73.55391404	Western Connecticut Planning Region
317816	Ordering, Referring, Prescribing	N/A	1043578552	0	0	ARMAS, JUDY ANN C PHARMD	10/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH65673	N/A	N/A	N/A	N/A	N/A	1141 WEST AVE L	None	LANCASTER	CA	93534	7077	00	06000	34.66039349	-118.1514285	Los Angeles County
317890	Ordering, Referring, Prescribing	N/A	1043689698	0	0	ALAGHEHBANDZADEH, SHADI	8/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73524	N/A	N/A	N/A	N/A	N/A	1911 LINCOLN BLVD	None	SANTA MONICA	CA	90025	0000	00	06000	34.01192219	-118.482444	Los Angeles County
317896	Ordering, Referring, Prescribing	N/A	1043693252	0	0	AUDELO, RAMON LCSW	1/10/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87451	N/A	N/A	N/A	N/A	N/A	800 MING AVE	None	BAKERSFIELD	CA	93307	0000	00	06000	35.33951949	-119.0109555	Kern County
317911	Ordering, Referring, Prescribing	N/A	1043717218	0	0	ALVAREZ, PEDRO MD	6/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163467	N/A	N/A	N/A	N/A	N/A	1333 MERIDIAN AVE.	None	SAN JOSE	CA	95125	5212	00	06000	37.30176	-121.9136465	Santa Clara County
317960	Ordering, Referring, Prescribing	N/A	1043787344	0	0	ALONSO, MARILU	5/21/2024	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	SP37253	N/A	N/A	N/A	N/A	N/A	3364 BEYER BLVD	None	SAN YSIDRO	CA	92173	1322	00	06000	32.56624454	-117.0611925	San Diego County
317963	Ordering, Referring, Prescribing	N/A	1043779903	0	0	ANDRES, GAL MD	2/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179058	N/A	N/A	N/A	N/A	N/A	2940 INLAND EMPIRE BLVD	None	ONTARIO	CA	91764	4898	00	06000	34.069788	-117.5884605	San Bernardino County
317995	Ordering, Referring, Prescribing	N/A	1043844947	0	0	ARNOLD, KELLIE L NP	3/13/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014206	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
318033	Ordering, Referring, Prescribing	N/A	1043942477	0	0	AGUILAR, PHILLIP N NP	3/19/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95021440	N/A	N/A	N/A	N/A	N/A	123 S ALVARADO ST	None	LOS ANGELES	CA	90057	2201	00	06000	34.06593048	-118.2708351	Los Angeles County
318037	Ordering, Referring, Prescribing	N/A	1043967417	0	0	ALCONCEL, MURIELLE LMFT	9/30/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	150227	N/A	N/A	N/A	N/A	N/A	1301 PINE AVE	None	LONG BEACH	CA	90813	3124	00	06000	33.782913	-118.192417	Los Angeles County
318071	Ordering, Referring, Prescribing	N/A	1053097568	0	0	AGUILAR-TANPHANICH, ROSARIO M NP	4/19/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022801	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
318077	Ordering, Referring, Prescribing	N/A	1053137935	0	0	ALEGADO, AUDRIE C NP	3/3/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95024175	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
318078	Ordering, Referring, Prescribing	N/A	1053151506	0	0	AVE, JHOANNE NP	11/3/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027955	N/A	N/A	N/A	N/A	N/A	1133 CHELSEA ST	None	RIDGECREST	CA	93555	3208	00	06000	35.64262361	-117.6671491	Kern County
318090	Ordering, Referring, Prescribing	N/A	1053312868	0	0	ABBOTT, LARA MD	9/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A72880	N/A	N/A	N/A	N/A	N/A	1600 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
318097	Ordering, Referring, Prescribing	N/A	1053341354	0	0	ALLEN, NANCY B NP	12/14/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	7036	N/A	N/A	N/A	N/A	N/A	844 OLD TUNNEL ROAD	None	GRASS VALLEY	CA	95945	8524	00	06000	39.23512508	-121.0306878	Nevada County
318114	Ordering, Referring, Prescribing	N/A	1053438424	0	0	ANGEL, MARY A NP	8/19/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	6613	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVENUE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
318119	Ordering, Referring, Prescribing	N/A	1053442186	0	0	ABBOTT, CHESTER MD	3/24/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A73915	N/A	N/A	N/A	N/A	N/A	897 GRANITE DR.	None	PASADENA	CA	91101	3501	00	06000	34.13703447	-118.1317905	Los Angeles County
318123	Ordering, Referring, Prescribing	N/A	1053442699	0	0	ADAMS, SHARON LPCC	8/27/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC7924	N/A	N/A	N/A	N/A	N/A	555 HOSPITAL LN	None	SUSANVILLE	CA	96130	4808	00	06000	40.40857373	-120.666989	Lassen County
318156	Ordering, Referring, Prescribing	N/A	1053488767	0	0	AVRAMOV, VALENTIN Y	4/7/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A109609	N/A	N/A	N/A	N/A	N/A	1414 N CALIFORNIA ST	None	STOCKTON	CA	95202	1515	00	06000	37.96761084	-121.2883234	San Joaquin County
318208	Ordering, Referring, Prescribing	N/A	1053574202	0	0	ABBOTT, KRISTI LCSW	7/6/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	65194	N/A	N/A	N/A	N/A	N/A	9343 TECH CENTER DR	110	SACRAMENTO	CA	95826	2563	00	06000	38.564091	-121.3509285	Sacramento County
318226	Ordering, Referring, Prescribing	N/A	1053607119	0	0	AARONSON, JENIFER P MD	5/6/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A128241	N/A	N/A	N/A	N/A	N/A	4058 WILLOWS RD	None	ALPINE	CA	91901	1668	00	06000	32.836428	-116.7257385	San Diego County
318298	Ordering, Referring, Prescribing	N/A	1053722736	0	0	ADAM, TAREK N	2/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154524	N/A	N/A	N/A	N/A	N/A	720 WOOD ST.	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
318332	Ordering, Referring, Prescribing	N/A	1053760702	0	0	ARAUJO, ZASHARAH A LMFT	11/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129470	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
318338	Ordering, Referring, Prescribing	N/A	1053771105	0	0	ANDERS, NICOLE PSYD	12/28/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY28048	N/A	N/A	N/A	N/A	N/A	9713 SANTA MONICA BLVD.	201	BEVERLY HILLS	CA	90210	4236	00	06000	34.06835061	-118.4076858	Los Angeles County
318346	Ordering, Referring, Prescribing	N/A	1053780874	0	0	AUNG, WAI H	12/26/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D65133	N/A	N/A	N/A	N/A	N/A	7843 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91605	2523	00	06000	34.213581	-118.3878055	Los Angeles County
318354	Ordering, Referring, Prescribing	N/A	1053781666	0	0	AMBROSI, RICHARD A LMFT	4/13/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125507	N/A	N/A	N/A	N/A	N/A	2440 6TH ST	None	EUREKA	CA	95501	0788	00	06000	40.80368802	-124.1456878	Humboldt County
318361	Ordering, Referring, Prescribing	N/A	1053794180	0	0	AVIV, RACHEL M MD	2/2/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A147322	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
318381	Ordering, Referring, Prescribing	N/A	1053820043	0	0	ALFORD, JESSICA LPCC	5/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	11565	N/A	N/A	N/A	N/A	N/A	4990 WILLIAMS AVE	None	LA MESA	CA	91942	7409	00	06000	32.76933362	-117.0371085	San Diego County
318431	Ordering, Referring, Prescribing	N/A	1053906347	0	0	ANNON, JEFFREY J LMFT	2/2/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT130948	N/A	N/A	N/A	N/A	N/A	5601 W SLAUSON AVE	192	CULVER CITY	CA	90230	6582	00	06000	33.98900447	-118.37979	Los Angeles County
318435	Ordering, Referring, Prescribing	N/A	1053926923	0	0	ACEVEDO VENEGAS, ELISA V NP	11/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95015273	N/A	N/A	N/A	N/A	N/A	251 LANDIS AVENUE	None	CHULA VISTA	CA	91910	2628	00	06000	32.6425313	-117.0814859	San Diego County
318467	Ordering, Referring, Prescribing	N/A	1063014959	0	0	ARREOLA, LETICIA E PHARMD	8/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH83439	N/A	N/A	N/A	N/A	N/A	12184 PALMDALE RD	None	VICTORVILLE	CA	92392	8538	00	06000	34.50671077	-117.3988281	San Bernardino County
318481	Ordering, Referring, Prescribing	N/A	1063055184	0	0	ALMAZAN, AURA E NP	2/2/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013099	N/A	N/A	N/A	N/A	N/A	5256 MISSION BLVD	None	JURUPA VALLEY	CA	92509	4624	00	06000	33.99261717	-117.3987262	Riverside County
318548	Ordering, Referring, Prescribing	N/A	1063490514	0	0	AMICK, LETICIA	9/16/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	21549	N/A	N/A	N/A	N/A	N/A	121 W LEXINGTON DR.	SUITE 346	GLENDALE	CA	91203	2203	00	06000	34.1517575	-118.2560706	Los Angeles County
318618	Ordering, Referring, Prescribing	N/A	1063594372	0	0	ANSARI, RASHAD MD	11/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G52073	N/A	N/A	N/A	N/A	N/A	2023 W VISTA WAY STE J,	None	VISTA	CA	92083	6013	00	06000	33.1854871	-117.2850592	San Diego County
318636	Ordering, Referring, Prescribing	N/A	1063633626	0	0	ARMITSTEAD, NATALIE J LMFT	4/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52468	N/A	N/A	N/A	N/A	N/A	515 S CEDAR AVE	None	FRESNO	CA	93702	2908	00	06000	36.73744912	-119.7543742	Fresno County
318641	Ordering, Referring, Prescribing	N/A	1063652576	0	0	AVILA, PRISCILLA LMFT	2/13/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT79768	N/A	N/A	N/A	N/A	N/A	525 N CABRILLO PARK DR	300	SANTA ANA	CA	92701	9270	00	06000	33.75047365	-117.8404984	Orange County
318730	Ordering, Referring, Prescribing	N/A	1063793255	0	0	AGHAKHANYAN, GAYANE MD	10/28/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A128312	N/A	N/A	N/A	N/A	N/A	330 E LIVE OAK AVE	None	ARCADIA	CA	91006	5617	00	06000	34.10850998	-118.0219204	Los Angeles County
318744	Ordering, Referring, Prescribing	N/A	1063806743	0	0	AGUILERA, ANGEL MD	12/4/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144702	N/A	N/A	N/A	N/A	N/A	23501 CINEMA DR	200	VALENCIA	CA	91355	5428	00	06000	34.42039699	-118.5463513	Los Angeles County
318783	Ordering, Referring, Prescribing	N/A	1063844579	0	0	ALEKSIEJUK, PHILLIP A MD	5/18/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A141203	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	225	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
318807	Ordering, Referring, Prescribing	N/A	1063887495	0	0	ARNETT, KIMBERLY A NP	6/19/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021152	N/A	N/A	N/A	N/A	N/A	5870 ARLINGTON AVE	None	RIVERSIDE	CA	92504	2037	00	06000	33.94592702	-117.4313099	Riverside County
318812	Ordering, Referring, Prescribing	N/A	1063888311	0	0	ARIAS, CHRISTINA LCSW	6/25/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83638	N/A	N/A	N/A	N/A	N/A	445 11TH ST	None	ORANGE COVE	CA	93626	2211	00	06000	36.62723052	-119.319103	Fresno County
318821	Ordering, Referring, Prescribing	N/A	1063902096	0	0	ALEXANDER, IRINA LMFT	2/17/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124360	N/A	N/A	N/A	N/A	N/A	444 34TH ST	None	OAKLAND	CA	94609	2816	00	06000	37.82202446	-122.2640524	Alameda County
318830	Ordering, Referring, Prescribing	N/A	1063924652	0	0	AVEY, AMANDA L PHARMD	3/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	77635	N/A	N/A	N/A	N/A	N/A	22633 SAVI RANCH PKWY	None	YORBA LINDA	CA	92887	4647	00	06000	33.87492883	-117.7432851	Orange County
318862	Ordering, Referring, Prescribing	N/A	1063975027	0	0	AZARFAR, AVIVA PHARMD	8/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79395	N/A	N/A	N/A	N/A	N/A	18430 SHERMAN WAY	None	RESEDA	CA	91335	6856	00	06000	34.20105549	-118.534329	Los Angeles County
318889	Ordering, Referring, Prescribing	N/A	1073022414	0	0	ANDREWS-CARDOZA, KYM M LCSW	12/4/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	119493	N/A	N/A	N/A	N/A	N/A	5168 HONPIE ROAD	None	PLACERVILLE	CA	95667	8682	00	06000	38.6943603	-120.9018271	El Dorado County
318893	Ordering, Referring, Prescribing	N/A	1073024592	0	0	ARANEO, SOPHIA M LCSW	6/16/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108566	N/A	N/A	N/A	N/A	N/A	2225 CHALLENGER WAY	None	SANTA ROSA	CA	95407	5400	00	06000	38.425482	-122.75262	Sonoma County
318907	Ordering, Referring, Prescribing	N/A	1073046199	0	0	ARMSTEAD, MELINDA MD	3/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165164	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
318923	Ordering, Referring, Prescribing	N/A	1073070447	0	0	AGUAYO, DIANA LCSW	6/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	86906	N/A	N/A	N/A	N/A	N/A	1555 S GAREY AVE	None	POMONA	CA	91766	5222	00	06000	34.04317024	-117.7497127	Los Angeles County
318924	Ordering, Referring, Prescribing	N/A	1073072096	0	0	AKIN, PATRICK DO	6/29/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21389	N/A	N/A	N/A	N/A	N/A	1200 W MAIN ST	None	TURLOCK	CA	95380	5107	00	06000	37.4926695	-120.862917	Stanislaus County
318969	Ordering, Referring, Prescribing	N/A	1073166955	0	0	ATTIA, NAGI PHARMD	11/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80567	N/A	N/A	N/A	N/A	N/A	1520 BRUNDAGE LN	None	BAKERSFIELD	CA	93304	2949	00	06000	35.355456	-119.0196225	Kern County
318981	Ordering, Referring, Prescribing	N/A	1073191102	0	0	ARELLANO-ANDERSON, JACOB MD	4/9/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A192313	N/A	N/A	N/A	N/A	N/A	1691 THE ALAMEDA	None	SAN JOSE	CA	95126	2203	00	06000	37.3373761	-121.9192532	Santa Clara County
318982	Ordering, Referring, Prescribing	N/A	1073192027	0	0	AMEZCUA, EDUARDO MD	2/27/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194215	N/A	N/A	N/A	N/A	N/A	26538 MOULTON PKWY	SUITE 38E	LAGUNA HILLS	CA	92653	8232	00	06000	33.57744684	-117.702553	Orange County
318983	Ordering, Referring, Prescribing	N/A	1073173365	0	0	AVILEZ, JESSICA LMFT	11/3/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	151081	N/A	N/A	N/A	N/A	N/A	405 W 5TH ST	211	SANTA ANA	CA	92701	4522	00	06000	33.74893088	-117.8713859	Orange County
319002	Ordering, Referring, Prescribing	N/A	1073307757	0	0	ASADI, YEKTA J DDS	3/31/2025	Taxonomy not applicable	NA	n/a	000	Unknown	111367	N/A	N/A	N/A	N/A	N/A	3591 HAMMER AVE	STE D	NORCO	CA	92860	1376	00	06000	33.93596741	-117.5572685	Riverside County
319019	Ordering, Referring, Prescribing	N/A	1073518965	0	0	ARIELLA, LYNDA PHD	5/10/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY19450	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
319067	Ordering, Referring, Prescribing	N/A	1073684684	0	0	ANDRADE, MIRIAM M PSYD	4/13/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY23089	N/A	N/A	N/A	N/A	N/A	1430 WILLOW PASS RD	None	CONCORD	CA	94520	7928	00	06000	37.97055112	-122.0492933	Contra Costa County
319110	Ordering, Referring, Prescribing	N/A	1073805461	0	0	AL SAYED, GHADA M MD	7/12/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C180413	N/A	N/A	N/A	N/A	N/A	1033 CLEMENT ST	None	SAN FRANCISCO	CA	94118	2112	00	06000	37.78261628	-122.470294	San Francisco County
319113	Ordering, Referring, Prescribing	N/A	1073800389	0	0	ARIAS, CLAUDIA LMFT	6/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	88852	N/A	N/A	N/A	N/A	N/A	327 S K ST	None	TULARE	CA	93274	5416	00	06000	36.20476387	-119.3454489	Tulare County
319134	Ordering, Referring, Prescribing	N/A	1073849204	0	0	ALVAREZ, JOSE A LMFT	8/8/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110667	N/A	N/A	N/A	N/A	N/A	3850 CRENSHAW BLVD	None	LOS ANGELES	CA	90008	1821	00	06000	34.01581788	-118.3348506	Los Angeles County
319141	Ordering, Referring, Prescribing	N/A	1073863445	0	0	ARMADO, RONALD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67824	N/A	N/A	N/A	N/A	N/A	17284 SLOVER AVE	203	FONTANA	CA	92337	7584	00	06000	34.065396	-117.4277475	San Bernardino County
319144	Ordering, Referring, Prescribing	N/A	1073867768	0	0	ARRIAZA, DAISY Y LCSW	3/11/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93519	N/A	N/A	N/A	N/A	N/A	5757 WILSHIRE BLVD.	SUITE 200	LOS ANGELES	CA	90036	0000	00	06000	34.0624504	-118.3534253	Los Angeles County
319214	Ordering, Referring, Prescribing	N/A	1073979936	0	0	AXELROD, MALLORY R LCSW	12/28/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW72307	N/A	N/A	N/A	N/A	N/A	10929 SOUTH ST.	STE. 208B	CERRITOS	CA	90703	5368	00	06000	33.85836353	-118.101204	Los Angeles County
319233	Ordering, Referring, Prescribing	N/A	1073988143	0	0	ATASHPANJEH, NEGAR PHARMD	1/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	73991	N/A	N/A	N/A	N/A	N/A	5356 E WHITTIER BLVD	None	LOS ANGELES	CA	90022	4032	00	06000	34.01989465	-118.1549717	Los Angeles County
319275	Ordering, Referring, Prescribing	N/A	1083056279	0	0	ASUNCION, JENNIFER S LCSW	6/15/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75956	N/A	N/A	N/A	N/A	N/A	1000 EUCLID AVE	None	NATIONAL CITY	CA	91950	0000	00	06000	32.68067201	-117.0804893	San Diego County
319309	Ordering, Referring, Prescribing	N/A	1083111595	0	0	ADAMS, DANIEL MD	8/31/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A174738	N/A	N/A	N/A	N/A	N/A	3409 CALLOWAY DR	None	BAKERSFIELD	CA	93312	2528	00	06000	35.39132551	-119.11007	Kern County
319374	Ordering, Referring, Prescribing	N/A	1083208318	0	0	ALEXANDER, KEVON S CNP	2/24/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95016775	N/A	N/A	N/A	N/A	N/A	121 S. LONG BEACH BLVD.	None	COMPTON	CA	90221	3423	00	06000	33.89475493	-118.2080292	Los Angeles County
319376	Ordering, Referring, Prescribing	N/A	1083223697	0	0	ASKARI, JESSICA A LMFT	7/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120514	N/A	N/A	N/A	N/A	N/A	2101 ROSECRANS AVENUE	SUITE 3270	EL SEGUNDO	CA	90245	4736	00	06000	33.90199426	-118.3875106	Los Angeles County
319423	Ordering, Referring, Prescribing	N/A	1083347645	0	0	AVAREN, ZARYN LCSW	12/30/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW127949	N/A	N/A	N/A	N/A	N/A	2204 NATIONAL AVE	None	SAN DIEGO	CA	92113	3615	00	06000	32.69715769	-117.1399272	San Diego County
319458	Ordering, Referring, Prescribing	N/A	1083496988	0	0	AVAGYAN, HOVHANNES NP	2/25/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025690	N/A	N/A	N/A	N/A	N/A	3030 W OLYMPIC BLVD	217	LOS ANGELES	CA	90006	6501	00	06000	34.05260995	-118.3015825	Los Angeles County
319461	Ordering, Referring, Prescribing	N/A	1083647051	0	0	ACEBO, ANDRE M DC	12/26/2021	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	20074	N/A	N/A	N/A	N/A	N/A	1330 LAS TABLAS RD	None	TEMPLETON	CA	93465	9758	00	06000	35.55442548	-120.723759	San Luis Obispo County
319474	Ordering, Referring, Prescribing	N/A	1083700892	0	0	AGREGADO, FATIMA O LCSW	11/20/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW23171	N/A	N/A	N/A	N/A	N/A	330 E LIVE OAK AVE	None	ARCADIA	CA	91006	5617	00	06000	34.10850998	-118.0219204	Los Angeles County
319479	Ordering, Referring, Prescribing	N/A	1083719835	0	0	ALEXAKOS, MARK J MD	5/24/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C157529	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUITION BLVD.	None	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
319498	Ordering, Referring, Prescribing	N/A	1083755664	0	0	ANDREWS, MARIAH J LMFT	5/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44986	N/A	N/A	N/A	N/A	N/A	769 BLAINE STREET	SUITE B	RIVERSIDE	CA	92507	3970	00	06000	33.98300646	-117.327555	Riverside County
319552	Ordering, Referring, Prescribing	N/A	1083878227	0	0	AROCHE, ANTULIO B DO	11/14/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A13631	N/A	N/A	N/A	N/A	N/A	400 CAMARILLO RANCH RD	SUITE 101	CAMARILLO	CA	93012	5901	00	06000	34.220943	-119.0186825	Ventura County
319574	Ordering, Referring, Prescribing	N/A	1083917439	0	0	ASAMOAH, YAW O PA-C	5/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA20953	N/A	N/A	N/A	N/A	N/A	23900 IRONWOOD AVE	None	MORENO VALLEY	CA	92557	7151	00	06000	33.94665346	-117.245061	Riverside County
319579	Ordering, Referring, Prescribing	N/A	1083927883	0	0	ALVARADO, GILLERMINA LMFT	1/1/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	152419	N/A	N/A	N/A	N/A	N/A	572 N ARROWHEAD AVE	None	SAN BERNARDINO	CA	92401	1251	00	06000	34.109667	-117.289669	San Bernardino County
319582	Ordering, Referring, Prescribing	N/A	1083940506	0	0	AMIRIAN, LEAH M PHARMD	10/9/2018	Taxonomy not applicable	NA	n/a	000	Unknown	61469	N/A	N/A	N/A	N/A	N/A	1510 SAN PABLO STREET	144	LOS ANGELES	CA	90033	5394	00	06000	34.06287152	-118.2029433	Los Angeles County
319589	Ordering, Referring, Prescribing	N/A	1083948012	0	0	ALA, ANN M CNP	10/21/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007810	N/A	N/A	N/A	N/A	N/A	72724 29 PALMS HWY	103	TWENTYNINE PALMS	CA	92277	2459	00	06000	34.13547448	-116.076159	San Bernardino County
319608	Ordering, Referring, Prescribing	N/A	1083980247	0	0	AKANDE, ADERONKE NP	3/28/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	21597	N/A	N/A	N/A	N/A	N/A	2292 FARADAY AVE STE 110	STE 110	CARLSBAD	CA	92008	7239	00	06000	33.13490794	-117.2765569	San Diego County
319630	Ordering, Referring, Prescribing	N/A	1093002636	0	0	AL-DHAHER, ZAINAB MD	12/5/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A143479	N/A	N/A	N/A	N/A	N/A	302 CHERRY LANE	208	MANTECA	CA	95337	4311	00	06000	37.8013889	-121.2310042	San Joaquin County
319668	Ordering, Referring, Prescribing	N/A	1093076622	0	0	ALEIA, JUSTIN DO	10/15/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17272	N/A	N/A	N/A	N/A	N/A	1520 EUREKA RD	STE 102	ROSEVILLE	CA	95661	2849	00	06000	38.74944235	-121.2487091	Placer County
319669	Ordering, Referring, Prescribing	N/A	1093076416	0	0	AGUIRRE, LARRY PA-C	7/20/2020	Taxonomy not applicable	NA	n/a	000	Unknown	PA21850	N/A	N/A	N/A	N/A	N/A	350 E. GOBBI ST	None	UKIAH	CA	95482	5511	00	06000	39.14427808	-123.2021038	Mendocino County
319688	Ordering, Referring, Prescribing	N/A	1093112658	0	0	ADAME, ALEXANDRA LCSW	10/22/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100763	N/A	N/A	N/A	N/A	N/A	23501 CINEMA DR	None	VALENCIA	CA	91355	5428	00	06000	34.42039699	-118.5463513	Los Angeles County
319714	Ordering, Referring, Prescribing	N/A	1093150583	0	0	ADATO, SIVAN G LPCC	4/20/2020	Taxonomy not applicable	NA	n/a	000	Unknown	7800	N/A	N/A	N/A	N/A	N/A	3001 INTERNATIONAL BLVD	None	OAKLAND	CA	94601	2203	00	06000	37.77859396	-122.2279493	Alameda County
319716	Ordering, Referring, Prescribing	N/A	1093159493	0	0	ANDRADE, RIA R MD	2/8/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A134344	N/A	N/A	N/A	N/A	N/A	501 S IDAHO ST	100	LA HABRA	CA	90631	6047	00	06000	33.927525	-117.959216	Orange County
319741	Ordering, Referring, Prescribing	N/A	1093186652	0	0	ANYANWU, LINDA C	9/19/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D65205	N/A	N/A	N/A	N/A	N/A	5701 S HOOVER ST	None	LOS ANGELES	CA	90037	4045	00	06000	33.9903	-118.2871595	Los Angeles County
319758	Ordering, Referring, Prescribing	N/A	1093209330	0	0	ARIAS, ANA M LCSW	2/28/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121255	N/A	N/A	N/A	N/A	N/A	3031 S VERMONT AVE	None	LOS ANGELES	CA	90007	3033	00	06000	34.02666679	-118.2915608	Los Angeles County
319778	Ordering, Referring, Prescribing	N/A	1093239436	0	0	AGUILAR, SHELLY NP	2/1/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	22945	N/A	N/A	N/A	N/A	N/A	1910 N BUSH ST	None	SANTA ANA	CA	92706	2816	00	06000	33.76222337	-117.866393	Orange County
319793	Ordering, Referring, Prescribing	N/A	1093262438	0	0	ANGULO, ROXANNA LMFT	2/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT118389	N/A	N/A	N/A	N/A	N/A	530 W BADILLO ST	None	COVINA	CA	91722	3787	00	06000	34.08625283	-117.8999625	Los Angeles County
319810	Ordering, Referring, Prescribing	N/A	1093288730	0	0	APRIL, MONIQUE NP	12/5/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95009340	N/A	N/A	N/A	N/A	N/A	901 W ORANGETHORPE AVE	None	FULLERTON	CA	92832	2826	00	06000	33.85940147	-117.939735	Orange County
319875	Ordering, Referring, Prescribing	N/A	1093480014	0	0	ARGUETA, MARILYN M LCSW	10/22/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	126878	N/A	N/A	N/A	N/A	N/A	1301 PINE AVENUE	None	LONG BEACH	CA	90813	3424	00	06000	33.782913	-118.192417	Los Angeles County
319914	Ordering, Referring, Prescribing	N/A	1093807224	0	0	ALZUBAIDI, AMIL D LMFT	3/7/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	41761	N/A	N/A	N/A	N/A	N/A	155 E 4TH STREET	None	PERRIS	CA	92570	2124	00	06000	33.78233952	-117.2273265	Riverside County
319955	Ordering, Referring, Prescribing	N/A	1093893679	0	0	AYYALA, SREEDEVI MD	8/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A90855	N/A	N/A	N/A	N/A	N/A	6001 E WASHINGTON BLVD	STE 200	COMMERCE	CA	90040	2455	00	06000	33.99703164	-118.1499826	Los Angeles County
319959	Ordering, Referring, Prescribing	N/A	1093887622	0	0	ADAMS, NOHRA R	2/11/2014	Taxonomy not applicable	NA	n/a	000	Unknown	PA18287	N/A	N/A	N/A	N/A	N/A	5440 THORNWOOD	SUITE G	SAN JOSE	CA	95123	1217	00	06000	37.25346406	-121.8609675	Santa Clara County
320007	Ordering, Referring, Prescribing	N/A	1093976649	0	0	ARENA, MICHAEL MD	4/17/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138433	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
320039	Ordering, Referring, Prescribing	N/A	1104043868	0	0	ABEL, ERIN D	6/21/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D40570	N/A	N/A	N/A	N/A	N/A	740 SOLANO ST	None	CORNING	CA	96021	3352	00	06000	39.92792649	-122.175513	Tehama County
320057	Ordering, Referring, Prescribing	N/A	1104090570	0	0	AVINA, ERICA LMFT	5/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52579	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
320078	Ordering, Referring, Prescribing	N/A	1104135391	0	0	ABOVIAN, VIGEN V	8/17/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A106757	N/A	N/A	N/A	N/A	N/A	435 ARDEN AVE	330	GLENDALE	CA	91203	1130	00	06000	34.15848148	-118.2628845	Los Angeles County
320095	Ordering, Referring, Prescribing	N/A	1104169655	0	0	ATALLAH, HANI MD	6/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A132530	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE	100	GILROY	CA	95020	3673	00	06000	37.03080985	-121.5741639	Santa Clara County
320102	Ordering, Referring, Prescribing	N/A	1104178532	0	0	ANDRADE, ROSE K LCSW	3/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29464	N/A	N/A	N/A	N/A	N/A	17800 HWY 18	None	APPLE VALLEY	CA	92307	1221	00	06000	34.54007429	-117.2744761	San Bernardino County
320140	Ordering, Referring, Prescribing	N/A	1104220888	0	0	ALAADEL, AYA PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71554	N/A	N/A	N/A	N/A	N/A	3201 W 6TH ST	None	LOS ANGELES	CA	90020	5001	00	06000	34.0636545	-118.2922515	Los Angeles County
320141	Ordering, Referring, Prescribing	N/A	1104238625	0	0	AUMENT, SAMANTHA LCSW	6/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	82781	N/A	N/A	N/A	N/A	N/A	125 W MISSION AVE	103	ESCONDIDO	CA	92025	1720	00	06000	33.12998866	-117.0864074	San Diego County
320175	Ordering, Referring, Prescribing	N/A	1104290055	0	0	ALLINGHAM, TAMI C LMFT	5/11/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132739	N/A	N/A	N/A	N/A	N/A	6301 BEACH BLVD	245	BUENA PARK	CA	90621	2840	00	06000	33.86880928	-117.9983013	Orange County
320182	Ordering, Referring, Prescribing	N/A	1104302231	0	0	AZHAR MUNIR, REHAN MD	1/31/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173565	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
320257	Ordering, Referring, Prescribing	N/A	1104407337	0	0	AZANI, ARI B MD	4/8/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A195353	N/A	N/A	N/A	N/A	N/A	2130 NATIONAL AVE	None	SAN DIEGO	CA	92113	2209	00	06000	32.69800063	-117.1411927	San Diego County
320258	Ordering, Referring, Prescribing	N/A	1104407501	0	0	ALVAREZ, CARLA ANGELA N DMD	6/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	107492	N/A	N/A	N/A	N/A	N/A	1325 N ANAHEIM BLVD	SUITE 200	ANAHEIM	CA	92801	1202	00	06000	33.85331047	-117.9199617	Orange County
320298	Ordering, Referring, Prescribing	N/A	1104528827	0	0	ALVAREZ, ALEXANDER M MD	1/7/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL12486	N/A	N/A	N/A	N/A	N/A	1043 ELM AVE	SUITE 302	LONG BEACH	CA	90813	3295	00	06000	33.779655	-118.1880065	Los Angeles County
320305	Ordering, Referring, Prescribing	N/A	1104537315	0	0	AMZALAG, MESHI NP	11/10/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023313	N/A	N/A	N/A	N/A	N/A	7301 STATE ST.	None	HUNTINGTON PARK	CA	90255	5823	00	06000	33.97149395	-118.2097278	Los Angeles County
320313	Ordering, Referring, Prescribing	N/A	1104649417	0	0	AGUINALDO, MARIE A NP	9/25/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032363	N/A	N/A	N/A	N/A	N/A	1102 E CLARK AVE	STE120A	SANTA MARIA	CA	93455	5175	00	06000	34.86499805	-120.4185338	Santa Barbara County
320329	Ordering, Referring, Prescribing	N/A	1104837947	0	0	ADBERG, CHRISTINA L	5/19/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A60964	N/A	N/A	N/A	N/A	N/A	400 W 30TH ST	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
320416	Ordering, Referring, Prescribing	N/A	1114054053	0	0	ARREDONDO, PATRICIA P LCSW	7/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26964	N/A	N/A	N/A	N/A	N/A	1300 17TH ST	None	BAKERSFIELD	CA	93301	4533	00	06000	35.37476047	-119.016774	Kern County
320420	Ordering, Referring, Prescribing	N/A	1114058559	0	0	ADAMS, CASSANDRA J LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	18941	N/A	N/A	N/A	N/A	N/A	14600 SHERMAN WAY	100D	VAN NUYS	CA	91405	2283	00	06000	34.20025916	-118.4500763	Los Angeles County
320424	Ordering, Referring, Prescribing	N/A	1114059458	0	0	ARANA, SANDRA R LCSW	9/1/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW110270	N/A	N/A	N/A	N/A	N/A	3787 S VERMONT AVE	None	LOS ANGELES	CA	90007	4203	00	06000	34.01739	-118.291567	Los Angeles County
320449	Ordering, Referring, Prescribing	N/A	1114123213	0	0	AULWES, JULIENNE O MD	1/14/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A115289	N/A	N/A	N/A	N/A	N/A	720 WOOD STREET	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
320462	Ordering, Referring, Prescribing	N/A	1114141082	0	0	AUSTIN, DARYL W LMFT	12/30/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT97601	N/A	N/A	N/A	N/A	N/A	209 E. 7TH ST.	None	MADERA	CA	93638	3780	00	06000	36.96069768	-120.0559841	Madera County
320495	Ordering, Referring, Prescribing	N/A	1114209376	0	0	AYERS, NAMIKO LCSW	9/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	64702	N/A	N/A	N/A	N/A	N/A	16350 FILBERT ST	None	SYLMAR	CA	91342	1002	00	06000	34.31595736	-118.4853828	Los Angeles County
320529	Ordering, Referring, Prescribing	N/A	1114275278	0	0	ANGULO, DENISE LCSW	5/10/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	103441	N/A	N/A	N/A	N/A	N/A	2933 UNIVERSITY AVE	None	RIVERSIDE	CA	92507	4243	00	06000	33.97760919	-117.3651828	Riverside County
320530	Ordering, Referring, Prescribing	N/A	1114274396	0	0	ACERET, REBECA F LMFT	4/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103034	N/A	N/A	N/A	N/A	N/A	31 TOWER RD	None	SAN MATEO	CA	94402	4000	00	06000	37.51232162	-122.3333429	San Mateo County
320538	Ordering, Referring, Prescribing	N/A	1114298130	0	0	ABRESCH, LISA M PA	2/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	21227	N/A	N/A	N/A	N/A	N/A	3220 MISSION AVE	SUITE 1	OCEANSIDE	CA	92058	1351	00	06000	33.2141644	-117.3472638	San Diego County
320540	Ordering, Referring, Prescribing	N/A	1114290665	0	0	AGUIRRE, JANELLE M LMFT	2/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	85879	N/A	N/A	N/A	N/A	N/A	11731 E TELEGRAPH RD.	None	SANTA FE SPRINGS	CA	90670	6819	00	06000	33.94630253	-118.0832082	Los Angeles County
320551	Ordering, Referring, Prescribing	N/A	1114315637	0	0	AGUAYO, GABRIELA LMFT	1/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT117075	N/A	N/A	N/A	N/A	N/A	8220 S SAN PEDRO ST	None	LOS ANGELES	CA	90003	3030	00	06000	33.96420053	-118.2695043	Los Angeles County
320559	Ordering, Referring, Prescribing	N/A	1114323755	0	0	ADEYEMI, OLAJUMOKE M NP	12/7/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019346	N/A	N/A	N/A	N/A	N/A	1752 S VICTORIA AVE	250	VENTURA	CA	93003	6192	00	06000	34.25916679	-119.2090522	Ventura County
320573	Ordering, Referring, Prescribing	N/A	1114347291	0	0	ARAGON, DARINKA M MD	6/29/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139241	N/A	N/A	N/A	N/A	N/A	2204 NATIONAL AVE	None	SAN DIEGO	CA	92113	3615	00	06000	32.69715769	-117.1399272	San Diego County
320605	Ordering, Referring, Prescribing	N/A	1114394806	0	0	AREH, NKOLIKA LMFT	11/27/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	110654	N/A	N/A	N/A	N/A	N/A	26520 CACTUS AVEBUE	None	MORENO VALLEY	CA	92555	3927	00	06000	33.912117	-117.195849	Riverside County
320626	Ordering, Referring, Prescribing	N/A	1114429909	0	0	AKPAN, GODFREY NP	9/27/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027438	N/A	N/A	N/A	N/A	N/A	1809 W REDLANDS BLVD	None	REDLANDS	CA	92373	8054	00	06000	34.06288379	-117.2156673	San Bernardino County
320627	Ordering, Referring, Prescribing	N/A	1114429719	0	0	ADIMORAH, ADAOBI M NP	5/27/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021094	N/A	N/A	N/A	N/A	N/A	1910 ORANGE TREE LN	None	REDLANDS	CA	92374	4500	00	06000	34.06785848	-117.2189386	San Bernardino County
320659	Ordering, Referring, Prescribing	N/A	1114479177	0	0	ALLEN, BLANCA A NP	3/4/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95011336	N/A	N/A	N/A	N/A	N/A	1005 E. WASHINGTON BLVD.	STE A	LOS ANGELES	CA	90021	3020	00	06000	34.02578238	-118.2530622	Los Angeles County
320689	Ordering, Referring, Prescribing	N/A	1114557170	0	0	ANDERSON, JOILYN C NP	9/9/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012727	N/A	N/A	N/A	N/A	N/A	69175 RAMON RD STE A	STE A	CATHEDRAL CITY	CA	92234	3344	00	06000	33.813621	-116.456193	Riverside County
320694	Ordering, Referring, Prescribing	N/A	1114567898	0	0	ABREU, ELMER F	1/23/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013627	N/A	N/A	N/A	N/A	N/A	14335 IBEX AVE	None	NORWALK	CA	90650	4961	00	06000	33.90118426	-118.0741873	Los Angeles County
320738	Ordering, Referring, Prescribing	N/A	1114682796	0	0	AQUI, PRINCESS LOUISE V NP	1/20/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018979	N/A	N/A	N/A	N/A	N/A	2501 W EL SEGUNDO BLVD	B	HAWTHORNE	CA	90250	3317	00	06000	33.91648148	-118.3206645	Los Angeles County
320740	Ordering, Referring, Prescribing	N/A	1114698370	0	0	ADKISSON, SARAH L OT	10/19/2021	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	1502	N/A	N/A	N/A	N/A	N/A	875 EL CAJON BLVD	None	EL CAJON	CA	92020	5714	00	06000	32.78535272	-116.9770049	San Diego County
320751	Ordering, Referring, Prescribing	N/A	1114916376	0	0	AFKHAM-EBRAHIMI, SAM MD	11/27/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A60777	N/A	N/A	N/A	N/A	N/A	16030 VENTURA BLVD	605	ENCINO	CA	91436	2705	00	06000	34.15615339	-118.4824038	Los Angeles County
320786	Ordering, Referring, Prescribing	N/A	1124068515	0	0	AKPEK, GORGUN MD	10/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C152104	N/A	N/A	N/A	N/A	N/A	715 TANK FARM RD	STE C	SAN LUIS OBISPO	CA	93401	7068	00	06000	35.24853234	-120.642458	San Luis Obispo County
320789	Ordering, Referring, Prescribing	N/A	1124105432	0	0	ALTOBELLI, ARLENE M PSYD	2/17/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY17584	N/A	N/A	N/A	N/A	N/A	212 CARMEN LANE	None	SANTA MARIA	CA	93458	7769	00	06000	34.92481416	-120.4383025	Santa Barbara County
320843	Ordering, Referring, Prescribing	N/A	1124182175	0	0	AKIYAMA, LYNDA K LCSW	2/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW22508	N/A	N/A	N/A	N/A	N/A	680 LANGSDORF DR	200	FULLERTON	CA	92831	3702	00	06000	33.87673088	-117.8824577	Orange County
320862	Ordering, Referring, Prescribing	N/A	1124208251	0	0	AGUILERA, ESMERALDA LCSW	4/12/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81226	N/A	N/A	N/A	N/A	N/A	204 E.BEACH ST	None	WATSONVILLE	CA	95076	4809	00	06000	36.91224802	-121.7541363	Santa Cruz County
320872	Ordering, Referring, Prescribing	N/A	1124241419	0	0	AMEZOLA, MARIA L LMFT	12/1/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	143260	N/A	N/A	N/A	N/A	N/A	2719 N AIR FRESNO DR	None	FRESNO	CA	93727	1546	00	06000	36.77448139	-119.7281325	Fresno County
320884	Ordering, Referring, Prescribing	N/A	1124269246	0	0	ALVAREZ, MARITZA B PSYD	8/1/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY22435	N/A	N/A	N/A	N/A	N/A	2101 CAROL DR	None	FULLERTON	CA	92833	3009	00	06000	33.86884507	-117.9665489	Orange County
320886	Ordering, Referring, Prescribing	N/A	1124272273	0	0	ARIAS, SALVADOR LCSW	7/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95427	N/A	N/A	N/A	N/A	N/A	1300 17TH STREET	None	BAKERSFIELD	CA	93301	4533	00	06000	35.37476047	-119.016774	Kern County
320890	Ordering, Referring, Prescribing	N/A	1124278916	0	0	ANDINO, TANYA N LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT90045	N/A	N/A	N/A	N/A	N/A	855 N. ORANGE GROVE BLVD	None	PASADENA	CA	91103	9998	00	06000	34.15695727	-118.1527027	Los Angeles County
320995	Ordering, Referring, Prescribing	N/A	1124463179	0	0	AHSAN, IRFAN DPM	8/18/2019	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5494	N/A	N/A	N/A	N/A	N/A	23413 LYONS AVE	None	SANTA CLARITA	CA	91355	3028	00	06000	34.37974287	-118.5428596	Los Angeles County
320999	Ordering, Referring, Prescribing	N/A	1124433081	0	0	AKRONG, ABIGAIL O PHARMD	8/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	68526	N/A	N/A	N/A	N/A	N/A	17051 BEAR VALLEY RD	None	APPLE VALLEY	CA	92307	0000	00	06000	34.47193328	-117.1399375	San Bernardino County
321066	Ordering, Referring, Prescribing	N/A	1124563366	0	0	ANAND, MANMIT K NP	11/15/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005092	N/A	N/A	N/A	N/A	N/A	18601 VALLEY BLVD	None	BLOOMINGTON	CA	92316	1831	00	06000	34.07045653	-117.3982455	San Bernardino County
321072	Ordering, Referring, Prescribing	N/A	1124564828	0	0	ASATRYAN, LUCINA N LMFT	12/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123657	N/A	N/A	N/A	N/A	N/A	21545 CENTRE POINTE PARK	None	SANTA CALRITA	CA	91350	2947	00	06000	34.413021	-118.514534	Los Angeles County
321085	Ordering, Referring, Prescribing	N/A	1124582150	0	0	ABRAHAM, KHADEJAH K LMFT	9/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT121682	N/A	N/A	N/A	N/A	N/A	11601 S. WESTERN AVE.	None	LOS ANGELES	CA	90047	5006	00	06000	33.92826552	-118.3092091	Los Angeles County
321095	Ordering, Referring, Prescribing	N/A	1124591508	0	0	AL KHAZAALI, ALI PHARMD	11/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80083	N/A	N/A	N/A	N/A	N/A	543 SWEETWATER RD.	None	SPRING VALLEY	CA	91977	5627	00	06000	32.708178	-117.008559	San Diego County
321101	Ordering, Referring, Prescribing	N/A	1124634514	0	0	ANDRADE, YAHAIRA J LPCC	6/19/2023	Taxonomy not applicable	NA	n/a	000	Unknown	14099	N/A	N/A	N/A	N/A	N/A	100 POPLAR AVE	None	MODESTO	CA	95354	0510	00	06000	37.64602395	-121.000188	Stanislaus County
321111	Ordering, Referring, Prescribing	N/A	1124634563	0	0	ARDOIN, RACHEL A NP	6/29/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015034	N/A	N/A	N/A	N/A	N/A	11721 E TELEGRAPH RD	SUITE A	SANTA FE SPRINGS	CA	90670	3674	00	06000	33.94629336	-118.0832752	Los Angeles County
321131	Ordering, Referring, Prescribing	N/A	1124675095	0	0	AULAKH, AMBER K PA-C	11/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60346	N/A	N/A	N/A	N/A	N/A	344 E 6TH ST	None	MADERA	CA	93638	3631	00	06000	36.96288964	-120.0556279	Madera County
321136	Ordering, Referring, Prescribing	N/A	1124699855	0	0	ABDON, RALAINE NP	7/10/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017716	N/A	N/A	N/A	N/A	N/A	8233 E STOCKTON BLVD	A	SACRAMENTO	CA	95828	8203	00	06000	38.459628	-121.4095815	Sacramento County
321148	Ordering, Referring, Prescribing	N/A	1124760194	0	0	ALCOLEA TAMAYO, YOELBIS MD	7/12/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197709	N/A	N/A	N/A	N/A	N/A	5427 WHITTIER BLVD	None	LOS ANGELES	CA	90022	4101	00	06000	34.01966132	-118.1536008	Los Angeles County
321178	Ordering, Referring, Prescribing	N/A	1134168891	0	0	AN, LAURI I MD	10/6/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A42565	N/A	N/A	N/A	N/A	N/A	3255 WILSHIRE BLVD	SUITE 120	LOS ANGELES	CA	90010	1404	00	06000	34.0618166	-118.2932612	Los Angeles County
321198	Ordering, Referring, Prescribing	N/A	1134225980	0	0	ABRIGNANI, LAURA NP	9/24/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	8836	N/A	N/A	N/A	N/A	N/A	345 CAMINO DEL REMEDIO	None	SANTA BARBARA	CA	93110	1332	00	06000	34.444782	-119.7794675	Santa Barbara County
321221	Ordering, Referring, Prescribing	N/A	1134258643	0	0	AMAYA, JANET M LCSW	3/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28646	N/A	N/A	N/A	N/A	N/A	1965 LIVE OAK BLVD	None	YUBA CITY	CA	95991	8850	00	06000	39.15563037	-121.620091	Sutter County
321253	Ordering, Referring, Prescribing	N/A	1134330368	0	0	AHMED, ZAHEERUDDIN MD	12/10/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C127721	N/A	N/A	N/A	N/A	N/A	7170 N FINANCIAL DR ,	UNIT 110	FRESNO	CA	93720	2939	00	06000	36.84000952	-119.7711439	Fresno County
321345	Ordering, Referring, Prescribing	N/A	1134508476	0	0	AGUILAR-GODINEZ, ELIZABETH LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105695	N/A	N/A	N/A	N/A	N/A	658 E BRIER DR	200	SAN BERNARDINO	CA	92408	2880	00	06000	34.07137738	-117.2702805	San Bernardino County
321355	Ordering, Referring, Prescribing	N/A	1134520331	0	0	ALEGRIA, MARYFLOR LCSW	11/5/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88217	N/A	N/A	N/A	N/A	N/A	20151 NORDHOFF ST	None	CHATSWORTH	CA	91311	6215	00	06000	34.23182352	-118.572948	Los Angeles County
321368	Ordering, Referring, Prescribing	N/A	1134543143	0	0	ALCOCER, VERONICA LMFT	5/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103192	N/A	N/A	N/A	N/A	N/A	1031 25TH ST	None	SAN DIEGO	CA	92102	2102	00	06000	32.716404	-117.1402635	San Diego County
321420	Ordering, Referring, Prescribing	N/A	1134632086	0	0	ANDRADE-FLORES, VALERIA LMFT	12/7/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT127639	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR.	STE. 210	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
321453	Ordering, Referring, Prescribing	N/A	1134679053	0	0	ANG, DAISY MAE S NP	11/12/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005609	N/A	N/A	N/A	N/A	N/A	6022 VARIEL AVE	None	WOODLAND HILLS	CA	91367	3719	00	06000	34.180029	-118.592771	Los Angeles County
321461	Ordering, Referring, Prescribing	N/A	1134692445	0	0	AGUWA, MARIAN LCSW	4/14/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	86372	N/A	N/A	N/A	N/A	N/A	833 SEQUOIA AVE	None	LINDSAY	CA	93247	1424	00	06000	36.212967	-119.0961185	Tulare County
321465	Ordering, Referring, Prescribing	N/A	1134690621	0	0	AMENERO, JOANNA MSW LCSW	3/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94459	N/A	N/A	N/A	N/A	N/A	11502 S. VERMONT AVE.	SUITE C	LOS ANGELES	CA	90044	0000	00	06000	33.929928	-118.291572	Los Angeles County
321503	Ordering, Referring, Prescribing	N/A	1134779903	0	0	AKERS, MATTHEW A	2/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124559	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	SUITE 401	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
321515	Ordering, Referring, Prescribing	N/A	1134862329	0	0	AGUILERA-GALVAN, MARICELA A	4/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86000	N/A	N/A	N/A	N/A	N/A	1120 E CLARK AVE	None	ORCUTT	CA	93455	8205	00	06000	34.86500248	-120.417299	Santa Barbara County
321535	Ordering, Referring, Prescribing	N/A	1134889611	0	0	ANJALI, UNKNOWN DDS PC	12/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	DDS107209	N/A	N/A	N/A	N/A	N/A	124 S A ST	None	MADERA	CA	93638	3619	00	06000	36.96397997	-120.0545315	Madera County
321557	Ordering, Referring, Prescribing	N/A	1144287053	0	0	APPLETONE, MELISSA A MD	2/26/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	17311	N/A	N/A	N/A	N/A	N/A	620 SKYLINE DR	None	JACKSON	TN	38301	3923	00	06000	35.63721	-88.831359	Madison County
321558	Ordering, Referring, Prescribing	N/A	1144284290	0	0	AULD, RICHARD M MD	5/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A35764	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
321643	Ordering, Referring, Prescribing	N/A	1144460130	0	0	ARANA, MIRIAM E PA-C	1/20/2024	Taxonomy not applicable	NA	n/a	000	Unknown	20320	N/A	N/A	N/A	N/A	N/A	670 COUNTY ROAD 83	None	CANBY	CA	96015	9722	00	06000	41.44344745	-120.8718025	Modoc County
321657	Ordering, Referring, Prescribing	N/A	1144502121	0	0	ARWADE, TINA B PHARMD	7/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	40174	N/A	N/A	N/A	N/A	N/A	216 WESTLAKE CENTER	None	DALY CITY	CA	94015	1430	00	06000	37.70123591	-122.4833751	San Mateo County
321658	Ordering, Referring, Prescribing	N/A	1144506759	0	0	ARGUETA-TRUJILLO, JUAN A PHARMD	7/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	58806	N/A	N/A	N/A	N/A	N/A	575 N SANBORN RD	None	SALINAS	CA	93905	0575	00	06000	36.68179908	-121.6229784	Monterey County
321693	Ordering, Referring, Prescribing	N/A	1144581497	0	0	AGUILAR, MARIA S LCSW	5/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76304	N/A	N/A	N/A	N/A	N/A	1303 W WALNUT PKWY	None	COMPTON	CA	90220	5030	00	06000	33.87724562	-118.2446904	Los Angeles County
321710	Ordering, Referring, Prescribing	N/A	1144612979	0	0	ANDERSON, ANDREA LMFT	6/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	103871	N/A	N/A	N/A	N/A	N/A	8912 VOLUNTEER LANE	None	SACRAMENTO	CA	95826	3221	00	06000	38.55438	-121.3756965	Sacramento County
321734	Ordering, Referring, Prescribing	N/A	1144637067	0	0	AHN, JENNIFER	6/11/2018	Taxonomy not applicable	NA	n/a	000	Unknown	NP95004177	N/A	N/A	N/A	N/A	N/A	1530 S. OLIVE STREET	None	LOS ANGELES	CA	90015	3023	00	06000	34.03542552	-118.2652073	Los Angeles County
321759	Ordering, Referring, Prescribing	N/A	1144673211	0	0	ARCOS, KARINA LCSW	9/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80187	N/A	N/A	N/A	N/A	N/A	695 S. VERMONT AVE.	None	LOS ANGELES	CA	90005	1101	00	06000	34.06078495	-118.2916863	Los Angeles County
321780	Ordering, Referring, Prescribing	N/A	1144699588	0	0	ARREDONDO, JOANNA LCSW	1/1/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99436	N/A	N/A	N/A	N/A	N/A	7170 N FINANCIAL DR	110	FRESNO	CA	93720	2939	00	06000	36.84000952	-119.7711439	Fresno County
321797	Ordering, Referring, Prescribing	N/A	1144724428	0	0	AHADY, BAHAR M MD	4/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166134	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	1265	00	06000	38.555181	-121.4566785	Sacramento County
321815	Ordering, Referring, Prescribing	N/A	1144744699	0	0	ASHER-SCHAPIRO, SHAYNA L LCSW	4/25/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114955	N/A	N/A	N/A	N/A	N/A	3200 CLAYTON ROAD	None	CONCORD	CA	94519	2819	00	06000	37.97283909	-122.0196497	Contra Costa County
321844	Ordering, Referring, Prescribing	N/A	1144778226	0	0	AZIZ, MARIA LMFT	8/17/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134253	N/A	N/A	N/A	N/A	N/A	2335 COUNTRY HILLS DR	None	ANTIOCH	CA	94509	7319	00	06000	37.97021462	-121.7841321	Contra Costa County
321852	Ordering, Referring, Prescribing	N/A	1144797770	0	0	ADAMS, CHRISTOPHER B PHARMD	4/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72254	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
321860	Ordering, Referring, Prescribing	N/A	1144804691	0	0	AGUILAR-PORTILLO, GEORGINA MD	8/13/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184608	N/A	N/A	N/A	N/A	N/A	450 E SAN JACINTO AVE	None	PERRIS	CA	92571	2833	00	06000	33.78662816	-117.2164923	Riverside County
321879	Ordering, Referring, Prescribing	N/A	1144835323	0	0	AMIN, PRANAV PHARMD	11/2/2022	Taxonomy not applicable	NA	n/a	000	Unknown	87263	N/A	N/A	N/A	N/A	N/A	325 S WILLIS ST	None	VISALIA	CA	93291	6105	00	06000	36.327717	-119.2981005	Tulare County
321894	Ordering, Referring, Prescribing	N/A	1144858127	0	0	ARANEZ, CHARITY MAY MD	7/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A21454	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
321907	Ordering, Referring, Prescribing	N/A	1144880790	0	0	ATTAR, ASHLEY J PA-C	9/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60084	N/A	N/A	N/A	N/A	N/A	2433 MARCONI AVE	None	SACRAMENTO	CA	95821	4807	00	06000	38.619405	-121.4045595	Sacramento County
321912	Ordering, Referring, Prescribing	N/A	1144881004	0	0	ANDRAWOS, KIROLOS Y	8/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76401	N/A	N/A	N/A	N/A	N/A	12384 PALMDALE RD	105	VICTORVILLE	CA	92392	8506	00	06000	34.50675814	-117.3929237	San Bernardino County
321916	Ordering, Referring, Prescribing	N/A	1144891250	0	0	ABING, AURA FRANCES G	11/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	LEP3600	N/A	N/A	N/A	N/A	N/A	398 B ST.	None	SOUTH SAN FRANCIS	CA	94080	0001	00	06000	37.64968275	-122.4281922	San Mateo County
321962	Ordering, Referring, Prescribing	N/A	1154066025	0	0	AGHAZARIAN, ANI T PA-C	6/15/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA61251	N/A	N/A	N/A	N/A	N/A	1414 S. GRAND AVE	200	LOS ANGELES	CA	90015	3067	00	06000	34.03661142	-118.2657227	Los Angeles County
322018	Ordering, Referring, Prescribing	N/A	1154441731	0	0	ANDAL, IEDA	11/2/2022	Taxonomy not applicable	NA	n/a	000	Unknown	14668	N/A	N/A	N/A	N/A	N/A	13356 ELDRIDGE AVE	None	SYLMAR	CA	91342	3200	00	06000	34.31405061	-118.4197394	Los Angeles County
322061	Ordering, Referring, Prescribing	N/A	1154519031	0	0	AMBRIZ, MARICELA LMFT	6/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	98271	N/A	N/A	N/A	N/A	N/A	1800 SOLAR DR FL 3	STE D	OXNARD	CA	93030	2655	00	06000	34.21748414	-119.1449177	Ventura County
322079	Ordering, Referring, Prescribing	N/A	1154555274	0	0	ASRAT, WELANSA E MD	12/5/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C151473	N/A	N/A	N/A	N/A	N/A	21730 S. VERMONT AVE.,	122	TORRANCE	CA	90502	2196	00	06000	33.830658	-118.290203	Los Angeles County
322080	Ordering, Referring, Prescribing	N/A	1154548899	0	0	AMBLER, MARY T LCSW	2/23/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW16930	N/A	N/A	N/A	N/A	N/A	200 S WELLS ROAD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
322085	Ordering, Referring, Prescribing	N/A	1154564177	0	0	AVILA, DAHLIA LMSW	6/21/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW76974	N/A	N/A	N/A	N/A	N/A	820 E GILBERT ST	None	SAN BERNARDINO	CA	92415	0928	00	06000	34.1268333	-117.2687417	San Bernardino County
322093	Ordering, Referring, Prescribing	N/A	1154584365	0	0	ALCANTARA, CARLOS A PHD	2/18/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26821	N/A	N/A	N/A	N/A	N/A	594 N GLASSELL ST	None	ORANGE	CA	92867	6748	00	06000	33.796782	-117.853129	Orange County
322134	Ordering, Referring, Prescribing	N/A	1154649630	0	0	ALMAZAN, ROSALVA LMFT	11/12/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT83512	N/A	N/A	N/A	N/A	N/A	15339 SATICOY ST.	None	VAN NUYS	CA	91405	1003	00	06000	34.2084865	-118.4678505	Los Angeles County
322143	Ordering, Referring, Prescribing	N/A	1154626604	0	0	ABLIAN, JOCELYN A NP	2/22/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	565903	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	6962	00	06000	34.09813032	-118.2901794	Los Angeles County
322152	Ordering, Referring, Prescribing	N/A	1154684421	0	0	ADAMS, HOLLY PHARMD	3/23/2018	Taxonomy not applicable	NA	n/a	000	Unknown	68278	N/A	N/A	N/A	N/A	N/A	3550 MURPHY CANYON RD	None	SAN DIEGO	CA	92123	9656	00	06000	32.80792564	-117.1150773	San Diego County
322154	Ordering, Referring, Prescribing	N/A	1154693893	0	0	ALEXIS, DIANA	7/29/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0738752	N/A	N/A	N/A	N/A	N/A	21001 SHERMAN WAY	#9	CANOGA PARK	CA	91303	1760	00	06000	34.20113553	-118.5912126	Los Angeles County
322185	Ordering, Referring, Prescribing	N/A	1154741809	0	0	ALLISON, STEFANI L LMFT	5/23/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115234	N/A	N/A	N/A	N/A	N/A	1141 LEVER BLVD	None	STOCKTON	CA	95207	2812	00	06000	37.92329923	-121.3032998	San Joaquin County
322258	Ordering, Referring, Prescribing	N/A	1154857506	0	0	ABDI, YASMIN N LMFT	7/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120461	N/A	N/A	N/A	N/A	N/A	39600 LOGAN DR	None	FREMONT	CA	94538	1912	00	06000	37.53641964	-121.9842026	Alameda County
322266	Ordering, Referring, Prescribing	N/A	1154859601	0	0	ANDERSON, LINDSAY M LMFT	5/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT118958	N/A	N/A	N/A	N/A	N/A	455 1ST STREET	None	WOODLAND	CA	95695	4023	00	06000	38.675781	-121.773122	Yolo County
322300	Ordering, Referring, Prescribing	N/A	1154940682	0	0	ADIB, HANIA MD	8/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL5271	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
322301	Ordering, Referring, Prescribing	N/A	1154940849	0	0	ABARYAN, ZVART MD	12/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A186472	N/A	N/A	N/A	N/A	N/A	3250 WILSHIRE BLVD	SUITE 320	LOS ANGELES	CA	90010	1577	00	06000	34.06176363	-118.2932622	Los Angeles County
322304	Ordering, Referring, Prescribing	N/A	1154942209	0	0	ALTMAN, RACHEL	12/30/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95212048	N/A	N/A	N/A	N/A	N/A	1107 W POPLAR AVE	None	PORTERVILLE	CA	93257	5839	00	06000	36.05128153	-119.0422344	Tulare County
322306	Ordering, Referring, Prescribing	N/A	1154953735	0	0	ABASI, RABIE PHARMD	7/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	82453	N/A	N/A	N/A	N/A	N/A	3853 ROSECRANS ST	None	SAN DIEGO	CA	92110	3115	00	06000	32.75391982	-117.2024389	San Diego County
322314	Ordering, Referring, Prescribing	N/A	1154949451	0	0	AUEYONG, ORADEE B NP	7/1/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014776	N/A	N/A	N/A	N/A	N/A	731 S. HIGHLAND	None	FULLERTON	CA	92832	2753	00	06000	33.863598	-117.928718	Orange County
322359	Ordering, Referring, Prescribing	N/A	1164057022	0	0	AMOO, MARGARET A NP	1/22/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013762	N/A	N/A	N/A	N/A	N/A	491 E. ALESSANDRO BLVD	None	RIVERSIDE	CA	92508	6071	00	06000	33.91628714	-117.3230954	Riverside County
322366	Ordering, Referring, Prescribing	N/A	1164059044	0	0	ALI, HADI MD	3/10/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180489	N/A	N/A	N/A	N/A	N/A	325 E 7TH ST	None	LOS ANGELES	CA	90014	9001	00	06000	34.04209386	-118.2486813	Los Angeles County
322391	Ordering, Referring, Prescribing	N/A	1164117891	0	0	AHMAD, SAMEERA OD	2/5/2024	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	35623	N/A	N/A	N/A	N/A	N/A	11980 MOUNT VERNON AVE	None	GRAND TERRACE	CA	92313	5172	00	06000	34.036353	-117.3136565	San Bernardino County
322396	Ordering, Referring, Prescribing	N/A	1164134078	0	0	AL BAYATI, MUSTAFA M DDS	12/3/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108434	N/A	N/A	N/A	N/A	N/A	808 W. 58TH STREET	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
322409	Ordering, Referring, Prescribing	N/A	1164190948	0	0	AVAKERETYAN, JULIANA PHARMD	3/25/2022	Taxonomy not applicable	NA	n/a	000	Unknown	84975	N/A	N/A	N/A	N/A	N/A	13550 PAXTON ST	None	PACOIMA	CA	91331	2352	00	06000	34.27263559	-118.4275767	Los Angeles County
322413	Ordering, Referring, Prescribing	N/A	1164197471	0	0	ALVARADO, DIANA C NP	1/22/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018000	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
322418	Ordering, Referring, Prescribing	N/A	1164233789	0	0	AHMED, MAERAH PA-C	1/21/2025	Taxonomy not applicable	NA	n/a	000	Unknown	65731	N/A	N/A	N/A	N/A	N/A	15791 BEAR VALLEY RD	None	HESPERIA	CA	92345	1746	00	06000	34.47063553	-117.3190095	San Bernardino County
322419	Ordering, Referring, Prescribing	N/A	1164194247	0	0	ADAMS, ALICIA M CNP	8/11/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95018073	N/A	N/A	N/A	N/A	N/A	1035 PLACER STREET	None	REDDING	CA	96001	1035	00	06000	40.58349378	-122.3853903	Shasta County
322429	Ordering, Referring, Prescribing	N/A	1164452272	0	0	AHLUWALIA, GURPREET S MD	3/3/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C159740	N/A	N/A	N/A	N/A	N/A	1250 MORENA BLVD	None	SAN DIEGO	CA	92110	3815	00	06000	32.76963745	-117.2036361	San Diego County
322433	Ordering, Referring, Prescribing	N/A	1164464442	0	0	ACCIAIOLI, JOSEPH R LCSW	12/28/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81140	N/A	N/A	N/A	N/A	N/A	5125 SKYWAY	None	PARADISE	CA	95969	5624	00	06000	39.74598961	-121.640736	Butte County
322437	Ordering, Referring, Prescribing	N/A	1164496709	0	0	ALGAIER, ROBERT J MD	1/26/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A44076	N/A	N/A	N/A	N/A	N/A	1560 MARKET ST,	None	REDDING	CA	96001	0001	00	06000	40.58346871	-122.390608	Shasta County
322470	Ordering, Referring, Prescribing	N/A	1164554937	0	0	AJA, VASILIKI LMFT	12/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT34111	N/A	N/A	N/A	N/A	N/A	500 N. STREET	SUITE D	MODESTO	CA	95350	5814	00	06000	37.6443392	-121.0048755	Stanislaus County
322482	Ordering, Referring, Prescribing	N/A	1164572525	0	0	AGUILUZ-LEE, JACQUELINE B DO MD	8/20/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A7451	N/A	N/A	N/A	N/A	N/A	13330 BLOOMFIELD AVENUE	111	NORWALK	CA	90650	3264	00	06000	33.90988905	-118.0644875	Los Angeles County
322516	Ordering, Referring, Prescribing	N/A	1164639555	0	0	ATANI, SOBHA R	9/11/2001	Taxonomy not applicable	NA	n/a	099	DENTIST	D48224	N/A	N/A	N/A	N/A	N/A	10561 MERRITT ST	None	CASTROVILLE	CA	95012	3310	00	06000	36.76699229	-121.7597014	Monterey County
322558	Ordering, Referring, Prescribing	N/A	1164718334	0	0	ALBA, CAYO CNP	8/1/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026401	N/A	N/A	N/A	N/A	N/A	50 BRANSCOMB RD	None	LAYTONVILLE	CA	95454	0870	00	06000	39.68781544	-123.4842982	Mendocino County
322571	Ordering, Referring, Prescribing	N/A	1164750386	0	0	ARNOLD, MARCIA L	4/1/2020	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	4370	N/A	N/A	N/A	N/A	N/A	1901 N RICE AVE	170-180	OXNARD	CA	93030	7912	00	06000	34.21960355	-119.1421345	Ventura County
322583	Ordering, Referring, Prescribing	N/A	1164762845	0	0	AMEZQUITA, PRISCILLA S LCSW	12/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW85338	N/A	N/A	N/A	N/A	N/A	1301 PINE AVE	None	LONG BEACE	CA	90813	3124	00	06000	33.782913	-118.192417	Los Angeles County
322622	Ordering, Referring, Prescribing	N/A	1164824785	0	0	AMARO CHAVEZ, ADILENE LMFT	6/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126464	N/A	N/A	N/A	N/A	N/A	4001 MISSION OAKS RD	I	CAMARILLO	CA	93012	5121	00	06000	34.21641579	-119.0166203	Ventura County
322654	Ordering, Referring, Prescribing	N/A	1164891313	0	0	ALBRIGHT, RYAN N LMFT	12/2/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	109390	N/A	N/A	N/A	N/A	N/A	3360 N. HWY 59	SUITE K	MERCED	CA	95348	9405	00	06000	37.32547941	-120.5047136	Merced County
322663	Ordering, Referring, Prescribing	N/A	1164909735	0	0	ARCE GASTELUM, ALHELI MD	10/24/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A174340	N/A	N/A	N/A	N/A	N/A	302 FRESNO STREET	#101	FRESNO	CA	93706	3611	00	06000	36.72393092	-119.8091084	Fresno County
322673	Ordering, Referring, Prescribing	N/A	1164923892	0	0	ACOSTA, LIZBETH PA	2/18/2025	Taxonomy not applicable	NA	n/a	000	Unknown	PA65976	N/A	N/A	N/A	N/A	N/A	3255 WILSHIRE BLVD	120	LOS ANGELES	CA	90010	1404	00	06000	34.0618166	-118.2932612	Los Angeles County
322683	Ordering, Referring, Prescribing	N/A	1164940185	0	0	ALI, FADHL PHARMD	12/22/2020	Taxonomy not applicable	NA	n/a	000	Unknown	79676	N/A	N/A	N/A	N/A	N/A	497 OLLER ST	None	MENDOTA	CA	93640	2312	00	06000	36.75721705	-120.3824941	Fresno County
322725	Ordering, Referring, Prescribing	N/A	1174010169	0	0	AFARI, FREDERICK A MD	7/1/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A173474	N/A	N/A	N/A	N/A	N/A	50249 CESAR CHAVEZ ST	STE K	COACHELLA	CA	92236	4120	00	06000	33.68245553	-116.1816607	Riverside County
322747	Ordering, Referring, Prescribing	N/A	1174034821	0	0	ANZO, CELESTE LMFT	1/24/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	144564	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	STE 220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
322750	Ordering, Referring, Prescribing	N/A	1174035885	0	0	ABAS, ARCELYN NP	5/31/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007839	N/A	N/A	N/A	N/A	N/A	2720 S BRISTOL ST	None	SANTA ANA	CA	92704	6210	00	06000	33.710463	-117.8854565	Orange County
322753	Ordering, Referring, Prescribing	N/A	1174051775	0	0	ALEXANDER, TIANITA D	9/8/2017	Taxonomy not applicable	NA	n/a	000	Unknown	54578	N/A	N/A	N/A	N/A	N/A	2540 SISTER MARY COLUMBA	DR	RED BLUFF	CA	96080	4327	00	06000	40.14893664	-122.2178101	Tehama County
322756	Ordering, Referring, Prescribing	N/A	1174061147	0	0	AFZALI, DANIEL M PHARMD	7/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH76143	N/A	N/A	N/A	N/A	N/A	3460 EL CAMINO REAL	None	SANTA CLARA	CA	95051	2809	00	06000	37.35225555	-121.9921875	Santa Clara County
322767	Ordering, Referring, Prescribing	N/A	1174080238	0	0	ARCHER VOSE, ASHLEY S	9/26/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010958	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
322844	Ordering, Referring, Prescribing	N/A	1174239032	0	0	AYAT, YASAMAN LAC	7/13/2022	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	19452	N/A	N/A	N/A	N/A	N/A	1179 N MCDOWELL BLVD	None	PETALUMA	CA	94954	6559	00	06000	38.26876442	-122.6598332	Sonoma County
322850	Ordering, Referring, Prescribing	N/A	1174257828	0	0	AKUBUILO, CHIDERA PA-C	6/6/2024	Taxonomy not applicable	NA	n/a	000	Unknown	64589	N/A	N/A	N/A	N/A	N/A	4425 S CENTRAL AVE	None	LOS ANGELES	CA	90011	3629	00	06000	34.003116	-118.2565185	Los Angeles County
322924	Ordering, Referring, Prescribing	N/A	1174683189	0	0	ALVAREZ, IRAIDA LMFT	11/2/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105698	N/A	N/A	N/A	N/A	N/A	1666 PRECISION PARK LN	None	SAN YSIDRO	CA	92173	1346	00	06000	32.5659146	-117.059667	San Diego County
322948	Ordering, Referring, Prescribing	N/A	1174714745	0	0	ALLEN, TANYA G LMFT	11/6/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT45373	N/A	N/A	N/A	N/A	N/A	29632 HWY 299 E	None	ROUND MOUNTAIN	CA	96084	0228	00	06000	40.80385331	-121.9397745	Shasta County
322995	Ordering, Referring, Prescribing	N/A	1174816425	0	0	ABELDT, SUSAN DDS	10/31/2022	Taxonomy not applicable	NA	n/a	000	Unknown	33889	N/A	N/A	N/A	N/A	N/A	52 S MAIN ST	None	ANGELS CAMP	CA	95222	9153	00	06000	38.08181342	-120.5580433	Calaveras County
323009	Ordering, Referring, Prescribing	N/A	1174853402	0	0	AUERBACH, FELICIA LCSW	1/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW65056	N/A	N/A	N/A	N/A	N/A	16650 SHERMAN WAY	202	VAN NUYS	CA	91406	3782	00	06000	34.20108451	-118.4959755	Los Angeles County
323043	Ordering, Referring, Prescribing	N/A	1174894208	0	0	ARREDONDO, ADRIANA NP	6/9/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	21477	N/A	N/A	N/A	N/A	N/A	1704 COLORADO BLVD	None	LOS ANGELES	CA	90041	1338	00	06000	34.13930153	-118.203894	Los Angeles County
323066	Ordering, Referring, Prescribing	N/A	1174920508	0	0	ARVIZU, VIRGINIA LCSW	7/8/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	109038	N/A	N/A	N/A	N/A	N/A	1453 W TEMPLE ST	None	LOS ANGELES	CA	90026	4915	00	06000	34.06757953	-118.2579864	Los Angeles County
323082	Ordering, Referring, Prescribing	N/A	1174936975	0	0	ALLEN, BRANDON K LCSW	2/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121103	N/A	N/A	N/A	N/A	N/A	144 STONY POINT RD	None	SANTA ROSA	CA	95401	4122	00	06000	38.440494	-122.74353	Sonoma County
323096	Ordering, Referring, Prescribing	N/A	1174957070	0	0	ANDERSON, CHRISTOPHER M LCSW	2/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121111	N/A	N/A	N/A	N/A	N/A	1060 MANOR RD	None	EL SOBRANTE	CA	94803	1336	00	06000	37.98283758	-122.3044728	Contra Costa County
323097	Ordering, Referring, Prescribing	N/A	1174957153	0	0	ALMEIDA, MURILO LMFT	2/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	100619	N/A	N/A	N/A	N/A	N/A	6051 N FRESNO ST	201	FRESNO	CA	93710	5280	00	06000	36.823905	-119.781436	Fresno County
323124	Ordering, Referring, Prescribing	N/A	1174995542	0	0	AHUJA, ARTI C LMFT	9/2/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127907	N/A	N/A	N/A	N/A	N/A	4831 PANAMA LANE	A-1	BAKERSFIELD	CA	93313	3462	00	06000	35.2958804	-119.0563375	Kern County
323132	Ordering, Referring, Prescribing	N/A	1184000408	0	0	ARROW, CANDICE J LMFT	7/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT48585	N/A	N/A	N/A	N/A	N/A	1450 CIVIC COURT	SUITE 200	CONCORD	CA	94521	1629	00	06000	37.9718675	-122.0496338	Contra Costa County
323140	Ordering, Referring, Prescribing	N/A	1184007718	0	0	ARDINA, ANNE-FRANCELLE L MD	12/5/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146080	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
323149	Ordering, Referring, Prescribing	N/A	1184024085	0	0	ASBAGHI MAMAGHANI, NAGHMEH E	12/7/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	105125	N/A	N/A	N/A	N/A	N/A	4327 GOLDEN CENTER DR	None	PLACERVILLE	CA	95667	4327	00	06000	38.70662835	-120.8276613	El Dorado County
323150	Ordering, Referring, Prescribing	N/A	1184026338	0	0	ATYABI, VANESSA NP	2/14/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001317	N/A	N/A	N/A	N/A	N/A	915 N MILPAS ST	None	SANTA BARBARA	CA	93103	2331	00	06000	34.43040726	-119.6909855	Santa Barbara County
323162	Ordering, Referring, Prescribing	N/A	1184042699	0	0	ANDERSON, BRIAN T MD	9/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139122	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
323179	Ordering, Referring, Prescribing	N/A	1184061103	0	0	AHMED, ASRA S MD	12/10/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159755	N/A	N/A	N/A	N/A	N/A	66 HURLBUT ST	None	PASADENA	CA	91105	4025	00	06000	34.12993251	-118.1516625	Los Angeles County
323219	Ordering, Referring, Prescribing	N/A	1184114357	0	0	ANTOUN, MORA	12/3/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH74970	N/A	N/A	N/A	N/A	N/A	13394 LIMONITE AVE	SUITE B120	EASTVALE	CA	92880	7272	00	06000	33.97535937	-117.5754567	Riverside County
323227	Ordering, Referring, Prescribing	N/A	1184128985	0	0	ARCHER, JOAN M LCSW	12/1/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	14615	N/A	N/A	N/A	N/A	N/A	21000 PLUMMER STREET	None	CHATSWORTH	CA	91311	4903	00	06000	34.24271597	-118.5915861	Los Angeles County
323228	Ordering, Referring, Prescribing	N/A	1184129884	0	0	AKPARANTA, CHRISTINE N MD	1/31/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A192556	N/A	N/A	N/A	N/A	N/A	1 HOPE DR	None	TUSTIN	CA	92782	0221	00	06000	33.71470753	-117.8323965	Orange County
323268	Ordering, Referring, Prescribing	N/A	1184194383	0	0	ALAY, IVANNIA CSW	6/26/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	109369	N/A	N/A	N/A	N/A	N/A	101 E REDLANDS BLVD	215	REDLANDS	CA	92373	4775	00	06000	34.05731952	-117.181197	San Bernardino County
323270	Ordering, Referring, Prescribing	N/A	1184191033	0	0	APER, ANNA LCSW	9/21/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	104159	N/A	N/A	N/A	N/A	N/A	6060 SUNRISE VISTA DR	2100	CITRUS HEIGHTS	CA	95610	7053	00	06000	38.676861	-121.263903	Sacramento County
323323	Ordering, Referring, Prescribing	N/A	1184290025	0	0	AJAYI, SHERIE NP	12/2/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025539	N/A	N/A	N/A	N/A	N/A	1530 S OLIVE ST	None	LOS ANGELES	CA	90015	3023	00	06000	34.03542552	-118.2652073	Los Angeles County
323333	Ordering, Referring, Prescribing	N/A	1184349896	0	0	ALVAREZ, VERONICA	2/6/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028993	N/A	N/A	N/A	N/A	N/A	625 HILBY AVE	None	SEASIDE	CA	93955	5720	00	06000	36.60257396	-121.8495595	Monterey County
323353	Ordering, Referring, Prescribing	N/A	1184396822	0	0	AZIM, HALIMA B NP	2/27/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95024430	N/A	N/A	N/A	N/A	N/A	13118 SHERMAN WAY	None	NORTH HOLLYWOOD	CA	91605	4645	00	06000	34.20117448	-118.4188095	Los Angeles County
323395	Ordering, Referring, Prescribing	N/A	1184722837	0	0	AUSTIN, KATHERINE	5/8/2017	Taxonomy not applicable	NA	n/a	000	Unknown	19309	N/A	N/A	N/A	N/A	N/A	1251 DRAPER ST	None	KINGSBURG	CA	93631	1934	00	06000	36.51344551	-119.5547644	Fresno County
323409	Ordering, Referring, Prescribing	N/A	1184750481	0	0	ADATO, LEVANA LCSW	11/14/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24051	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
323418	Ordering, Referring, Prescribing	N/A	1184756231	0	0	ARAGON, PERLA M LCSW	2/18/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100094	N/A	N/A	N/A	N/A	N/A	20151 NORDHOFF ST	None	CHATSWORTH	CA	91311	6215	00	06000	34.23182352	-118.572948	Los Angeles County
323421	Ordering, Referring, Prescribing	N/A	1184763575	0	0	AGNESS, MELISA M MD	9/5/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A45512	N/A	N/A	N/A	N/A	N/A	140 LITTON DR	208	GRASS VALLEY	CA	95945	5077	00	06000	39.23422354	-121.0525426	Nevada County
323450	Ordering, Referring, Prescribing	N/A	1184827297	0	0	AWADALLA, JOSEPH K MD	11/8/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A47833	N/A	N/A	N/A	N/A	N/A	4445 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	0001	00	06000	33.9760587	-117.3800672	Riverside County
323477	Ordering, Referring, Prescribing	N/A	1184883993	0	0	ABRAHAM, ANDREW J MD	10/26/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C152081	N/A	N/A	N/A	N/A	N/A	1396 BROOKCROFT LN	None	GARNET VALLEY	PA	19060	1818	00	06000	39.83701704	-75.49714417	Delaware County
323484	Ordering, Referring, Prescribing	N/A	1184889420	0	0	ARREGUIN, SONIA G LCSW	11/6/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW64023	N/A	N/A	N/A	N/A	N/A	2705 HIGHLAND AVE	None	SELMA	CA	93662	3389	00	06000	36.57294963	-119.6288289	Fresno County
323491	Ordering, Referring, Prescribing	N/A	1184902579	0	0	ANBALAGAN, EMAYA MD	2/2/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A127293	N/A	N/A	N/A	N/A	N/A	251 LLEWELLYN AVE	None	CAMPBELL	CA	95008	1940	00	06000	37.29173129	-121.9584335	Santa Clara County
323512	Ordering, Referring, Prescribing	N/A	1184933228	0	0	ARMIJO, ISRAEL K	8/29/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D59865	N/A	N/A	N/A	N/A	N/A	90 VIA JUANA LANE	None	SANTA YNEZ	CA	93460	9679	00	06000	34.60546842	-120.0931812	Santa Barbara County
323525	Ordering, Referring, Prescribing	N/A	1184959611	0	0	ALLEN, JENNIFER D LCSW	4/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW68263	N/A	N/A	N/A	N/A	N/A	4000 LONG BEACH BLVD	STE 252	LONG BEACH	CA	90807	2617	00	06000	33.830928	-118.189321	Los Angeles County
323552	Ordering, Referring, Prescribing	N/A	1194001990	0	0	AYERS, MARISA PA	1/17/2023	Taxonomy not applicable	NA	n/a	000	Unknown	21792	N/A	N/A	N/A	N/A	N/A	1560 MESA RD	STE 100	NIPOMO	CA	93444	0001	00	06000	35.02977199	-120.5498922	San Luis Obispo County
323556	Ordering, Referring, Prescribing	N/A	1184998148	0	0	AHN, JENNIFER Y PHARMD	5/5/2022	Taxonomy not applicable	NA	n/a	000	Unknown	57978	N/A	N/A	N/A	N/A	N/A	12350 CARMEL MOUNTAIN RD	None	SAN DIEGO	CA	92128	4616	00	06000	32.987565	-117.078192	San Diego County
323582	Ordering, Referring, Prescribing	N/A	1194058297	0	0	ARELLANO, LUIS LCSW	1/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	76106	N/A	N/A	N/A	N/A	N/A	6601 STEPHENS RANCH RD	None	LA VERNE	CA	91750	1146	00	06000	34.154775	-117.740052	Los Angeles County
323588	Ordering, Referring, Prescribing	N/A	1194074047	0	0	ARIAS, JENNIFER B LCSW	3/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75219	N/A	N/A	N/A	N/A	N/A	176 HOLSTON DR	None	LANCASTER	CA	93535	4531	00	06000	34.6649465	-118.1286477	Los Angeles County
323590	Ordering, Referring, Prescribing	N/A	1194070110	0	0	ANDERSON, JAY R	6/12/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	101391	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
323592	Ordering, Referring, Prescribing	N/A	1194075614	0	0	ADACHI, ALISON M	7/23/2013	Taxonomy not applicable	NA	n/a	099	DENTIST	D61866	N/A	N/A	N/A	N/A	N/A	1807 BAY RD	None	EAST PALO ALTO	CA	94303	1312	00	06000	37.47199121	-122.1344629	San Mateo County
323643	Ordering, Referring, Prescribing	N/A	1194159871	0	0	ANTONIO, TIAGO B LCSW	6/19/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW90529	N/A	N/A	N/A	N/A	N/A	8851 CENTER DR	None	LA MESA	CA	91942	3017	00	06000	32.78189749	-117.0075062	San Diego County
323648	Ordering, Referring, Prescribing	N/A	1194184242	0	0	AGUILAR, JOSE G NP	11/3/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003959	N/A	N/A	N/A	N/A	N/A	11888 BARTLETT AVE	None	ADELANTO	CA	92301	1709	00	06000	34.57927736	-117.4068692	San Bernardino County
323661	Ordering, Referring, Prescribing	N/A	1194198226	0	0	ALTAMIRANO, AUTUMN C MSW LCSW	12/7/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW90439	N/A	N/A	N/A	N/A	N/A	1301 PINE AVE	None	LONG BEACH	AL	90813	3124	00	06000	33.782913	-118.192417	Los Angeles County
323673	Ordering, Referring, Prescribing	N/A	1194217539	0	0	ALSHAMMARY, MOHAMMED MD	1/18/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176049	N/A	N/A	N/A	N/A	N/A	1111 W CHASE AVE	None	EL CAJON	CA	92020	5710	00	06000	32.78161035	-116.9764603	San Diego County
323698	Ordering, Referring, Prescribing	N/A	1194254094	0	0	ALEKSANDRYAN, TAMARA PHARMD	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56829	N/A	N/A	N/A	N/A	N/A	18419 ARMINTA ST	None	RESEDA	CA	91335	0000	00	06000	34.21386051	-118.534347	Los Angeles County
323737	Ordering, Referring, Prescribing	N/A	1194345975	0	0	ASANAD, SAMUEL MD	4/4/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A195274	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
323750	Ordering, Referring, Prescribing	N/A	1194380238	0	0	ALVARADO, ANGELA M LMFT	3/23/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125073	N/A	N/A	N/A	N/A	N/A	316 E E ST	None	ONTARIO	CA	91764	3712	00	06000	34.067898	-117.6477975	San Bernardino County
323757	Ordering, Referring, Prescribing	N/A	1194405787	0	0	AMBARTSUMYAN, AILEEN NP	11/7/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95027985	N/A	N/A	N/A	N/A	N/A	1311 N. SAN FERNANDO BLV	None	BURBANK	CA	91504	4236	00	06000	34.18947282	-118.3206362	Los Angeles County
323773	Ordering, Referring, Prescribing	N/A	1194375303	0	0	ANULUOHA, ANTHONIA NP	12/31/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012788	N/A	N/A	N/A	N/A	N/A	5230 PACIFIC CONCOURSE D	None	LOS ANGELES	CA	90045	6200	00	06000	33.92774198	-118.3727493	Los Angeles County
323776	Ordering, Referring, Prescribing	N/A	1194463281	0	0	AQUINO COBAR, SUSAN Y NP	5/17/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020989	N/A	N/A	N/A	N/A	N/A	1543 E PALMDALE BLVD	F	PALMDALE	CA	93550	2000	00	06000	34.57966352	-118.101582	Los Angeles County
323786	Ordering, Referring, Prescribing	N/A	1194571984	0	0	ACOSTA-MARISCAL, JANICE S OT	2/27/2024	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT26123	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
323817	Ordering, Referring, Prescribing	N/A	1194824177	0	0	ANDIVE, VIJAY R MD	9/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	26562	N/A	N/A	N/A	N/A	N/A	10820 PARKSIDE DR	None	KNOXVILLE	TN	37934	1956	00	06000	35.90003918	-84.14416556	Knox County
323848	Ordering, Referring, Prescribing	N/A	1194868695	0	0	AMANCIO, ISABEL C LMFT	4/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT39580	N/A	N/A	N/A	N/A	N/A	4205 W. FIGARDEN DR.	None	FRESNO	CA	93722	6051	00	06000	36.82930754	-119.8669532	Fresno County
323888	Ordering, Referring, Prescribing	N/A	1194943944	0	0	ALBA-VALENCIA, NICOLE R MD	5/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A94404	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	00	06000	37.34293689	-121.9270392	Santa Clara County
323892	Ordering, Referring, Prescribing	N/A	1194948083	0	0	AZEVEDO, ANDREA B	2/17/2009	Taxonomy not applicable	NA	n/a	099	DENTIST	D48785	N/A	N/A	N/A	N/A	N/A	6015 WATT AVE	STE 2	NORTH HIGHLANDS	CA	95660	4294	00	06000	38.676627	-121.3842375	Sacramento County
323968	Ordering, Referring, Prescribing	N/A	1205114550	0	0	ALPERT, BENJAMIN M PSYD	11/1/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	28915	N/A	N/A	N/A	N/A	N/A	10737 CAMINO RUIZ	235	SAN DIEGO	CA	92126	2359	00	06000	32.91416051	-117.1437943	San Diego County
323978	Ordering, Referring, Prescribing	N/A	1205125804	0	0	AZARIAN, VAHE M MD	6/2/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A125140	N/A	N/A	N/A	N/A	N/A	985 W VERNON AVE.	None	LOS ANGELES	CA	90037	3038	00	06000	34.00370943	-118.2912135	Los Angeles County
323981	Ordering, Referring, Prescribing	N/A	1205131083	0	0	ANGELES, RACHEL F	6/12/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	D45856	N/A	N/A	N/A	N/A	N/A	66675 PIERSON BLVD	None	DSRT HOT SPGS	CA	92240	3737	00	06000	33.96138951	-116.498223	Riverside County
324004	Ordering, Referring, Prescribing	N/A	1205161924	0	0	ABACI, MARIA E MSW LCSW	7/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28072	N/A	N/A	N/A	N/A	N/A	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	00	06000	37.9469952	-122.5373892	Marin County
324010	Ordering, Referring, Prescribing	N/A	1205186608	0	0	AVILA, KRISTINA V LCSW	10/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	98143	N/A	N/A	N/A	N/A	N/A	439 W 97TH ST	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
324056	Ordering, Referring, Prescribing	N/A	1205278793	0	0	AUBIN, DANIELLE LCSW	2/28/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87299	N/A	N/A	N/A	N/A	N/A	10 N. SAN PEDRO RD	STE 1020	SAN RAFAEL	CA	94903	4178	00	06000	37.99529182	-122.5300426	Marin County
324069	Ordering, Referring, Prescribing	N/A	1205306479	0	0	AZIZUDDIN, YUMNA NP	2/7/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029008	N/A	N/A	N/A	N/A	N/A	5925 W LAS POSITAS BLVD	STE 100	PLEASANTON	CA	94588	8537	00	06000	37.68360997	-121.8990082	Alameda County
324119	Ordering, Referring, Prescribing	N/A	1205368826	0	0	AZHIR, RAMIN MD	9/28/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163697	N/A	N/A	N/A	N/A	N/A	3834 S WESTERN AVE	None	LOS ANGELES	CA	90062	1104	00	06000	34.016157	-118.3088825	Los Angeles County
324167	Ordering, Referring, Prescribing	N/A	1205466059	0	0	AYALA, VANESSA LCSW	6/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW123324	N/A	N/A	N/A	N/A	N/A	901 W VICTORIA ST, SUITE	F&G	COMPTON	CA	90220	6321	00	06000	33.86784006	-118.2368928	Los Angeles County
324192	Ordering, Referring, Prescribing	N/A	1205558533	0	0	ARANDA, GILBERTO PT	9/7/2022	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	302845	N/A	N/A	N/A	N/A	N/A	4341 SPYRES WAY	None	MODESTO	CA	95356	9259	00	06000	37.70172145	-120.9995081	Stanislaus County
324229	Ordering, Referring, Prescribing	N/A	1205865151	0	0	AMBROSIO, EMILIA MD	11/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A69413	N/A	N/A	N/A	N/A	N/A	430 BLOSSER RD	None	SANTA MARIA	CA	93458	4908	00	06000	34.957406	-120.4534862	Santa Barbara County
324315	Ordering, Referring, Prescribing	N/A	1215063268	0	0	ANTONOWICH, ANNA M NP	11/1/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF13718	N/A	N/A	N/A	N/A	N/A	236 W 6TH ST	None	RENO	NV	89503	2863	00	06000	39.53151304	-119.8186228	Washoe County
324323	Ordering, Referring, Prescribing	N/A	1215076609	0	0	ANTOR, PASCALE V LCSW	3/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29804	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
324334	Ordering, Referring, Prescribing	N/A	1215097217	0	0	ALEXANDER, JANET LMFT	2/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40456	N/A	N/A	N/A	N/A	N/A	4444 CALLE REAL	None	GOLETA	CA	93110	1002	00	06000	34.44240122	-119.7765542	Santa Barbara County
324342	Ordering, Referring, Prescribing	N/A	1215114897	0	0	ABBASI, KAFIA H MD	7/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A113195	N/A	N/A	N/A	N/A	N/A	1803 W MARCH LANE	SUITE C	STOCKTON	CA	95207	6414	00	06000	37.98757139	-121.3281902	San Joaquin County
324392	Ordering, Referring, Prescribing	N/A	1215217500	0	0	AVALOS, ERICALYNN S LMFT	1/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	90320	N/A	N/A	N/A	N/A	N/A	1812 WEST PARK AVE.	None	REDLANDS	CA	92373	9999	00	06000	34.05931058	-117.216243	San Bernardino County
324397	Ordering, Referring, Prescribing	N/A	1215219985	0	0	AL JONAID, ABDULKAHER PHARMD	7/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62069	N/A	N/A	N/A	N/A	N/A	1424 BROADWAY ST	None	EUREKA	CA	95501	0134	00	06000	40.7935752	-124.1772614	Humboldt County
324466	Ordering, Referring, Prescribing	N/A	1215331095	0	0	ANGARA, CHRISTOPHER	9/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH62765	N/A	N/A	N/A	N/A	N/A	732 MOTT ST	None	SAN FERNANDO	CA	91340	2737	00	06000	34.27661761	-118.4442372	Los Angeles County
324467	Ordering, Referring, Prescribing	N/A	1215328075	0	0	APOLINAR, MARIO LMFT	8/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121233	N/A	N/A	N/A	N/A	N/A	2227 CAPRICORN WAY, SUIT	None	SANTA ROSA	CA	95407	5478	00	06000	38.425266	-122.749875	Sonoma County
324478	Ordering, Referring, Prescribing	N/A	1215354337	0	0	ALAJAJIAN, DAVID R MD	1/2/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A147528	N/A	N/A	N/A	N/A	N/A	7531 SANTA MONICA BLVD	SUITE 100	WEST HOLLYWOOD	CA	90046	6458	00	06000	34.09081315	-118.3541261	Los Angeles County
324488	Ordering, Referring, Prescribing	N/A	1215369525	0	0	AFRAM, FAIRUZ PHARMD	7/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	68611	N/A	N/A	N/A	N/A	N/A	2900 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2302	00	06000	38.547882	-121.454955	Sacramento County
324494	Ordering, Referring, Prescribing	N/A	1215371745	0	0	ALLEN, LINDSAY E PA-C	2/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA22865	N/A	N/A	N/A	N/A	N/A	500 WEST HOSPITAL ROAD	SUITE# A	FRENCH CAMP	CA	95231	9693	00	06000	37.88652418	-121.2820956	San Joaquin County
324508	Ordering, Referring, Prescribing	N/A	1215390166	0	0	ARJA, SOWMYA	3/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A167950	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
324529	Ordering, Referring, Prescribing	N/A	1215442405	0	0	AZENKOT, TALI MD	3/4/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176737	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
324580	Ordering, Referring, Prescribing	N/A	1215514823	0	0	ANI, SAMUEL O DO	3/5/2025	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A23049	N/A	N/A	N/A	N/A	N/A	875 EL CAJON BLVD	None	EL CAJON	CA	92020	5714	00	06000	32.78535272	-116.9770049	San Diego County
324582	Ordering, Referring, Prescribing	N/A	1215522743	0	0	ALVARADO, ALEJANDRA LMFT	2/9/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	144921	N/A	N/A	N/A	N/A	N/A	555 N PERRIS BLVD	None	PERRIS	CA	92571	2811	00	06000	33.79131	-117.226053	Riverside County
324587	Ordering, Referring, Prescribing	N/A	1215534888	0	0	AGUERO, ROSA M CNP	1/19/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016418	N/A	N/A	N/A	N/A	N/A	10200 SEPULVEDA BLVD	None	MISSION HILLS	CA	91345	2649	00	06000	34.25572562	-118.4673156	Los Angeles County
324589	Ordering, Referring, Prescribing	N/A	1215526678	0	0	ADEWUMI, OLUFUNKE A NP	5/27/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017440	N/A	N/A	N/A	N/A	N/A	2151 E PALMDALE BLVD	None	PALMDALE	CA	93550	4037	00	06000	34.58013142	-118.0898273	Los Angeles County
324599	Ordering, Referring, Prescribing	N/A	1215557830	0	0	ALLEN, JONATHAN M MD	8/16/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179842	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
324612	Ordering, Referring, Prescribing	N/A	1215593074	0	0	AHMED, ROMA NP	2/19/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95010484	N/A	N/A	N/A	N/A	N/A	2975 ZOE AVE	None	HUNTINGTON PARK	CA	90255	5278	00	06000	33.9793863	-118.216134	Los Angeles County
324660	Ordering, Referring, Prescribing	N/A	1215921697	0	0	ANGUIANO, FRANCISCO E MD FACOG	3/22/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G61584	N/A	N/A	N/A	N/A	N/A	765 MEDICAL CENTER CT	SUITE 209	CHULA VISTA	CA	91911	6600	00	06000	32.619069	-117.020835	San Diego County
324717	Ordering, Referring, Prescribing	N/A	1225157480	0	0	APODACA-STOLTZ, ERIKA A LMFT	6/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	86809	N/A	N/A	N/A	N/A	N/A	4640 SPYRES WAY, BLDG B	STE. 7	MODESTO	CA	95356	9800	00	06000	37.70627517	-120.9976228	Stanislaus County
324718	Ordering, Referring, Prescribing	N/A	1225162464	0	0	ABELOWITZ, STEVEN MD	7/2/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A56395	N/A	N/A	N/A	N/A	N/A	4968 BOOTH CIR	106	IRVINE	CA	92604	3360	00	06000	33.68590715	-117.7855253	Orange County
324728	Ordering, Referring, Prescribing	N/A	1225168305	0	0	ARELLANO, NAOMI LCSW	1/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26959	N/A	N/A	N/A	N/A	N/A	420 E 3RD STREET	SUITE 910	LOS ANGELES	CA	90013	1644	00	06000	34.04702011	-118.241912	Los Angeles County
324733	Ordering, Referring, Prescribing	N/A	1225176506	0	0	ANTHONY, GIHAN DDS	10/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	43275	N/A	N/A	N/A	N/A	N/A	6368 HOLLYWOOD BLVD	None	LOS ANGELES	CA	90028	6320	00	06000	34.1015865	-118.328976	Los Angeles County
324736	Ordering, Referring, Prescribing	N/A	1225189343	0	0	AREVALO, EDWARD G MD	9/10/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A49719	N/A	N/A	N/A	N/A	N/A	7986 DAGGET ST	None	SAN DIEGO	CA	92111	2321	00	06000	32.82363345	-117.1512855	San Diego County
324764	Ordering, Referring, Prescribing	N/A	1225234974	0	0	ANWAR, GUL I MD	8/28/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A109555	N/A	N/A	N/A	N/A	N/A	105 E SYDNOR AVE	100	RIDGECREST	CA	93555	5546	00	06000	35.64096373	-117.6688699	Kern County
324766	Ordering, Referring, Prescribing	N/A	1225241771	0	0	AVALOS, SANDRA L LCSW	3/4/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW69898	N/A	N/A	N/A	N/A	N/A	401 E OCEAN AVE	None	LOMPOC	CA	93436	6828	00	06000	34.6389765	-120.4537095	Santa Barbara County
324787	Ordering, Referring, Prescribing	N/A	1225288582	0	0	AGVANYAN, EDGAR MD	4/20/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A105325	N/A	N/A	N/A	N/A	N/A	544 N GLENDALE AVE	None	GLENDALE	CA	91206	3311	00	06000	34.15454904	-118.2429872	Los Angeles County
324809	Ordering, Referring, Prescribing	N/A	1225329238	0	0	ARBIA, ELIZABETH	8/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19032	N/A	N/A	N/A	N/A	N/A	330 N BRAND BLVD	700	GLENDALE	CA	91203	2308	00	06000	34.15116156	-118.2549512	Los Angeles County
324849	Ordering, Referring, Prescribing	N/A	1225410137	0	0	ACKERMAN, KRISTEN N LMFT	6/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114822	N/A	N/A	N/A	N/A	N/A	10717 CAMINO RUIZ	STE 207	SAN DIEGO	CA	92126	2360	00	06000	32.91373261	-117.1437822	San Diego County
324877	Ordering, Referring, Prescribing	N/A	1225456643	0	0	AJAYI, ANTONETTE A MD	6/26/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A137868	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
324879	Ordering, Referring, Prescribing	N/A	1225446743	0	0	ASCENCIO LARIOS, BRENDA L LCSW	4/2/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW104717	N/A	N/A	N/A	N/A	N/A	345 5TH ST.	18	HOLLISTER	CA	95023	3081	00	06000	36.85144793	-121.4029697	San Benito County
324895	Ordering, Referring, Prescribing	N/A	1225481278	0	0	ALVAREZ, STEPHANIE M LMFT	4/8/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132227	N/A	N/A	N/A	N/A	N/A	108 W VICTORIA ST	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
324931	Ordering, Referring, Prescribing	N/A	1225526395	0	0	ABINA, OLUWATOSIN PA-C	12/22/2019	Taxonomy not applicable	NA	n/a	000	Unknown	55508	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR	None	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
324941	Ordering, Referring, Prescribing	N/A	1225529886	0	0	ARMOOGAM, AMANDA LCSW	5/29/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122809	N/A	N/A	N/A	N/A	N/A	21545 CENTRE POINTE PKWY	None	SANTA CLARITA	CA	91350	2947	00	06000	34.413021	-118.514534	Los Angeles County
324952	Ordering, Referring, Prescribing	N/A	1225553902	0	0	AQUILINA, CHARLES M PSYD	8/15/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY33521	N/A	N/A	N/A	N/A	N/A	380 W MACARTHUR BLVD	None	OAKLAND	CA	94609	2819	00	06000	37.82519027	-122.2609525	Alameda County
324984	Ordering, Referring, Prescribing	N/A	1225588650	0	0	ARIAS, CARLTON A LMFT	6/2/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT126276	N/A	N/A	N/A	N/A	N/A	855 CANYON RD	None	REDDING	CA	96001	5544	00	06000	40.48978049	-122.3926387	Shasta County
324993	Ordering, Referring, Prescribing	N/A	1225616006	0	0	ACEVEDO, RIGO I MD	9/6/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181760	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
325009	Ordering, Referring, Prescribing	N/A	1225660871	0	0	AYODELE, MERCY NP	4/29/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011326	N/A	N/A	N/A	N/A	N/A	4011 N MARKS AVE	None	FRESNO	CA	93722	4555	00	06000	36.794691	-119.8443365	Fresno County
325053	Ordering, Referring, Prescribing	N/A	1235150988	0	0	ASCHERMAN, HAROLD NP	1/10/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	7157	N/A	N/A	N/A	N/A	N/A	1035 PLACER ST	None	REDDING	CA	96001	1170	00	06000	40.58349378	-122.3853903	Shasta County
325065	Ordering, Referring, Prescribing	N/A	1235182544	0	0	ALPERT, RUSSELL T MD	12/28/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A67486	N/A	N/A	N/A	N/A	N/A	64 BLEECKER STREET	151	NEW YORK	NY	10012	2711	00	06000	40.72617	-73.9953495	New York County
325083	Ordering, Referring, Prescribing	N/A	1235242231	0	0	ABEDINZADEH, LILA J	9/21/2011	Taxonomy not applicable	NA	n/a	099	DENTIST	D51461	N/A	N/A	N/A	N/A	N/A	355 CENTRAL AVE	None	FILLMORE	CA	93015	1920	00	06000	34.40028802	-118.9137057	Ventura County
325106	Ordering, Referring, Prescribing	N/A	1235281486	0	0	ALEXANDER, ONNA LCSW	6/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	21617	N/A	N/A	N/A	N/A	N/A	84 BROADWAY	None	RICHMOND	CA	94804	0150	00	06000	37.9323378	-122.3469072	Contra Costa County
325140	Ordering, Referring, Prescribing	N/A	1235346156	0	0	ACKER, KIRSTEN PSYD	4/29/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26425	N/A	N/A	N/A	N/A	N/A	3301 E 12TH ST	SUITE 259	OAKLAND	CA	94601	2940	00	06000	37.77617499	-122.2247899	Alameda County
325142	Ordering, Referring, Prescribing	N/A	1235330812	0	0	ABDUL-JABBAR, KAREEM LCSW	11/3/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83587	N/A	N/A	N/A	N/A	N/A	7821 S. AVALON BLVD	None	LOS ANGELES	CA	90003	2358	00	06000	33.969393	-118.265197	Los Angeles County
325144	Ordering, Referring, Prescribing	N/A	1235352279	0	0	ANDERSEN, STACIE LMFT	5/13/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41753	N/A	N/A	N/A	N/A	N/A	19 E 6TH STREET	None	TRACY	CA	95376	4107	00	06000	37.73489581	-121.425137	San Joaquin County
325213	Ordering, Referring, Prescribing	N/A	1235478660	0	0	ANDERSON, JAMES LCSW	8/12/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	125093	N/A	N/A	N/A	N/A	N/A	58945 BUSINESS CENTER DR	STE. D	YUCCA VALLEY	CA	92284	7307	00	06000	34.12183989	-116.3776058	San Bernardino County
325220	Ordering, Referring, Prescribing	N/A	1235484817	0	0	AGDA, CHRISTINA C LCSW	4/6/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28273	N/A	N/A	N/A	N/A	N/A	1830 S. CENTRAL STREET	None	VISALIA	CA	93277	4418	00	06000	36.314271	-119.311362	Tulare County
325242	Ordering, Referring, Prescribing	N/A	1235521162	0	0	ALLEN, AMY R LCSW	6/26/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW86992	N/A	N/A	N/A	N/A	N/A	2180 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4558	00	06000	35.27488974	-120.6468257	San Luis Obispo County
325294	Ordering, Referring, Prescribing	N/A	1235598459	0	0	AMEZQUITA, WENDI LCSW	6/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	68046	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	SUITE 120	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
325314	Ordering, Referring, Prescribing	N/A	1235626672	0	0	AHN, SOHEE PHARMD	8/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77432	N/A	N/A	N/A	N/A	N/A	22930 S WESTERN AVE	None	TORRANCE	CA	90501	5112	00	06000	33.81746045	-118.3087871	Los Angeles County
325319	Ordering, Referring, Prescribing	N/A	1235640459	0	0	AGOPYAN, IRMA	8/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62224	N/A	N/A	N/A	N/A	N/A	8005 EL CAMINO REAL	None	ATASCADERO	CA	93422	5211	00	06000	35.47712859	-120.6559822	San Luis Obispo County
325336	Ordering, Referring, Prescribing	N/A	1235662388	0	0	ANNALA, AMY LCSW	2/26/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	113867	N/A	N/A	N/A	N/A	N/A	2934 N FRESNO ST	None	FRESNO	CA	93703	1123	00	06000	36.777735	-119.7815105	Fresno County
325353	Ordering, Referring, Prescribing	N/A	1235690397	0	0	ADEDAYO, TOLULOPE T NP	7/11/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010806	N/A	N/A	N/A	N/A	N/A	903 E DEVONSHIRE AVE	SUITE D	HEMET	CA	92543	3000	00	06000	33.75116958	-116.9627485	Riverside County
325370	Ordering, Referring, Prescribing	N/A	1235741729	0	0	ALCANTARA, PAOLO ANDONI	1/25/2023	Taxonomy not applicable	NA	n/a	000	Unknown	83067	N/A	N/A	N/A	N/A	N/A	932 S EUCLID ST	None	ANAHEIM	CA	92802	1523	00	06000	33.81900658	-117.9413125	Orange County
325392	Ordering, Referring, Prescribing	N/A	1235794611	0	0	ARRIAZA, JOCELYN LCSW	9/25/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	126306	N/A	N/A	N/A	N/A	N/A	37926 47TH STREET EAST	SUITE D AND G	PALMDALE	CA	93552	3272	00	06000	34.57140358	-118.0449908	Los Angeles County
325403	Ordering, Referring, Prescribing	N/A	1235809161	0	0	ALVAREZ, ITZEL LCSW	12/30/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW127937	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	3211	00	06000	37.36411044	-121.9052075	Santa Clara County
325418	Ordering, Referring, Prescribing	N/A	1235903253	0	0	ALVARADO GONZALEZ, KAREN PA-C	10/20/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63542	N/A	N/A	N/A	N/A	N/A	147 N BRENT ST	None	VENTURA	CA	93003	2809	00	06000	34.2746295	-119.2573399	Ventura County
325442	Ordering, Referring, Prescribing	N/A	1245232644	0	0	ALCANTARA-FERNANDEZ, ROWENA	10/4/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	12418	N/A	N/A	N/A	N/A	N/A	17909 SOLEDAD CANYON RD	2ND FLOOR	SANTA CLARITA	CA	91387	3210	00	06000	34.41652621	-118.4458684	Los Angeles County
325483	Ordering, Referring, Prescribing	N/A	1245357250	0	0	AZNAR, JAIME G LCSW	6/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24640	N/A	N/A	N/A	N/A	N/A	601 S GLENOAKS BLVD	200	BURBANK	CA	91502	1474	00	06000	34.17930759	-118.3011138	Los Angeles County
325497	Ordering, Referring, Prescribing	N/A	1245375500	0	0	ADAMS, SARAH E LCSW	6/30/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	61770	N/A	N/A	N/A	N/A	N/A	115 S LA CUMBRE LN	200	SANTA BARBARA	CA	93105	5102	00	06000	34.43809964	-119.7511604	Santa Barbara County
325509	Ordering, Referring, Prescribing	N/A	1245393651	0	0	ANDREWS, THOMAS J MD	1/12/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G79955	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
325512	Ordering, Referring, Prescribing	N/A	1245411693	0	0	ANDERSON, BRAD M LCSW	6/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW74174	N/A	N/A	N/A	N/A	N/A	600 G STREET	None	UNION CITY	CA	94587	2400	00	06000	37.59996226	-122.0201927	Alameda County
325514	Ordering, Referring, Prescribing	N/A	1245413186	0	0	ARNETT, CYNTHIA C MD	2/6/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G73983	N/A	N/A	N/A	N/A	N/A	6950 65TH STREET	None	SACRAMENTO	CA	95823	2316	00	06000	38.50065	-121.4357265	Sacramento County
325545	Ordering, Referring, Prescribing	N/A	1245465400	0	0	AYVAZIAN, NAIRI M LMFT	11/25/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53909	N/A	N/A	N/A	N/A	N/A	1540 E COLORADO ST	None	GLENDALE	CA	91205	1514	00	06000	34.1427285	-118.230039	Los Angeles County
325563	Ordering, Referring, Prescribing	N/A	1245498351	0	0	ANDERSON, ANEL	1/25/2016	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	60011	N/A	N/A	N/A	N/A	N/A	WARNER AVE AT COLLEGE DR	None	CHICO	CA	95929	0777	00	06000	39.731526	-121.850361	Butte County
325565	Ordering, Referring, Prescribing	N/A	1245495217	0	0	ACOSTA, LETICIA F LMFT	2/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52410	N/A	N/A	N/A	N/A	N/A	11731 E. TELEGRAPH ROAD	G	SANTA FE SPRINGS	CA	90670	6819	00	06000	33.94630253	-118.0832082	Los Angeles County
325591	Ordering, Referring, Prescribing	N/A	1245551761	0	0	AMPUERO, MARILYN C LMFT	3/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84760	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
325600	Ordering, Referring, Prescribing	N/A	1245566520	0	0	ALVES, KATHRYN L	6/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	77405	N/A	N/A	N/A	N/A	N/A	9343 TECH CENTER DR	None	SACRAMENTO	CA	95826	2563	00	06000	38.564091	-121.3509285	Sacramento County
325604	Ordering, Referring, Prescribing	N/A	1245575976	0	0	ATKINSON, ALEXI LCSW	3/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82952	N/A	N/A	N/A	N/A	N/A	1965 LIVE OAK BLVD	None	YUBA CITY	CA	95991	8850	00	06000	39.15563037	-121.620091	Sutter County
325612	Ordering, Referring, Prescribing	N/A	1245584499	0	0	ABITO, ROSALISA D LMFT	6/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105987	N/A	N/A	N/A	N/A	N/A	17707 STUDEBAKER ROAD	None	CERRITOS, CA	CA	90703	1001	00	06000	33.87008991	-118.0991298	Los Angeles County
325627	Ordering, Referring, Prescribing	N/A	1245606102	0	0	ADAM, CYNTHIA S	1/30/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002834	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
325636	Ordering, Referring, Prescribing	N/A	1245615509	0	0	AVILES-SCOTT, ABRAN A LMFT	8/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT113688	N/A	N/A	N/A	N/A	N/A	2459 HICKORY DR	None	CONCORD	CA	94520	1729	00	06000	37.98978459	-122.0351401	Contra Costa County
325640	Ordering, Referring, Prescribing	N/A	1245615384	0	0	AKHTAR, ALI LMFT	1/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	85730	N/A	N/A	N/A	N/A	N/A	3787 S VERMONT AVE	None	LOS ANGELES	CA	90007	4203	00	06000	34.01739	-118.291567	Los Angeles County
325644	Ordering, Referring, Prescribing	N/A	1245623081	0	0	ALEMAN, LINDAMARIE R LMFT	11/3/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129039	N/A	N/A	N/A	N/A	N/A	6051 N FRESNO ST	201	FRESNO	CA	93710	5280	00	06000	36.823905	-119.781436	Fresno County
325647	Ordering, Referring, Prescribing	N/A	1245634781	0	0	AUSTIN, KASSANDRA L LMFT	3/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114974	N/A	N/A	N/A	N/A	N/A	3300 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3137	00	06000	35.37353416	-119.0392409	Kern County
325682	Ordering, Referring, Prescribing	N/A	1245694017	0	0	AVILA, HUMBERTO MD	4/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	A154080	N/A	N/A	N/A	N/A	N/A	16645 RD 26	None	MADERA	CA	93638	0000	00	06000	36.99081371	-120.0742049	Madera County
325707	Ordering, Referring, Prescribing	N/A	1245726801	0	0	ANIS, ABANOB PHARMD	11/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78442	N/A	N/A	N/A	N/A	N/A	25850 NORTH THE OLD ROAD	None	VALENCIA	CA	91355	0000	00	06000	34.3908174	-118.5734984	Los Angeles County
325714	Ordering, Referring, Prescribing	N/A	1245752617	0	0	AHMED, IRFAN MD	7/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A169419	N/A	N/A	N/A	N/A	N/A	3250 WILSHIRE BLVD	SUITE 500	LOS ANGELES	CA	90010	1577	00	06000	34.06176363	-118.2932622	Los Angeles County
325715	Ordering, Referring, Prescribing	N/A	1245755586	0	0	ABDELMALAK, SAMEH LMFT	2/20/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124459	N/A	N/A	N/A	N/A	N/A	129 VIOLET AVENUE	B	MONROVIA	CA	91606	5406	00	06000	34.15011003	-118.0130864	Los Angeles County
325740	Ordering, Referring, Prescribing	N/A	1245771088	0	0	ALVARADO, REBECCA L LMFT	4/30/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125822	N/A	N/A	N/A	N/A	N/A	525 N CABRILLO PARK DR	300	SANTA ANA	CA	92701	5017	00	06000	33.75047365	-117.8404984	Orange County
325762	Ordering, Referring, Prescribing	N/A	1245795020	0	0	ALANIZ, LILLIAM M	7/25/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	103350	N/A	N/A	N/A	N/A	N/A	66675 PIERSON BLVD	None	DSRT HOT SPGS	CA	92240	3737	00	06000	33.96138951	-116.498223	Riverside County
325769	Ordering, Referring, Prescribing	N/A	1245811421	0	0	ALVARADO, PATRICIA	4/27/2020	Taxonomy not applicable	NA	n/a	000	Unknown	264404	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
325776	Ordering, Referring, Prescribing	N/A	1245830223	0	0	ANDRADE, ALEXY F NP	12/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95015700	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL STREET	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
325780	Ordering, Referring, Prescribing	N/A	1245837913	0	0	ASTILLA, JEANETTE L NP	11/24/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015567	N/A	N/A	N/A	N/A	N/A	8330 RESEDA BLVD.	None	RESEDA	CA	91324	4619	00	06000	34.221609	-118.5360405	Los Angeles County
325806	Ordering, Referring, Prescribing	N/A	1245877174	0	0	ALFI, DINA PHARMD	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80918	N/A	N/A	N/A	N/A	N/A	10955 MAGNOLIA BLVD	None	NORTH HOLLYWOOD	CA	91601	3907	00	06000	34.16490852	-118.3694715	Los Angeles County
325823	Ordering, Referring, Prescribing	N/A	1245928704	0	0	ALVAREZ, VALERIA PA	9/28/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63415	N/A	N/A	N/A	N/A	N/A	71777 SAN JACINTO DR	202	RANCHO MIRAGE	CA	92270	3543	00	06000	33.74394755	-116.4124572	Riverside County
325825	Ordering, Referring, Prescribing	N/A	1245926849	0	0	AKITA, ALAN T NP	7/1/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030863	N/A	N/A	N/A	N/A	N/A	250 N G ST	EXPRESS CARE CLINIC	SAN BERNARDINO	CA	92410	3220	00	06000	34.10398409	-117.2994149	San Bernardino County
325839	Ordering, Referring, Prescribing	N/A	1245987551	0	0	AYALA, DINESA CNP	7/6/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012348	N/A	N/A	N/A	N/A	N/A	18250 ROSCOE BLVD	None	NORTHRIDGE	CA	91325	4226	00	06000	34.22076142	-118.5313223	Los Angeles County
325860	Ordering, Referring, Prescribing	N/A	1255031654	0	0	AL-WAZEER, ELAF	12/6/2022	Taxonomy not applicable	NA	n/a	000	Unknown	74336	N/A	N/A	N/A	N/A	N/A	515 W WASHINGTON ST	None	SAN DIEGO	CA	92103	1986	00	06000	32.74978816	-117.168151	San Diego County
325882	Ordering, Referring, Prescribing	N/A	1255164943	0	0	ABAYA, ANA MAE NP	8/16/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031734	N/A	N/A	N/A	N/A	N/A	16127 FOOTHILL BLVD	None	FONTANA	CA	92335	3374	00	06000	34.10650281	-117.4531156	San Bernardino County
325883	Ordering, Referring, Prescribing	N/A	1255187381	0	0	ALLEN, CANDIS R	4/29/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95029943	N/A	N/A	N/A	N/A	N/A	39918 ASHWOOD LANE	None	MURRIETA	CA	92563	0001	00	06000	33.57973688	-117.179737	Riverside County
325921	Ordering, Referring, Prescribing	N/A	1255451894	0	0	ABAD-SANTOS, GREGORIO	4/18/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A42068	N/A	N/A	N/A	N/A	N/A	11100 WARNER AVE	352	FOUNTAIN VALLEY	CA	92708	7513	00	06000	33.716291	-117.9355051	Orange County
325922	Ordering, Referring, Prescribing	N/A	1255457867	0	0	ABBOTT, ALICIA LMFT	11/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT40307	N/A	N/A	N/A	N/A	N/A	19401 S VERMONT AVENUE	L102	TORRANCE	CA	90502	4418	00	06000	33.85486409	-118.2905603	Los Angeles County
326001	Ordering, Referring, Prescribing	N/A	1255614335	0	0	ARRIAGA-KUMASAKA, CARMEN LMFT	11/22/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT14459	N/A	N/A	N/A	N/A	N/A	1663 DOMINICAN WAY	214	SANTA CRUZ	CA	95065	1556	00	06000	36.99029729	-121.9809324	Santa Cruz County
326006	Ordering, Referring, Prescribing	N/A	1255615845	0	0	AGUILAR, DIEGO PHARMD	7/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH63527	N/A	N/A	N/A	N/A	N/A	1591 GEER RD	None	TURLOCK	CA	95380	3200	00	06000	37.506834	-120.848997	Stanislaus County
326049	Ordering, Referring, Prescribing	N/A	1255698098	0	0	AREVALO, MILAGRO R LMFT	2/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53804	N/A	N/A	N/A	N/A	N/A	1925 E DAKOTA AVE	None	FRESNO	CA	93726	4821	00	06000	36.78683208	-119.7876584	Fresno County
326052	Ordering, Referring, Prescribing	N/A	1255700514	0	0	ACEVEDO, NANCY LMFT	3/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT117819	N/A	N/A	N/A	N/A	N/A	3002 ARMSTRONG ST	None	SAN DIEGO	CA	92111	5702	00	06000	32.80043242	-117.165431	San Diego County
326054	Ordering, Referring, Prescribing	N/A	1255693651	0	0	ALBANESE, NATALIE N	12/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C170905	N/A	N/A	N/A	N/A	N/A	818 W SEVENTH ST	930	LOS ANGELES	CA	90017	3407	00	06000	34.04892591	-118.259182	Los Angeles County
326061	Ordering, Referring, Prescribing	N/A	1255716452	0	0	ANDERSON, MICHELLE R LCSW	6/9/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101910	N/A	N/A	N/A	N/A	N/A	6931 VAN NUYS BLVD. #102	None	VAN NUYS	CA	91405	3980	00	06000	34.19649	-118.448787	Los Angeles County
326073	Ordering, Referring, Prescribing	N/A	1255700027	0	0	AREVALO, DOLORES C LCSW	6/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	85252	N/A	N/A	N/A	N/A	N/A	4211 SOUTH AVALON BOULEV	None	LOS ANGELES	CA	90011	5622	00	06000	34.007238	-118.2653065	Los Angeles County
326081	Ordering, Referring, Prescribing	N/A	1255734232	0	0	AVILES, SANDRA Y LMFT	11/30/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112401	N/A	N/A	N/A	N/A	N/A	1000 CORPORATE CENTER DR	650	MONTEREY PARK	CA	91754	7600	00	06000	34.0512793	-118.1623484	Los Angeles County
326086	Ordering, Referring, Prescribing	N/A	1255735874	0	0	ADAMSROSELLE, ANNIE LCSW	7/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	82163	N/A	N/A	N/A	N/A	N/A	ONE COMMUNITY HEALTH	1500 21ST STREET	SACRAMENTO	CA	95811	5216	00	06000	0	0	None
326087	Ordering, Referring, Prescribing	N/A	1255748596	0	0	AUR, RADIT PA-C	11/19/2017	Taxonomy not applicable	NA	n/a	000	Unknown	51737	N/A	N/A	N/A	N/A	N/A	2315 E ANAHEIM ST	None	LONG BEACH	CA	90804	3501	00	06000	33.78263692	-118.1640686	Los Angeles County
326090	Ordering, Referring, Prescribing	N/A	1255748869	0	0	ABBOU, NORA	9/21/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120321	N/A	N/A	N/A	N/A	N/A	801 S GRAND AVENUE	475	LOS ANGELES	CA	90017	4622	00	06000	34.04532806	-118.258462	Los Angeles County
326095	Ordering, Referring, Prescribing	N/A	1255764072	0	0	AVELAR MARTINEZ, SONIA E LCSW	8/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW96487	N/A	N/A	N/A	N/A	N/A	3751 STOCKER ST	None	VIEW PARK	CA	90008	5101	00	06000	34.00616017	-118.3385751	Los Angeles County
326154	Ordering, Referring, Prescribing	N/A	1255863205	0	0	ACEBEDO GONZALEZ, ESTELA C LCSW	1/13/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99591	N/A	N/A	N/A	N/A	N/A	2440 TULARE STREET	SUITE 200	FRESNO	CA	93721	2208	00	06000	36.73727495	-119.7852493	Fresno County
326218	Ordering, Referring, Prescribing	N/A	1255968590	0	0	ARVIZU, JOSHUA A MD	7/15/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180487	N/A	N/A	N/A	N/A	N/A	20601 WEST PAOLI LANE	None	WEIMAR	CA	95736	0518	00	06000	39.03521526	-120.9755343	Placer County
326253	Ordering, Referring, Prescribing	N/A	1265032486	0	0	ANDERSON, WESLEY E NP	12/20/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015486	N/A	N/A	N/A	N/A	N/A	50249 CESAR CHAVEZ ST	None	COACHELLA	CA	92236	1530	00	06000	33.68245553	-116.1816607	Riverside County
326270	Ordering, Referring, Prescribing	N/A	1265069553	0	0	AGUILA CAMACHO, VICTORIA PA-C	10/23/2020	Taxonomy not applicable	NA	n/a	000	Unknown	58765	N/A	N/A	N/A	N/A	N/A	1206 E 17TH ST STE 101	None	SANTA ANA	CA	92701	2641	00	06000	33.75983651	-117.8539425	Orange County
326289	Ordering, Referring, Prescribing	N/A	1265127138	0	0	AGYAPONG-DANKWAH, PRISCILLA O NP	11/8/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025102	N/A	N/A	N/A	N/A	N/A	335 EAST AVENUE I	None	LANCASTER	CA	93535	0000	00	06000	34.7041113	-118.1247548	Los Angeles County
326343	Ordering, Referring, Prescribing	N/A	1265501043	0	0	AMBROSIO, CARMELA M	7/29/2004	Taxonomy not applicable	NA	n/a	099	DENTIST	D50721	N/A	N/A	N/A	N/A	N/A	7967 BROADWAY	None	LEMON GROVE	CA	91945	1809	00	06000	32.74269062	-117.0268984	San Diego County
326344	Ordering, Referring, Prescribing	N/A	1265501928	0	0	AUH, SUZIE PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH47306	N/A	N/A	N/A	N/A	N/A	21255 BURBANK BLVD	SUITE #150	WOODLAND HILLS	CA	91367	0000	00	06000	34.17331011	-118.5940107	Los Angeles County
326349	Ordering, Referring, Prescribing	N/A	1265506893	0	0	ACCETTA, AUGUST D MD FACOG	5/24/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G61628	N/A	N/A	N/A	N/A	N/A	9730 BRIMHALL RD	SUITE 1	BAKERSFIELD	CA	93312	2786	00	06000	35.36873516	-119.1105773	Kern County
326375	Ordering, Referring, Prescribing	N/A	1265566814	0	0	ALTMAN, EMILY S MD	11/30/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G55817	N/A	N/A	N/A	N/A	N/A	4760 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4820	00	06000	34.00134941	-118.4039837	Los Angeles County
326387	Ordering, Referring, Prescribing	N/A	1265589329	0	0	AZIMI, SHERRI S OD	8/21/2018	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT10574	N/A	N/A	N/A	N/A	N/A	2067 W VISTA WAY	120	VISTA	CA	92083	6032	00	06000	33.18505594	-117.285958	San Diego County
326401	Ordering, Referring, Prescribing	N/A	1265628341	0	0	ARELIS, BRIGITTE LMFT	9/29/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129509	N/A	N/A	N/A	N/A	N/A	14393 PARK AVE 200	None	VICTORVILLE	CA	92300	0092	00	06000	34.5123	-117.3248825	San Bernardino County
326413	Ordering, Referring, Prescribing	N/A	1265661110	0	0	ARVIZU, ELIZABETH E NP	4/23/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	19083	N/A	N/A	N/A	N/A	N/A	2620 CHESTER AVE	None	BAKERSFIELD	CA	93301	2015	00	06000	35.383563	-119.018681	Kern County
326423	Ordering, Referring, Prescribing	N/A	1265684914	0	0	ARREAZA, AMY NP	2/24/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000177	N/A	N/A	N/A	N/A	N/A	625 34TH STREET	SUITE 100 & 200	BAKERSFIELD	CA	93301	2305	00	06000	35.39046051	-119.0092725	Kern County
326427	Ordering, Referring, Prescribing	N/A	1265696660	0	0	ALI, MARWAN M MD	5/28/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A125238	N/A	N/A	N/A	N/A	N/A	1792 TRIBUTE RD STE 200	STE 200	SACRAMENTO	CA	95815	4320	00	06000	38.598219	-121.445964	Sacramento County
326502	Ordering, Referring, Prescribing	N/A	1265805436	0	0	ANDRADE, VICTOR J PHARMD	1/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH65388	N/A	N/A	N/A	N/A	N/A	1988 HACIENDA DR	None	VISTA	CA	92081	6026	00	06000	33.18501367	-117.2846232	San Diego County
326615	Ordering, Referring, Prescribing	N/A	1265985766	0	0	ARSALANIAN, MIRNA LMFT	12/30/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	152345	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
326646	Ordering, Referring, Prescribing	N/A	1275053423	0	0	AVETYAN, LILIT DC	5/7/2018	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	32638	N/A	N/A	N/A	N/A	N/A	1311 N SAN FERNANDO BLVD	None	BURBANK	CA	91504	4236	00	06000	34.18947282	-118.3206362	Los Angeles County
326669	Ordering, Referring, Prescribing	N/A	1275090516	0	0	AU, TIFFANY J PHARMD	9/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH85205	N/A	N/A	N/A	N/A	N/A	1826 W ORANGETHORPE AVE	None	FULLERTON	CA	92833	4406	00	06000	33.85917352	-117.96057	Orange County
326673	Ordering, Referring, Prescribing	N/A	1275095259	0	0	ALEM, MONIKANKANA MD	9/15/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179554	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
326689	Ordering, Referring, Prescribing	N/A	1275117160	0	0	ALNEAIMY, ASEEL DMD	1/29/2025	Taxonomy not applicable	NA	n/a	000	Unknown	111214	N/A	N/A	N/A	N/A	N/A	57019 YUCCA TRL	SUITE #C	YUCCA VALLEY	CA	92284	7909	00	06000	34.1205273	-116.4202324	San Bernardino County
326698	Ordering, Referring, Prescribing	N/A	1275146243	0	0	ALBTOUSH, BILAL J	7/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80664	N/A	N/A	N/A	N/A	N/A	8766 NAVAJO RD	None	SAN DIEGO	CA	92119	2722	00	06000	32.8030677	-117.0089304	San Diego County
326717	Ordering, Referring, Prescribing	N/A	1275190472	0	0	ALEJE, NIMOTA O NP	3/12/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95014192	N/A	N/A	N/A	N/A	N/A	7212 ORANGETHORPE AVE ST	9A	BUENA PARK	CA	90621	4668	00	06000	33.85890953	-118.007244	Orange County
326723	Ordering, Referring, Prescribing	N/A	1275192791	0	0	AHMED, HUMEIRA B PHARMD	3/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56043	N/A	N/A	N/A	N/A	N/A	5190 CLAYTON RD	PHARMACY	CONCORD	CA	94521	3102	00	06000	37.95482456	-121.9652861	Contra Costa County
326724	Ordering, Referring, Prescribing	N/A	1275194516	0	0	ARIAS, VICTOR H MD	11/18/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183312	N/A	N/A	N/A	N/A	N/A	1005 E WASHINGTON BLVD	SUITE A	LOS ANGELES	CA	90021	3082	00	06000	34.02578238	-118.2530622	Los Angeles County
326726	Ordering, Referring, Prescribing	N/A	1275195661	0	0	ARISTORENAS, MARITESS C	7/20/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	103937	N/A	N/A	N/A	N/A	N/A	522 S SAN PEDRO ST	None	LOS ANGELES	CA	90013	2102	00	06000	34.0436196	-118.2442541	Los Angeles County
326730	Ordering, Referring, Prescribing	N/A	1275200628	0	0	ADELSTEIN, SHAINA R LCSW	12/18/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	119843	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
326739	Ordering, Referring, Prescribing	N/A	1275216202	0	0	ALVARADO, AMANDA M PA	7/28/2023	Taxonomy not applicable	NA	n/a	000	Unknown	63111	N/A	N/A	N/A	N/A	N/A	6301 3RD ST	None	SAN FRANCISCO	CA	94124	3501	00	06000	37.72070671	-122.3963144	San Francisco County
326808	Ordering, Referring, Prescribing	N/A	1275663437	0	0	ASHUR, OPHRA LCSW	2/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	14210	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR	None	OXNARD	CA	93036	2612	00	06000	34.219566	-119.1539365	Ventura County
326840	Ordering, Referring, Prescribing	N/A	1275708760	0	0	AHONI, BEVERLY MD	6/3/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C152938	N/A	N/A	N/A	N/A	N/A	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43816059	-120.6279677	Lassen County
326884	Ordering, Referring, Prescribing	N/A	1275815094	0	0	AMRANYAN, STELLA PHARMD	8/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	66051	N/A	N/A	N/A	N/A	N/A	15316 NORDHOFF ST	None	NORTH HILLS	CA	91343	2234	00	06000	34.23548263	-118.465897	Los Angeles County
326967	Ordering, Referring, Prescribing	N/A	1275940595	0	0	ALFON, SANDRA NP	10/17/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	14549	N/A	N/A	N/A	N/A	N/A	6801 COLDWATER CANYON AV	None	NORTH HOLLYWOOD	CA	91605	5162	00	06000	34.194447	-118.4138285	Los Angeles County
326972	Ordering, Referring, Prescribing	N/A	1275948473	0	0	AL ANI, NAJWAN N MD	10/12/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144974	N/A	N/A	N/A	N/A	N/A	7826 BROADWAY	None	LEMON GROVE	CA	91945	1801	00	06000	32.74280549	-117.029889	San Diego County
326980	Ordering, Referring, Prescribing	N/A	1275958183	0	0	AYALA, ROBERT M LMFT	9/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT95754	N/A	N/A	N/A	N/A	N/A	115 TOWN AND COUNTRY DR	None	DANVILLE	CA	94526	3897	00	06000	37.81399962	-121.9986978	Contra Costa County
326987	Ordering, Referring, Prescribing	N/A	1275969354	0	0	AOUN, ANDREA R PSYD	12/23/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	30371	N/A	N/A	N/A	N/A	N/A	725 S GRAND AVE	None	GLENDORA	CA	91740	4141	00	06000	34.125822	-117.8727585	Los Angeles County
327018	Ordering, Referring, Prescribing	N/A	1285007179	0	0	AGUIRRE LUNA, MAYRA F LMFT	1/12/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	144333	N/A	N/A	N/A	N/A	N/A	1212 N. CALIFORNIA ST.	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
327020	Ordering, Referring, Prescribing	N/A	1285010918	0	0	ASHAMALLA, MARIANA PHARMD	1/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69200	N/A	N/A	N/A	N/A	N/A	9917 TOPANGA CANYON BLVD	None	CHATSWORTH	CA	91311	0000	00	06000	34.250535	-118.6060655	Los Angeles County
327038	Ordering, Referring, Prescribing	N/A	1285034975	0	0	ALLISON, BROCK	5/27/2020	Taxonomy not applicable	NA	n/a	000	Unknown	51060	N/A	N/A	N/A	N/A	N/A	1822 N CHESTER AVE	None	BAKERSFIELD	CA	93308	2565	00	06000	35.42296358	-119.020892	Kern County
327053	Ordering, Referring, Prescribing	N/A	1285061705	0	0	AGOSTINO, NICOLE D	10/8/2015	Taxonomy not applicable	NA	n/a	000	Unknown	23300	N/A	N/A	N/A	N/A	N/A	918 W FOOTHILL BLVD	STE A	UPLAND	CA	91786	3772	00	06000	34.10676594	-117.6636152	San Bernardino County
327063	Ordering, Referring, Prescribing	N/A	1285069070	0	0	ALTOMARI, ANNINA L LMFT	11/10/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107394	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	157	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
327088	Ordering, Referring, Prescribing	N/A	1285104026	0	0	ANANTH, MINA P MD	11/16/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A163145	N/A	N/A	N/A	N/A	N/A	1334 E MAIN ST	#2926	SANTA PAULA	CA	93060	2926	00	06000	34.35623058	-119.0531091	Ventura County
327143	Ordering, Referring, Prescribing	N/A	1285195347	0	0	ARENA, KAITLIN M MD	12/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178534	N/A	N/A	N/A	N/A	N/A	1530 S. OLIVE ST.	None	LOS ANGELES	CA	90015	3023	00	06000	34.03542552	-118.2652073	Los Angeles County
327153	Ordering, Referring, Prescribing	N/A	1285217539	0	0	AVILA-CORTES, SERENA DO	2/21/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A20423	N/A	N/A	N/A	N/A	N/A	420 S GLENDORA AVE	None	WEST COVINA	CA	91790	3001	00	06000	34.06750236	-117.925203	Los Angeles County
327180	Ordering, Referring, Prescribing	N/A	1285254037	0	0	AHMED, OMAR PHARMD	3/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80906	N/A	N/A	N/A	N/A	N/A	320 CHANNING WAY	326	SAN RAFAEL	CA	94903	2638	00	06000	38.01179391	-122.5375125	Marin County
327219	Ordering, Referring, Prescribing	N/A	1285383844	0	0	ALVAREZ DE LA CRUZ, JOHNNY MD	7/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187645	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
327224	Ordering, Referring, Prescribing	N/A	1285383117	0	0	ANUGOM, JUDITH NP	1/29/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95019407	N/A	N/A	N/A	N/A	N/A	801 S GRAND AVENUE	401	LOS ANGELES	CA	90017	4622	00	06000	34.04532806	-118.258462	Los Angeles County
327249	Ordering, Referring, Prescribing	N/A	1285648303	0	0	AMES, MICHAEL	10/28/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	10314	N/A	N/A	N/A	N/A	N/A	10866 WASHINGTON BLVD	175	CULVER CITY	CA	90232	3610	00	06000	34.01383535	-118.4087708	Los Angeles County
327265	Ordering, Referring, Prescribing	N/A	1285705608	0	0	ABRAHAM, JOSEPH E	11/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	APH10731	N/A	N/A	N/A	N/A	N/A	970 EMBARCADERO DEL MAR	None	GOLETA	CA	93117	4869	00	06000	34.411707	-119.857011	Santa Barbara County
327295	Ordering, Referring, Prescribing	N/A	1285775528	0	0	ATKINSON, NANCY J LMFT	6/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38137	N/A	N/A	N/A	N/A	N/A	1320 ARNOLD DR.	SUITE 170	MARTINEZ	CA	94553	6537	00	06000	37.9930463	-122.0986922	Contra Costa County
327343	Ordering, Referring, Prescribing	N/A	1285874214	0	0	ANDERSON, KRISTINA M LMFT	11/8/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT135755	N/A	N/A	N/A	N/A	N/A	1160 S GRAND AVE	None	GLENDORA	CA	91740	5000	00	06000	34.11736533	-117.8725213	Los Angeles County
327393	Ordering, Referring, Prescribing	N/A	1285943597	0	0	AL-HASHIMI, ADIL DDS	2/19/2024	Taxonomy not applicable	NA	n/a	000	Unknown	59837	N/A	N/A	N/A	N/A	N/A	1850 SPRING RIDGE DRIVE	None	SUSANVILLE	CA	96130	6100	00	06000	40.43814074	-120.6259249	Lassen County
327396	Ordering, Referring, Prescribing	N/A	1285963918	0	0	ADDISON, JULIE LMFT	2/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT42166	N/A	N/A	N/A	N/A	N/A	2370 SKYWAY DR	104	SANTA MARIA	CA	93455	1133	00	06000	34.917183	-120.453982	Santa Barbara County
327401	Ordering, Referring, Prescribing	N/A	1285967158	0	0	ALTAMIRA SANCHEZ, MAIRA A LCSW	3/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	63913	N/A	N/A	N/A	N/A	N/A	550 S VERMONT AVE	None	LOS ANGELES	CA	90020	1912	00	06000	34.064091	-118.2916225	Los Angeles County
327421	Ordering, Referring, Prescribing	N/A	1295016020	0	0	ALMAOUI, NOOR S LCSW	11/16/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	78873	N/A	N/A	N/A	N/A	N/A	12510 VAN NUYS BLVD	201	PACOIMA	CA	91331	1338	00	06000	34.27814981	-118.4055414	Los Angeles County
327450	Ordering, Referring, Prescribing	N/A	1295081156	0	0	ALVES-AVILA, CHRISTINA M LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT102825	N/A	N/A	N/A	N/A	N/A	600 N ARROWHEAD AVE	STE 200	SAN BERNARDINO	CA	92401	1164	00	06000	34.110486	-117.2896755	San Bernardino County
327480	Ordering, Referring, Prescribing	N/A	1295138923	0	0	ARMSTRONG, STEPHENIE LMFT	10/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122761	N/A	N/A	N/A	N/A	N/A	1750 CIRBY WAY	None	ROSEVILLE	CA	95661	5520	00	06000	38.72953047	-121.258368	Placer County
327483	Ordering, Referring, Prescribing	N/A	1295139343	0	0	ABUKHIRAN, HUSAM	11/14/2023	Taxonomy not applicable	NA	n/a	000	Unknown	71398	N/A	N/A	N/A	N/A	N/A	15555 MAIN ST	STE 108	HESPERIA	CA	92345	3423	00	06000	34.42475918	-117.3236171	San Bernardino County
327509	Ordering, Referring, Prescribing	N/A	1295176709	0	0	ASKARZOI, KHAN DMD MSD	6/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	DDS62594	N/A	N/A	N/A	N/A	N/A	124 S A ST	None	MADERA	CA	93638	3619	00	06000	36.96397997	-120.0545315	Madera County
327530	Ordering, Referring, Prescribing	N/A	1295209047	0	0	AJIBOYE, ABIBAT B NP	1/8/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028619	N/A	N/A	N/A	N/A	N/A	3056 CASTRO VALLEY BOULE	STE#102	CASTRO VALLEY	CA	94546	2750	00	06000	37.69553812	-122.0816554	Alameda County
327541	Ordering, Referring, Prescribing	N/A	1295244747	0	0	ABRAHAMIAN, SOSI PHARMD	7/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	77258	N/A	N/A	N/A	N/A	N/A	18568 VENTURA BLVD	None	TARZANA	CA	91356	4146	00	06000	34.16940375	-118.5377537	Los Angeles County
327543	Ordering, Referring, Prescribing	N/A	1295241438	0	0	ALCALA, ELLIOTT LCSW	10/30/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74235	N/A	N/A	N/A	N/A	N/A	1328 SOUTH MISSION RD	None	FALLBROOK	CA	92028	4006	00	06000	33.36868654	-117.2507699	San Diego County
327572	Ordering, Referring, Prescribing	N/A	1295282283	0	0	AZZOPARDI, CATHERINE LCSW	8/26/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	103545	N/A	N/A	N/A	N/A	N/A	905 E. 8TH STREET	None	LOS ANGELES	CA	90021	1848	00	06000	34.03639545	-118.2465917	Los Angeles County
327603	Ordering, Referring, Prescribing	N/A	1295345486	0	0	AYERZA, LESLIE PA-C	7/23/2023	Taxonomy not applicable	NA	n/a	000	Unknown	58086	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
327608	Ordering, Referring, Prescribing	N/A	1295349595	0	0	APRILETTI, TARA NP	5/8/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015343	N/A	N/A	N/A	N/A	N/A	2950 INTERNATIONAL BLVD	None	OAKLAND	CA	94601	2228	00	06000	37.77893032	-122.2284286	Alameda County
327626	Ordering, Referring, Prescribing	N/A	1295397719	0	0	ABTAHI, KIMIYA DMD	12/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	104601	N/A	N/A	N/A	N/A	N/A	1500 CAPITOLA RD	None	SANTA CRUZ	CA	95062	1000	00	06000	36.97641295	-121.9850639	Santa Cruz County
327636	Ordering, Referring, Prescribing	N/A	1295470581	0	0	ALLEN, DANITA	5/25/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025348	N/A	N/A	N/A	N/A	N/A	12370 HESPERIA RD	#6	VICTORVILLE	CA	92395	7719	00	06000	34.47625382	-117.2913208	San Bernardino County
327649	Ordering, Referring, Prescribing	N/A	1295517407	0	0	ALEXANDER, VICKIE NP	9/25/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025484	N/A	N/A	N/A	N/A	N/A	12830 HESPERIA RD	SUITE D	VICTORVILLE	CA	92395	7788	00	06000	34.48395212	-117.2903629	San Bernardino County
327656	Ordering, Referring, Prescribing	N/A	1295587764	0	0	ALEMAN, BRISEIDA E NP	4/22/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029885	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
327664	Ordering, Referring, Prescribing	N/A	1295569044	0	0	AGADA, IHUOMA M NP	2/23/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023344	N/A	N/A	N/A	N/A	N/A	10300 COMPTON AVE	None	LOS ANGELES	CA	90001	0000	00	06000	33.94274917	-118.2461916	Los Angeles County
327669	Ordering, Referring, Prescribing	N/A	1295733038	0	0	AMBARAM, RINA Y	10/2/2006	Taxonomy not applicable	NA	n/a	099	DENTIST	D52012	N/A	N/A	N/A	N/A	N/A	12150 NEW YORK RANCH RD	None	JACKSON	CA	95642	9407	00	06000	38.38476766	-120.7396521	Amador County
327694	Ordering, Referring, Prescribing	N/A	1295810992	0	0	AOKI-COLLINS, KRISTAN K PHARMD	2/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53003	N/A	N/A	N/A	N/A	N/A	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	00	06000	36.84133078	-119.7824983	Fresno County
327725	Ordering, Referring, Prescribing	N/A	1295894350	0	0	ANDERSON, DORIS C LCSW	1/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW11549	N/A	N/A	N/A	N/A	N/A	215 W. BEAMER STREET	None	DAVIS	CA	95695	2510	00	06000	38.68483629	-121.7937301	Yolo County
327734	Ordering, Referring, Prescribing	N/A	1295902930	0	0	AHN, MICHELLE J MD	9/3/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A121280	N/A	N/A	N/A	N/A	N/A	500-B JEFFERSON BLVD	None	WEST SACRAMENTO	CA	65605	2349	00	06000	38.58758543	-121.5270475	Yolo County
327780	Ordering, Referring, Prescribing	N/A	1306021613	0	0	AUSTIN, ADINA G LMFT	9/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	90184	N/A	N/A	N/A	N/A	N/A	2690 CIENEGA RD	None	HOLLISTER	CA	95023	9687	00	06000	36.82375129	-121.4010426	San Benito County
327793	Ordering, Referring, Prescribing	N/A	1306035399	0	0	ARMSTEAD, BAILEY V LMFT	12/9/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFT109518	N/A	N/A	N/A	N/A	N/A	101 CIRBY HILLS DR	None	ROSEVILLE	CA	95678	4360	00	06000	38.7303989	-121.2872592	Placer County
327824	Ordering, Referring, Prescribing	N/A	1306121652	0	0	ASHTON, JENNA M	2/2/2017	Taxonomy not applicable	NA	n/a	000	Unknown	53850	N/A	N/A	N/A	N/A	N/A	21001 SHERMAN WAY	STE 9	CANOGA PARK	CA	91303	3683	00	06000	34.20113553	-118.5912126	Los Angeles County
327878	Ordering, Referring, Prescribing	N/A	1306194410	0	0	ALKAZAKI, USAMA PHARMD	3/5/2020	Taxonomy not applicable	NA	n/a	000	Unknown	RPH69696	N/A	N/A	N/A	N/A	N/A	505 N. MOLLISON AVE.	STE. 103	EL CAJON	CA	92021	6159	00	06000	32.80048689	-116.9509459	San Diego County
327882	Ordering, Referring, Prescribing	N/A	1306196399	0	0	ANDERSON, CARRIE LMFT	5/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	114740	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
327896	Ordering, Referring, Prescribing	N/A	1306220991	0	0	AMINI, MIRIAM N LMFT	12/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123366	N/A	N/A	N/A	N/A	N/A	545 ESTUDILLO AVE	None	SAN LEANDRO	CA	94577	4611	00	06000	37.72679439	-122.1491972	Alameda County
327925	Ordering, Referring, Prescribing	N/A	1306245899	0	0	ARRIAZA, GRAECIA LMFT	3/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114571	N/A	N/A	N/A	N/A	N/A	849 E. 6TH ST.	None	LOS ANGELES	CA	90021	1026	00	06000	34.03994957	-118.2414778	Los Angeles County
327931	Ordering, Referring, Prescribing	N/A	1306272851	0	0	ARENS, MARIANNA LMFT	1/12/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	137182	N/A	N/A	N/A	N/A	N/A	6635 FLORENCE AVE	101	BELL GARDENS	CA	90201	4909	00	06000	33.96212715	-118.1462995	Los Angeles County
327932	Ordering, Referring, Prescribing	N/A	1306274568	0	0	ANDERSON, CASSANDRA L RN CPNP	2/1/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	23418	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
327961	Ordering, Referring, Prescribing	N/A	1306324090	0	0	ARMBRUSTER, KARA NP	9/25/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014775	N/A	N/A	N/A	N/A	N/A	1295 BROADWAY	201	CHULA VISTA	CA	91911	2982	00	06000	32.60364599	-117.0786521	San Diego County
327969	Ordering, Referring, Prescribing	N/A	1306332028	0	0	AGUILAR, LUIS E PSYD	1/15/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY34659	N/A	N/A	N/A	N/A	N/A	7601 IMPERIAL HWY	None	DOWNEY	CA	90242	3456	00	06000	33.929829	-118.157607	Los Angeles County
327975	Ordering, Referring, Prescribing	N/A	1306351978	0	0	AIVAZYAN, LILIA E PHARMD	3/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76759	N/A	N/A	N/A	N/A	N/A	9518 OBECK AVE	None	ARLETA	CA	91331	5442	00	06000	34.24298539	-118.4350874	Los Angeles County
328043	Ordering, Referring, Prescribing	N/A	1306498712	0	0	AZARIAN, ARLENE M LCSW	4/22/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW122104	N/A	N/A	N/A	N/A	N/A	237 N CENTRAL AVE	None	GLENDALE	CA	91203	2531	00	06000	34.14943423	-118.2579487	Los Angeles County
328053	Ordering, Referring, Prescribing	N/A	1306512611	0	0	AVOUNDJIAN, ANI	12/2/2022	Taxonomy not applicable	NA	n/a	000	Unknown	84774	N/A	N/A	N/A	N/A	N/A	18533 SOLEDAD CANYON RD	None	SANTA CLARITA	CA	91351	3722	00	06000	34.41652146	-118.45647	Los Angeles County
328071	Ordering, Referring, Prescribing	N/A	1306579131	0	0	ADZHEMYAN, KRISTINE PHARMD	12/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH85387	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DRIVE	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
328088	Ordering, Referring, Prescribing	N/A	1306831912	0	0	ATIGA, JON J MD	10/8/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A43702	N/A	N/A	N/A	N/A	N/A	25405 HANCOCK AVE.	108	MURRIETA	CA	92562	5983	00	06000	33.5580833	-117.1850127	Riverside County
328104	Ordering, Referring, Prescribing	N/A	1306897723	0	0	ALLANKI, SAILAJA	4/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C138838	N/A	N/A	N/A	N/A	N/A	1414 N. CALIFORNIA ST	None	STOCKTON	CA	95202	1003	00	06000	37.96761084	-121.2883234	San Joaquin County
328124	Ordering, Referring, Prescribing	N/A	1306928668	0	0	AZARNIVAR, AMIR MD	4/18/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A51876	N/A	N/A	N/A	N/A	N/A	2550 W MAIN ST	301	ALHAMBRA	CA	91801	7003	00	06000	34.09508966	-118.1517558	Los Angeles County
328129	Ordering, Referring, Prescribing	N/A	1306942909	0	0	ALLEN, GWEN M MD	2/21/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A61790	N/A	N/A	N/A	N/A	N/A	1141 W. REDONDO BEACH BL	402	GARDENA	CA	90247	4181	00	06000	33.89247036	-118.2941482	Los Angeles County
328151	Ordering, Referring, Prescribing	N/A	1306989348	0	0	ABED, EVLIN PSYD	6/25/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY21800	N/A	N/A	N/A	N/A	N/A	1605 EASTLAKE AVE	None	LOS ANGELES	CA	90033	1009	00	06000	34.06300636	-118.2054784	Los Angeles County
328212	Ordering, Referring, Prescribing	N/A	1316111230	0	0	ARELLANO, NATALIA LCSW	2/9/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27226	N/A	N/A	N/A	N/A	N/A	901 W ORANGETHORPE AVE	None	FULLERTON	CA	92832	2826	00	06000	33.85940147	-117.939735	Orange County
328214	Ordering, Referring, Prescribing	N/A	1316117682	0	0	ANAYA, LAURA	5/1/2013	Taxonomy not applicable	NA	n/a	000	Unknown	PA19609	N/A	N/A	N/A	N/A	N/A	2185 PACHECO ST	None	CONCORD	CA	94520	2309	00	06000	37.97878977	-122.0345486	Contra Costa County
328272	Ordering, Referring, Prescribing	N/A	1316240666	0	0	AWOH, MAH NP	1/26/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028857	N/A	N/A	N/A	N/A	N/A	2540 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	00	06000	40.14893664	-122.2178101	Tehama County
328279	Ordering, Referring, Prescribing	N/A	1316247638	0	0	ABELL, CHARLES F PHARMD	4/17/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH41009	N/A	N/A	N/A	N/A	N/A	1135 LINDERO CANYON RD	None	THOUSAND OAKS	CA	91362	0000	00	06000	34.184133	-118.788336	Ventura County
328302	Ordering, Referring, Prescribing	N/A	1316299910	0	0	ADEWALE, SCARLETT C	7/11/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW105929	N/A	N/A	N/A	N/A	N/A	1816 S FIGUEROA ST	6TH FLOOR	LOS ANGELES	CA	90015	3422	00	06000	34.03542929	-118.2713663	Los Angeles County
328324	Ordering, Referring, Prescribing	N/A	1316314362	0	0	APPLEBY, KIMBERLY T	9/21/2015	Taxonomy not applicable	NA	n/a	024	PHARMACIES/PHARMACISTS	71276	N/A	N/A	N/A	N/A	N/A	4211 SOUTH AVALON BLVD	None	LOS ANGELES	CA	90011	5622	00	06000	34.007238	-118.2653065	Los Angeles County
328403	Ordering, Referring, Prescribing	N/A	1316445406	0	0	AGUILAR, LAURA L LMFT	2/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124585	N/A	N/A	N/A	N/A	N/A	4164 BROCKTON AVE	None	RIVERSIDE	CA	92501	3400	00	06000	33.98077024	-117.3813862	Riverside County
328416	Ordering, Referring, Prescribing	N/A	1316465560	0	0	ABEYGUNARATNE, THILINI A LMFT	6/3/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126299	N/A	N/A	N/A	N/A	N/A	1950 MARKET ST	None	RIVERSIDE	CA	92501	1720	00	06000	34.00316496	-117.3767967	Riverside County
328419	Ordering, Referring, Prescribing	N/A	1316465834	0	0	AGUIRRE VERDUGO, ISELA G LCSW	10/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97599	N/A	N/A	N/A	N/A	N/A	11741 TELEGRAPH RD	SUITE A	SANTA FE SPRINGS	CA	90670	3681	00	06000	33.9462235	-118.0830161	Los Angeles County
328421	Ordering, Referring, Prescribing	N/A	1316459605	0	0	AARON, BIANCA LMFT	11/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123270	N/A	N/A	N/A	N/A	N/A	3450 3RD STREET BLDG 1	UNIT 1C	SAN FRANCISCO	CA	94104	1444	00	06000	37.74535239	-122.387252	San Francisco County
328428	Ordering, Referring, Prescribing	N/A	1316476013	0	0	AMBRIZ, ORFANELLI LCSW	9/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96755	N/A	N/A	N/A	N/A	N/A	8019 COMPTON AVE	None	LOS ANGELES	CA	90001	3409	00	06000	33.9664185	-118.2477481	Los Angeles County
328466	Ordering, Referring, Prescribing	N/A	1316530678	0	0	ADAMS, JESSICA M PA-C	8/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59435	N/A	N/A	N/A	N/A	N/A	5555 GROSSMONT CENTER DR	None	LA MESA	CA	91942	3019	00	06000	32.781483	-117.007182	San Diego County
328484	Ordering, Referring, Prescribing	N/A	1316567043	0	0	AKINNAGBE, OLUWAFEMISAYO MD	4/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184336	N/A	N/A	N/A	N/A	N/A	593 W 6TH ST	None	SAN PEDRO	CA	90731	2521	00	06000	33.73875253	-118.2899475	Los Angeles County
328515	Ordering, Referring, Prescribing	N/A	1316652779	0	0	ABSI, CHRISTIAN M PA-C	4/1/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64309	N/A	N/A	N/A	N/A	N/A	728 E VALLEY PKWY	None	ESCONDIDO	CA	92025	3052	00	06000	33.12769389	-117.0730873	San Diego County
328517	Ordering, Referring, Prescribing	N/A	1316683485	0	0	ARROYO ROMERO, IRENE NP	6/13/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017540	N/A	N/A	N/A	N/A	N/A	5385 FRANKLIN BLVD	SUITE K	SACRAMENTO	CA	95820	4717	00	06000	38.526282	-121.471398	Sacramento County
328524	Ordering, Referring, Prescribing	N/A	1316691769	0	0	ALEXANDER, KATHERINE A	4/1/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020551	N/A	N/A	N/A	N/A	N/A	26600 CACTUS AVE	SUITE 300	MORENO VALLEY	CA	92555	3901	00	06000	33.91013953	-117.193383	Riverside County
328551	Ordering, Referring, Prescribing	N/A	1316984255	0	0	ANDREWS, PETER R MD	2/8/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C176269	N/A	N/A	N/A	N/A	N/A	1220 25TH ST	None	SACRAMENTO	CA	95816	5005	00	06000	38.572101	-121.4747055	Sacramento County
328567	Ordering, Referring, Prescribing	N/A	1326068115	0	0	ALFANO, KIMBERLY R PHD	12/29/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY14650	N/A	N/A	N/A	N/A	N/A	5266 HOLLISTER AVE	SUITE 200	SANTA BARBARA	CA	93111	4038	00	06000	34.43497016	-119.8071895	Santa Barbara County
328568	Ordering, Referring, Prescribing	N/A	1326048018	0	0	ALTHAUS, SANDRA MD	6/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G89080	N/A	N/A	N/A	N/A	N/A	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43816059	-120.6279677	Lassen County
328572	Ordering, Referring, Prescribing	N/A	1326094582	0	0	ADLER, JACQUELINE D MD	2/28/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A52362	N/A	N/A	N/A	N/A	N/A	711 W. FLORENCE AVE	None	LOS ANGELES	CA	90044	6105	00	06000	33.9746755	-118.286415	Los Angeles County
328598	Ordering, Referring, Prescribing	N/A	1326128406	0	0	ALEXANDER, DANIEL J LMFT	3/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT113809	N/A	N/A	N/A	N/A	N/A	1200 N MAIN ST	SUITE 300	SANTA ANA	CA	92701	3640	00	06000	33.755175	-117.8676195	Orange County
328599	Ordering, Referring, Prescribing	N/A	1326132754	0	0	ACHAR, SURITI MD	12/5/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G80882	N/A	N/A	N/A	N/A	N/A	5454 EL CAJON BLVD	None	SAN DIEGO	CA	92115	3621	00	06000	32.75809043	-117.0778038	San Diego County
328601	Ordering, Referring, Prescribing	N/A	1326133182	0	0	AROM, MARION PHD	1/8/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY7162	N/A	N/A	N/A	N/A	N/A	9201 WILSHIRE BLVD	207	BEVERLY HILLS	CA	90210	5517	00	06000	34.06707891	-118.3924873	Los Angeles County
328647	Ordering, Referring, Prescribing	N/A	1326200833	0	0	AHLAS, ANDREAS G MD	12/9/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A124942	N/A	N/A	N/A	N/A	N/A	1430 TRUXTON AVE.	SUITE 400	BAKERSFIELD	CA	93301	5220	00	06000	35.37345768	-119.0173312	Kern County
328686	Ordering, Referring, Prescribing	N/A	1326299769	0	0	ANGELINI, ELEONORA M	5/13/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	19843	N/A	N/A	N/A	N/A	N/A	56366 MANZANITA LAKE DR	None	NORTH FORK	CA	93643	9676	00	06000	37.25045073	-119.5204452	Madera County
328714	Ordering, Referring, Prescribing	N/A	1326320979	0	0	ALHAIK, NUHA	8/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53503	N/A	N/A	N/A	N/A	N/A	2750 PINOLE VALLEY RD	None	PINOLE	CA	94564	1425	00	06000	37.9939821	-122.285688	Contra Costa County
328718	Ordering, Referring, Prescribing	N/A	1326321290	0	0	ALBRIGHT, MARK H LCSW	11/20/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW80496	N/A	N/A	N/A	N/A	N/A	137 S. MATHEWS ST	None	LOS ANGELES	CA	90033	4025	00	06000	34.04209069	-118.2093793	Los Angeles County
328732	Ordering, Referring, Prescribing	N/A	1326340845	0	0	AWRAHA, AEVEN A CO	1/15/2020	Taxonomy not applicable	NA	n/a	012	DISPENSING OPTICIANS	6167	N/A	N/A	N/A	N/A	N/A	562 E. MAIN STREET	None	EL CAJON	CA	92020	4008	00	06000	32.79497646	-116.955063	San Diego County
328760	Ordering, Referring, Prescribing	N/A	1326372566	0	0	AKINTADE, ZAINAB M LCSW	12/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80128	N/A	N/A	N/A	N/A	N/A	2310 N 1ST ST	201	SAN JOSE	CA	95131	1040	00	06000	37.38023139	-121.9232445	Santa Clara County
328765	Ordering, Referring, Prescribing	N/A	1326369638	0	0	ARJMAND, ANISA N PHARMD	4/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH65007	N/A	N/A	N/A	N/A	N/A	10990 SAN DIEGO MISSION	None	SAN DIEGO	CA	92108	2417	00	06000	32.7850186	-117.1023292	San Diego County
328772	Ordering, Referring, Prescribing	N/A	1326387606	0	0	ATTALLAH, IRENE A PHARMD	7/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60060	N/A	N/A	N/A	N/A	N/A	43112 15TH ST W	None	LANCASTER	CA	93534	6219	00	06000	34.66467	-118.1567445	Los Angeles County
328778	Ordering, Referring, Prescribing	N/A	1326412321	0	0	AMATYA, DEEPA	3/18/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH47881	N/A	N/A	N/A	N/A	N/A	2035 HILLHURST AVE	None	LOS ANGELES	CA	90027	2702	00	06000	34.108785	-118.2874465	Los Angeles County
328779	Ordering, Referring, Prescribing	N/A	1326415431	0	0	ADAMS WILKINS, EMILY LMFT	12/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123840	N/A	N/A	N/A	N/A	N/A	2580 LAKE TAHOE BLVD	SUITE D	SOUTH LAKE TAHOE	CA	96150	7727	00	06000	38.92607502	-119.98503	El Dorado County
328798	Ordering, Referring, Prescribing	N/A	1326439829	0	0	ANDERSON, LINDA S PHARMD	4/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	39165	N/A	N/A	N/A	N/A	N/A	1540 FROOM RANCH WAY	None	SAN LUIS OBISPO	CA	93405	7211	00	06000	35.25089426	-120.6906169	San Luis Obispo County
328810	Ordering, Referring, Prescribing	N/A	1326462748	0	0	AGHVINIAN, REHAN LCSW	11/20/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	77562	N/A	N/A	N/A	N/A	N/A	20151 NORDHOFF ST	None	CHATSWORTH	CA	91311	6215	00	06000	34.23182352	-118.572948	Los Angeles County
328826	Ordering, Referring, Prescribing	N/A	1326483603	0	0	ASH, MEGAN M MD	9/12/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133531	N/A	N/A	N/A	N/A	N/A	2020 J STREET	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
328867	Ordering, Referring, Prescribing	N/A	1326561630	0	0	ASHBY, DEJEUNEE MD	1/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A141365	N/A	N/A	N/A	N/A	N/A	808 W. 58TH ST.	None	LOS ANGELES	CA	90037	4045	00	06000	33.98965917	-118.287673	Los Angeles County
328902	Ordering, Referring, Prescribing	N/A	1326604232	0	0	AMADI, GEORGE O NP	5/23/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011782	N/A	N/A	N/A	N/A	N/A	66 HURLBUT ST	None	PASADENA	CA	91105	4025	00	06000	34.12993251	-118.1516625	Los Angeles County
328921	Ordering, Referring, Prescribing	N/A	1326643750	0	0	AZCARATE, ANNETTE A NP	11/19/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015998	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
328949	Ordering, Referring, Prescribing	N/A	1326707589	0	0	ARREDONDO, PAUL CNP	2/8/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018072	N/A	N/A	N/A	N/A	N/A	940 E WILLIAMS ST	102	BANNING	CA	92220	5848	00	06000	33.92715416	-116.8662911	Riverside County
328951	Ordering, Referring, Prescribing	N/A	1326710690	0	0	ARZUMANYAN, ANI LMFT	10/31/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	142515	N/A	N/A	N/A	N/A	N/A	237 N CENTRAL AVE.	C	GLENDALE	CA	91203	0000	00	06000	34.14943423	-118.2579487	Los Angeles County
328965	Ordering, Referring, Prescribing	N/A	1326773946	0	0	ASSAM, MICAELA A NP	7/29/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015058	N/A	N/A	N/A	N/A	N/A	2145 5TH AVE	None	OROVILLE	CA	95965	5870	00	06000	39.50368243	-121.5646958	Butte County
329025	Ordering, Referring, Prescribing	N/A	1336264241	0	0	ALAMI, OTHMAN MD	4/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C148200	N/A	N/A	N/A	N/A	N/A	4250 AUBURN BLVD	None	SACRAMENTO	CA	95841	4100	00	06000	38.642832	-121.3649325	Sacramento County
329042	Ordering, Referring, Prescribing	N/A	1336287150	0	0	ANDERSON, BONNIE J LMFT	2/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	38595	N/A	N/A	N/A	N/A	N/A	350 E.GOBBI ST	B	UKIAH	CA	95482	5511	00	06000	39.14427808	-123.2021038	Mendocino County
329072	Ordering, Referring, Prescribing	N/A	1336355130	0	0	ARBOUET, SASCHA MD	9/18/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C160551	N/A	N/A	N/A	N/A	N/A	902 S MYRTLE AVE	None	MONROVIA	CA	91016	3427	00	06000	34.14233552	-118.0008646	Los Angeles County
329095	Ordering, Referring, Prescribing	N/A	1336401777	0	0	ANDREANI, MILENA M LCSW	3/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	84392	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	#401	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
329097	Ordering, Referring, Prescribing	N/A	1336409291	0	0	AYVAZIAN, ARBI DO	12/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A12896	N/A	N/A	N/A	N/A	N/A	4864 SANTA MONICA BLVD	None	LOS ANGELES	CA	90029	2634	00	06000	34.09082353	-118.2957075	Los Angeles County
329123	Ordering, Referring, Prescribing	N/A	1336447416	0	0	ANDERSON, THEODORE A LMFT	2/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	84546	N/A	N/A	N/A	N/A	N/A	13001 RAMONA BLVD	I	BALDWIN PARK	CA	91706	3752	00	06000	34.07969659	-117.9895641	Los Angeles County
329134	Ordering, Referring, Prescribing	N/A	1336472216	0	0	AGUILAR-HERNANDEZ, JULIAN A	1/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	66063	N/A	N/A	N/A	N/A	N/A	7515 VAN NUYS BLVD	None	VAN NUYS	CA	91405	1949	00	06000	34.207344	-118.4487995	Los Angeles County
329228	Ordering, Referring, Prescribing	N/A	1336597004	0	0	AVINA, MAYRA P NP	11/16/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95004872	N/A	N/A	N/A	N/A	N/A	1141 PEAR TREE LANE	None	NAPA	CA	94558	6484	00	06000	38.32125908	-122.2921523	Napa County
329232	Ordering, Referring, Prescribing	N/A	1336604727	0	0	ASH, ROBERT F DDS	3/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	103416	N/A	N/A	N/A	N/A	N/A	6339 MACK RD	None	SACRAMENTO	CA	95823	4655	00	06000	38.475585	-121.4285265	Sacramento County
329237	Ordering, Referring, Prescribing	N/A	1336614031	0	0	ABDELMISEH, SARAH H LMFT	1/5/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130453	N/A	N/A	N/A	N/A	N/A	3600 WILSHIRE BLVD	2200	LOS ANGELES	CA	90010	2632	00	06000	34.0617065	-118.3036455	Los Angeles County
329283	Ordering, Referring, Prescribing	N/A	1336678457	0	0	AQUIL, YASIN K LMFT	3/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	118782	N/A	N/A	N/A	N/A	N/A	3741 STOCKER ST	100	LOS ANGELES	CA	90008	5109	00	06000	34.00623019	-118.3384304	Los Angeles County
329346	Ordering, Referring, Prescribing	N/A	1336826445	0	0	ALCANTARA, KAREN NP	11/7/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023245	N/A	N/A	N/A	N/A	N/A	9128 WOODMAN AVE	None	ARLETA	CA	91331	6405	00	06000	34.23612313	-118.4409578	Los Angeles County
329348	Ordering, Referring, Prescribing	N/A	1336850841	0	0	AYALA, VALERIA PHARMD	11/3/2022	Taxonomy not applicable	NA	n/a	000	Unknown	87278	N/A	N/A	N/A	N/A	N/A	774 ADMIRAL CALLAGHAN LN	None	VALLEJO	CA	94591	3650	00	06000	38.12591271	-122.2280142	Solano County
329368	Ordering, Referring, Prescribing	N/A	1336971084	0	0	AGUILAR, DAVID O NP	6/27/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030815	N/A	N/A	N/A	N/A	N/A	1060 70TH STREET	None	LONG BEACH	CA	90805	9996	00	06000	33.8818064	-118.1800311	Los Angeles County
329403	Ordering, Referring, Prescribing	N/A	1346279460	0	0	ABDUL-RAZAK, BASIMA M MD	7/8/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C53991	N/A	N/A	N/A	N/A	N/A	1800 SPRING RIDGE DR	None	SUSANVILLE	CA	96130	6100	00	06000	40.43816059	-120.6279677	Lassen County
329418	Ordering, Referring, Prescribing	N/A	1346311149	0	0	ARCHIBALD, GERI M	9/10/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	4026	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
329423	Ordering, Referring, Prescribing	N/A	1346334596	0	0	ADESHINA, YEWANDE MD	10/11/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C159909	N/A	N/A	N/A	N/A	N/A	5125 SKYWAY	None	PARADISE	CA	95969	5624	00	06000	39.74598961	-121.640736	Butte County
329428	Ordering, Referring, Prescribing	N/A	1346340577	0	0	ABE, TAKESHI LMFT	2/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41734	N/A	N/A	N/A	N/A	N/A	3331 POWER INN RD	None	SACRAMENTO	CA	95826	3889	00	06000	38.543391	-121.4077095	Sacramento County
329453	Ordering, Referring, Prescribing	N/A	1346382611	0	0	ARMENTA, JORGE PA-C	1/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	13694	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
329497	Ordering, Referring, Prescribing	N/A	1346475902	0	0	ANDREWS, KIRK M LMFT	3/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT24321	N/A	N/A	N/A	N/A	N/A	21632 WESLEY DR	None	LAGUNA BEACH	CA	92651	8167	00	06000	33.51391597	-117.7525083	Orange County
329502	Ordering, Referring, Prescribing	N/A	1346486578	0	0	ASSADABADI, ROBERTO L PA-C	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	20061	N/A	N/A	N/A	N/A	N/A	3701 J ST	201	SACRAMENTO	CA	95816	5562	00	06000	38.571237	-121.4566245	Sacramento County
329517	Ordering, Referring, Prescribing	N/A	1346514106	0	0	ANDALON, DARRELL O	11/3/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D61199	N/A	N/A	N/A	N/A	N/A	6901 S ATLANTIC BLVD	None	BELL	CA	90201	3646	00	06000	33.97291242	-118.1878808	Los Angeles County
329581	Ordering, Referring, Prescribing	N/A	1346621398	0	0	ALVAREZ, BENICIA PHARMD	3/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71066	N/A	N/A	N/A	N/A	N/A	1721 W YOSEMITE AVE	None	MANTECA	CA	95337	5130	00	06000	37.79735353	-121.2443415	San Joaquin County
329613	Ordering, Referring, Prescribing	N/A	1346655677	0	0	ALFONSO, ANTONIO A	11/18/2014	Taxonomy not applicable	NA	n/a	099	DENTIST	D63500	N/A	N/A	N/A	N/A	N/A	732 MOTT ST	STE 110	SAN FERNANDO	CA	91340	4240	00	06000	34.27661761	-118.4442372	Los Angeles County
329632	Ordering, Referring, Prescribing	N/A	1346690096	0	0	ASGHAR, ELISE B MD	3/30/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A153661	N/A	N/A	N/A	N/A	N/A	208 CONCOURSE BLVD	#1	SANTA ROSA	CA	95403	8210	00	06000	38.51255309	-122.7884839	Sonoma County
329644	Ordering, Referring, Prescribing	N/A	1346712775	0	0	AZIZ, ABDUL M NP	11/20/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010748	N/A	N/A	N/A	N/A	N/A	81-557 DR. CARREON BLVD	C-9	INDIO	CA	92201	5965	00	06000	33.70743317	-116.2302643	Riverside County
329664	Ordering, Referring, Prescribing	N/A	1346738721	0	0	AYALEW, WENDMNEW A	3/30/2018	Taxonomy not applicable	NA	n/a	000	Unknown	55467	N/A	N/A	N/A	N/A	N/A	1107 W POPLAR AVE	None	PORTERVILLE	CA	93257	5839	00	06000	36.05128153	-119.0422344	Tulare County
329681	Ordering, Referring, Prescribing	N/A	1346768777	0	0	AL-RAWI, BASSAM T	10/13/2022	Taxonomy not applicable	NA	n/a	099	DENTIST	108150	N/A	N/A	N/A	N/A	N/A	101 W COAST RD	None	REDWAY	CA	95560	0769	00	06000	40.11704433	-123.8133408	Humboldt County
329714	Ordering, Referring, Prescribing	N/A	1346829744	0	0	AMIN, MILAN D MD	10/28/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A191759	N/A	N/A	N/A	N/A	N/A	3514 30TH ST	None	SAN DIEGO	CA	92104	4120	00	06000	32.74247286	-117.1301067	San Diego County
329766	Ordering, Referring, Prescribing	N/A	1346967965	0	0	ARRIOLA ZARATE, DAMARIS E DDS	10/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	108285	N/A	N/A	N/A	N/A	N/A	123 S ALVARADO ST	None	LOS ANGELES	CA	90057	2201	00	06000	34.06593048	-118.2708351	Los Angeles County
329789	Ordering, Referring, Prescribing	N/A	1356045884	0	0	ANDERSON, NADIA A DO	9/30/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL3403	N/A	N/A	N/A	N/A	N/A	455 OCONNOR DR	None	SAN JOSE	CA	95128	1633	00	06000	37.326654	-121.939897	Santa Clara County
329793	Ordering, Referring, Prescribing	N/A	1356074025	0	0	APUNGU, JOTHAM PHARMD	4/29/2023	Taxonomy not applicable	NA	n/a	000	Unknown	85766	N/A	N/A	N/A	N/A	N/A	3850 17TH ST	None	SAN FRANCISCO	CA	94114	2031	00	06000	37.76272129	-122.4318522	San Francisco County
329800	Ordering, Referring, Prescribing	N/A	1356108880	0	0	ALLEN, MARISSA A RN	4/16/2023	Taxonomy not applicable	NA	n/a	000	Unknown	809898	N/A	N/A	N/A	N/A	N/A	2111 MISSION AVE	None	OCEANSIDE	CA	92058	2326	00	06000	33.20572898	-117.3626661	San Diego County
329825	Ordering, Referring, Prescribing	N/A	1356379283	0	0	AVGERIS, ARISTIDES C MD	2/27/2018	Taxonomy not applicable	NA	n/a	000	Unknown	C153293	N/A	N/A	N/A	N/A	N/A	21900 BURBANK BLVD	None	WOODLAND HILLS	CA	91367	0000	00	06000	34.1719246	-118.6044964	Los Angeles County
329873	Ordering, Referring, Prescribing	N/A	1356483044	0	0	ALAEI, ZHADE D LMFT	4/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51057	N/A	N/A	N/A	N/A	N/A	679 S. NEW HAMPSHIRE	400	LOS ANGELES	CA	90005	1355	00	06000	34.06107902	-118.2929191	Los Angeles County
329898	Ordering, Referring, Prescribing	N/A	1356553945	0	0	AGUILAR-PASCASIO, LIELANIE MAE	10/15/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C191567	N/A	N/A	N/A	N/A	N/A	120 N 8TH ST	None	EL CENTRO	CA	92243	2328	00	06000	32.793282	-115.5614685	Imperial County
329999	Ordering, Referring, Prescribing	N/A	1356721575	0	0	ABDO, RAGHAD H PHARMD	3/29/2018	Taxonomy not applicable	NA	n/a	000	Unknown	47073	N/A	N/A	N/A	N/A	N/A	1235 S DIAMOND BAR BLVD	None	DIAMOND BAR	CA	91765	4121	00	06000	33.99993979	-117.811849	Los Angeles County
330004	Ordering, Referring, Prescribing	N/A	1356731335	0	0	ALVERGUE, BRIANA M	2/24/2016	Taxonomy not applicable	NA	n/a	000	Unknown	52235	N/A	N/A	N/A	N/A	N/A	28780 SINGLE OAK DR	SUITE 160	TEMECULA	CA	92590	5528	00	06000	33.49890392	-117.1612965	Riverside County
330011	Ordering, Referring, Prescribing	N/A	1356741516	0	0	ADLER, JESSICA LMFT	10/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122231	N/A	N/A	N/A	N/A	N/A	200 24TH ST	None	RICHMOND	CA	94804	1804	00	06000	37.93439778	-122.3465322	Contra Costa County
330015	Ordering, Referring, Prescribing	N/A	1356753875	0	0	ATKINSON, CHRISTINA A LMFT	5/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104011	N/A	N/A	N/A	N/A	N/A	2225 CHALLENGER WAY	None	SANTA ROSA	CA	95407	5441	00	06000	38.425482	-122.75262	Sonoma County
330019	Ordering, Referring, Prescribing	N/A	1356759146	0	0	ALLEN, DANIEL J OD	11/10/2021	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	15103	N/A	N/A	N/A	N/A	N/A	1 W CALIFORNIA BLVD	STE 513	PASADENA	CA	91105	3029	00	06000	34.13581545	-118.1510145	Los Angeles County
330020	Ordering, Referring, Prescribing	N/A	1356764351	0	0	ANDERSON, CHRISTINE T NP	6/18/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000273	N/A	N/A	N/A	N/A	N/A	5609 J STREET	SUITE C	SACRAMENTO	CA	95819	3957	00	06000	38.564829	-121.434228	Sacramento County
330024	Ordering, Referring, Prescribing	N/A	1356765853	0	0	ADAMS, SARAH A	12/12/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	5745	N/A	N/A	N/A	N/A	N/A	1140 W MISSION RD	None	SAN MARCOS	CA	92069	1415	00	06000	33.151851	-117.178731	San Diego County
330029	Ordering, Referring, Prescribing	N/A	1356769996	0	0	AVENDANO, CARMEN G MD	5/3/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	65450	N/A	N/A	N/A	N/A	N/A	1455 ST FRANCIS AVE	None	SHAKOPEE	MN	55379	3374	00	06000	44.771976	-93.502944	Scott County
330033	Ordering, Referring, Prescribing	N/A	1356776777	0	0	ASLANYAN-ZAMORA, ALISA L LCSW	11/9/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW78800	N/A	N/A	N/A	N/A	N/A	20151 NORDHOFF ST	None	CHATSWORTH	CA	91311	6215	00	06000	34.23182352	-118.572948	Los Angeles County
330082	Ordering, Referring, Prescribing	N/A	1356856694	0	0	ALAVI, ALI MD	10/3/2021	Taxonomy not applicable	NA	n/a	000	Unknown	A163793	N/A	N/A	N/A	N/A	N/A	1012 MAIN ST	SUITE 101	RAMONA	CA	92065	2170	00	06000	33.04181722	-116.8689096	San Diego County
330086	Ordering, Referring, Prescribing	N/A	1356869093	0	0	ACEVEDO MORENO, MARIELA LMFT	9/22/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	114914	N/A	N/A	N/A	N/A	N/A	1400 EMELINE AVE	None	SANTA CRUZ	CA	95060	1976	00	06000	36.99276804	-122.0178271	Santa Cruz County
330098	Ordering, Referring, Prescribing	N/A	1356891055	0	0	ARREDONDO, STEPHANIE LCSW	1/7/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW117013	N/A	N/A	N/A	N/A	N/A	1900 ROYALTY DR	180	POMONA	CA	91767	3032	00	06000	34.07754346	-117.7463466	Los Angeles County
330102	Ordering, Referring, Prescribing	N/A	1356892327	0	0	ALFARO-SANTIAGO, SHEILA I LCSW	5/20/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101590	N/A	N/A	N/A	N/A	N/A	11565 LAUREL CANYON BOUL	116	SAN FERNANDO	CA	91340	4650	00	06000	34.28018218	-118.4549135	Los Angeles County
330116	Ordering, Referring, Prescribing	N/A	1356920631	0	0	AWAN, IMAD M MD	10/30/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A191788	N/A	N/A	N/A	N/A	N/A	11980 MOUNT VERNON AVE	None	GRAND TERRACE	CA	92313	5172	00	06000	34.036353	-117.3136565	San Bernardino County
330133	Ordering, Referring, Prescribing	N/A	1356952311	0	0	AU, CHELANE PHARMD	1/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83009	N/A	N/A	N/A	N/A	N/A	1335 WEBSTER ST	None	SAN FRANCISCO	CA	94115	4277	00	06000	37.78279538	-122.4309399	San Francisco County
330134	Ordering, Referring, Prescribing	N/A	1356955157	0	0	ABUYAGHI, ANTONE R PHARMD	6/10/2020	Taxonomy not applicable	NA	n/a	000	Unknown	RPH82476	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	9373	00	06000	38.36981229	-120.8002806	Amador County
330164	Ordering, Referring, Prescribing	N/A	1366017550	0	0	ADAM, KAAVYA MD MPH	12/2/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL8252	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
330180	Ordering, Referring, Prescribing	N/A	1366058430	0	0	AGUIRRE, BRIANNA N PHARMD	11/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83178	N/A	N/A	N/A	N/A	N/A	3902 WASHINGTON BLVD	None	FREMONT	CA	94538	4954	00	06000	37.53267585	-121.9573339	Alameda County
330189	Ordering, Referring, Prescribing	N/A	1366068124	0	0	ACEVEDO, NATALIE MD	8/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189132	N/A	N/A	N/A	N/A	N/A	661 W FIRST ST	None	TUSTIN	CA	92780	2939	00	06000	33.74578153	-117.831231	Orange County
330196	Ordering, Referring, Prescribing	N/A	1366064800	0	0	AYODELE, NAOMI PA	2/28/2020	Taxonomy not applicable	NA	n/a	000	Unknown	57888	N/A	N/A	N/A	N/A	N/A	398 SOUTH GREEN VALLEY R	None	WATSONVILLE	CA	95076	0000	00	06000	36.93055964	-121.7769628	Santa Cruz County
330215	Ordering, Referring, Prescribing	N/A	1366145088	0	0	ATTIA, MONICA MD	7/1/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197252	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
330222	Ordering, Referring, Prescribing	N/A	1366180416	0	0	ANTALEK, ALLISON Y NP	5/24/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021041	N/A	N/A	N/A	N/A	N/A	40910 FREMONT BLVD	None	FREMONT	CA	94538	4375	00	06000	37.53384106	-121.9607241	Alameda County
330228	Ordering, Referring, Prescribing	N/A	1366182396	0	0	AMIGONE, CARLEY LCSW	1/22/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	65022	N/A	N/A	N/A	N/A	N/A	5758 W LAS POSITAS BLVD	None	PLEASANTON	CA	94588	4083	00	06000	37.68523856	-121.8934051	Alameda County
330260	Ordering, Referring, Prescribing	N/A	1366516122	0	0	AHUJA, LALIT PHARMD	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	50170	N/A	N/A	N/A	N/A	N/A	7373 WEST LN	None	STOCKTON	CA	95210	3377	00	06000	38.017701	-121.297869	San Joaquin County
330269	Ordering, Referring, Prescribing	N/A	1366529273	0	0	AYALA, MANUEL PHARMD	2/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	49143	N/A	N/A	N/A	N/A	N/A	12254 BELLFLOWER BLVD	None	DOWNEY	CA	90242	2804	00	06000	33.921405	-118.125323	Los Angeles County
330291	Ordering, Referring, Prescribing	N/A	1366575433	0	0	ALARID, ANGELA M LCSW	10/27/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	60081	N/A	N/A	N/A	N/A	N/A	1741 E 120TH ST	TRAILER 6	LOS ANGELES	CA	90059	3051	00	06000	33.92464326	-118.2427028	Los Angeles County
330313	Ordering, Referring, Prescribing	N/A	1366627812	0	0	ALLEN, AMY A LMFT	10/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	87661	N/A	N/A	N/A	N/A	N/A	2311 W EL SEGUNDO BLVD	None	HAWTHORNE	CA	90250	3315	00	06000	33.91647947	-118.3189815	Los Angeles County
330342	Ordering, Referring, Prescribing	N/A	1366697930	0	0	AGUSTIN, MYHA J LCSW	7/11/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29774	N/A	N/A	N/A	N/A	N/A	1816 S FIGUEROA ST	6TH FLOOR	LOS ANGELES	CA	90015	3422	00	06000	34.03542929	-118.2713663	Los Angeles County
330351	Ordering, Referring, Prescribing	N/A	1366724288	0	0	AHN, HAEJIN PHARMD	7/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56552	N/A	N/A	N/A	N/A	N/A	4170 EL CAMINO REAL	None	PALO ALTO	CA	94306	0001	00	06000	37.41148135	-122.1243315	Santa Clara County
330357	Ordering, Referring, Prescribing	N/A	1366738353	0	0	ARROYO, MARIA S LCSW	10/26/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	111502	N/A	N/A	N/A	N/A	N/A	29775 HAUN RD	None	MENIFEE	CA	92586	6540	00	06000	33.68839122	-117.1750902	Riverside County
330359	Ordering, Referring, Prescribing	N/A	1366730004	0	0	ALMAROSA, PAULINA MSW LCSW	10/4/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW95970	N/A	N/A	N/A	N/A	N/A	222 SOUTH HARBOR	SUITE 650	ANAHEIM	CA	92805	3756	00	06000	33.83250163	-117.9188893	Orange County
330431	Ordering, Referring, Prescribing	N/A	1366853194	0	0	ARREAZA, HECTOR J MD	2/22/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A144976	N/A	N/A	N/A	N/A	N/A	7800 NILES STREET	None	BAKERSFIELD	CA	93306	4922	00	06000	35.37628052	-118.9179	Kern County
330451	Ordering, Referring, Prescribing	N/A	1366880692	0	0	ASTVATSATURYAN, KRISTINE MD	5/25/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139202	N/A	N/A	N/A	N/A	N/A	2928 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	3110	00	06000	34.04364362	-118.2006515	Los Angeles County
330459	Ordering, Referring, Prescribing	N/A	1366878985	0	0	ADLER, ALISSA LCSW	1/6/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	86217	N/A	N/A	N/A	N/A	N/A	760 MOUNTAIN VIEW ST	None	ALTADENA	CA	91001	4925	00	06000	34.19178664	-118.1657029	Los Angeles County
330468	Ordering, Referring, Prescribing	N/A	1366907461	0	0	AVINA, ELIZABETH C NP	8/28/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95012589	N/A	N/A	N/A	N/A	N/A	316 N. MAIN STREET	None	SALINAS	CA	93901	2855	00	06000	36.682749	-121.6533777	Monterey County
330478	Ordering, Referring, Prescribing	N/A	1366921900	0	0	ARNOLD, DUSTIN PSYD	8/8/2018	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	30264	N/A	N/A	N/A	N/A	N/A	15206 PARTHENIA ST	None	NORTH HILLS	CA	91343	5305	00	06000	34.22817313	-118.4636497	Los Angeles County
330524	Ordering, Referring, Prescribing	N/A	1376000505	0	0	ARCINIEGA, JOSE B PA-C	1/17/2019	Taxonomy not applicable	NA	n/a	000	Unknown	56473	N/A	N/A	N/A	N/A	N/A	147 N BRENT ST	None	VENTURA	CA	93003	2809	00	06000	34.2746295	-119.2573399	Ventura County
330535	Ordering, Referring, Prescribing	N/A	1376018432	0	0	AHMAD, ABDUL A PHARMD	12/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79368	N/A	N/A	N/A	N/A	N/A	3380 COACH LN	None	CAMERON PARK	CA	95682	8454	00	06000	38.65807602	-120.970776	El Dorado County
330541	Ordering, Referring, Prescribing	N/A	1376028613	0	0	ARREOLA, ASUNCION M RN	10/30/2017	Taxonomy not applicable	NA	n/a	000	Unknown	536450	N/A	N/A	N/A	N/A	N/A	5000 W CYPRESS	None	VISALIA	CA	93277	8300	00	06000	36.324207	-119.3463225	Tulare County
330549	Ordering, Referring, Prescribing	N/A	1376006726	0	0	AULD, JACQUELINE D	1/7/2019	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80191	N/A	N/A	N/A	N/A	N/A	775 S TUCKER RD	None	TEHACHAPI	CA	93561	2502	00	06000	35.125704	-118.4678675	Kern County
330550	Ordering, Referring, Prescribing	N/A	1376043125	0	0	ANDERSON, THERNELL R PHARMD	8/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78015	N/A	N/A	N/A	N/A	N/A	880 SUTTON WAY	None	GRASS VALLEY	CA	95945	5167	00	06000	39.23520763	-121.0340543	Nevada County
330555	Ordering, Referring, Prescribing	N/A	1376053157	0	0	ANGELIS, EKATERINI W LMFT	7/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	120127	N/A	N/A	N/A	N/A	N/A	150 E OLIVE AVE	203	BURBANK	CA	91502	1846	00	06000	34.18064474	-118.3089507	Los Angeles County
330557	Ordering, Referring, Prescribing	N/A	1376053413	0	0	AJALA-STAATS, DNP, CATHERINE NP	2/25/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95006286	N/A	N/A	N/A	N/A	N/A	7140 INDIANA AVE	None	RIVERSIDE	CA	92504	4544	00	06000	33.93890182	-117.3977958	Riverside County
330564	Ordering, Referring, Prescribing	N/A	1376070383	0	0	ALI, ASGHAR MD	9/20/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	46606	N/A	N/A	N/A	N/A	N/A	2145 5TH AVE	None	OROVILLE	CA	95965	5870	00	06000	39.50368243	-121.5646958	Butte County
330594	Ordering, Referring, Prescribing	N/A	1376134585	0	0	ABOAGYE, WENDI	5/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59277	N/A	N/A	N/A	N/A	N/A	14623 HAWTHORNE BLVD	None	LAWNDALE	CA	90260	1581	00	06000	33.898572	-118.3527775	Los Angeles County
330596	Ordering, Referring, Prescribing	N/A	1376140871	0	0	ANDREWS, LIA M LCSW	4/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW92642	N/A	N/A	N/A	N/A	N/A	21935 VAN BUREN ST	A1	GRAND TERRACE	CA	92313	5652	00	06000	34.02658652	-117.3263805	San Bernardino County
330599	Ordering, Referring, Prescribing	N/A	1376152967	0	0	AZADEGAN, MAHVASH LMFT	9/3/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41192	N/A	N/A	N/A	N/A	N/A	1460 MARIA LANE	SUITE 300	WALNUT CREEK	CA	94596	5314	00	06000	37.89249772	-122.0566087	Contra Costa County
330656	Ordering, Referring, Prescribing	N/A	1376383703	0	0	AUSTRIA, JOANNE	4/11/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95029778	N/A	N/A	N/A	N/A	N/A	18709 EAST PETUNIA STREE	None	AZUSA	CA	91702	0001	00	06000	34.1229965	-117.885078	Los Angeles County
330663	Ordering, Referring, Prescribing	N/A	1376547612	0	0	ANSEL, DAVID A MD	9/17/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G137323	N/A	N/A	N/A	N/A	N/A	21507 EAST CLIFF DR	None	SANTA CRUZ	CA	95062	4844	00	06000	36.96330203	-121.9900666	Santa Cruz County
330733	Ordering, Referring, Prescribing	N/A	1376726844	0	0	ATKINS, MAUREEN E LMFT	9/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113744	N/A	N/A	N/A	N/A	N/A	1000A EMELINE AVE	None	SANTA CRUZ	CA	95060	1900	00	06000	36.99138135	-122.0175926	Santa Cruz County
330741	Ordering, Referring, Prescribing	N/A	1376731570	0	0	ANDERSON, NATHANIAL R PA-C	4/9/2019	Taxonomy not applicable	NA	n/a	000	Unknown	53324	N/A	N/A	N/A	N/A	N/A	706 PEACH ST	None	CORNING	CA	96021	3355	00	06000	39.928689	-122.174397	Tehama County
330758	Ordering, Referring, Prescribing	N/A	1376779744	0	0	ANDRES-KIM, MARISSA L MD	1/26/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A118959	N/A	N/A	N/A	N/A	N/A	20151 NORDHOFF ST	210	CHATSWORTH	CA	91311	6215	00	06000	34.23182352	-118.572948	Los Angeles County
330794	Ordering, Referring, Prescribing	N/A	1376856203	0	0	ALMASI, ARSINEH NP	9/10/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005477	N/A	N/A	N/A	N/A	N/A	8215 VAN NUYS BLVD STE 2	STE 210	PANORAMA CITY	CA	91402	4833	00	06000	34.22026244	-118.4488066	Los Angeles County
330846	Ordering, Referring, Prescribing	N/A	1376937557	0	0	ABDALLA, JACQUELINE M MD	12/5/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145419	N/A	N/A	N/A	N/A	N/A	4600 BROADWAY	1100	SACRAMENTO	CA	95820	1527	00	06000	38.546127	-121.452669	Sacramento County
330857	Ordering, Referring, Prescribing	N/A	1376949230	0	0	AUNG, CHAN M MD	4/5/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A140828	N/A	N/A	N/A	N/A	N/A	790 E BONITA AVE	FL 2	POMONA	CA	91767	1906	00	06000	34.09621447	-117.737406	Los Angeles County
330891	Ordering, Referring, Prescribing	N/A	1376992107	0	0	AKINTUJOYE, OLUWATOYIN M MD	2/9/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151867	N/A	N/A	N/A	N/A	N/A	2801 S SAN PEDRO ST	None	LOS ANGELES	CA	90011	2023	00	06000	34.01966657	-118.2625434	Los Angeles County
330906	Ordering, Referring, Prescribing	N/A	1386020642	0	0	AHN, JIMMY Y PHARMD	3/2/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH85964	N/A	N/A	N/A	N/A	N/A	6041 CADILLAC AVE	516	LOS ANGELES	CA	90034	1702	00	06000	34.03781261	-118.3755101	Los Angeles County
330999	Ordering, Referring, Prescribing	N/A	1386154540	0	0	AJILEYE, LATOYA L CNP	2/22/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007968	N/A	N/A	N/A	N/A	N/A	5142 AMBERLAND SQ	None	ATLANTA	GA	30349	1696	00	06000	33.61456951	-84.57532708	Fulton County
331037	Ordering, Referring, Prescribing	N/A	1386199131	0	0	ADELABU-SOULE, ADEOLA LCSW	10/13/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	97350	N/A	N/A	N/A	N/A	N/A	264 LANDIS AVE	#101	CHULA VISTA	CA	91910	2627	00	06000	32.6423214	-117.0814646	San Diego County
331133	Ordering, Referring, Prescribing	N/A	1386621738	0	0	ALLEN, BARBARA C NP	3/17/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	382448	N/A	N/A	N/A	N/A	N/A	1442 ETHAN WAY	STE 100	SACRAMENTO	CA	95825	2232	00	06000	38.592126	-121.4190765	Sacramento County
331158	Ordering, Referring, Prescribing	N/A	1386709319	0	0	AU, ELAIN Y PHARMD	3/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	51267	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 362	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
331200	Ordering, Referring, Prescribing	N/A	1386778967	0	0	ANTONIO, ETHEL U NP	11/23/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95007507	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	SUITE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
331201	Ordering, Referring, Prescribing	N/A	1386779908	0	0	ARIAS, BETTY L LMFT	5/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT39939	N/A	N/A	N/A	N/A	N/A	649 E ALBERTONI ST	100	CARSON	CA	90746	1538	00	06000	33.87194399	-118.2643054	Los Angeles County
331216	Ordering, Referring, Prescribing	N/A	1386811172	0	0	AKINS, PAMELA LCSW	1/29/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	39980	N/A	N/A	N/A	N/A	N/A	6110 GARFIELD AVENUE	None	SACRAMENTO	CA	95841	2009	00	06000	38.676888	-121.3362945	Sacramento County
331219	Ordering, Referring, Prescribing	N/A	1386812170	0	0	ADKISSON, CAROL R LMFT	3/17/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	83484	N/A	N/A	N/A	N/A	N/A	17057 FOOTHILL BLVD	205	FONTANA	CA	92335	3521	00	06000	34.10654917	-117.4330007	San Bernardino County
331226	Ordering, Referring, Prescribing	N/A	1386820322	0	0	ANCELLOTTI, LORETTA	11/7/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	15237	N/A	N/A	N/A	N/A	N/A	6991 N STATE ST	None	REDWOOD VALLEY	CA	95470	9629	00	06000	39.2438212	-123.207113	Mendocino County
331232	Ordering, Referring, Prescribing	N/A	1386830602	0	0	APPLETON, SARAH E LMFT	4/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48208	N/A	N/A	N/A	N/A	N/A	5121 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2656	00	06000	35.35413152	-119.058471	Kern County
331240	Ordering, Referring, Prescribing	N/A	1386856102	0	0	ASHAR, DEVYANI N	10/14/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	D43107	N/A	N/A	N/A	N/A	N/A	1333 MERIDIAN AVE	None	SAN JOSE	CA	95125	5212	00	06000	37.30176	-121.9136465	Santa Clara County
331241	Ordering, Referring, Prescribing	N/A	1386850436	0	0	ARMIN, SEAN S MD	12/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A88304	N/A	N/A	N/A	N/A	N/A	12626 RIVERSIDE DR	103	VALLEY VILLAGE	CA	91607	3420	00	06000	34.15758449	-118.408131	Los Angeles County
331243	Ordering, Referring, Prescribing	N/A	1386873610	0	0	ALARCON, EVELYN MD	12/22/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A111516	N/A	N/A	N/A	N/A	N/A	802 BREWSTER AVE	None	REDWOOD CITY	CA	94063	1510	00	06000	37.48873991	-122.2339433	San Mateo County
331289	Ordering, Referring, Prescribing	N/A	1386978609	0	0	AFZALI, MICHELLE M NP	1/4/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	19223	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVENUE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
331330	Ordering, Referring, Prescribing	N/A	1396032751	0	0	AGGARWAL, SAURABH MD	4/6/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A172183	N/A	N/A	N/A	N/A	N/A	949 CALHOUN PLACE	D	HEMET	CA	92543	4403	00	06000	33.7502744	-116.9618423	Riverside County
331373	Ordering, Referring, Prescribing	N/A	1396119707	0	0	ANTRIM, ANNA	1/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59187	N/A	N/A	N/A	N/A	N/A	189 NIBLICK RD	None	PASO ROBLES	CA	93446	4845	00	06000	35.61505753	-120.6811935	San Luis Obispo County
331376	Ordering, Referring, Prescribing	N/A	1396124145	0	0	ALDERSON, CHEVON	12/20/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A155746	N/A	N/A	N/A	N/A	N/A	2630 1ST AVE	None	SAN DIEGO	CA	92103	6599	00	06000	32.73288727	-117.1639712	San Diego County
331426	Ordering, Referring, Prescribing	N/A	1396192019	0	0	ANDRADE DE ZAPATA, JOSEFA HEDITH LPCC	3/8/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC4994	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE	SUITE 100	GILROY	CA	95020	3617	00	06000	37.03080985	-121.5741639	Santa Clara County
331428	Ordering, Referring, Prescribing	N/A	1396167011	0	0	ALPUERTO, MARIE PHARMD	12/7/2017	Taxonomy not applicable	NA	n/a	000	Unknown	64795	N/A	N/A	N/A	N/A	N/A	4211 S. AVALON BLVD.	None	LOS ANGELES	CA	90011	5622	00	06000	34.007238	-118.2653065	Los Angeles County
331450	Ordering, Referring, Prescribing	N/A	1396222576	0	0	ARIANJAM, ALI PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	76901	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
331506	Ordering, Referring, Prescribing	N/A	1396323424	0	0	ABDULNOUR, ANGELA PHARMD	2/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80917	N/A	N/A	N/A	N/A	N/A	99 N LA CIENEGA BLVD	STE 200	BEVERLY HILLS	CA	90211	2222	00	06000	34.06736471	-118.3763201	Los Angeles County
331508	Ordering, Referring, Prescribing	N/A	1396327607	0	0	AMINI, ALI	7/21/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83183	N/A	N/A	N/A	N/A	N/A	5695 ALTON PKWY	None	IRVINE	CA	92618	4059	00	06000	33.66846665	-117.786127	Orange County
331515	Ordering, Referring, Prescribing	N/A	1396340881	0	0	AROMDEE, PATHANAPONG LCSW	3/4/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW121389	N/A	N/A	N/A	N/A	N/A	15350 SHERMAN WAY	STE 200	VAN NUYS	CA	91406	4203	00	06000	34.20109649	-118.467432	Los Angeles County
331521	Ordering, Referring, Prescribing	N/A	1396346763	0	0	APPLEGATE, JILL	3/14/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	145815	N/A	N/A	N/A	N/A	N/A	3650 STANDISH AVE	None	SANTA ROSA	CA	95407	8113	00	06000	38.388438	-122.72283	Sonoma County
331548	Ordering, Referring, Prescribing	N/A	1396386900	0	0	AVILA, CARINA LMFT	3/30/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146120	N/A	N/A	N/A	N/A	N/A	525 TECHNOLOGY CT	105	RIVERSIDE	CA	92507	2191	00	06000	33.99998544	-117.3235185	Riverside County
331587	Ordering, Referring, Prescribing	N/A	1396492641	0	0	AJIZ, LETTY	9/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018610	N/A	N/A	N/A	N/A	N/A	400 W 30TH ST	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
331627	Ordering, Referring, Prescribing	N/A	1396817326	0	0	ALVAREZ, LISA LMFT	12/15/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	92560	N/A	N/A	N/A	N/A	N/A	2615 S MILLER ST	SUITE 106	SANTA MARIA	CA	93455	1775	00	06000	34.91141828	-120.4320168	Santa Barbara County
331637	Ordering, Referring, Prescribing	N/A	1396845186	0	0	ANOSHIVANI, ARDE K MD	8/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A33651	N/A	N/A	N/A	N/A	N/A	4631 TELLER AVE SUITE 10	None	NEWPORT BEACH	CA	92660	0810	00	06000	33.66641504	-117.857408	Orange County
331648	Ordering, Referring, Prescribing	N/A	1396861258	0	0	AGAYAN, MARIAM LMFT	1/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52186	N/A	N/A	N/A	N/A	N/A	117 N R ST	None	MADERA	CA	93637	4465	00	06000	36.95311832	-120.0734055	Madera County
331678	Ordering, Referring, Prescribing	N/A	1396895736	0	0	AUSTIN, LEIA M LMFT	4/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45921	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
331684	Ordering, Referring, Prescribing	N/A	1396906616	0	0	ALI, ASHRAF MD	12/17/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C50761	N/A	N/A	N/A	N/A	N/A	902 S MYRTLE AVE	None	MONROVIA	CA	91016	3427	00	06000	34.14233552	-118.0008646	Los Angeles County
331702	Ordering, Referring, Prescribing	N/A	1396952545	0	0	ARON, ZOE S MD	11/18/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A106202	N/A	N/A	N/A	N/A	N/A	11080 W OLYMPIC BLVD	None	LOS ANGELES	CA	90064	1937	00	06000	34.04036814	-118.4376056	Los Angeles County
331744	Ordering, Referring, Prescribing	N/A	1407041585	0	0	ALGEE, MARK R DC	1/24/2017	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	28927	N/A	N/A	N/A	N/A	N/A	100 FOURTH STREET	BLDG A	TAFT	CA	93268	2415	00	06000	35.13983007	-119.4578478	Kern County
331750	Ordering, Referring, Prescribing	N/A	1407042732	0	0	AGUILAR, DELIA V MSW LCSW	4/13/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25808	N/A	N/A	N/A	N/A	N/A	327 S K ST	None	TULARE	CA	93274	5416	00	06000	36.20476387	-119.3454489	Tulare County
331757	Ordering, Referring, Prescribing	N/A	1407074008	0	0	ADDAMS, CECILIA LMFT	11/16/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45251	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
331760	Ordering, Referring, Prescribing	N/A	1407090566	0	0	AHUJA, SUKHDEEP K MD	6/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C134983	N/A	N/A	N/A	N/A	N/A	1887 MONTEREY RD	None	SAN JOSE	CA	95112	6192	00	06000	37.308636	-121.8664102	Santa Clara County
331764	Ordering, Referring, Prescribing	N/A	1407104854	0	0	ALCALA, KARINA E	3/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100842	N/A	N/A	N/A	N/A	N/A	47825 OASIS STREET	None	INDIO	CA	92201	6950	00	06000	33.70112861	-116.2209066	Riverside County
331783	Ordering, Referring, Prescribing	N/A	1407132871	0	0	ALEJO-MEDINA, RANDY PHARMD	3/20/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH47532	N/A	N/A	N/A	N/A	N/A	1213 FAIR OAKS AVE	None	SOUTH PASADENA	CA	91030	0000	00	06000	34.11153	-118.1505165	Los Angeles County
331793	Ordering, Referring, Prescribing	N/A	1407163884	0	0	ANDAR, MARIAM NP	3/23/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	20662	N/A	N/A	N/A	N/A	N/A	751 MEDICAL CENTER CT	None	CHULA VISTA	CA	91911	6617	00	06000	32.61822301	-117.0234938	San Diego County
331797	Ordering, Referring, Prescribing	N/A	1407159429	0	0	ANDREWS, JENNY PA	9/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	56754	N/A	N/A	N/A	N/A	N/A	316 S STRATFORD AVE	STE B	SANTA MARIA	CA	93454	5908	00	06000	34.95019447	-120.4147816	Santa Barbara County
331832	Ordering, Referring, Prescribing	N/A	1407239403	0	0	AFSHAR, NEDA NP	2/10/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95001962	N/A	N/A	N/A	N/A	N/A	7600 HOSPITAL DR	J	SACRAMENTO	CA	95823	5406	00	06000	38.463876	-121.414698	Sacramento County
331868	Ordering, Referring, Prescribing	N/A	1407304306	0	0	AVERBACH, RACHELLE F LMFT	7/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	23824	N/A	N/A	N/A	N/A	N/A	3230 KERNER BLVD	None	SAN RAFAEL	CA	94901	4840	00	06000	37.96037915	-122.5019455	Marin County
331873	Ordering, Referring, Prescribing	N/A	1407305253	0	0	AL HAWASLI, IMAN A LCSW	9/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW86268	N/A	N/A	N/A	N/A	N/A	5 MAREBLU SUITE 100	None	ALISO VIEJO	CA	92656	3014	00	06000	33.57250566	-117.7027366	Orange County
331884	Ordering, Referring, Prescribing	N/A	1407323322	0	0	ALBU, LUCIA	10/26/2018	Taxonomy not applicable	NA	n/a	000	Unknown	56217	N/A	N/A	N/A	N/A	N/A	3701 J ST	STE 201	SACRAMENTO	CA	95816	5542	00	06000	38.571237	-121.4566245	Sacramento County
331902	Ordering, Referring, Prescribing	N/A	1407344948	0	0	ALIDOOST, MARJAN MD	7/23/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A174046	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
331909	Ordering, Referring, Prescribing	N/A	1407353600	0	0	ABDELKARIM, AYMAN J MD	11/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164817	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
331930	Ordering, Referring, Prescribing	N/A	1407364292	0	0	ARELLANO, HAILEY H LMFT	1/12/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130578	N/A	N/A	N/A	N/A	N/A	3400 DOUGLAS BLVD	None	ROSEVILLE	CA	95661	4278	00	06000	38.74390969	-121.2319271	Placer County
331933	Ordering, Referring, Prescribing	N/A	1407384456	0	0	AHMAD, AMMAR A MD	2/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164323	N/A	N/A	N/A	N/A	N/A	1600 E BELLE TER	None	BAKERSFIELD	CA	93307	3871	00	06000	35.34672702	-118.9837495	Kern County
331935	Ordering, Referring, Prescribing	N/A	1407385149	0	0	AGYEMANG-BOAKYE, GILBERT NP	6/22/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	827478	N/A	N/A	N/A	N/A	N/A	11711 SAND CANYON ROAD	None	YUCAIPA	CA	92354	3155	00	06000	34.03910186	-117.1061254	San Bernardino County
331936	Ordering, Referring, Prescribing	N/A	1407388226	0	0	ALVAREZ, ABIGAIL A NP	3/6/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006107	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
331944	Ordering, Referring, Prescribing	N/A	1407415144	0	0	AGWUMEZIE, JULITA C	3/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	57751	N/A	N/A	N/A	N/A	N/A	1590 SYCAMORE AVENUE	None	HERCULES	CA	94547	0001	00	06000	38.00906255	-122.2702626	Contra Costa County
331961	Ordering, Referring, Prescribing	N/A	1407469554	0	0	ALEXANDRIAN, ANDRE NP	10/15/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014960	N/A	N/A	N/A	N/A	N/A	18646 OXNARD ST.	None	TARZANA	CA	91356	1411	00	06000	34.17993229	-118.5397265	Los Angeles County
331999	Ordering, Referring, Prescribing	N/A	1407578354	0	0	AMMON, ALONDRA M MA OTR	9/21/2021	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	18414	N/A	N/A	N/A	N/A	N/A	2686 SPRING ST	None	REDWOOD CITY	CA	94063	3522	00	06000	37.48231745	-122.2081659	San Mateo County
332000	Ordering, Referring, Prescribing	N/A	1407585656	0	0	ALVARADO, JOSEFINA E LMFT	7/30/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT148460	N/A	N/A	N/A	N/A	N/A	5100 S EASTERN AVE	SUITE 100	COMMERCE	CA	90040	2950	00	06000	33.98882955	-118.1615175	Los Angeles County
332021	Ordering, Referring, Prescribing	N/A	1407853690	0	0	ABIAOUI, AMAL P	9/27/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D47027	N/A	N/A	N/A	N/A	N/A	525 ROBERTS LANE	None	BAKERSFIELD	CA	93308	4799	00	06000	35.40860151	-119.0317455	Kern County
332135	Ordering, Referring, Prescribing	N/A	1417088493	0	0	AGARD, CLARISSA H LMFT	10/11/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT77670	N/A	N/A	N/A	N/A	N/A	18245 HWY 18 SUITE 6	None	APPLE VALLEY	CA	92307	2217	00	06000	34.54026632	-117.2656302	San Bernardino County
332177	Ordering, Referring, Prescribing	N/A	1417174095	0	0	ALLISON, HEIDI LCSW	9/18/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW20142	N/A	N/A	N/A	N/A	N/A	3840 WEST CHANNEL ISLAND	None	OXNARD	CA	93035	4001	00	06000	34.17563185	-119.2224935	Ventura County
332207	Ordering, Referring, Prescribing	N/A	1417239005	0	0	ARIAS, LARRY M PHARMD	2/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65675	N/A	N/A	N/A	N/A	N/A	5615 SCOTTS VALLEY DR	None	SCOTTS VALLEY	CA	95066	3492	00	06000	37.06232425	-122.0064552	Santa Cruz County
332233	Ordering, Referring, Prescribing	N/A	1417298480	0	0	AVILA-PEREZ, JESSICA M LMFT	6/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102165	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	SUITE 150	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
332239	Ordering, Referring, Prescribing	N/A	1417314485	0	0	ABELLADA, MARINEL G CNP	4/19/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006519	N/A	N/A	N/A	N/A	N/A	300 PROSPERITY BLVD	None	CHOWCHILLA	CA	93610	8498	00	06000	37.12533191	-120.2539247	Madera County
332247	Ordering, Referring, Prescribing	N/A	1417321720	0	0	AURORA, MAGI MD	12/27/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156995	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95616	9701	00	06000	38.56371578	-121.7691963	Yolo County
332251	Ordering, Referring, Prescribing	N/A	1417326174	0	0	AGUIRRE, ALEJANDRA LCSW	3/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88526	N/A	N/A	N/A	N/A	N/A	912 FREMONT ST	None	DELANO	CA	93215	2713	00	06000	35.76763031	-119.2498143	Kern County
332275	Ordering, Referring, Prescribing	N/A	1417342981	0	0	AGARWAL, DEEPAK DO	10/5/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18239	N/A	N/A	N/A	N/A	N/A	222 W PUEBLO ST	B	SANTA BARBARA	CA	93105	3805	00	06000	34.43099377	-119.7214822	Santa Barbara County
332278	Ordering, Referring, Prescribing	N/A	1417351503	0	0	ABDULLAH, AZHAR MD	2/10/2020	Taxonomy not applicable	NA	n/a	000	Unknown	A154833	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS STE 22	STE 220	MISSION VIEJO	CA	92691	6468	00	06000	33.56536541	-117.670334	Orange County
332307	Ordering, Referring, Prescribing	N/A	1417401035	0	0	AGUILAR-FUENTES, LISA LCSW	1/12/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106508	N/A	N/A	N/A	N/A	N/A	800 SCENIC DR	None	MODESTO	CA	95350	6131	00	06000	37.64722447	-120.9836925	Stanislaus County
332311	Ordering, Referring, Prescribing	N/A	1417409954	0	0	ARNOLD, JEANNE F NP	5/11/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	826287	N/A	N/A	N/A	N/A	N/A	1524 W LACEY BLVD	STE 101	HANFORD	CA	93230	5990	00	06000	36.32816338	-119.6690189	Kings County
332324	Ordering, Referring, Prescribing	N/A	1417440199	0	0	AGUILAR, JACK MD	4/13/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166084	N/A	N/A	N/A	N/A	N/A	8405 BEVERLY BLVD	LOS ANGELES CA 90028	LOS ANGELES	CA	90048	3401	00	06000	34.07607952	-118.373418	Los Angeles County
332351	Ordering, Referring, Prescribing	N/A	1417476672	0	0	ARNOLD, AARON B DC	11/26/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC33997	N/A	N/A	N/A	N/A	N/A	251 LANDIS AVENUE	None	CHULA VISTA	CA	91910	2628	00	06000	32.6425313	-117.0814859	San Diego County
332360	Ordering, Referring, Prescribing	N/A	1417488941	0	0	AN, LUCIA S MD	8/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158092	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
332366	Ordering, Referring, Prescribing	N/A	1417498759	0	0	AYANLEKE, FUNTO A	5/25/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	101236	N/A	N/A	N/A	N/A	N/A	1116 W TOKAY ST	None	LODI	CA	95240	3963	00	06000	38.12631653	-121.28661	San Joaquin County
332423	Ordering, Referring, Prescribing	N/A	1417606096	0	0	ADIGWU, YVONNE MD	8/29/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189666	N/A	N/A	N/A	N/A	N/A	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
332462	Ordering, Referring, Prescribing	N/A	1417903428	0	0	AMAYA, ZEDA G MD	4/22/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A48390	N/A	N/A	N/A	N/A	N/A	5580 CALLE REAL	None	SANTA BARBARA	CA	93111	1646	00	06000	34.44131559	-119.8184752	Santa Barbara County
332471	Ordering, Referring, Prescribing	N/A	1417926452	0	0	AQUINO, FEDERICO C DDS	11/22/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS52286	N/A	N/A	N/A	N/A	N/A	820 W BROADWAY ST	None	NEEDLES	CA	92363	2729	00	06000	34.83897407	-114.6052958	San Bernardino County
332536	Ordering, Referring, Prescribing	N/A	1427181064	0	0	ALFARO, MARIA G LMFT	1/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47737	N/A	N/A	N/A	N/A	N/A	15339 SATICOY ST	None	VAN NUYS	CA	91406	3345	00	06000	34.2084865	-118.4678505	Los Angeles County
332559	Ordering, Referring, Prescribing	N/A	1427220896	0	0	AKINS, SHERI L LMFT	3/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101384	N/A	N/A	N/A	N/A	N/A	2525 N CHESTER AVE	None	BAKERSFIELD	CA	93308	1770	00	06000	35.429463	-119.0213795	Kern County
332583	Ordering, Referring, Prescribing	N/A	1427280841	0	0	ARREOLA, JOSEFINA LCSW	6/12/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW99470	N/A	N/A	N/A	N/A	N/A	506 W JACKMAN ST	None	LANCASTER	CA	93534	2531	00	06000	34.70193469	-118.1377582	Los Angeles County
332593	Ordering, Referring, Prescribing	N/A	1427312255	0	0	ALARIE, CHARLES J LMFT	5/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT97280	N/A	N/A	N/A	N/A	N/A	2225 CHALLENGER WAY	None	SANTA ROSA	CA	95407	5441	00	06000	38.425482	-122.75262	Sonoma County
332605	Ordering, Referring, Prescribing	N/A	1427331552	0	0	AONG, TINA PHARMD	7/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65661	N/A	N/A	N/A	N/A	N/A	2500 MERCED ST	None	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
332618	Ordering, Referring, Prescribing	N/A	1427327766	0	0	ASSADI, KHATEREH A MD	10/12/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C154956	N/A	N/A	N/A	N/A	N/A	2409 NORTH BROADWAY AVEN	None	LOS ANGELES	CA	90031	2218	00	06000	34.07365452	-118.216595	Los Angeles County
332625	Ordering, Referring, Prescribing	N/A	1427363407	0	0	AVALOS-GARCIA, CLAUDIA LMFT	12/4/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT103955	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
332628	Ordering, Referring, Prescribing	N/A	1427364470	0	0	ARROYO, MICHELLE C PHARMD	3/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64568	N/A	N/A	N/A	N/A	N/A	25825 S. VERMONT	None	HARBOR CITY	CA	90710	3599	00	06000	33.7892965	-118.2937327	Los Angeles County
332630	Ordering, Referring, Prescribing	N/A	1427370618	0	0	AUNG, MOE MD	11/13/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A128745	N/A	N/A	N/A	N/A	N/A	150 N RENO ST	None	LOS ANGELES	CA	90026	4656	00	06000	34.07274763	-118.2804096	Los Angeles County
332684	Ordering, Referring, Prescribing	N/A	1427466911	0	0	ADEMA, JILLEAN LMFT	12/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT116618	N/A	N/A	N/A	N/A	N/A	3810 ROSIN CT	170	SACRAMENTO	CA	95834	1656	00	06000	38.637702	-121.474773	Sacramento County
332689	Ordering, Referring, Prescribing	N/A	1427474238	0	0	AGHAZADEH, NASTARAN PHARMD	8/2/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70427	N/A	N/A	N/A	N/A	N/A	26701 QUAIL CREEK	109	LAGUNA HILLS	CA	92656	2802	00	06000	33.57493097	-117.7036315	Orange County
332707	Ordering, Referring, Prescribing	N/A	1427494616	0	0	AVULA, HARSHITH R MD	6/26/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A141293	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
332745	Ordering, Referring, Prescribing	N/A	1427553999	0	0	AGASARKISIAN, LOUSINE MD	10/13/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A191503	N/A	N/A	N/A	N/A	N/A	45104 10TH ST W	None	LANCASTER	CA	93534	2310	00	06000	34.702929	-118.1480935	Los Angeles County
332751	Ordering, Referring, Prescribing	N/A	1427572700	0	0	ALDEN, STEVEN B NP	6/13/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	622236	N/A	N/A	N/A	N/A	N/A	12835 POINTE DEL MAR WAY	1	DEL MAR	CA	92014	3846	00	06000	32.93216216	-117.2433492	San Diego County
332779	Ordering, Referring, Prescribing	N/A	1427604347	0	0	ALBARRAN, MIGUEL A NP	4/9/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95029723	N/A	N/A	N/A	N/A	N/A	1508 GARCES HWY	SUITE 1	DELANO	CA	93215	3607	00	06000	35.76141641	-119.2369096	Kern County
332782	Ordering, Referring, Prescribing	N/A	1427619071	0	0	ASHRAF, RESHMIN MD	4/7/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177576	N/A	N/A	N/A	N/A	N/A	211 EASTMOOR AVE	None	DALY CITY	CA	94015	2036	00	06000	37.6847337	-122.4787562	San Mateo County
332791	Ordering, Referring, Prescribing	N/A	1427628247	0	0	AVETISYAN-HARVEY, LILLIE LCSW	11/13/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100984	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
332807	Ordering, Referring, Prescribing	N/A	1427670025	0	0	ACOSTA DE GONZALEZ, MARIA I MD	10/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189397	N/A	N/A	N/A	N/A	N/A	26600 CACTUS AVENUE	STE 300	MORENO VALLEY	CA	92555	3901	00	06000	33.91013953	-117.193383	Riverside County
332811	Ordering, Referring, Prescribing	N/A	1427685403	0	0	AMEGADZIE, SEAN S MD	12/10/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL5007	N/A	N/A	N/A	N/A	N/A	1930 MARKET STREET	None	SAN FRANCISCO	CA	94102	6228	00	06000	37.77037155	-122.4255051	San Francisco County
332841	Ordering, Referring, Prescribing	N/A	1427797299	0	0	ALLHEB, ZAINAB H	4/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH86036	N/A	N/A	N/A	N/A	N/A	7072 N CEDAR AVE	None	FRESNO	CA	93720	3300	00	06000	36.83844242	-119.7540735	Fresno County
332845	Ordering, Referring, Prescribing	N/A	1427818327	0	0	ADAMS, AMENA NP	2/28/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029289	N/A	N/A	N/A	N/A	N/A	347 W MISSION AVE	None	ESCONDIDO	CA	92025	1729	00	06000	33.12861918	-117.0906689	San Diego County
332852	Ordering, Referring, Prescribing	N/A	1427891159	0	0	AROSEMENA, ANGELA LCSW	5/2/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122298	N/A	N/A	N/A	N/A	N/A	1676 PASEO DEL ORO	#308	CHULA VISTA	CA	91913	0027	00	06000	32.6160371	-116.9887365	San Diego County
332870	Ordering, Referring, Prescribing	N/A	1437205853	0	0	ALOYAN, TAMARA MD	10/29/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A92239	N/A	N/A	N/A	N/A	N/A	5000 W SUNSET BLVD	SUITE 600	LOS ANGELES	CA	90027	5861	00	06000	34.0981066	-118.2986382	Los Angeles County
332878	Ordering, Referring, Prescribing	N/A	1437224466	0	0	ALEGRIA, MARCO A	9/18/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D38955	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
332947	Ordering, Referring, Prescribing	N/A	1437343902	0	0	AHUMADA, CHRISTINA G	11/12/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY22878	N/A	N/A	N/A	N/A	N/A	4760 SEPULVEDA BLVD	None	LOS ANGELES	CA	90230	4820	00	06000	34.00134941	-118.4039837	Los Angeles County
332992	Ordering, Referring, Prescribing	N/A	1437424447	0	0	ATWAL-KHANNA, SANJEEVAN	5/15/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	618061	N/A	N/A	N/A	N/A	N/A	1707 EYE ST	100	BAKERSFIELD	CA	93301	5208	00	06000	35.37461686	-119.020062	Kern County
333005	Ordering, Referring, Prescribing	N/A	1437434693	0	0	AGUILA, JENNIFER V NP	1/21/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	21338	N/A	N/A	N/A	N/A	N/A	7240 E YALE AVE	None	FRESNO	CA	93737	0007	00	06000	36.77030547	-119.6593785	Fresno County
333031	Ordering, Referring, Prescribing	N/A	1437476587	0	0	ARROYO-CONTRERAS, MARIE LMFT	7/23/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114790	N/A	N/A	N/A	N/A	N/A	1501 N IMPERIAL AVE	None	CALEXICO	CA	92231	1851	00	06000	32.68128856	-115.4986798	Imperial County
333035	Ordering, Referring, Prescribing	N/A	1437485646	0	0	AVALOS, CARLA M MSW LCSW	12/15/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29106	N/A	N/A	N/A	N/A	N/A	10605 BALBOA BLVD	SUITE 100	GRANADA HILLS	CA	91344	6342	00	06000	34.263378	-118.5022965	Los Angeles County
333037	Ordering, Referring, Prescribing	N/A	1437482098	0	0	ANDERSON, HARRIET LMFT	9/24/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84065	N/A	N/A	N/A	N/A	N/A	44349 LOWTREE AVE, SUITE	None	LANCASTER	CA	93534	4104	00	06000	34.68904178	-118.153931	Los Angeles County
333044	Ordering, Referring, Prescribing	N/A	1437503752	0	0	ABAYEV, JOSEPH N MD	12/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170046	N/A	N/A	N/A	N/A	N/A	7402 HOLLISTER AVE	None	GOLETA	CA	93117	2583	00	06000	34.42987025	-119.8878468	Santa Barbara County
333049	Ordering, Referring, Prescribing	N/A	1437505302	0	0	ANDERSEN, BRETT	8/2/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115133	N/A	N/A	N/A	N/A	N/A	22471 ASPAN ST	None	LAKE FOREST	CA	92630	1642	00	06000	33.63624985	-117.7119697	Orange County
333071	Ordering, Referring, Prescribing	N/A	1437535721	0	0	ALVARADO, YESSENIA LMFT	2/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124569	N/A	N/A	N/A	N/A	N/A	8337 TELEGRAPH RD	SUITE 300	PICO RIVERA	CA	90660	4957	00	06000	33.96454327	-118.1134473	Los Angeles County
333130	Ordering, Referring, Prescribing	N/A	1437618725	0	0	ALI, MUSAAB MD	1/5/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176137	N/A	N/A	N/A	N/A	N/A	2085 RUSTIN AVE	None	RIVERSIDE	CA	92507	2498	00	06000	33.99323085	-117.3355363	Riverside County
333134	Ordering, Referring, Prescribing	N/A	1437625571	0	0	AMARAL, MAURA M LMFT	4/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT117165	N/A	N/A	N/A	N/A	N/A	2415 UNIVERSITY AVE	301	EAST PALO ALTO	CA	94303	1164	00	06000	37.47232529	-122.139568	San Mateo County
333139	Ordering, Referring, Prescribing	N/A	1437620366	0	0	ARZATE, ADRIANA	12/7/2018	Taxonomy not applicable	NA	n/a	000	Unknown	56364	N/A	N/A	N/A	N/A	N/A	201 E LAKEVIEW AVE	None	WOODLAKE	CA	93286	1301	00	06000	36.4172997	-119.0975768	Tulare County
333141	Ordering, Referring, Prescribing	N/A	1437631926	0	0	ALDERSON, TAYLOR LMFT	8/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120638	N/A	N/A	N/A	N/A	N/A	36977 PARK AVE	None	BURNEY	CA	96013	0000	00	06000	40.87640189	-121.6730441	Shasta County
333149	Ordering, Referring, Prescribing	N/A	1437640786	0	0	ARSHAWSKY, LISA S CNM	9/23/2020	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	1674	N/A	N/A	N/A	N/A	N/A	11500 W OLYMPIC BLVD	570	LOS ANGELES	CA	90064	1524	00	06000	34.03617514	-118.4445122	Los Angeles County
333157	Ordering, Referring, Prescribing	N/A	1437654589	0	0	ABTIN, KATAYOUN DPM	9/13/2021	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5803	N/A	N/A	N/A	N/A	N/A	1726 S BENTLEY AVE	APT 302	LOS ANGELES	CA	90025	4343	00	06000	34.04717561	-118.4426094	Los Angeles County
333173	Ordering, Referring, Prescribing	N/A	1437679925	0	0	ALBURY, JANNEL Y NP	10/15/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007590	N/A	N/A	N/A	N/A	N/A	31180 ROAD 72	None	GOSHEN	CA	93227	9997	00	06000	36.35594779	-119.4124242	Tulare County
333200	Ordering, Referring, Prescribing	N/A	1437715273	0	0	ARGABRIGHT, ALLISON	5/22/2018	Taxonomy not applicable	NA	n/a	000	Unknown	2780	N/A	N/A	N/A	N/A	N/A	1331 E CALAVERAS BLVD	None	MILPITAS	CA	95035	5707	00	06000	37.43600807	-121.8825011	Santa Clara County
333215	Ordering, Referring, Prescribing	N/A	1437760410	0	0	AUNG, KELVIN PHARMD	8/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH80575	N/A	N/A	N/A	N/A	N/A	1360 E PACHECO BLVD	None	LOS BANOS	CA	93635	4938	00	06000	37.0569817	-120.8344525	Merced County
333216	Ordering, Referring, Prescribing	N/A	1437762853	0	0	ASSADI, FEROZE NP	10/20/2020	Taxonomy not applicable	NA	n/a	000	Unknown	95015725	N/A	N/A	N/A	N/A	N/A	3701 J ST	201	SACRAMENTO	CA	95816	5562	00	06000	38.571237	-121.4566245	Sacramento County
333229	Ordering, Referring, Prescribing	N/A	1437768017	0	0	ALYAS, ALISIA PA-C	1/2/2023	Taxonomy not applicable	NA	n/a	000	Unknown	58466	N/A	N/A	N/A	N/A	N/A	165 S FIRST ST	None	EL CAJON	CA	92019	4795	00	06000	32.794002	-116.944563	San Diego County
333263	Ordering, Referring, Prescribing	N/A	1437862968	0	0	ADEFRIS, SENAIT NP	5/26/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023455	N/A	N/A	N/A	N/A	N/A	3500 WHITTIER BLVD	107	LOS ANGELES	CA	90023	1746	00	06000	34.02656881	-118.1982818	Los Angeles County
333279	Ordering, Referring, Prescribing	N/A	1437896446	0	0	AGHABEKYAN, ANNA NP	5/16/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020630	N/A	N/A	N/A	N/A	N/A	801 S CHEVY CHASE DR	250	GLENDALE	CA	91205	4431	00	06000	34.136757	-118.2396195	Los Angeles County
333309	Ordering, Referring, Prescribing	N/A	1447290432	0	0	ACOSTA-PEREZ, SIGFREDO MD	4/19/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G89403	N/A	N/A	N/A	N/A	N/A	1310 HANNA AVE	STE 1 & 3	CORCORAN	CA	93212	2314	00	06000	36.09975818	-119.5641426	Kings County
333310	Ordering, Referring, Prescribing	N/A	1447265137	0	0	AWDYKOVYCH, MARTA MD	11/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A44027	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
333468	Ordering, Referring, Prescribing	N/A	1447636329	0	0	ALVARADO, JEREMY J LCSW	12/27/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	106346	N/A	N/A	N/A	N/A	N/A	349 E K6	A	LANCASTER	CA	93535	9353	00	06000	34.66949452	-118.1244465	Los Angeles County
333477	Ordering, Referring, Prescribing	N/A	1447647045	0	0	AMIHYIA, AMMA B PHARMD	10/26/2019	Taxonomy not applicable	NA	n/a	000	Unknown	46340	N/A	N/A	N/A	N/A	N/A	3630 SMITH AVE	A	ACTON	CA	93510	2500	00	06000	34.46808762	-118.1958834	Los Angeles County
333483	Ordering, Referring, Prescribing	N/A	1447652516	0	0	ALVARO, EPHRAIM PHARMD	7/14/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71524	N/A	N/A	N/A	N/A	N/A	1344 W REDONDO BEACH BLV	None	GARDENA	CA	90247	3356	00	06000	33.89151984	-118.299757	Los Angeles County
333489	Ordering, Referring, Prescribing	N/A	1447670245	0	0	ARCHER, ANDREW F MD	6/12/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156287	N/A	N/A	N/A	N/A	N/A	592 RIO LINDO AVE	None	CHICO	CA	95926	1817	00	06000	39.75427022	-121.8482553	Butte County
333502	Ordering, Referring, Prescribing	N/A	1447681994	0	0	ALVAREZ, ENRIQUE B LCSW	6/25/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	62393	N/A	N/A	N/A	N/A	N/A	828 SOUTH BASCOM AV	None	SAN JOSE	CA	95128	0000	00	06000	37.31225204	-121.9317854	Santa Clara County
333541	Ordering, Referring, Prescribing	N/A	1447732409	0	0	ALVAREZ-NUTTING, MARY NP	10/29/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010112	N/A	N/A	N/A	N/A	N/A	1898 THE ALAMEDA	None	SAN JOSE	CA	95126	0000	00	06000	37.34062947	-121.9227747	Santa Clara County
333542	Ordering, Referring, Prescribing	N/A	1447732821	0	0	AGUILAR, DOLORES LPCC	3/20/2023	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC13437	N/A	N/A	N/A	N/A	N/A	2001 28TH STREET	None	BAKERSFIELD	CA	93301	1924	00	06000	35.38486605	-119.0251102	Kern County
333578	Ordering, Referring, Prescribing	N/A	1447790696	0	0	AFEK, ADI V RN	9/25/2018	Taxonomy not applicable	NA	n/a	000	Unknown	95100236	N/A	N/A	N/A	N/A	N/A	1650 VALENCIA STREET	None	SAN FRANCISCO	CA	94110	0000	00	06000	37.74617273	-122.4201514	San Francisco County
333610	Ordering, Referring, Prescribing	N/A	1447870522	0	0	ALVARADO, CAMILA D MD	3/21/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A185010	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	None	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
333612	Ordering, Referring, Prescribing	N/A	1447887666	0	0	ANG, KWAN-KEAT MD	4/18/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A177850	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
333628	Ordering, Referring, Prescribing	N/A	1447927538	0	0	AVILA, ANGELICA M NP	10/31/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025556	N/A	N/A	N/A	N/A	N/A	1500 6TH AVE	None	DELANO	CA	93215	3011	00	06000	35.76504054	-119.236779	Kern County
333647	Ordering, Referring, Prescribing	N/A	1457015026	0	0	AMORELLI, DANIELLE L LMFT	10/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	44357	N/A	N/A	N/A	N/A	N/A	438 EDDIE LN	None	SEBASTOPOL	CA	95472	3425	00	06000	38.40853221	-122.8216073	Sonoma County
333648	Ordering, Referring, Prescribing	N/A	1457020398	0	0	ABBE, BRIE A CNM	12/6/2021	Taxonomy not applicable	NA	n/a	082	LICENSED MIDWIVES	236227	N/A	N/A	N/A	N/A	N/A	333 LAWS AVE	None	UKIAH	CA	95482	6540	00	06000	39.12772164	-123.2111168	Mendocino County
333649	Ordering, Referring, Prescribing	N/A	1447984505	0	0	ALSAAD, MAIADA M PHARMD	4/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH86079	N/A	N/A	N/A	N/A	N/A	4029 43RD ST	700	SAN DIEGO	CA	92105	1510	00	06000	32.75012697	-117.1019424	San Diego County
333655	Ordering, Referring, Prescribing	N/A	1457027476	0	0	ALEKSEEV, IGOR	1/10/2024	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	18847	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL ST	None	SAN FRANCISCO	CA	94110	1390	00	06000	37.76460716	-122.416335	San Francisco County
333658	Ordering, Referring, Prescribing	N/A	1457041683	0	0	AWAD, ABANOUB PA	10/13/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63500	N/A	N/A	N/A	N/A	N/A	6368 HOLLYWOOD BLVD	None	LOS ANGELES	CA	90028	6320	00	06000	34.1015865	-118.328976	Los Angeles County
333706	Ordering, Referring, Prescribing	N/A	1457408585	0	0	AZIMA, SHOHREH LMFT	1/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT42886	N/A	N/A	N/A	N/A	N/A	6931 VAN NUYS BLVD.	102	VAN NUYS	CA	91405	3980	00	06000	34.19649	-118.448787	Los Angeles County
333726	Ordering, Referring, Prescribing	N/A	1457472565	0	0	AGUIRRE, GAIL M LCSW	3/10/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW21442	N/A	N/A	N/A	N/A	N/A	1950 ALAMEDA DE LAS PULG	None	SAN MATEO	CA	94403	1222	00	06000	37.545779	-122.3213093	San Mateo County
333731	Ordering, Referring, Prescribing	N/A	1457474033	0	0	ARENE, TAGBO E MD MPH	1/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139396	N/A	N/A	N/A	N/A	N/A	303 E. VANDERBILT WAY CO	None	SAN BERNARDINO	CA	92415	2804	00	06000	34.06872265	-117.2775832	San Bernardino County
333749	Ordering, Referring, Prescribing	N/A	1457507667	0	0	ANGEL, ERIKA S PHARMD	3/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60118	N/A	N/A	N/A	N/A	N/A	84 RIO SERENA AVE	None	CAMPBELL	CA	95008	1523	00	06000	37.28755146	-121.9788714	Santa Clara County
333754	Ordering, Referring, Prescribing	N/A	1457502650	0	0	ALBERT, LISA LCSW	12/16/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	18564	N/A	N/A	N/A	N/A	N/A	501 N BROOKHURST ST	320	ANAHEIM	CA	92801	5226	00	06000	33.8384428	-117.9590628	Orange County
333778	Ordering, Referring, Prescribing	N/A	1457552267	0	0	ALQUIJAY, JENNIFER E PSYD	7/6/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	19035	N/A	N/A	N/A	N/A	N/A	1125 W 6TH ST	None	LOS ANGELES	CA	90017	1893	00	06000	34.05441139	-118.2628642	Los Angeles County
333810	Ordering, Referring, Prescribing	N/A	1457636946	0	0	AWUAH, EUGENE K	10/2/2022	Taxonomy not applicable	NA	n/a	000	Unknown	56137	N/A	N/A	N/A	N/A	N/A	3500 COFFEE RD	None	MODESTO	CA	95355	1305	00	06000	37.690002	-120.976061	Stanislaus County
333814	Ordering, Referring, Prescribing	N/A	1457641383	0	0	ANDREWS, JULIE LCSW	8/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93765	N/A	N/A	N/A	N/A	N/A	137 N COTTONWOOD ST	None	WOODLAND	CA	95695	6646	00	06000	38.68538399	-121.7933582	Yolo County
333832	Ordering, Referring, Prescribing	N/A	1457668188	0	0	ASADI, NAZANIN K PHARMD	7/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56184	N/A	N/A	N/A	N/A	N/A	20505 SHERMAB WAY	None	CANOGA PARK	CA	91306	3427	00	06000	34.20115951	-118.5802425	Los Angeles County
333838	Ordering, Referring, Prescribing	N/A	1457687204	0	0	ATALLA, MARTA	5/8/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A121879	N/A	N/A	N/A	N/A	N/A	557 N. MACLAY AVE, SAN F	101-102	SAN FERNANDO	CA	91340	2424	00	06000	34.28872206	-118.4339388	Los Angeles County
333870	Ordering, Referring, Prescribing	N/A	1457739203	0	0	ALAM, HIRA H	11/4/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	100846	N/A	N/A	N/A	N/A	N/A	420 S GLENDORA AVE	None	WEST COVINA	CA	91790	3001	00	06000	34.06750236	-117.925203	Los Angeles County
333893	Ordering, Referring, Prescribing	N/A	1457770273	0	0	ANTONYAN, ALBERT MD	6/4/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156298	N/A	N/A	N/A	N/A	N/A	1125 E 17TH ST.	SUITE W248	SANTA ANA	CA	92701	2205	00	06000	33.76004145	-117.854838	Orange County
333925	Ordering, Referring, Prescribing	N/A	1457816464	0	0	ANJOMSHOAA, SAHAR PHARMD	12/13/2019	Taxonomy not applicable	NA	n/a	000	Unknown	73761	N/A	N/A	N/A	N/A	N/A	1235 STRATFORD AVE	None	DIXON	CA	95620	2024	00	06000	38.45801447	-121.838922	Solano County
333932	Ordering, Referring, Prescribing	N/A	1457820763	0	0	ABAEZE, NNENNA NP	3/28/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016894	N/A	N/A	N/A	N/A	N/A	ONE WASHINGTON	None	SAN JOSE	CA	95112	2222	00	06000	37.33435188	-121.8806371	Santa Clara County
333980	Ordering, Referring, Prescribing	N/A	1457882169	0	0	ALCAZAR, SHERRY I LMFT	7/6/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119967	N/A	N/A	N/A	N/A	N/A	1420 WILLOW PASS RD	SUITE 200	CONCORD	CA	94520	5823	00	06000	37.96956948	-122.0507563	Contra Costa County
333991	Ordering, Referring, Prescribing	N/A	1457895856	0	0	ALLAN, BETH C NP	8/5/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	639575	N/A	N/A	N/A	N/A	N/A	1045 N LAKE AVE	None	PASADENA	CA	91104	4521	00	06000	34.16394511	-118.1324885	Los Angeles County
334003	Ordering, Referring, Prescribing	N/A	1457912016	0	0	AMBIKA-RAJENDRAN, MINU MD	8/25/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181521	N/A	N/A	N/A	N/A	N/A	1081 NORTH CHINA LAKE BO	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
334011	Ordering, Referring, Prescribing	N/A	1457939928	0	0	ASKAR, MINA N MD	6/23/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187343	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
334035	Ordering, Referring, Prescribing	N/A	1457990632	0	0	ALSALIHI, ABDULLA N PHARMD	7/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	81474	N/A	N/A	N/A	N/A	N/A	1492 BLUE OAKS BLVD	None	ROSEVILLE	CA	95747	0000	00	06000	38.79553451	-121.3278885	Placer County
334075	Ordering, Referring, Prescribing	N/A	1467079145	0	0	ALTERMAN-PARADISO, GRACE A LCSW	2/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94166	N/A	N/A	N/A	N/A	N/A	522 S SAN PEDRO ST	None	LOS ANGELES	CA	90013	2102	00	06000	34.0436196	-118.2442541	Los Angeles County
334085	Ordering, Referring, Prescribing	N/A	1467088492	0	0	ADA, MELISSA R MD	2/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL3444	N/A	N/A	N/A	N/A	N/A	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	00	06000	33.78034779	-117.8655767	Orange County
334131	Ordering, Referring, Prescribing	N/A	1467423772	0	0	ACOSTA, JUAN M MD	10/1/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A66595	N/A	N/A	N/A	N/A	N/A	52565 HARRISON STREET	SUITE 104	COACHELLA	CA	92236	1534	00	06000	33.71023983	-116.1827622	Riverside County
334155	Ordering, Referring, Prescribing	N/A	1467516369	0	0	AZARMIPUR, MALLY OD	5/24/2022	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	12512	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
334198	Ordering, Referring, Prescribing	N/A	1467638254	0	0	ALMAGUER, JENNIFER D LPCC	9/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC10245	N/A	N/A	N/A	N/A	N/A	9431 HAVEN AVE	SUITE 100	RANCHO CUCAMONGA	CA	91730	5878	00	06000	34.082244	-117.5756135	San Bernardino County
334206	Ordering, Referring, Prescribing	N/A	1467647982	0	0	ANDREWS, TODD PSYD	3/30/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY29927	N/A	N/A	N/A	N/A	N/A	815 HYDE ST	100	SAN FRANCISCO	CA	94109	5996	00	06000	37.78855	-122.416917	San Francisco County
334227	Ordering, Referring, Prescribing	N/A	1467693903	0	0	ARRATOONIAN, ARLET S	6/26/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS47446	N/A	N/A	N/A	N/A	N/A	6001 E. WASHINGTON BLVD	None	COMMERCE	CA	90040	2451	00	06000	33.99703164	-118.1499826	Los Angeles County
334229	Ordering, Referring, Prescribing	N/A	1467692061	0	0	ANDERSON, REBECCA R LMFT	6/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48490	N/A	N/A	N/A	N/A	N/A	438 N. WHITE RD	None	SAN JOSE	CA	95127	0126	00	06000	37.3776149	-121.8374887	Santa Clara County
334272	Ordering, Referring, Prescribing	N/A	1467737403	0	0	AGUILAR, JANETT	9/15/2015	Taxonomy not applicable	NA	n/a	000	Unknown	51899	N/A	N/A	N/A	N/A	N/A	4211 S AVALON BLVD	None	LOS ANGELES	CA	90011	5622	00	06000	34.007238	-118.2653065	Los Angeles County
334302	Ordering, Referring, Prescribing	N/A	1467817510	0	0	ABILLE, GINEVEVE CHARMAINE V LMFT	12/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123845	N/A	N/A	N/A	N/A	N/A	21455 BIRCH ST.	STE. 201	HAYWARD	CA	94541	2165	00	06000	37.68159734	-122.0935159	Alameda County
334311	Ordering, Referring, Prescribing	N/A	1467828921	0	0	ANDERSON, JOSIE M LMFT	6/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT87262	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	STE. 210	OXNARD	CA	92036	0673	00	06000	34.219566	-119.1539365	Ventura County
334335	Ordering, Referring, Prescribing	N/A	1467858589	0	0	ARROYO, ANDREA LCSW	4/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW82149	N/A	N/A	N/A	N/A	N/A	2000 ALAMEDA DE LAS PULG	200	SAN MATEO	CA	94403	1293	00	06000	37.54524373	-122.3205511	San Mateo County
334341	Ordering, Referring, Prescribing	N/A	1467867135	0	0	ARDESHANA, MOHITKUMAR MD	5/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A146912	N/A	N/A	N/A	N/A	N/A	995 W FOOTHILL BLVD	None	CLAREMONT	CA	91711	3304	00	06000	34.10715052	-117.7342425	Los Angeles County
334376	Ordering, Referring, Prescribing	N/A	1467908251	0	0	AKEL, IMAD MD	7/22/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159901	N/A	N/A	N/A	N/A	N/A	7950 CHERRY AVE STE 105	STE 105	FONTANA	CA	92336	4023	00	06000	34.109667	-117.4887355	San Bernardino County
334401	Ordering, Referring, Prescribing	N/A	1467947903	0	0	ANDERSON, CHICONIA LMFT	1/3/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	123051	N/A	N/A	N/A	N/A	N/A	9713 SANTA MONICA BLVD.	201	BEVERLY HILLS	CA	90210	4236	00	06000	34.06835061	-118.4076858	Los Angeles County
334405	Ordering, Referring, Prescribing	N/A	1467951038	0	0	ANTONIOLI, STEPHANIE LMFT	2/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	41205	N/A	N/A	N/A	N/A	N/A	499 LOMA ALTA AVE	None	LOS GATOS	CA	95030	6627	00	06000	37.21747493	-121.9662128	Santa Clara County
334442	Ordering, Referring, Prescribing	N/A	1477013068	0	0	AU, ANDY PHARMD	7/5/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH79791	N/A	N/A	N/A	N/A	N/A	1750 NORIEGA ST	None	SAN FRANCISCO	CA	94122	4308	00	06000	37.75400557	-122.4826488	San Francisco County
334459	Ordering, Referring, Prescribing	N/A	1477045870	0	0	ACEVES, ALEJANDRA LCSW	8/26/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	125494	N/A	N/A	N/A	N/A	N/A	439 W. 97TH STREET	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
334476	Ordering, Referring, Prescribing	N/A	1477079242	0	0	ADAMS, AERON R CNP	12/1/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016135	N/A	N/A	N/A	N/A	N/A	41870 GARSTIN DR	None	BIG BEAR LAKE	CA	92315	2088	00	06000	34.24602097	-116.8885243	San Bernardino County
334479	Ordering, Referring, Prescribing	N/A	1477067239	0	0	AMOS, MADISON E PA-C	5/24/2023	Taxonomy not applicable	NA	n/a	000	Unknown	62769	N/A	N/A	N/A	N/A	N/A	501 S. SHORE CENTER WEST	STE 103-A	ALAMEDA	CA	94501	5762	00	06000	37.75884896	-122.2528366	Alameda County
334497	Ordering, Referring, Prescribing	N/A	1477108470	0	0	AKAKPO MAXWELL, BELINDA NP	12/23/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95012180	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
334504	Ordering, Referring, Prescribing	N/A	1477126613	0	0	ABRAMS, TARA G LCSW	7/17/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW116578	N/A	N/A	N/A	N/A	N/A	1303 SAN CARLOS AVE	None	SAN CARLOS	CA	94070	2317	00	06000	37.50572931	-122.2621879	San Mateo County
334525	Ordering, Referring, Prescribing	N/A	1477178465	0	0	ARAIZA, DAVID N MD	5/4/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A186047	N/A	N/A	N/A	N/A	N/A	701 E CHANNEL ST	None	STOCKTON	CA	95202	2628	00	06000	37.95604528	-121.2821834	San Joaquin County
334530	Ordering, Referring, Prescribing	N/A	1477181212	0	0	ALRADDAWI, SHAHLAN	7/3/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197476	N/A	N/A	N/A	N/A	N/A	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	00	06000	34.03781261	-118.3755101	Los Angeles County
334573	Ordering, Referring, Prescribing	N/A	1477370435	0	0	ARNOLD, ELIZABETH A NP	7/9/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95031025	N/A	N/A	N/A	N/A	N/A	808 W 58TH STREET	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
334618	Ordering, Referring, Prescribing	N/A	1477625713	0	0	AQUINO, SANDRA C MD	3/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A80025	N/A	N/A	N/A	N/A	N/A	1720 E 120TH ST	None	LOS ANGELES	CA	90059	3052	00	06000	33.92455929	-118.2423557	Los Angeles County
334625	Ordering, Referring, Prescribing	N/A	1477629970	0	0	ANDERSEN, CLAYTON A DC	10/18/2017	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	11545	N/A	N/A	N/A	N/A	N/A	161 NORTH MILL STREET	None	TEHACHAPI	CA	93561	2523	00	06000	35.13410412	-118.4520157	Kern County
334647	Ordering, Referring, Prescribing	N/A	1477685220	0	0	ABERLE, KIMBERLY N LMFT	12/9/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47059	N/A	N/A	N/A	N/A	N/A	11716 ENTERPRISE DR	None	AUBURN	CA	95603	3732	00	06000	38.90720197	-121.0838099	Placer County
334672	Ordering, Referring, Prescribing	N/A	1477746972	0	0	ANDERSON, PATRICIA G LMFT	4/14/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	39975	N/A	N/A	N/A	N/A	N/A	226 W OJAI AVE.	STE 101-180	OJAI	CA	93023	3277	00	06000	34.44760276	-119.2488095	Ventura County
334700	Ordering, Referring, Prescribing	N/A	1477800191	0	0	AHNLUND, CAROL H PHARMD	4/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	70403	N/A	N/A	N/A	N/A	N/A	951 PALOMAR AIRPORT RD	None	CARLSBAD	CA	92011	1110	00	06000	33.12192014	-117.3157437	San Diego County
334707	Ordering, Referring, Prescribing	N/A	1477809036	0	0	ARELLANES, MARIAH LMFT	1/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	91507	N/A	N/A	N/A	N/A	N/A	1812 W PARK	None	REDLANDS	CA	92373	8014	00	06000	34.05931058	-117.216243	San Bernardino County
334717	Ordering, Referring, Prescribing	N/A	1477820264	0	0	ARTEAGA, MONICA LCSW	3/14/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW67599	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
334726	Ordering, Referring, Prescribing	N/A	1477837458	0	0	ARREDONDO, OLGA LMFT	4/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT108174	N/A	N/A	N/A	N/A	N/A	40 E MINARETS AVE	None	PINEDALE	CA	93650	1239	00	06000	36.84269447	-119.7897525	Fresno County
334761	Ordering, Referring, Prescribing	N/A	1477906576	0	0	ANDAKYAN, ARTHUR PHARMD	2/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH73211	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPARTMENT 190	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
334824	Ordering, Referring, Prescribing	N/A	1477999399	0	0	ADAMONIS JR, ADAM W	10/30/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D62919	N/A	N/A	N/A	N/A	N/A	732 MOTT ST	STE 110	SAN FERNANDO	CA	91340	4240	00	06000	34.27661761	-118.4442372	Los Angeles County
334852	Ordering, Referring, Prescribing	N/A	1487033379	0	0	ASSALI, OMAR W	3/24/2018	Taxonomy not applicable	NA	n/a	000	Unknown	45465	N/A	N/A	N/A	N/A	N/A	450 E CYPRESS AVE	None	REDLANDS	CA	92373	6115	00	06000	34.04965529	-117.1723119	San Bernardino County
334856	Ordering, Referring, Prescribing	N/A	1487030656	0	0	AMADI, ADAMMA T NP	6/9/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95002583	N/A	N/A	N/A	N/A	N/A	4137 VERDUGO RD	None	LOS ANGELES	CA	90065	3820	00	06000	34.1261475	-118.2319835	Los Angeles County
334869	Ordering, Referring, Prescribing	N/A	1487052601	0	0	ALIG-DIMALANTA, ERIN LMFT	3/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105131	N/A	N/A	N/A	N/A	N/A	1965 LIVE OAK BLVD	None	YUBA CITY	CA	95991	8850	00	06000	39.15563037	-121.620091	Sutter County
334947	Ordering, Referring, Prescribing	N/A	1487152054	0	0	AZUELA, LAUREN Y NP	2/18/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013110	N/A	N/A	N/A	N/A	N/A	615 W CIVIC CENTER DR	None	SANTA ANA	CA	92701	4006	00	06000	33.75157048	-117.8744355	Orange County
334967	Ordering, Referring, Prescribing	N/A	1487175071	0	0	ALAM, AMMAR MD	9/10/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170125	N/A	N/A	N/A	N/A	N/A	301 THE CITY DR S	2090	ORANGE	CA	92868	3205	00	06000	33.78547994	-117.8888036	Orange County
335013	Ordering, Referring, Prescribing	N/A	1487270294	0	0	AMPARO, ANNABETH LMFT	12/3/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115164	N/A	N/A	N/A	N/A	N/A	355 TUOLUMNE STREET	SUITE 1200	VALLEJO	CA	94590	5700	00	06000	38.10261225	-122.2382555	Solano County
335016	Ordering, Referring, Prescribing	N/A	1487245833	0	0	ARRUE, CLAUDIA M NP	2/6/2024	Taxonomy not applicable	NA	n/a	000	Unknown	95014069	N/A	N/A	N/A	N/A	N/A	1919 W 7TH STREET	None	LOS ANGELES	CA	90025	7042	00	06000	34.05575686	-118.2751751	Los Angeles County
335053	Ordering, Referring, Prescribing	N/A	1487371530	0	0	ARORA, SANDEEP DMD	10/19/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS108296	N/A	N/A	N/A	N/A	N/A	200 E ANAHEIM ST	None	WILMINGTON	CA	90744	4516	00	06000	33.78003976	-118.2608958	Los Angeles County
335115	Ordering, Referring, Prescribing	N/A	1487746855	0	0	ALSHEIKH, HUDA Y MD	10/17/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C133872	N/A	N/A	N/A	N/A	N/A	8881 FLETCHER PKWY	200	LA MESA	CA	91942	3135	00	06000	32.78442148	-117.0073814	San Diego County
335128	Ordering, Referring, Prescribing	N/A	1487778569	0	0	ADAMS, JAMES R LMFT	9/8/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	39400	N/A	N/A	N/A	N/A	N/A	10776 FREMONT ST.	None	YUCAIPA	CA	92399	9630	00	06000	34.058052	-117.0280305	San Bernardino County
335131	Ordering, Referring, Prescribing	N/A	1487778650	0	0	ANDREWS, DINA LCSW	12/29/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	15114	N/A	N/A	N/A	N/A	N/A	1301 PINE AVE.	None	LONG BEACH	CA	90813	3124	00	06000	33.782913	-118.192417	Los Angeles County
335141	Ordering, Referring, Prescribing	N/A	1487786356	0	0	ANTYPAS, JOSEPH S	6/28/1993	Taxonomy not applicable	NA	n/a	099	DENTIST	D40525	N/A	N/A	N/A	N/A	N/A	3324 SANTA FE ST	STE B	RIVERBANK	CA	95367	2317	00	06000	37.73599025	-120.9348606	Stanislaus County
335152	Ordering, Referring, Prescribing	N/A	1487796470	0	0	ABNOOSIAN, CARLA R LCSW	3/7/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28438	N/A	N/A	N/A	N/A	N/A	2035 E. BALL RD	None	ANAHEIM	CA	92861	6425	00	06000	33.81812448	-117.8880075	Orange County
335169	Ordering, Referring, Prescribing	N/A	1487848164	0	0	AN, REGINA LCSW	12/19/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW26730	N/A	N/A	N/A	N/A	N/A	1515 W MISSION RD	None	ALHAMBRA	CA	91803	1618	00	06000	34.08224297	-118.1404375	Los Angeles County
335212	Ordering, Referring, Prescribing	N/A	1487948345	0	0	AYALA, LILLIE R PHARMD	3/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	62709	N/A	N/A	N/A	N/A	N/A	1755 HACIENDA DR	None	VISTA	CA	92081	4546	00	06000	33.18744941	-117.2759225	San Diego County
335217	Ordering, Referring, Prescribing	N/A	1487954475	0	0	ARRE, JOHN R PHARMD	3/16/2018	Taxonomy not applicable	NA	n/a	000	Unknown	43614	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS SEC2-B	BOISE	ID	83706	0000	00	06000	43.59860438	-116.1806635	Ada County
335219	Ordering, Referring, Prescribing	N/A	1487961884	0	0	ALMARIO, BELINDA V LMFT	3/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	88858	N/A	N/A	N/A	N/A	N/A	4565 CALIFORNIA AVE	None	LONG BEACH	CA	90807	1507	00	06000	33.841926	-118.1822395	Los Angeles County
335239	Ordering, Referring, Prescribing	N/A	1487990396	0	0	ASPACHER, GREGG S PHARMD	8/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	43353	N/A	N/A	N/A	N/A	N/A	1 CAMINO ALTO	None	MILL VALLEY	CA	94941	2974	00	06000	37.89413915	-122.5301214	Marin County
335244	Ordering, Referring, Prescribing	N/A	1497003578	0	0	ADAMS, ROBYN C LCSW	6/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW74359	N/A	N/A	N/A	N/A	N/A	1260 MORENA BLVD	STE 100	SAN DIEGO	CA	92110	3889	00	06000	32.77077343	-117.2018542	San Diego County
335256	Ordering, Referring, Prescribing	N/A	1497019806	0	0	AHMADI, NASER MD	7/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A132282	N/A	N/A	N/A	N/A	N/A	2050 FAIRMONT DR	2 BLDG. C-D	SAN LEANDRO	CA	94578	1001	00	06000	37.710738	-122.1146415	Alameda County
335275	Ordering, Referring, Prescribing	N/A	1497040430	0	0	AKRE, KAREN A LMFT	1/6/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	137026	N/A	N/A	N/A	N/A	N/A	1407 GARDEN STREET	None	SAN LUIS OBISPO	CA	93401	3917	00	06000	35.27698986	-120.661399	San Luis Obispo County
335291	Ordering, Referring, Prescribing	N/A	1497071443	0	0	ABESA, MARIA R MD	11/11/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A124305	N/A	N/A	N/A	N/A	N/A	4725 MARKET ST	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
335299	Ordering, Referring, Prescribing	N/A	1497095707	0	0	ANWAR, TAHIR M DO	7/6/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15147	N/A	N/A	N/A	N/A	N/A	228 W MCDOWELL AVE	None	ALTURAS	CA	96101	3934	00	06000	41.48004239	-120.5440923	Modoc County
335336	Ordering, Referring, Prescribing	N/A	1497146526	0	0	ANGELO, DESIREE LCSW	5/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92168	N/A	N/A	N/A	N/A	N/A	982 MISSION ST	None	SAN FRANCISCO	CA	94103	2911	00	06000	37.7813638	-122.4082438	San Francisco County
335346	Ordering, Referring, Prescribing	N/A	1497157036	0	0	APGAR, DANIEL C LMFT	12/10/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113864	N/A	N/A	N/A	N/A	N/A	101 CIRBY HILLS DR	None	ROSEVILLE	CA	95678	4360	00	06000	38.7303989	-121.2872592	Placer County
335358	Ordering, Referring, Prescribing	N/A	1497173694	0	0	AIKOYE, SALISU A MD	6/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A154761	N/A	N/A	N/A	N/A	N/A	1627 S HARGRAVE ST	None	BANNING	CA	92220	6169	00	06000	33.910425	-116.867936	Riverside County
335395	Ordering, Referring, Prescribing	N/A	1497237598	0	0	APOLLONIO, GABRIELLA PA	10/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	56024	N/A	N/A	N/A	N/A	N/A	1298 COAST VILLAGE RD	None	SANTA BARBARA	CA	93108	2719	00	06000	34.42163391	-119.6402236	Santa Barbara County
335434	Ordering, Referring, Prescribing	N/A	1497298798	0	0	ALVIZURES, MIRIAM LMFT	5/20/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119180	N/A	N/A	N/A	N/A	N/A	2121 W TEMPLE ST	None	LOS ANGELES	CA	90026	4915	00	06000	34.07053729	-118.268744	Los Angeles County
335440	Ordering, Referring, Prescribing	N/A	1497308084	0	0	ABUMAALI, ALNASHMI E	7/22/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34280	N/A	N/A	N/A	N/A	N/A	145 N 2ND ST	STE 101	CHOWCHILLA	CA	93610	2904	00	06000	37.12342437	-120.260796	Madera County
335447	Ordering, Referring, Prescribing	N/A	1497321020	0	0	ANDREWS, THOMAS C LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT107451	N/A	N/A	N/A	N/A	N/A	500B JEFFERSON BLVD	180	DAVIS	CA	95616	9701	00	06000	0	0	None
335470	Ordering, Referring, Prescribing	N/A	1497351597	0	0	ALEXANDER, JULIE E PA	3/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59282	N/A	N/A	N/A	N/A	N/A	4211 S. AVALON BLVD.	A	LOS ANGELES	CA	90011	1211	00	06000	34.007238	-118.2653065	Los Angeles County
335474	Ordering, Referring, Prescribing	N/A	1497398002	0	0	AYALA, VERONICA M LMFT	4/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125572	N/A	N/A	N/A	N/A	N/A	840 GUADALUPE PKWY	None	SAN JOSE	CA	95110	1714	00	06000	37.34957284	-121.9080687	Santa Clara County
335501	Ordering, Referring, Prescribing	N/A	1497463889	0	0	AHMED, HIBA DC	10/27/2022	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	36493	N/A	N/A	N/A	N/A	N/A	1999 MOWRY AVE	None	FREMONT	CA	94538	1738	00	06000	37.55783419	-121.9808484	Alameda County
335506	Ordering, Referring, Prescribing	N/A	1497471825	0	0	ALINEJAD, MOHAMMAD NP	9/13/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021186	N/A	N/A	N/A	N/A	N/A	24151 VENTURA BLVD	SUITE 120	CALABASAS	CA	91302	1276	00	06000	34.15289089	-118.6567002	Los Angeles County
335565	Ordering, Referring, Prescribing	N/A	1497879647	0	0	ALVAREZ-RITTMASTER, MONICA PSYD	6/14/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY16780	N/A	N/A	N/A	N/A	N/A	125 W THOUSAND OAKS BLVD	None	THOUSAND OAKS	CA	91360	0000	00	06000	34.17854676	-118.8805015	Ventura County
335571	Ordering, Referring, Prescribing	N/A	1497883821	0	0	ARLT, CAROLE L LMFT	11/11/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50687	N/A	N/A	N/A	N/A	N/A	12966 EUCLID ST	None	GARDEN GROVE	CA	92840	5200	00	06000	33.77455935	-117.9378298	Orange County
335580	Ordering, Referring, Prescribing	N/A	1497888622	0	0	ANDERSON, JESSICA D LCSW	6/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29802	N/A	N/A	N/A	N/A	N/A	1441 LIBERTY STREET	None	REDDING	CA	91354	0000	00	06000	40.5857177	-122.3870781	Shasta County
335616	Ordering, Referring, Prescribing	N/A	1497973705	0	0	ALVAREZ, KAREN F	3/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47017	N/A	N/A	N/A	N/A	N/A	350 90TH ST	SECOND FLOOR	DALY CITY	CA	94015	1879	00	06000	37.69111548	-122.473143	San Mateo County
335650	Ordering, Referring, Prescribing	N/A	1508072919	0	0	AHILIGWO, OKWUDILI B	1/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	48687	N/A	N/A	N/A	N/A	N/A	1200 MANGROVE AVE	None	CHICO	CA	95926	3558	00	06000	39.74235637	-121.8385941	Butte County
335654	Ordering, Referring, Prescribing	N/A	1508080193	0	0	AMINIAN, A M MD	7/9/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A40672	N/A	N/A	N/A	N/A	N/A	7375 N FRESNO ST	101	FRESNO	CA	93720	2478	00	06000	36.844218	-119.7838975	Fresno County
335689	Ordering, Referring, Prescribing	N/A	1508146093	0	0	ALANIZ, MARISSA B PHARMD	8/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	45507	N/A	N/A	N/A	N/A	N/A	401 N AZUSA AVE	None	COVINA	CA	91722	3069	00	06000	34.08845439	-117.9079036	Los Angeles County
335693	Ordering, Referring, Prescribing	N/A	1508146325	0	0	AZUCENA, JACQUELINE L LCSW	11/9/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75725	N/A	N/A	N/A	N/A	N/A	1400 S GRAND AVE	600	LOS ANGELES	CA	90015	2881	00	06000	34.03692236	-118.2655238	Los Angeles County
335716	Ordering, Referring, Prescribing	N/A	1508178211	0	0	ARAMBULA, ALICIA	7/1/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT140258	N/A	N/A	N/A	N/A	N/A	11741 TELEGRAPH RD	None	SANTA FE SPRINGS	CA	90670	3681	00	06000	33.9462235	-118.0830161	Los Angeles County
335722	Ordering, Referring, Prescribing	N/A	1508183856	0	0	ANDREWS, STEPHANIE L LMFT	3/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	89987	N/A	N/A	N/A	N/A	N/A	4660 VIEWRIDGE AVE	None	SAN DIEGO	CA	92123	1638	00	06000	32.82425423	-117.121121	San Diego County
335797	Ordering, Referring, Prescribing	N/A	1508316696	0	0	ALEDO, SHELLY	12/24/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	127865	N/A	N/A	N/A	N/A	N/A	4058 WILLOWS RD	None	ALPINE	CA	91901	1668	00	06000	32.836428	-116.7257385	San Diego County
335824	Ordering, Referring, Prescribing	N/A	1508359662	0	0	AGTARAP, FRANTZE PHARMD	5/19/2019	Taxonomy not applicable	NA	n/a	000	Unknown	79250	N/A	N/A	N/A	N/A	N/A	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
335834	Ordering, Referring, Prescribing	N/A	1508379389	0	0	ALFONSO, HOPE C NP	6/13/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007353	N/A	N/A	N/A	N/A	N/A	222 W EULALIA ST	211	GLENDALE	CA	91204	2849	00	06000	34.12653215	-118.257121	Los Angeles County
335841	Ordering, Referring, Prescribing	N/A	1508386442	0	0	ABDOLI, SHERWIN MD	6/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156958	N/A	N/A	N/A	N/A	N/A	612 W DUARTE RD	STE 804	ARCADIA	CA	91007	9250	00	06000	34.12647805	-118.051994	Los Angeles County
335852	Ordering, Referring, Prescribing	N/A	1508398769	0	0	AKHTAR, SUJI L LMFT	12/2/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	108607	N/A	N/A	N/A	N/A	N/A	3787 S VERMONT AVE	None	LOS ANGELES	CA	90007	4203	00	06000	34.01739	-118.291567	Los Angeles County
335863	Ordering, Referring, Prescribing	N/A	1508418583	0	0	ALJAYOSI, WALID K PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78784	N/A	N/A	N/A	N/A	N/A	3900 LAKEVILLE HWY	None	PETALUMA	CA	94954	5698	00	06000	38.2304311	-122.5827918	Sonoma County
335866	Ordering, Referring, Prescribing	N/A	1508437229	0	0	ALVARADO, GABRIELLA M NP	3/15/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017713	N/A	N/A	N/A	N/A	N/A	284 SPRUCE ST	None	GRIDLEY	CA	95948	2216	00	06000	39.36699345	-121.6910745	Butte County
335874	Ordering, Referring, Prescribing	N/A	1508437898	0	0	ALBADAWI, SUHA M LMFT	7/7/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126823	N/A	N/A	N/A	N/A	N/A	440 W. BASELINE ROAD, SU	SUITE B	CLAREMONT	CA	91711	1607	00	06000	34.12157647	-117.721782	Los Angeles County
335908	Ordering, Referring, Prescribing	N/A	1508536582	0	0	AVILES, CHARYSSE MARIE D LCSW	5/24/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101627	N/A	N/A	N/A	N/A	N/A	3177 OCEAN VIEW BLVD	None	SAN DIEGO	CA	92113	1432	00	06000	32.7011883	-117.1261025	San Diego County
335914	Ordering, Referring, Prescribing	N/A	1508553025	0	0	ASSALI, RYAN DDS	9/3/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS108940	N/A	N/A	N/A	N/A	N/A	6501 GARFIELD AVE	None	BELL GARDENS	CA	90201	1805	00	06000	33.97292523	-118.1475473	Los Angeles County
335923	Ordering, Referring, Prescribing	N/A	1508583378	0	0	AGUAYO, CHRISTINE M NP	10/12/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022995	N/A	N/A	N/A	N/A	N/A	1005 E WASHINGTON BLVD	None	LOS ANGELES	CA	90021	3068	00	06000	34.02578238	-118.2530622	Los Angeles County
335936	Ordering, Referring, Prescribing	N/A	1508683376	0	0	ALSOL, MAUREEN NP	9/23/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032284	N/A	N/A	N/A	N/A	N/A	6608 MERCY CT	None	FAIR OAKS	CA	95628	3170	00	06000	38.665917	-121.3106895	Sacramento County
336037	Ordering, Referring, Prescribing	N/A	1518044312	0	0	ANGSTMANN, ANGELA D MD	5/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A88382	N/A	N/A	N/A	N/A	N/A	1701 OCEAN AVE	None	SAN FRANCISCO	CA	94112	0000	00	06000	37.72476918	-122.4604495	San Francisco County
336040	Ordering, Referring, Prescribing	N/A	1518049659	0	0	ALVAREZ, JUANA R CNP	9/4/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	12609	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
336061	Ordering, Referring, Prescribing	N/A	1518088137	0	0	ASTACIO-CEBALLOS, ELSA LMFT	4/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT96605	N/A	N/A	N/A	N/A	N/A	982 MISSION ST	None	SAN FRANCISCO	CA	94103	2911	00	06000	37.7813638	-122.4082438	San Francisco County
336064	Ordering, Referring, Prescribing	N/A	1518093343	0	0	ACOSTA, RACHEL A LMFT	2/28/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT44941	N/A	N/A	N/A	N/A	N/A	1904 RICHLAND AVE	None	CERES	CA	95307	4562	00	06000	37.60031128	-120.9658226	Stanislaus County
336078	Ordering, Referring, Prescribing	N/A	1518121060	0	0	AMAYA, BLANCA E LCSW	6/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88710	N/A	N/A	N/A	N/A	N/A	2311 W EL SEGUNDO BLVD	None	HAWTHORNE	CA	90250	3315	00	06000	33.91647947	-118.3189815	Los Angeles County
336080	Ordering, Referring, Prescribing	N/A	1518119833	0	0	AGUIRRE, ELIZABETH N PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61800	N/A	N/A	N/A	N/A	N/A	200 MUIR ROAD	None	MARTINEZ	CA	94553	4614	00	06000	37.99430233	-122.1107194	Contra Costa County
336090	Ordering, Referring, Prescribing	N/A	1518152479	0	0	ANDRADE, ALBA R PSYD	4/10/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY34984	N/A	N/A	N/A	N/A	N/A	1721 GRIFFIN AVE	None	LOS ANGELES	CA	90031	3312	00	06000	34.06331668	-118.2114477	Los Angeles County
336125	Ordering, Referring, Prescribing	N/A	1518213628	0	0	ARTHUR, BETHANY M LMFT	3/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	98904	N/A	N/A	N/A	N/A	N/A	2640 BRESLAUER WAY	None	REDDING	CA	96001	4246	00	06000	40.5496754	-122.3791396	Shasta County
336156	Ordering, Referring, Prescribing	N/A	1518267665	0	0	ARELLANO, RACHEL M PHARMD	11/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH50981	N/A	N/A	N/A	N/A	N/A	2505 SAN RAMON VALLEY BL	None	SAN RAMON	CA	94583	1603	00	06000	37.77418776	-121.9755744	Contra Costa County
336182	Ordering, Referring, Prescribing	N/A	1518328681	0	0	ALFARO, BALESKA C LMFT	6/7/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT109803	N/A	N/A	N/A	N/A	N/A	1201 W LA VETA AVE	None	ORANGE	CA	92868	4203	00	06000	33.78034779	-117.8655767	Orange County
336183	Ordering, Referring, Prescribing	N/A	1518329382	0	0	ALTMAN, ALEXANDER J MD	2/25/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150622	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FLOOR SUITE. 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
336194	Ordering, Referring, Prescribing	N/A	1518345941	0	0	ARMS, LUTHER	3/15/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157473	N/A	N/A	N/A	N/A	N/A	3440 VIKING DR	None	SACRAMENTO	CA	95827	2844	00	06000	38.562795	-121.33143	Sacramento County
336224	Ordering, Referring, Prescribing	N/A	1518379197	0	0	ARCHER, NICHOLA V PHARMD	9/9/2019	Taxonomy not applicable	NA	n/a	000	Unknown	RPH70577	N/A	N/A	N/A	N/A	N/A	2590 N TEXAS ST	None	FAIRFIELD	CA	94533	1606	00	06000	38.27606445	-122.0340458	Solano County
336231	Ordering, Referring, Prescribing	N/A	1518393057	0	0	ALLEE, MICHELLE Y LCSW	11/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87497	N/A	N/A	N/A	N/A	N/A	8233 E. STOCKTON BLVD	STE D	SACRAMENTO	CA	95828	8203	00	06000	38.459628	-121.4095815	Sacramento County
336241	Ordering, Referring, Prescribing	N/A	1518403047	0	0	ASCHERI, ERIC PHARMD	1/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	62534	N/A	N/A	N/A	N/A	N/A	3500 E. PACIFIC COAST HI	None	LONG BEACH	CA	90804	1904	00	06000	33.78983447	-118.1510145	Los Angeles County
336247	Ordering, Referring, Prescribing	N/A	1518411065	0	0	ALCARAZ, FELICIA M LMFT	3/5/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	104114	N/A	N/A	N/A	N/A	N/A	5121 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2656	00	06000	35.35413152	-119.058471	Kern County
336288	Ordering, Referring, Prescribing	N/A	1518495795	0	0	AREVALO, ERIKA S LMFT	9/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121569	N/A	N/A	N/A	N/A	N/A	2425 BISSO LN	None	CONCORD	CA	94520	4897	00	06000	37.98393807	-122.0466953	Contra Costa County
336330	Ordering, Referring, Prescribing	N/A	1518587302	0	0	AQUILLAS, CLER V NP	7/6/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014166	N/A	N/A	N/A	N/A	N/A	2098 S CENTRAL AVE	None	LOS ANGELES	CA	90011	1235	00	06000	34.0227101	-118.2521314	Los Angeles County
336343	Ordering, Referring, Prescribing	N/A	1518665074	0	0	AUSTIN, TAYLOR R PHARMD	9/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH86724	N/A	N/A	N/A	N/A	N/A	6041 CADILLAC AVE	None	LOS ANGELES	CA	90034	1702	00	06000	34.03781261	-118.3755101	Los Angeles County
336344	Ordering, Referring, Prescribing	N/A	1518664879	0	0	AZIZ, BASSAM E NP	4/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023263	N/A	N/A	N/A	N/A	N/A	6001 E WASHINGTON BLVD	None	COMMERCE	CA	90040	2414	00	06000	33.99703164	-118.1499826	Los Angeles County
336351	Ordering, Referring, Prescribing	N/A	1518677061	0	0	ABAJIAN, BRIDGET PA	12/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	62159	N/A	N/A	N/A	N/A	N/A	3224 W OLYMPIC BLVD	None	LOS ANGELES	CA	90006	2317	00	06000	34.05260149	-118.3069623	Los Angeles County
336358	Ordering, Referring, Prescribing	N/A	1518718246	0	0	AREVALO, ERIKA PHARMD	4/16/2023	Taxonomy not applicable	NA	n/a	000	Unknown	77722	N/A	N/A	N/A	N/A	N/A	1325 N ANAHEIM BLVD	102	ANAHEIM	CA	92801	1202	00	06000	33.85331047	-117.9199617	Orange County
336362	Ordering, Referring, Prescribing	N/A	1518787605	0	0	ARELLANES, JACQUELINE PHARMD	9/9/2024	Taxonomy not applicable	NA	n/a	000	Unknown	90141	N/A	N/A	N/A	N/A	N/A	525 EL CAMINO REAL	None	MENLO PARK	CA	94025	5108	00	06000	37.451159	-122.1785406	San Mateo County
336382	Ordering, Referring, Prescribing	N/A	1528046463	0	0	APPELBAUM, BRUCE D MD	1/7/2020	Taxonomy not applicable	NA	n/a	000	Unknown	G69512	N/A	N/A	N/A	N/A	N/A	11277 GARDEN GROVE BLVD	None	GARDEN GROVE	CA	92843	1340	00	06000	33.77432916	-117.9360905	Orange County
336392	Ordering, Referring, Prescribing	N/A	1528064839	0	0	ALLIENDE, EUGENE A LMFT	11/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT41429	N/A	N/A	N/A	N/A	N/A	350 HIGH SCHOOL STREET	None	SAN ANDREAS	CA	95249	0607	00	06000	38.19864254	-120.6842699	Calaveras County
336414	Ordering, Referring, Prescribing	N/A	1528139557	0	0	ARIAS, MIGUEL A MD	11/30/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G59122	N/A	N/A	N/A	N/A	N/A	4760 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4820	00	06000	34.00134941	-118.4039837	Los Angeles County
336417	Ordering, Referring, Prescribing	N/A	1528143690	0	0	AHMADPOUR, FAY DDS	4/25/2023	Taxonomy not applicable	NA	n/a	000	Unknown	47834	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
336571	Ordering, Referring, Prescribing	N/A	1528438025	0	0	AYALA, MARIA P LCSW	9/1/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW110272	N/A	N/A	N/A	N/A	N/A	572 N ARROWHEAD AVE	None	SAN BERNARDINO	CA	92401	1251	00	06000	34.109667	-117.289669	San Bernardino County
336581	Ordering, Referring, Prescribing	N/A	1528449154	0	0	ASHRAF, TAHIR PHARMD	3/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	73619	N/A	N/A	N/A	N/A	N/A	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
336613	Ordering, Referring, Prescribing	N/A	1528491214	0	0	AOU, JANE C PHARMD	7/29/2021	Taxonomy not applicable	NA	n/a	000	Unknown	52851	N/A	N/A	N/A	N/A	N/A	128 S. STATE COLLEGE BLV	None	ANAHEIM	CA	92806	2921	00	06000	33.840252	-117.889103	Orange County
336616	Ordering, Referring, Prescribing	N/A	1528512514	0	0	ANI, JORCYELIN C LCSW	3/31/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93604	N/A	N/A	N/A	N/A	N/A	8945 GOLF LINKS RD	None	OAKLAND	CA	94605	4124	00	06000	37.76047483	-122.157608	Alameda County
336641	Ordering, Referring, Prescribing	N/A	1528553526	0	0	AUSTIN, SARAH A LCSW	10/3/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	117743	N/A	N/A	N/A	N/A	N/A	3200 CLAYTON RD	None	CONCORD	CA	94519	2819	00	06000	37.97283909	-122.0196497	Contra Costa County
336653	Ordering, Referring, Prescribing	N/A	1528582301	0	0	ALCANTAR-GOMEZ, ALEJANDRO LCSW	10/10/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	118549	N/A	N/A	N/A	N/A	N/A	217 W KERN AVE	None	MC FARLAND	CA	93250	1360	00	06000	35.67801221	-119.2297708	Kern County
336670	Ordering, Referring, Prescribing	N/A	1528599982	0	0	AVAKIAN, ANDRANIK NP	3/18/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007085	N/A	N/A	N/A	N/A	N/A	7766 N PALM AVENUE	107	FRESNO	CA	93711	5708	00	06000	36.85082306	-119.8052608	Fresno County
336695	Ordering, Referring, Prescribing	N/A	1528649969	0	0	ALAVI, CYRUS MD	12/2/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL8262	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
336702	Ordering, Referring, Prescribing	N/A	1528658531	0	0	ANDERSON, ZULFIA PA	6/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	59701	N/A	N/A	N/A	N/A	N/A	205 SOUTH STREET	None	FORT BRAGG	CA	95437	5540	00	06000	39.43009931	-123.8032471	Mendocino County
336711	Ordering, Referring, Prescribing	N/A	1528670015	0	0	ALI, NORA NP	7/11/2023	Taxonomy not applicable	NA	n/a	000	Unknown	95025860	N/A	N/A	N/A	N/A	N/A	30300 CAMINO CAPISTRANO	None	SAN JUAN CAPISTRA	CA	92675	1304	00	06000	33.5230101	-117.6683028	Orange County
336720	Ordering, Referring, Prescribing	N/A	1528695194	0	0	AMENDOLARA, BENJAMIN MD	2/15/2024	Taxonomy not applicable	NA	n/a	000	Unknown	A193967	N/A	N/A	N/A	N/A	N/A	627 SAN JULIAN ST	None	LOS ANGELES	CA	90014	2411	00	06000	34.04228203	-118.2466601	Los Angeles County
336723	Ordering, Referring, Prescribing	N/A	1528706314	0	0	ARAKELIAN, MELANIE R NP	6/29/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020952	N/A	N/A	N/A	N/A	N/A	8316 FOOTHILL BLVD	None	SUNLAND	CA	91040	2850	00	06000	34.25966652	-118.314342	Los Angeles County
336756	Ordering, Referring, Prescribing	N/A	1528880770	0	0	ALALONG, JAN K NP	12/30/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026741	N/A	N/A	N/A	N/A	N/A	625 34TH STREET	STE 100 & 200	BAKERSFIELD	CA	93301	2305	00	06000	35.39046051	-119.0092725	Kern County
336761	Ordering, Referring, Prescribing	N/A	1538111661	0	0	AULUCK, HARINDER MD	5/28/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A42771	N/A	N/A	N/A	N/A	N/A	1055 W HENDERSON AVE	None	PORTERVILLE	CA	93257	1490	00	06000	36.08036906	-119.0410926	Tulare County
336782	Ordering, Referring, Prescribing	N/A	1538173745	0	0	AVELAR, LILIANA P	2/4/2013	Taxonomy not applicable	NA	n/a	000	Unknown	00PA18156	N/A	N/A	N/A	N/A	N/A	1316 3RD ST PROMENADE	STE 201	SANTA MONICA	CA	90401	1382	00	06000	34.01670895	-118.497462	Los Angeles County
336816	Ordering, Referring, Prescribing	N/A	1538279534	0	0	ALLENDE, GABRIEL M NP	6/18/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95017591	N/A	N/A	N/A	N/A	N/A	9925 INTERNATIONAL BLVD	SUITE 5	OAKLAND	CA	94603	2558	00	06000	37.74332565	-122.1698542	Alameda County
336821	Ordering, Referring, Prescribing	N/A	1538285622	0	0	AIZPURU, VIVIAN K LMFT	6/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47034	N/A	N/A	N/A	N/A	N/A	1624 SANTA CLARA DR	145	ROSEVILLE	CA	95661	0028	00	06000	38.74308965	-121.2620987	Placer County
336832	Ordering, Referring, Prescribing	N/A	1538298351	0	0	ASHENDOUEK, CETH PHD	3/23/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY16636	N/A	N/A	N/A	N/A	N/A	1910 MAGNOLIA AVE	None	LOS ANGELES	CA	90007	1220	00	06000	34.039638	-118.2864045	Los Angeles County
336845	Ordering, Referring, Prescribing	N/A	1538310362	0	0	AHUJA, VASUDHA MD	2/19/2020	Taxonomy not applicable	NA	n/a	000	Unknown	A121791	N/A	N/A	N/A	N/A	N/A	21545 CENTRE POINTE PARK	None	SANTA CLARITA	CA	91350	2947	00	06000	34.413021	-118.514534	Los Angeles County
336936	Ordering, Referring, Prescribing	N/A	1538486352	0	0	AZIZADPINTO, PARISA MD	10/31/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A126926	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPRESSWAY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
336940	Ordering, Referring, Prescribing	N/A	1538494794	0	0	AZANZA, ROSANNA P LCSW	11/24/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	62048	N/A	N/A	N/A	N/A	N/A	323 N PRAIRIE AVE	350	INGLEWOOD	CA	90301	4502	00	06000	33.966333	-118.3439975	Los Angeles County
336947	Ordering, Referring, Prescribing	N/A	1538511159	0	0	AVITIA, JAVIER LCSW	3/8/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100422	N/A	N/A	N/A	N/A	N/A	631 MAPLE AVENUE	B	LOS ANGELES	CA	90014	2211	00	06000	34.04323075	-118.2485358	Los Angeles County
336958	Ordering, Referring, Prescribing	N/A	1538518949	0	0	ARNOLD, JESSICA L NP	2/25/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95004453	N/A	N/A	N/A	N/A	N/A	11326 MOUNTAIN VIEW AVE	STE. B	LOMA LINDA	CA	92354	3817	00	06000	34.04717443	-117.2436923	San Bernardino County
336987	Ordering, Referring, Prescribing	N/A	1538564026	0	0	ARMIJO, ROSALIE LCSW	1/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW120547	N/A	N/A	N/A	N/A	N/A	1936 CARLOTTA DR	None	CONCORD	CA	94519	1358	00	06000	37.98614491	-122.0061167	Contra Costa County
336999	Ordering, Referring, Prescribing	N/A	1538578109	0	0	AHERN, DOUGLAS P	2/6/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000328	N/A	N/A	N/A	N/A	N/A	4816 EAST 3RD ST	None	LOS ANGELES	CA	90022	1602	00	06000	34.03327647	-118.16037	Los Angeles County
337036	Ordering, Referring, Prescribing	N/A	1538620133	0	0	ARMSTEAD, TATYANA NP	6/30/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021512	N/A	N/A	N/A	N/A	N/A	91275 66TH ST	SUITE 500	MECCA	CA	92254	1251	00	06000	33.5692685	-116.0743905	Riverside County
337044	Ordering, Referring, Prescribing	N/A	1538651815	0	0	ARBELAEZ, DANIELA MD	9/13/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A171837	N/A	N/A	N/A	N/A	N/A	1418 E MAIN ST	STE 210	SANTA MARIA	CA	93454	4833	00	06000	34.95286855	-120.4137315	Santa Barbara County
337086	Ordering, Referring, Prescribing	N/A	1538728282	0	0	AWADALLA, HISHAM PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	78677	N/A	N/A	N/A	N/A	N/A	975 SERENO DRIVE	None	VALLEJO	CA	94589	2441	00	06000	38.12828446	-122.24821	Solano County
337105	Ordering, Referring, Prescribing	N/A	1538783873	0	0	ALEXANDER, MIYOSHI L	3/12/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014182	N/A	N/A	N/A	N/A	N/A	482 CORONA MALL	None	CORONA	CA	92879	1418	00	06000	33.87658954	-117.5663302	Riverside County
337134	Ordering, Referring, Prescribing	N/A	1538875794	0	0	ABUGUFA, HESHAM S DDS	2/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108556	N/A	N/A	N/A	N/A	N/A	161 N MILL ST	None	TEHACHAPI	CA	93561	1347	00	06000	35.13410412	-118.4520157	Kern County
337142	Ordering, Referring, Prescribing	N/A	1538921846	0	0	APOSTOL, STACEY NP	1/23/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028800	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
337158	Ordering, Referring, Prescribing	N/A	1548029200	0	0	ALVARADO, JOSE NP	11/8/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028002	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
337159	Ordering, Referring, Prescribing	N/A	1548020423	0	0	ACEVES MARTIN, BIANKA A MD	8/2/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	15171	N/A	N/A	N/A	N/A	N/A	501 J ST	None	SACRAMENTO	CA	95814	2325	00	06000	38.582118	-121.499325	Sacramento County
337214	Ordering, Referring, Prescribing	N/A	1548345184	0	0	ASTRACHAN, CRAIG W LCSW	12/15/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	28434	N/A	N/A	N/A	N/A	N/A	1720 E 120TH ST	None	LOS ANGELES	CA	90059	3052	00	06000	33.92455929	-118.2423557	Los Angeles County
337232	Ordering, Referring, Prescribing	N/A	1548392384	0	0	ALDAZ, MARIAM LMFT	2/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50772	N/A	N/A	N/A	N/A	N/A	17053 EAST FOOTHILL BLVD	BUILDING B	FONTANA	CA	92335	8505	00	06000	34.10655148	-117.432828	San Bernardino County
337251	Ordering, Referring, Prescribing	N/A	1548430879	0	0	ANGELES, JACQUELINE LMFT	11/24/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93466	N/A	N/A	N/A	N/A	N/A	323 N PRAIRIE AVE	None	INGLEWOOD	CA	90301	4502	00	06000	33.966333	-118.3439975	Los Angeles County
337283	Ordering, Referring, Prescribing	N/A	1548513997	0	0	ANGELES, MARYANNE M	1/8/2024	Taxonomy not applicable	NA	n/a	000	Unknown	253418	N/A	N/A	N/A	N/A	N/A	650 S BASCOM AVE	None	SAN JOSE	CA	95128	2601	00	06000	37.31503473	-121.931809	Santa Clara County
337293	Ordering, Referring, Prescribing	N/A	1548534100	0	0	ASLANIAN, SOSE LCSW	6/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	66434	N/A	N/A	N/A	N/A	N/A	16350 FILBERT ST	None	SYLMAR	CA	91342	1012	00	06000	34.31595736	-118.4853828	Los Angeles County
337296	Ordering, Referring, Prescribing	N/A	1548540867	0	0	ARDIS, JAMES J OD	7/18/2017	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	14193	N/A	N/A	N/A	N/A	N/A	525 ROBERTS LANE	None	BAKERSFIELD	CA	93308	4799	00	06000	35.40860151	-119.0317455	Kern County
337307	Ordering, Referring, Prescribing	N/A	1548557903	0	0	ABBOTT, RACHEL A MD	12/1/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A122734	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
337320	Ordering, Referring, Prescribing	N/A	1548573280	0	0	AROUCHANOVA, DIANA PHARMD	12/8/2018	Taxonomy not applicable	NA	n/a	000	Unknown	55762	N/A	N/A	N/A	N/A	N/A	9245 RESEDA BLVD	None	NORTHRIDGE	CA	91324	3137	00	06000	34.238583	-118.536108	Los Angeles County
337321	Ordering, Referring, Prescribing	N/A	1548593213	0	0	ANDREWSON, ULLA B LCSW	3/14/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	11401	N/A	N/A	N/A	N/A	N/A	652 PETALUMA AVE	H	SEBASTOPOL	CA	95472	4266	00	06000	38.39662494	-122.8201368	Sonoma County
337375	Ordering, Referring, Prescribing	N/A	1548684111	0	0	AMINI, RAMIN PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69953	N/A	N/A	N/A	N/A	N/A	10407 SANTA MONICA BLVD	None	LOS ANGELES	CA	90025	5009	00	06000	34.05735528	-118.4244855	Los Angeles County
337414	Ordering, Referring, Prescribing	N/A	1548747108	0	0	AVENT-JOHNSON, JESHANA E PSYD	3/24/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30170	N/A	N/A	N/A	N/A	N/A	954 WEST FOOTHILL BLVD	A	UPLAND	CA	91786	3782	00	06000	34.10675048	-117.6646365	San Bernardino County
337422	Ordering, Referring, Prescribing	N/A	1548763956	0	0	ALCALA, LINDA LMFT	3/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT117140	N/A	N/A	N/A	N/A	N/A	11951 HESPERIA RD	None	HESPERIA	CA	92345	1855	00	06000	34.46842866	-117.2924286	San Bernardino County
337457	Ordering, Referring, Prescribing	N/A	1548808264	0	0	ALANO, JACINTH	1/30/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008570	N/A	N/A	N/A	N/A	N/A	6095 N. 1ST STREET	None	FRESNO	CA	93710	5444	00	06000	36.82524765	-119.7723922	Fresno County
337467	Ordering, Referring, Prescribing	N/A	1548857998	0	0	ACOSTA, ALLIE LCSW	6/29/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW123702	N/A	N/A	N/A	N/A	N/A	11600 ELDRIDGE AVENUE	None	SYLMAR	CA	91342	6506	00	06000	34.28038404	-118.3838708	Los Angeles County
337491	Ordering, Referring, Prescribing	N/A	1548925779	0	0	AVILA, CLAUDIA LCSW	7/15/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	124100	N/A	N/A	N/A	N/A	N/A	1950 MARKET ST	None	RIVERSIDE	CA	92501	1720	00	06000	34.00316496	-117.3767967	Riverside County
337523	Ordering, Referring, Prescribing	N/A	1558058636	0	0	ARVIZU, MARGARITA NP	3/6/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95024510	N/A	N/A	N/A	N/A	N/A	2743 HIGHLAND AVE	None	NATIONAL CITY	CA	91950	7410	00	06000	32.66109542	-117.0920417	San Diego County
337545	Ordering, Referring, Prescribing	N/A	1558146159	0	0	ARCINIEGA-BUENO, JORDAN PA	11/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63708	N/A	N/A	N/A	N/A	N/A	3800 FLORIN ROAD	None	SACRAMENTO	CA	95823	1802	00	06000	38.495052	-121.463874	Sacramento County
337552	Ordering, Referring, Prescribing	N/A	1558314237	0	0	ABUKHIERAN, EMAD MD	11/9/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C166626	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
337556	Ordering, Referring, Prescribing	N/A	1558345843	0	0	AN, FRANK Y MD	4/21/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G62295	N/A	N/A	N/A	N/A	N/A	25043 NARBONNE AVE	None	LOMITA	CA	90717	2101	00	06000	33.796863	-118.3199875	Los Angeles County
337565	Ordering, Referring, Prescribing	N/A	1558390393	0	0	ANKROM, DOUGLAS W MD	6/13/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A52517	N/A	N/A	N/A	N/A	N/A	680 GUZZI LANE	SUITE 205	SONORA	CA	95370	5288	00	06000	37.97611058	-120.3719921	Tuolumne County
337572	Ordering, Referring, Prescribing	N/A	1558425132	0	0	AMATO, CECILY M PHARMD	4/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH50896	N/A	N/A	N/A	N/A	N/A	3240 ARDEN WAY	None	SACRAMENTO	CA	95825	2015	00	06000	38.594898	-121.3884765	Sacramento County
337579	Ordering, Referring, Prescribing	N/A	1558443531	0	0	ANDRADE-SILVERMAN, ANGELICA MD	10/23/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A52381	N/A	N/A	N/A	N/A	N/A	1333 MERIDIAN AVE	None	SAN JOSE	CA	95125	0001	00	06000	37.30176	-121.9136465	Santa Clara County
337582	Ordering, Referring, Prescribing	N/A	1558454090	0	0	AWENDER, JOSEPH DC	12/5/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	20907	N/A	N/A	N/A	N/A	N/A	2342 EL CAMINO REAL	SUITE 100	REDWOOD CITY	CA	94063	2874	00	06000	37.47484695	-122.2197447	San Mateo County
337612	Ordering, Referring, Prescribing	N/A	1558512350	0	0	AMERAULT, RACHEL E LMFT	11/18/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52142	N/A	N/A	N/A	N/A	N/A	1611 BUNKER HILL WAY	120	SALINAS	CA	93906	6004	00	06000	36.69971964	-121.6172769	Monterey County
337647	Ordering, Referring, Prescribing	N/A	1558606517	0	0	AMIN, PRADEEP PHARMD	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	40574	N/A	N/A	N/A	N/A	N/A	4108 N SIERRA WAY	None	SAN BERNARDINO	CA	92407	3825	00	06000	34.165917	-117.2850595	San Bernardino County
337676	Ordering, Referring, Prescribing	N/A	1558649707	0	0	ABEYTA, MELISSA LMFT	1/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	117889	N/A	N/A	N/A	N/A	N/A	530 KINGS COUNTY DR	104/106	HANFORD	CA	93230	5901	00	06000	36.33019889	-119.66862	Kings County
337701	Ordering, Referring, Prescribing	N/A	1558703439	0	0	AGUIAR, CHERI LCSW	4/30/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW86842	N/A	N/A	N/A	N/A	N/A	51 WELLNESS WAY	None	VALLEY SPRINGS	CA	95252	9736	00	06000	38.168667	-120.840039	Calaveras County
337718	Ordering, Referring, Prescribing	N/A	1558724963	0	0	AYALA-RODRIGUEZ, IRVING MD	2/24/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159093	N/A	N/A	N/A	N/A	N/A	2400 WIBLE ROAD	14	BAKERSFIELD	CA	93304	4734	00	06000	35.3328934	-119.0389535	Kern County
337725	Ordering, Referring, Prescribing	N/A	1558737379	0	0	AMELI, HAMID PHARMD	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	66295	N/A	N/A	N/A	N/A	N/A	1900 S MCDOWELL BLVD	None	PETALUMA	CA	94954	5473	00	06000	38.230006	-122.5958952	Sonoma County
337738	Ordering, Referring, Prescribing	N/A	1558775908	0	0	ARANETA, NICOLE MARIE ROSE	1/24/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A160531	N/A	N/A	N/A	N/A	N/A	1691 THE ALAMEDA	None	SAN JOSE	CA	95126	2203	00	06000	37.3373761	-121.9192532	Santa Clara County
337739	Ordering, Referring, Prescribing	N/A	1558779231	0	0	ADAMS, JESSE L LCSW	3/6/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114042	N/A	N/A	N/A	N/A	N/A	365 KUCK LN	None	PETALUMA	CA	94952	9606	00	06000	38.25757751	-122.7132072	Sonoma County
337751	Ordering, Referring, Prescribing	N/A	1558790014	0	0	AL MUGHAZZEZ, TAREQ A PHARMD	3/18/2018	Taxonomy not applicable	NA	n/a	000	Unknown	67372	N/A	N/A	N/A	N/A	N/A	6445 PACIFIC AVE	None	STOCKTON	CA	95207	3715	00	06000	38.00885138	-121.3198384	San Joaquin County
337767	Ordering, Referring, Prescribing	N/A	1558814509	0	0	AUERBACH JIMENE, DANIELA A	8/8/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	100473	N/A	N/A	N/A	N/A	N/A	2756 S ELM AVE	None	FRESNO	CA	93706	5435	00	06000	36.70090897	-119.7908648	Fresno County
337794	Ordering, Referring, Prescribing	N/A	1558856286	0	0	ALVAREZ, JAYLA J LPCC	1/19/2023	Taxonomy not applicable	NA	n/a	000	Unknown	13062	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
337802	Ordering, Referring, Prescribing	N/A	1558871020	0	0	AKPATI, NKECHI NP	4/30/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95007350	N/A	N/A	N/A	N/A	N/A	12450 VAN NUYS BLVD	200	PACOIMA	CA	91331	1391	00	06000	34.27894489	-118.4044363	Los Angeles County
337843	Ordering, Referring, Prescribing	N/A	1558943662	0	0	ATMOJO, MAYA PA-C	10/19/2023	Taxonomy not applicable	NA	n/a	000	Unknown	PA63517	N/A	N/A	N/A	N/A	N/A	2811 WILSHIRE BLVD.	930	SANTA MONICA	CA	90402	4803	00	06000	34.03785224	-118.4752132	Los Angeles County
337853	Ordering, Referring, Prescribing	N/A	1558973230	0	0	ARORA, JATIN J	7/23/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	105342	N/A	N/A	N/A	N/A	N/A	3030 EXPLORER DR	None	SACRAMENTO	CA	95827	2728	00	06000	38.563362	-121.332429	Sacramento County
337861	Ordering, Referring, Prescribing	N/A	1558990952	0	0	ALHAYEK, SOUBHI MD	3/14/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184899	N/A	N/A	N/A	N/A	N/A	1500 21 STREET	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
337875	Ordering, Referring, Prescribing	N/A	1568021913	0	0	AGUERO, AMETHYST M DO	2/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19473	N/A	N/A	N/A	N/A	N/A	128 N BROADWAY	None	ESCONDIDO	CA	92025	2714	00	06000	33.12249406	-117.0818384	San Diego County
337926	Ordering, Referring, Prescribing	N/A	1568142461	0	0	ATIYA, MOHAMED N PA	4/7/2024	Taxonomy not applicable	NA	n/a	000	Unknown	62885	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
337932	Ordering, Referring, Prescribing	N/A	1568182053	0	0	ARCINIEGA, MARIA L DDS	8/31/2022	Taxonomy not applicable	NA	n/a	000	Unknown	107933	N/A	N/A	N/A	N/A	N/A	732 MOTT ST	100-110	SAN FERNANDO	CA	91340	4212	00	06000	34.27661761	-118.4442372	Los Angeles County
337938	Ordering, Referring, Prescribing	N/A	1568191807	0	0	AARONSEN, TIFFANNE M CNP	10/27/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017872	N/A	N/A	N/A	N/A	N/A	81767 DOCTOR CARREON BLV	100	INDIO	CA	92201	5597	00	06000	33.70738112	-116.237755	Riverside County
337942	Ordering, Referring, Prescribing	N/A	1568202802	0	0	ANSARI, FATIMAH M DDS	4/26/2024	Taxonomy not applicable	NA	n/a	000	Unknown	110042	N/A	N/A	N/A	N/A	N/A	6001 E WASHINGTON BLVD	None	COMMERCE	CA	90040	2414	00	06000	33.99703164	-118.1499826	Los Angeles County
337969	Ordering, Referring, Prescribing	N/A	1568491074	0	0	ADAIR, TODD M OD	10/31/2021	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT9868	N/A	N/A	N/A	N/A	N/A	2020 J STREET	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
337974	Ordering, Referring, Prescribing	N/A	1568499606	0	0	AHMAD, IMDAD MD	10/27/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C51470	N/A	N/A	N/A	N/A	N/A	3972 N WATERMAN AVENUE	SUITE 104	SAN BERNARDINO	CA	92404	1767	00	06000	34.164153	-117.2787275	San Bernardino County
337990	Ordering, Referring, Prescribing	N/A	1568530095	0	0	ALBRIGHT, KRISTEN E LCSW	5/31/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW73272	N/A	N/A	N/A	N/A	N/A	7526 MONTEREY ST	None	GILROY	CA	95020	5826	00	06000	37.00852861	-121.5694352	Santa Clara County
338006	Ordering, Referring, Prescribing	N/A	1568578805	0	0	AGUILERA, DAVID M PHD	6/25/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY7157	N/A	N/A	N/A	N/A	N/A	39155 LIBERTY STREET	SUITE G732	FREMONT	CA	94538	1525	00	06000	37.55123907	-121.9828956	Alameda County
338012	Ordering, Referring, Prescribing	N/A	1568564193	0	0	AMIN, JAY S MD	8/9/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A40490	N/A	N/A	N/A	N/A	N/A	13095 JAMBOREE RD	None	TUSTIN	CA	92782	9150	00	06000	33.73033216	-117.7875003	Orange County
338017	Ordering, Referring, Prescribing	N/A	1568588093	0	0	ANDRES, SANIE JOE D LMFT	3/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45167	N/A	N/A	N/A	N/A	N/A	3950 REYNOLDS ROAD	None	RIVERSIDE	CA	92503	3517	00	06000	33.9184159	-117.4562188	Riverside County
338032	Ordering, Referring, Prescribing	N/A	1568627800	0	0	AMBAL, RITA PHARMD	3/31/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61213	N/A	N/A	N/A	N/A	N/A	270 INTERNATIONAL CIR	None	SAN JOSE	CA	95119	1130	00	06000	37.24047903	-121.7998157	Santa Clara County
338083	Ordering, Referring, Prescribing	N/A	1568732683	0	0	ANNAND, STACEY	4/26/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	98137	N/A	N/A	N/A	N/A	N/A	4990 WILLIAMS AVE	None	LA MESA	CA	91942	7409	00	06000	32.76933362	-117.0371085	San Diego County
338157	Ordering, Referring, Prescribing	N/A	1568828390	0	0	AZARPIRA, ALI PHARMD	3/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72569	N/A	N/A	N/A	N/A	N/A	1315 MARLESTA RD	None	PINOLE	CA	94564	2404	00	06000	38.00162037	-122.3020176	Contra Costa County
338178	Ordering, Referring, Prescribing	N/A	1568861722	0	0	ALVARADO, GRISELDA LCSW	3/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW79800	N/A	N/A	N/A	N/A	N/A	439 W 97TH ST	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
338187	Ordering, Referring, Prescribing	N/A	1568871994	0	0	ALDAPE, SONIA LIZETTE S LCSW	1/14/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91224	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY STREET	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
338198	Ordering, Referring, Prescribing	N/A	1568881829	0	0	AMARE, RACHEL A MD	6/16/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A138204	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL, SUITE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
338212	Ordering, Referring, Prescribing	N/A	1568899771	0	0	ALNATOUR, SAHAR PHARMD	4/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67569	N/A	N/A	N/A	N/A	N/A	3430 E LA PALMA AVE	MOB 2 RM 6791	ANAHEIM	CA	92806	2020	00	06000	33.852105	-117.8444835	Orange County
338237	Ordering, Referring, Prescribing	N/A	1568946424	0	0	AUBREY, CECILIA R NP	7/17/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006337	N/A	N/A	N/A	N/A	N/A	333 S BEAUDRY AVE	FLOOR 29	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
338262	Ordering, Referring, Prescribing	N/A	1568984417	0	0	ALDAIMALANI, SARAH LCSW	12/16/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99156	N/A	N/A	N/A	N/A	N/A	3200 CLAYTON RD	None	CONCORD	CA	94519	2819	00	06000	37.97283909	-122.0196497	Contra Costa County
338283	Ordering, Referring, Prescribing	N/A	1578023040	0	0	ANDERSON, MORGAN PA	9/9/2024	Taxonomy not applicable	NA	n/a	000	Unknown	65026	N/A	N/A	N/A	N/A	N/A	77 CASA ST	None	SAN LUIS OBISPO	CA	93405	5803	00	06000	35.29306786	-120.6650709	San Luis Obispo County
338295	Ordering, Referring, Prescribing	N/A	1578044996	0	0	ALEXANDRU, ANTOANELA IOANA PHARMD	1/11/2023	Taxonomy not applicable	NA	n/a	000	Unknown	74610	N/A	N/A	N/A	N/A	N/A	2440 S WESTERN AVE	29	SAN PEDRO	CA	90732	4334	00	06000	33.72325081	-118.3123796	Los Angeles County
338345	Ordering, Referring, Prescribing	N/A	1578121257	0	0	ARINIELLO, ALLISON L MD	3/19/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194814	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
338353	Ordering, Referring, Prescribing	N/A	1578140174	0	0	ARYASOMAYAJULA, CHINMAYI MD	5/20/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184881	N/A	N/A	N/A	N/A	N/A	700 LAWRENCE EXPY	None	SANTA CLARA	CA	95051	5173	00	06000	37.33578	-121.999329	Santa Clara County
338355	Ordering, Referring, Prescribing	N/A	1578140919	0	0	AVILA, DAVID MD	1/24/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A193340	N/A	N/A	N/A	N/A	N/A	3260 KERNER BLVD.	None	SAN RAFAEL	CA	94901	1656	00	06000	37.96081282	-122.501833	Marin County
338378	Ordering, Referring, Prescribing	N/A	1578208534	0	0	ANDRIC, PATRICIA E CNM	6/6/2021	Taxonomy not applicable	NA	n/a	005	CERTIFIED NURSE MIDWIFE	235747	N/A	N/A	N/A	N/A	N/A	26137 LA PAZ ROAD	SUITE 200	MISSION VIEJO	CA	92691	5321	00	06000	33.60038172	-117.6735855	Orange County
338379	Ordering, Referring, Prescribing	N/A	1578200234	0	0	ANDRADE, LUCY M LCSW	9/13/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	126027	N/A	N/A	N/A	N/A	N/A	725 E MAIN ST	3RD FLOOR	SANTA PAULA	CA	93060	2748	00	06000	34.35240876	-119.0649129	Ventura County
338381	Ordering, Referring, Prescribing	N/A	1578215398	0	0	ALVAREZ, ANNIKA NP	5/26/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95019539	N/A	N/A	N/A	N/A	N/A	4361 LATHAM ST	SUITE 270	RIVERSIDE	CA	92501	1730	00	06000	34.00212634	-117.3743133	Riverside County
338403	Ordering, Referring, Prescribing	N/A	1578294310	0	0	ARCILLA, GINO MD	8/23/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A189178	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
338448	Ordering, Referring, Prescribing	N/A	1578623427	0	0	ANDERSON, JILL D LMFT	2/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT35305	N/A	N/A	N/A	N/A	N/A	2925 MCMILLAN AVE	108	SAN LUIS OBISPO	CA	93401	6765	00	06000	35.263386	-120.648157	San Luis Obispo County
338453	Ordering, Referring, Prescribing	N/A	1578629739	0	0	ALLEN, TERESA M LMFT	8/14/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	39878	N/A	N/A	N/A	N/A	N/A	286 SANTA CLARA AVE	None	OAKLAND	CA	94610	2624	00	06000	37.81652567	-122.2496469	Alameda County
338463	Ordering, Referring, Prescribing	N/A	1578670964	0	0	AZATIAN, ARMEN MD	6/8/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A89967	N/A	N/A	N/A	N/A	N/A	12450 VAN NUYS BLVD	200	PACOIMA	CA	91331	1391	00	06000	34.27894489	-118.4044363	Los Angeles County
338476	Ordering, Referring, Prescribing	N/A	1578687992	0	0	ASCUE, YUKIKO N LCSW	3/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW19570	N/A	N/A	N/A	N/A	N/A	660 S FAIR OAKS AVE	None	SUNNYVALE	CA	94086	7913	00	06000	37.36442862	-122.024102	Santa Clara County
338495	Ordering, Referring, Prescribing	N/A	1578701934	0	0	ARNOLD, MONIKA T MSW LCSW	5/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW71530	N/A	N/A	N/A	N/A	N/A	438 N WHITE RD	None	SAN JOSE	CA	95127	1439	00	06000	37.3776149	-121.8374887	Santa Clara County
338500	Ordering, Referring, Prescribing	N/A	1578715181	0	0	AGARWAL, ANSHU PSYD	12/10/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY23604	N/A	N/A	N/A	N/A	N/A	4510 E PACIFIC COAST HWY	600	LONG BEACH	CA	90804	3279	00	06000	33.78815204	-118.1400821	Los Angeles County
338506	Ordering, Referring, Prescribing	N/A	1578729711	0	0	ACOSTA, EDWIN R	4/5/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D57256	N/A	N/A	N/A	N/A	N/A	351 FELICE DR	None	HOLLISTER	CA	95023	3361	00	06000	36.85325269	-121.4170104	San Benito County
338527	Ordering, Referring, Prescribing	N/A	1578757399	0	0	AMINABADI, MAHTAB K PHD	9/20/2017	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	24944	N/A	N/A	N/A	N/A	N/A	209 C ST	None	LEMOORE	CA	93245	2930	00	06000	36.30089987	-119.7833254	Kings County
338532	Ordering, Referring, Prescribing	N/A	1578763678	0	0	ALDRETE, SANDRA A LCSW	1/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29079	N/A	N/A	N/A	N/A	N/A	11050 E ARTESIA BLVD.	SUITE - F	CERRITOS	CA	90703	2542	00	06000	33.8728535	-118.097847	Los Angeles County
338547	Ordering, Referring, Prescribing	N/A	1578792263	0	0	ARAKELIAN, MARAL LMFT	7/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120564	N/A	N/A	N/A	N/A	N/A	520 W PALMDALE BLVD	D	PALMDALE	CA	93551	4229	00	06000	34.58407117	-118.1400842	Los Angeles County
338569	Ordering, Referring, Prescribing	N/A	1578828646	0	0	AUJLA, JASMEEN DDS	12/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS63038	N/A	N/A	N/A	N/A	N/A	6301 3RD STREET	None	SAN FRANCISCO	CA	94965	1172	00	06000	37.72070671	-122.3963144	San Francisco County
338573	Ordering, Referring, Prescribing	N/A	1578837274	0	0	ARMSTRONG-SUTTON, AVEN LUGH LCSW	9/6/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	125826	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
338583	Ordering, Referring, Prescribing	N/A	1578847745	0	0	ABOU-EL-SEOUD, AHMED M PHARMD	8/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH65034	N/A	N/A	N/A	N/A	N/A	8044 LIMONITE AVE	None	RIVERSIDE	CA	92509	6107	00	06000	33.97764677	-117.4608873	Riverside County
338637	Ordering, Referring, Prescribing	N/A	1578918744	0	0	AYALA-ORTIZ, DANIEL MD	4/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165457	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
338699	Ordering, Referring, Prescribing	N/A	1588003727	0	0	ALMANZAR, SERGIO LCSW	12/9/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	71549	N/A	N/A	N/A	N/A	N/A	1933 S BROADWAY	None	LOS ANGELES	CA	90007	4501	00	06000	34.03102377	-118.2660738	Los Angeles County
338715	Ordering, Referring, Prescribing	N/A	1588009864	0	0	AGOPIAN, CARINE PHARMD	3/25/2018	Taxonomy not applicable	NA	n/a	000	Unknown	57171	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	MS SEC2-B	BOISE	ID	83706	9998	00	06000	43.59860438	-116.1806635	Ada County
338725	Ordering, Referring, Prescribing	N/A	1588035687	0	0	AYRES, ALEXANDRIA	2/12/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131127	N/A	N/A	N/A	N/A	N/A	315 W HALEY STREET	102	SANTA BARBARA	CA	93101	0400	00	06000	34.41320534	-119.6993554	Santa Barbara County
338737	Ordering, Referring, Prescribing	N/A	1588048144	0	0	ARCE, VICTORIA LCSW	11/16/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW119247	N/A	N/A	N/A	N/A	N/A	855 N EUCLID AVE	None	ONTARIO	CA	91762	2729	00	06000	34.074063	-117.6514785	San Bernardino County
338739	Ordering, Referring, Prescribing	N/A	1588048037	0	0	ACEVEDO, ZULEYMA LCSW	2/18/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92623	N/A	N/A	N/A	N/A	N/A	439 W 97TH ST	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
338775	Ordering, Referring, Prescribing	N/A	1588078000	0	0	AL-JARBOUA, LA TASHA PA-C	2/21/2020	Taxonomy not applicable	NA	n/a	000	Unknown	54234	N/A	N/A	N/A	N/A	N/A	315 CARNINO DEL REMEDIO	B	SANTA BARBARA	CA	93110	1332	00	06000	34.444881	-119.7793725	Santa Barbara County
338797	Ordering, Referring, Prescribing	N/A	1588118392	0	0	AGUIAR VASQUEZ, EVELYN LCSW	8/18/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW109994	N/A	N/A	N/A	N/A	N/A	3260 KERNER BLVD	None	SAN RAFAEL	CA	94901	4840	00	06000	37.96081282	-122.501833	Marin County
338805	Ordering, Referring, Prescribing	N/A	1588134977	0	0	ABRANTES, PATRICIA LCSW	7/12/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW116389	N/A	N/A	N/A	N/A	N/A	3945 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2440	00	06000	34.02394552	-118.187748	Los Angeles County
338842	Ordering, Referring, Prescribing	N/A	1588202741	0	0	ASMARO, NIVEEN H PHARMD	3/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84145	N/A	N/A	N/A	N/A	N/A	950 W HAMILTON AVE	None	CAMPBELL	CA	95008	0406	00	06000	37.29405053	-121.9665695	Santa Clara County
338845	Ordering, Referring, Prescribing	N/A	1588203749	0	0	AYITEY, SALA A NP	6/9/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95013541	N/A	N/A	N/A	N/A	N/A	9415 MISSION BLVD	SUITE P	RIVERSIDE	CA	92509	2661	00	06000	34.01179145	-117.4903644	Riverside County
338846	Ordering, Referring, Prescribing	N/A	1588203103	0	0	ANAND, RACHNA CNP	6/18/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	842378	N/A	N/A	N/A	N/A	N/A	2400 WIBLE RD	None	BAKERSFIELD	CA	93304	4700	00	06000	35.3328934	-119.0389535	Kern County
338849	Ordering, Referring, Prescribing	N/A	1588212807	0	0	ALVAREZ, MARY D LMFT	5/23/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT139697	N/A	N/A	N/A	N/A	N/A	520 E. TULARE AVE	None	VISALIA	CA	93292	5221	00	06000	36.320679	-119.2870845	Tulare County
338852	Ordering, Referring, Prescribing	N/A	1588216709	0	0	ACEVES, JENNIFER LMFT	12/27/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130238	N/A	N/A	N/A	N/A	N/A	1301 PINE AVE	None	LONG BEACH	CA	90813	3124	00	06000	33.782913	-118.192417	Los Angeles County
338898	Ordering, Referring, Prescribing	N/A	1588337265	0	0	ACQUAYE, EYIZAH LMFT	4/10/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	139056	N/A	N/A	N/A	N/A	N/A	755 E. GILBERT ST	None	SAN BERNARDINO	CA	92404	5413	00	06000	34.1267535	-117.27081	San Bernardino County
338939	Ordering, Referring, Prescribing	N/A	1588698112	0	0	ALPER, MIKHAIL A	5/17/2017	Taxonomy not applicable	NA	n/a	000	Unknown	15856	N/A	N/A	N/A	N/A	N/A	1041 ROSE AVE	None	SELMA	CA	93662	3240	00	06000	36.56879252	-119.596257	Fresno County
339007	Ordering, Referring, Prescribing	N/A	1588834808	0	0	ANDERSON, JILL P LCSW	11/16/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW22885	N/A	N/A	N/A	N/A	N/A	4760 S SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4820	00	06000	34.00134941	-118.4039837	Los Angeles County
339018	Ordering, Referring, Prescribing	N/A	1588859987	0	0	ADAMS, SUZANNE M PHD	4/29/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY29244	N/A	N/A	N/A	N/A	N/A	1049 HOWARD STREET	None	SAN FRANCISCO	CA	94103	1519	00	06000	37.77871416	-122.4084009	San Francisco County
339056	Ordering, Referring, Prescribing	N/A	1588944201	0	0	ADAMS, JOHN MD	9/11/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A119705	N/A	N/A	N/A	N/A	N/A	1221 SOUTH AVENUE	WEST CAMPUS	SACRAMENTO	CA	95838	4464	00	06000	38.633418	-121.437189	Sacramento County
339074	Ordering, Referring, Prescribing	N/A	1588966543	0	0	ANDERSON, SARAH D LCSW	3/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	74675	N/A	N/A	N/A	N/A	N/A	7200 SKYWAY	None	PARADISE	CA	95969	3280	00	06000	39.76584095	-121.6165325	Butte County
339078	Ordering, Referring, Prescribing	N/A	1588970347	0	0	ALONA, EMILY C LCSW	7/22/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW69804	N/A	N/A	N/A	N/A	N/A	341 IRWIN LANE	None	SANTA ROSA	CA	95401	5603	00	06000	38.43621084	-122.7882082	Sonoma County
339134	Ordering, Referring, Prescribing	N/A	1598039356	0	0	ABRIL, NOEL P PA-C	6/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	16809	N/A	N/A	N/A	N/A	N/A	3500 E PACIFIC COAST HWY	None	LONG BEACH	CA	90804	1904	00	06000	33.78983447	-118.1510145	Los Angeles County
339154	Ordering, Referring, Prescribing	N/A	1598072837	0	0	ARPIARIAN, SARA E LCSW	6/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW70107	N/A	N/A	N/A	N/A	N/A	525 CABRILLO PARK DR	300	SANTA ANA	CA	92701	5017	00	06000	33.75047365	-117.8404984	Orange County
339161	Ordering, Referring, Prescribing	N/A	1598083164	0	0	ADENIYI, HAKEEM O	10/21/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A116609	N/A	N/A	N/A	N/A	N/A	2020 J STREET	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
339170	Ordering, Referring, Prescribing	N/A	1598094286	0	0	ABRAHAM, ANCY NP	3/22/2013	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN0653439	N/A	N/A	N/A	N/A	N/A	757 WESTWOOD PLAZA	STE 5215A	LOS ANGELES	CA	90095	7404	00	06000	34.06633051	-118.4452686	Los Angeles County
339196	Ordering, Referring, Prescribing	N/A	1598130973	0	0	ANDERSON, NATALIE J LMFT	4/26/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125724	N/A	N/A	N/A	N/A	N/A	2130 E 4TH ST	STE 150	SANTA ANA	CA	92705	3818	00	06000	33.74808392	-117.836143	Orange County
339197	Ordering, Referring, Prescribing	N/A	1598134538	0	0	AGUILAR, CYNTHIA LCSW	7/12/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW110146	N/A	N/A	N/A	N/A	N/A	108 WEST VICTORIA STREET	None	GARDENA	CA	90248	3523	00	06000	33.86509452	-118.2762279	Los Angeles County
339219	Ordering, Referring, Prescribing	N/A	1598164832	0	0	ANDERSEN, ROSA Y LMFT	3/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT99200	N/A	N/A	N/A	N/A	N/A	1661 N RAYMOND AVE	SUITE 200	ANAHEIM	CA	92801	1120	00	06000	33.858234	-117.906788	Orange County
339231	Ordering, Referring, Prescribing	N/A	1598185027	0	0	ADAMS, CHRISTOPHER MD	12/12/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A149154	N/A	N/A	N/A	N/A	N/A	227 COHASSET LN	None	CHICO	CA	95926	0000	00	06000	39.75058978	-121.8511887	Butte County
339277	Ordering, Referring, Prescribing	N/A	1598262404	0	0	AKBAR, ALEENA F DDS	5/15/2023	Taxonomy not applicable	NA	n/a	000	Unknown	108770	N/A	N/A	N/A	N/A	N/A	730 STORY RD	None	SAN JOSE	CA	95122	2624	00	06000	37.3292404	-121.8586317	Santa Clara County
339284	Ordering, Referring, Prescribing	N/A	1598273351	0	0	AMBRIZ, NATHALY D LMFT	11/16/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129288	N/A	N/A	N/A	N/A	N/A	2751 NAPA VALLEY CORPORA	A-211	NAPA	CA	94558	6216	00	06000	38.24829023	-122.2745626	Napa County
339297	Ordering, Referring, Prescribing	N/A	1598310872	0	0	APOLONI, DENISE LMFT	2/1/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT130934	N/A	N/A	N/A	N/A	N/A	850 E WARDLOW RD	None	LONG BEACH	CA	90807	4628	00	06000	33.81888054	-118.182069	Los Angeles County
339324	Ordering, Referring, Prescribing	N/A	1598356636	0	0	AHMED, IMRAN T	8/17/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	103956	N/A	N/A	N/A	N/A	N/A	2100 W 3RD ST	STE 220	LOS ANGELES	CA	90057	1993	00	06000	34.06308947	-118.2733326	Los Angeles County
339329	Ordering, Referring, Prescribing	N/A	1598373904	0	0	AGUILAR, NAYELY MSW LCSW	8/27/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	125530	N/A	N/A	N/A	N/A	N/A	1030 W WARNER AVE	None	SANTA ANA	CA	92707	3147	00	06000	33.71597598	-117.8819134	Orange County
339343	Ordering, Referring, Prescribing	N/A	1598390437	0	0	ALFRED, ASHRAF PHARMD	2/4/2021	Taxonomy not applicable	NA	n/a	000	Unknown	65176	N/A	N/A	N/A	N/A	N/A	10431 LEMON AVE	STE G	RANCHO CUCAMONGA	CA	91737	3763	00	06000	34.13966252	-117.5775255	San Bernardino County
339374	Ordering, Referring, Prescribing	N/A	1598520991	0	0	AVILA, EMILY RN BS	6/6/2023	Taxonomy not applicable	NA	n/a	000	Unknown	823025	N/A	N/A	N/A	N/A	N/A	150 DISTRICT CENTER DR	None	PALM SPRINGS	CA	92264	3626	00	06000	33.82485354	-116.4955129	Riverside County
339377	Ordering, Referring, Prescribing	N/A	1598535171	0	0	ALI, MEHRAN DDS	10/16/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS109597	N/A	N/A	N/A	N/A	N/A	2101 7TH ST	BUILDING A-F	WASCO	CA	93280	1502	00	06000	35.59426049	-119.3498955	Kern County
339394	Ordering, Referring, Prescribing	N/A	1598767931	0	0	ARSENAULT, DEBRA A DO	4/26/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A11742	N/A	N/A	N/A	N/A	N/A	2017 1ST AVE	100	SAN DIEGO	CA	92101	2033	00	06000	32.72646147	-117.1638767	San Diego County
339395	Ordering, Referring, Prescribing	N/A	1598777120	0	0	AKAHORI, LAURA J	9/29/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP14947	N/A	N/A	N/A	N/A	N/A	118 BENSON DR	None	LODI	CA	95242	3243	00	06000	38.13243568	-121.2993326	San Joaquin County
339426	Ordering, Referring, Prescribing	N/A	1598881674	0	0	ALVAREZ, ELIZABETH LMFT	3/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	C6742746	N/A	N/A	N/A	N/A	N/A	802 BREWSTER STREET	None	REDWOOD CITY	CA	94063	1510	00	06000	37.48873991	-122.2339433	San Mateo County
339435	Ordering, Referring, Prescribing	N/A	1598898082	0	0	AVETISYAN, RUZANNA LMFT	12/15/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47985	N/A	N/A	N/A	N/A	N/A	5628 E SLAUSON AVE	None	COMMERCE	CA	90040	2922	00	06000	33.98593459	-118.163681	Los Angeles County
339491	Ordering, Referring, Prescribing	N/A	1609003920	0	0	ALBA-KELLY, VALORIE A LCSW	4/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	66547	N/A	N/A	N/A	N/A	N/A	17800 HWY 18	None	APPLE VALLEY	CA	92307	1221	00	06000	34.54007429	-117.2744761	San Bernardino County
339542	Ordering, Referring, Prescribing	N/A	1609125368	0	0	AU, KENNETH S PHARMD	4/5/2022	Taxonomy not applicable	NA	n/a	000	Unknown	64648	N/A	N/A	N/A	N/A	N/A	450 10TH ST	None	SAN FRANCISCO	CA	94103	4304	00	06000	37.77094095	-122.4105065	San Francisco County
339544	Ordering, Referring, Prescribing	N/A	1609140219	0	0	AMIO, JULIE PHARMD	3/7/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH61152	N/A	N/A	N/A	N/A	N/A	9961 SIERRA AVE.	MOB 3	FONTANA	CA	92335	6794	00	06000	34.072245	-117.4319685	San Bernardino County
339545	Ordering, Referring, Prescribing	N/A	1609136316	0	0	ARMACOST, MICHELLE MD	2/11/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A125818	N/A	N/A	N/A	N/A	N/A	7601 E IMPERIAL HWY	None	DOWNEY	CA	90242	3456	00	06000	33.929829	-118.157607	Los Angeles County
339550	Ordering, Referring, Prescribing	N/A	1609143916	0	0	ASHLEY, ALYSSA W LMFT	12/7/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111473	N/A	N/A	N/A	N/A	N/A	3545 LONG BEACH BLVD	None	LONG BEACH	CA	90807	3941	00	06000	33.82086796	-118.18938	Los Angeles County
339572	Ordering, Referring, Prescribing	N/A	1609171909	0	0	AROONLAP, USA MD	2/23/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A109987	N/A	N/A	N/A	N/A	N/A	23228 MADERO	None	MISSION VIEJO	CA	92691	2706	00	06000	33.62548354	-117.6804077	Orange County
339596	Ordering, Referring, Prescribing	N/A	1609210244	0	0	AYOUB, AMANA PSYD	2/27/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	18214	N/A	N/A	N/A	N/A	N/A	2400 MOORPARK AVE	STE 300	SAN JOSE	CA	95128	2631	00	06000	37.3160785	-121.937121	Santa Clara County
339607	Ordering, Referring, Prescribing	N/A	1609223536	0	0	ARISTA, JAZMINE LCSW	2/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88016	N/A	N/A	N/A	N/A	N/A	450 W PALMDALE BLVD	None	PALMDALE	CA	93551	3104	00	06000	34.58291281	-118.1375187	Los Angeles County
339641	Ordering, Referring, Prescribing	N/A	1609292770	0	0	AFKHAMI, HASTI LMFT	12/2/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	93301	N/A	N/A	N/A	N/A	N/A	11080 W OLYMPIC BLVD	None	LOS ANGELES	CA	90064	1937	00	06000	34.04036814	-118.4376056	Los Angeles County
339667	Ordering, Referring, Prescribing	N/A	1609315811	0	0	ANOSIKE, CHRISTINA LMFT	2/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124197	N/A	N/A	N/A	N/A	N/A	928 BROADWAY	None	SAN DIEGO	CA	92101	5514	00	06000	32.71575045	-117.1560915	San Diego County
339676	Ordering, Referring, Prescribing	N/A	1609326859	0	0	ALFARO, AMY LCSW	9/7/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93430	N/A	N/A	N/A	N/A	N/A	525 E MAIN ST	None	EL CAJON	CA	92020	4007	00	06000	32.79492347	-116.955981	San Diego County
339696	Ordering, Referring, Prescribing	N/A	1609367762	0	0	ALCARAZ, ELIZABETH G LMFT	5/3/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT111895	N/A	N/A	N/A	N/A	N/A	3300 TRUXTON AVE.	None	BAKERSFIELD	CA	93301	3137	00	06000	35.37353416	-119.0392409	Kern County
339699	Ordering, Referring, Prescribing	N/A	1609346287	0	0	ARTEAGA, LETICIA LMFT	5/19/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	132832	N/A	N/A	N/A	N/A	N/A	3580 WILSHIRE BLVD. SUIT	None	LOS ANGELES	CA	90010	2151	00	06000	34.06170677	-118.302787	Los Angeles County
339724	Ordering, Referring, Prescribing	N/A	1609414689	0	0	AGUILAR, SCARLETT R LMFT	3/27/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT146037	N/A	N/A	N/A	N/A	N/A	2525 N CHESTER AVE	None	BAKERSFIELD	CA	93308	1770	00	06000	35.429463	-119.0213795	Kern County
339762	Ordering, Referring, Prescribing	N/A	1609499763	0	0	AGNEW, JORDAN PA-C	9/28/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61716	N/A	N/A	N/A	N/A	N/A	1627 E ANAHEIM ST	None	LONG BEACH	CA	90813	3809	00	06000	33.78263549	-118.171296	Los Angeles County
339799	Ordering, Referring, Prescribing	N/A	1609654953	0	0	AMATANGELO, ANGELICA F DDS	8/22/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS109172	N/A	N/A	N/A	N/A	N/A	726 POLK ST	4TH FLOOR	SAN FRANCISCO	CA	94109	7813	00	06000	37.78379532	-122.4192766	San Francisco County
339823	Ordering, Referring, Prescribing	N/A	1609918770	0	0	ALMOAYAD, MUNA A	7/11/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D44138	N/A	N/A	N/A	N/A	N/A	1502 E COLLINS AVE	None	ORANGE	CA	92867	5934	00	06000	33.80227852	-117.837333	Orange County
339849	Ordering, Referring, Prescribing	N/A	1609959683	0	0	ANNUNZIATA, JENNIFER E MD	5/31/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A73165	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	7M8	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
339853	Ordering, Referring, Prescribing	N/A	1609964154	0	0	AGARWAL, VIJAY P MD	8/7/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A43699	N/A	N/A	N/A	N/A	N/A	1330 N INDIAN CANYON DR	None	PALM SPRINGS	CA	92262	4880	00	06000	33.84144	-116.5455715	Riverside County
339866	Ordering, Referring, Prescribing	N/A	1609996107	0	0	ALCANTARA-BUENO, MARIA S	3/27/2018	Taxonomy not applicable	NA	n/a	099	DENTIST	D38792	N/A	N/A	N/A	N/A	N/A	1970 UNIVERSITY AVE	None	RIVERSIDE	CA	92507	5202	00	06000	33.97555819	-117.3545428	Riverside County
339885	Ordering, Referring, Prescribing	N/A	1619031317	0	0	ANEJA, ALKA MD	12/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A112029	N/A	N/A	N/A	N/A	N/A	355 TUOLUMNE ST	None	VALLEJO	CA	94590	5700	00	06000	38.10261225	-122.2382555	Solano County
339891	Ordering, Referring, Prescribing	N/A	1619039278	0	0	AHUJA, AAKASH M	2/15/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A99415	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	105	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
339893	Ordering, Referring, Prescribing	N/A	1619040292	0	0	ABDULRAHIM, AHMED M DC	2/22/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	28335	N/A	N/A	N/A	N/A	N/A	4725 MARKET ST	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
339918	Ordering, Referring, Prescribing	N/A	1619094281	0	0	ASELTINE, ROBYN M LCSW	2/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	20269	N/A	N/A	N/A	N/A	N/A	2712 MISSION STREET	None	SAN FRANCISCO	CA	94110	3104	00	06000	37.75336705	-122.4185922	San Francisco County
339924	Ordering, Referring, Prescribing	N/A	1619107968	0	0	AHUJA, RENO K MD	5/17/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C141861	N/A	N/A	N/A	N/A	N/A	201 N COURT ST	None	VISALIA	CA	93291	4918	00	06000	36.331218	-119.292561	Tulare County
339938	Ordering, Referring, Prescribing	N/A	1619133444	0	0	AILINANI, HARY MD	12/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C164092	N/A	N/A	N/A	N/A	N/A	36101 BOB HOPE DRIVE	A1	RANCHO MIRAGE	CA	92270	2002	00	06000	33.786126	-116.406086	Riverside County
339941	Ordering, Referring, Prescribing	N/A	1619156841	0	0	AMARANT, LISA LCSW	6/11/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	65550	N/A	N/A	N/A	N/A	N/A	121 DOWNEY AVENUE	None	MODESTO	CA	95354	1208	00	06000	37.64552748	-120.992607	Stanislaus County
340013	Ordering, Referring, Prescribing	N/A	1619271517	0	0	ALTAMIRANO, LEON PSYD	6/28/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY23734	N/A	N/A	N/A	N/A	N/A	150 VALPREDA RD	None	SAN MARCOS	CA	92069	2973	00	06000	33.14066871	-117.156095	San Diego County
340015	Ordering, Referring, Prescribing	N/A	1619277761	0	0	ANWAR, SHAHNAZ PHARMD	6/14/2022	Taxonomy not applicable	NA	n/a	000	Unknown	RPH51422	N/A	N/A	N/A	N/A	N/A	2851 DEL PASO RD	None	SACRAMENTO	CA	95835	2304	00	06000	38.657124	-121.5246015	Sacramento County
340018	Ordering, Referring, Prescribing	N/A	1619280443	0	0	AUCOIN-UNRUHE, ADRIANA LMFT	6/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT100826	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE.	SUITE 100	GILROY	CA	95020	3617	00	06000	37.03080985	-121.5741639	Santa Clara County
340033	Ordering, Referring, Prescribing	N/A	1619306719	0	0	ANGELES, ZAYRA J LCSW	9/5/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW105303	N/A	N/A	N/A	N/A	N/A	17800 HWY 18	None	APPLE VALLEY	CA	92307	0002	00	06000	34.54007429	-117.2744761	San Bernardino County
340042	Ordering, Referring, Prescribing	N/A	1619308491	0	0	AKINS, CONRAD P LCSW	4/1/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100879	N/A	N/A	N/A	N/A	N/A	650 N STATE ST	None	HEMET	CA	92543	2960	00	06000	33.757695	-116.9717535	Riverside County
340050	Ordering, Referring, Prescribing	N/A	1619344009	0	0	ALLRED, JEREMY A LCSW	12/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	98939	N/A	N/A	N/A	N/A	N/A	20 E ALISAL ST	None	SALINAS	CA	93901	3416	00	06000	36.67396737	-121.6534227	Monterey County
340081	Ordering, Referring, Prescribing	N/A	1619373933	0	0	ADAME, MONICA M LMFT	9/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	121949	N/A	N/A	N/A	N/A	N/A	202 N 8TH ST	None	EL CENTRO	CA	92243	2302	00	06000	32.794335	-115.5614775	Imperial County
340084	Ordering, Referring, Prescribing	N/A	1619378254	0	0	ARELLANO, LILIAN M LCSW	8/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96443	N/A	N/A	N/A	N/A	N/A	21545 CENTRE POINTE PARK	None	SANTA CLARITA	CA	91350	2947	00	06000	34.413021	-118.514534	Los Angeles County
340115	Ordering, Referring, Prescribing	N/A	1619427176	0	0	AMBRAZAITE, IEVA L OT	3/24/2019	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	15139	N/A	N/A	N/A	N/A	N/A	109 E EL PORTAL	None	SAN CLEMENTE	CA	92672	3976	00	06000	33.43156588	-117.620331	Orange County
340137	Ordering, Referring, Prescribing	N/A	1619472693	0	0	AL-OBEIDI, EBAA	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164569	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
340156	Ordering, Referring, Prescribing	N/A	1619507050	0	0	AVILES, RONLEY	9/27/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95013587	N/A	N/A	N/A	N/A	N/A	201 29TH STREET	STE. B	SACRAMENTO	CA	95816	3288	00	06000	38.581875	-121.463802	Sacramento County
340165	Ordering, Referring, Prescribing	N/A	1619521952	0	0	ARMENTA, ALYSSA M	2/29/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW121319	N/A	N/A	N/A	N/A	N/A	205 PASADENA AVE	None	SOUTH PASADENA	CA	91030	2919	00	06000	34.11219143	-118.1709685	Los Angeles County
340196	Ordering, Referring, Prescribing	N/A	1619589694	0	0	AVILA, MICHELLE LMFT	12/4/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	151796	N/A	N/A	N/A	N/A	N/A	3601 CALLE TECATE	201	CAMARILLO	CA	93012	5056	00	06000	34.22151847	-119.021535	Ventura County
340210	Ordering, Referring, Prescribing	N/A	1619636917	0	0	AL MAGSOOSI, REEM FALAH DDS	9/3/2023	Taxonomy not applicable	NA	n/a	000	Unknown	107183	N/A	N/A	N/A	N/A	N/A	2928 EASTERN AVE	None	SACRAMENTO	CA	95821	4210	00	06000	38.618703	-121.3635915	Sacramento County
340255	Ordering, Referring, Prescribing	N/A	1629030515	0	0	ADLER, FREDERICK W MD	3/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G50673	N/A	N/A	N/A	N/A	N/A	165 CAPP ST	None	SAN FRANCISCO	CA	94110	1209	00	06000	37.76403824	-122.4185654	San Francisco County
340256	Ordering, Referring, Prescribing	N/A	1629051750	0	0	AU, NATHAN H OD	9/13/2017	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	11857	N/A	N/A	N/A	N/A	N/A	2396 CRENSHAW BLVD	C	TORRANCE	CA	90501	3336	00	06000	33.82224412	-118.328446	Los Angeles County
340303	Ordering, Referring, Prescribing	N/A	1629143185	0	0	ALEXANDER, DARYL P MD	2/12/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G42141	N/A	N/A	N/A	N/A	N/A	400 W 30TH ST	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
340320	Ordering, Referring, Prescribing	N/A	1629197728	0	0	ANDRES, ABRAHAM LMFT	3/31/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	83995	N/A	N/A	N/A	N/A	N/A	800 SCENIC DR	None	MODESTO	CA	95350	6131	00	06000	37.64722447	-120.9836925	Stanislaus County
340330	Ordering, Referring, Prescribing	N/A	1629213186	0	0	AGUIRRE, RAQUEL E PHARMD	5/8/2019	Taxonomy not applicable	NA	n/a	000	Unknown	59205	N/A	N/A	N/A	N/A	N/A	1700 MOUNT VERNON AVE	None	BAKERSFIELD	CA	93306	4018	00	06000	35.382555	-118.970757	Kern County
340365	Ordering, Referring, Prescribing	N/A	1629311279	0	0	ARMATAS, CHRISTINA MD	6/26/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A132122	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
340373	Ordering, Referring, Prescribing	N/A	1629320999	0	0	ALLEN, MEGAN R LMFT	8/31/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40452	N/A	N/A	N/A	N/A	N/A	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	00	06000	37.9469952	-122.5373892	Marin County
340403	Ordering, Referring, Prescribing	N/A	1629355201	0	0	ANDERSON, RYAN P PHARMD	7/11/2021	Taxonomy not applicable	NA	n/a	000	Unknown	62127	N/A	N/A	N/A	N/A	N/A	9305 MISSION GORGE RD	None	SANTEE	CA	92071	3815	00	06000	32.83856247	-116.995401	San Diego County
340411	Ordering, Referring, Prescribing	N/A	1629369632	0	0	AGUILAR, YENY LMFT	5/15/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT139550	N/A	N/A	N/A	N/A	N/A	370 W. CRENSHAW BLVD	E-100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
340415	Ordering, Referring, Prescribing	N/A	1629376595	0	0	AVILA-HERRERA, RUBY R LMFT	10/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122786	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR	None	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
340423	Ordering, Referring, Prescribing	N/A	1629383997	0	0	AHMADI, SHAHRYAR MD	2/22/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C146477	N/A	N/A	N/A	N/A	N/A	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
340449	Ordering, Referring, Prescribing	N/A	1629427216	0	0	ASAVAMEDHI, ADRIANNA ANTOINETTE N L	3/20/2023	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC13439	N/A	N/A	N/A	N/A	N/A	1830 S CENTRAL ST	None	VISALIA	CA	93277	4418	00	06000	36.314271	-119.311362	Tulare County
340461	Ordering, Referring, Prescribing	N/A	1629470679	0	0	ARMSTRONG, STEPHANIE	4/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	71338	N/A	N/A	N/A	N/A	N/A	1800 HARRISON STREET	None	OAKLAND	CA	94612	0000	00	06000	37.80593773	-122.2656714	Alameda County
340477	Ordering, Referring, Prescribing	N/A	1629490693	0	0	ABAD, MATTHEW DO	3/17/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A19347	N/A	N/A	N/A	N/A	N/A	2710 GATEWAY OAKS DR	None	SACRAMENTO	CA	95833	3505	00	06000	38.61612	-121.5161055	Sacramento County
340491	Ordering, Referring, Prescribing	N/A	1629514856	0	0	AHMAD, ARSALLAN	4/17/2017	Taxonomy not applicable	NA	n/a	000	Unknown	856	N/A	N/A	N/A	N/A	N/A	230 BLUE RAVINE RD	None	FOLSOM	CA	95630	4748	00	06000	38.656422	-121.172049	Sacramento County
340515	Ordering, Referring, Prescribing	N/A	1629557236	0	0	AGUILAR, VENESSA	11/17/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123100	N/A	N/A	N/A	N/A	N/A	47950 DUNE PALMS RD	None	LA QUINTA	CA	92253	4000	00	06000	33.70220565	-116.2774057	Riverside County
340526	Ordering, Referring, Prescribing	N/A	1629573415	0	0	ALTINTAS, JACQUELINE T	9/28/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A191289	N/A	N/A	N/A	N/A	N/A	17909 SOLEDAD CANYON RD	2ND FLOOR	CANYON COUNTRY	CA	91387	3210	00	06000	34.41652621	-118.4458684	Los Angeles County
340563	Ordering, Referring, Prescribing	N/A	1629627120	0	0	ANYAH, EMILIA E CNP	10/17/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015702	N/A	N/A	N/A	N/A	N/A	815 HYDE STREET	SUITE 100	SAN FRANCISCO	CA	94109	5998	00	06000	37.78855	-122.416917	San Francisco County
340585	Ordering, Referring, Prescribing	N/A	1629653761	0	0	ACEBEDO, ETHELYNE JOYCE A NP	2/23/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95016763	N/A	N/A	N/A	N/A	N/A	20601 WEST PAOLI LANE	None	WEIMAR	CA	95736	0486	00	06000	39.03521526	-120.9755343	Placer County
340656	Ordering, Referring, Prescribing	N/A	1639200801	0	0	ALAMILLO ROY, MARTHA A LCSW	5/17/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	24465	N/A	N/A	N/A	N/A	N/A	2751 NAPA VALLEY CORPORA	BUILDING A, OFFICE A211	NAPA	CA	94559	1344	00	06000	38.24829023	-122.2745626	Napa County
340666	Ordering, Referring, Prescribing	N/A	1639217284	0	0	AHLFELD, RICHARD J DDS	11/12/2023	Taxonomy not applicable	NA	n/a	000	Unknown	22939	N/A	N/A	N/A	N/A	N/A	2540 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	00	06000	40.14893664	-122.2178101	Tehama County
340713	Ordering, Referring, Prescribing	N/A	1639321060	0	0	ANGERT, GWEN A PSYD	1/26/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY23429	N/A	N/A	N/A	N/A	N/A	263 S WEST ST	None	TULARE	CA	93274	3411	00	06000	36.20460711	-119.3668926	Tulare County
340739	Ordering, Referring, Prescribing	N/A	1639395791	0	0	ARBELAEZ, JANINE LMFT	2/26/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	36575	N/A	N/A	N/A	N/A	N/A	1111 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3131	00	06000	35.64171	-117.669847	Kern County
340747	Ordering, Referring, Prescribing	N/A	1639409048	0	0	ABRAHAMS, MARLIE J PA-C	3/26/2018	Taxonomy not applicable	NA	n/a	000	Unknown	20745	N/A	N/A	N/A	N/A	N/A	661 W. FIRST ST.	STE. G	TUSTIN	CA	92780	2939	00	06000	33.74578153	-117.831231	Orange County
340762	Ordering, Referring, Prescribing	N/A	1639446024	0	0	ATTARIAN, MONA LMFT	11/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT98535	N/A	N/A	N/A	N/A	N/A	12124 BULLIS RD	None	LYNWOOD	CA	90262	5106	00	06000	33.91614168	-118.2044211	Los Angeles County
340783	Ordering, Referring, Prescribing	N/A	1639471485	0	0	AVILA, NICK V LCSW	7/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75883	N/A	N/A	N/A	N/A	N/A	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	00	06000	37.9469952	-122.5373892	Marin County
340848	Ordering, Referring, Prescribing	N/A	1639554421	0	0	AGUILAR, VICTOR LMFT	11/6/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106018	N/A	N/A	N/A	N/A	N/A	1670 E 120TH ST	None	LOS ANGELES	CA	90059	3026	00	06000	33.92456051	-118.2417525	Los Angeles County
340871	Ordering, Referring, Prescribing	N/A	1639589708	0	0	AGUIRRE, MELISSA LCSW	4/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88828	N/A	N/A	N/A	N/A	N/A	602 ORCHARD ST	None	ARROYO GRANDE	CA	93420	4000	00	06000	35.11551362	-120.5762034	San Luis Obispo County
340885	Ordering, Referring, Prescribing	N/A	1639607294	0	0	ALI, SAIYED MD	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165663	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
340898	Ordering, Referring, Prescribing	N/A	1639627938	0	0	AKAKPO, KEREN PA-C	10/9/2024	Taxonomy not applicable	NA	n/a	000	Unknown	65189	N/A	N/A	N/A	N/A	N/A	193 FAIRVIEW LN	None	SONORA	CA	95370	4828	00	06000	37.97880957	-120.3912459	Tuolumne County
341002	Ordering, Referring, Prescribing	N/A	1639845993	0	0	AMAYUN, IRA V	10/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018990	N/A	N/A	N/A	N/A	N/A	351FELICE DRIVE	None	HOLLISTER	CA	95023	2208	00	06000	36.85325269	-121.4170104	San Benito County
341022	Ordering, Referring, Prescribing	N/A	1639931520	0	0	ALONSO, RUTH PSYD	1/11/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	34808	N/A	N/A	N/A	N/A	N/A	1625 E 4TH ST	None	LOS ANGELES	CA	90033	4201	00	06000	34.04297786	-118.2220181	Los Angeles County
341031	Ordering, Referring, Prescribing	N/A	1649022245	0	0	AKSKALYAN, ROSA PHARMD	9/15/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH88494	N/A	N/A	N/A	N/A	N/A	6521 VAN NUYS BLVD.	None	VAN NUYS	CA	91401	1425	00	06000	34.189497	-118.448759	Los Angeles County
341051	Ordering, Referring, Prescribing	N/A	1649267071	0	0	ABJELINA, KENNETH T MD	2/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A64789	N/A	N/A	N/A	N/A	N/A	23700 CAMINO DEL SOL	None	TORRANCE	CA	90505	5017	00	06000	33.8102385	-118.3441185	Los Angeles County
341061	Ordering, Referring, Prescribing	N/A	1649301854	0	0	ALCAIDE, JENNIFER F LCSW	5/30/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW26596	N/A	N/A	N/A	N/A	N/A	2655 CAMINO DEL RIO N	STE. 450	SAN DIEGO	CA	92108	1603	00	06000	32.77261373	-117.1347389	San Diego County
341085	Ordering, Referring, Prescribing	N/A	1649335324	0	0	ALEXANDER, SCOTT	8/26/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48075	N/A	N/A	N/A	N/A	N/A	1610 OAK PARK BLVD	None	PLEASANT HILL	CA	94523	4400	00	06000	37.9333393	-122.0627061	Contra Costa County
341089	Ordering, Referring, Prescribing	N/A	1649345067	0	0	AKPENYI, GEORGE I MD	1/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A96503	N/A	N/A	N/A	N/A	N/A	1720 E 120TH ST	None	LOS ANGELES	CA	90059	3052	00	06000	33.92455929	-118.2423557	Los Angeles County
341095	Ordering, Referring, Prescribing	N/A	1649352386	0	0	ALLISON, WILLIAM A	11/9/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	D27578	N/A	N/A	N/A	N/A	N/A	101 WEST COAST ROAD	# 769	REDWAY	CA	95560	0769	00	06000	40.11704433	-123.8133408	Humboldt County
341096	Ordering, Referring, Prescribing	N/A	1649352626	0	0	ALVAREZ, RICARDO MD	8/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G73709	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL STREET	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
341136	Ordering, Referring, Prescribing	N/A	1649462789	0	0	ALBOUGHOBAISH, PARVANEH N LMFT	3/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT89460	N/A	N/A	N/A	N/A	N/A	2178 JOHNSON AVE	None	SAN LUIS OBISPO	CA	93401	4535	00	06000	35.27488974	-120.6468257	San Luis Obispo County
341144	Ordering, Referring, Prescribing	N/A	1649469628	0	0	ABDULIAN, MICHAEL H MD	4/19/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A118845	N/A	N/A	N/A	N/A	N/A	1500 E CHEVY CHASE DR	STE 401	GLENDALE	CA	91206	4191	00	06000	34.15201194	-118.2322051	Los Angeles County
341174	Ordering, Referring, Prescribing	N/A	1649529652	0	0	ARCILA-MESA, MARIANA LCSW	2/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW79667	N/A	N/A	N/A	N/A	N/A	439 W. 97TH STREET	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
341212	Ordering, Referring, Prescribing	N/A	1649599366	0	0	ATTIA, ENAS F	10/17/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110082	N/A	N/A	N/A	N/A	N/A	1515 E ALLUVIAL AVE STE	STE 105	FRESNO	CA	93720	3832	00	06000	36.84470983	-119.7561692	Fresno County
341227	Ordering, Referring, Prescribing	N/A	1649609652	0	0	ATWATER, DESIREE LMFT	2/22/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT138021	N/A	N/A	N/A	N/A	N/A	17800 HWY 18 APPLE VALLE	17800 CA-18	APPLE VALLEY	CA	92307	1221	00	06000	34.54007429	-117.2744761	San Bernardino County
341257	Ordering, Referring, Prescribing	N/A	1649659624	0	0	ADAMSON, BRITTANY L NP	8/17/2015	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	518265	N/A	N/A	N/A	N/A	N/A	1442 ETHAN WAY	None	SACRAMENTO	CA	95825	7611	00	06000	38.592126	-121.4190765	Sacramento County
341273	Ordering, Referring, Prescribing	N/A	1649685496	0	0	ARAN, MARLINA G LMFT	4/5/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114355	N/A	N/A	N/A	N/A	N/A	2000 PHYSICIANS BLVD	None	BAKERSFIELD	CA	93301	1277	00	06000	35.396994	-119.0084938	Kern County
341279	Ordering, Referring, Prescribing	N/A	1649699968	0	0	ABDALLAH, ALI H DO	2/27/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15471	N/A	N/A	N/A	N/A	N/A	4725 MARKET ST	None	SAN DIEGO	CA	92102	4715	00	06000	32.71127386	-117.0929781	San Diego County
341292	Ordering, Referring, Prescribing	N/A	1649718578	0	0	ANSARI, MOHAM M	4/23/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	102994	N/A	N/A	N/A	N/A	N/A	4815 WATT AVE	None	NORTH HIGHLANDS	CA	95660	5108	00	06000	38.653245	-121.3836075	Sacramento County
341312	Ordering, Referring, Prescribing	N/A	1649754292	0	0	ADEYEYE, SUNDAY NP	1/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	NP95010038	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	SUITE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
341334	Ordering, Referring, Prescribing	N/A	1649790866	0	0	ASUNCION, PATRICIA PSYD	10/15/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32920	N/A	N/A	N/A	N/A	N/A	1601 MONTE VISTA AVENUE	SUITE 240	CLAREMONT	CA	91204	2548	00	06000	34.112259	-117.698539	Los Angeles County
341335	Ordering, Referring, Prescribing	N/A	1649791898	0	0	AL TEKREETI, MOHAMMED E	5/28/2019	Taxonomy not applicable	NA	n/a	099	DENTIST	101465	N/A	N/A	N/A	N/A	N/A	133 W MAIN ST	STE 100	EL CAJON	CA	92020	3325	00	06000	32.79492453	-116.9627861	San Diego County
341396	Ordering, Referring, Prescribing	N/A	1649922758	0	0	AWAZI, JUSTINA T NP	12/14/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95023626	N/A	N/A	N/A	N/A	N/A	2311 LOVERIDGE RD	None	PITTSBURG	CA	94565	5117	00	06000	38.00694767	-121.8712439	Contra Costa County
341418	Ordering, Referring, Prescribing	N/A	1649991282	0	0	ARMENTA, JOSCELYNE	8/2/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022111	N/A	N/A	N/A	N/A	N/A	2023 VALE RD	None	SAN PABLO	CA	94806	3834	00	06000	37.95369824	-122.3378493	Contra Costa County
341433	Ordering, Referring, Prescribing	N/A	1659029528	0	0	AWADA, NADIA PA-C	6/6/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA64590	N/A	N/A	N/A	N/A	N/A	12301 HAWTHORNE BLVD	None	HAWTHORNE	CA	90250	3808	00	06000	33.92064813	-118.3528905	Los Angeles County
341447	Ordering, Referring, Prescribing	N/A	1659086155	0	0	AALAM, MAHSHID N PHARMD	1/30/2022	Taxonomy not applicable	NA	n/a	000	Unknown	46894	N/A	N/A	N/A	N/A	N/A	1400 S. GRAND AVE.	801	LOS ANGELES	CA	90015	3068	00	06000	34.03692236	-118.2655238	Los Angeles County
341469	Ordering, Referring, Prescribing	N/A	1659303998	0	0	AHMED, KELLY MD	4/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A51407	N/A	N/A	N/A	N/A	N/A	14285 AMARGOSA ROAD	SUITE 100	VICTORVILLE	CA	92392	9707	00	06000	34.510329	-117.3301305	San Bernardino County
341494	Ordering, Referring, Prescribing	N/A	1659407823	0	0	ADAMS, NEAL H MD	3/18/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G43003	N/A	N/A	N/A	N/A	N/A	2751 NAPA VALLEY CORPORA	BUILDING A	NAPA	CA	94558	6216	00	06000	38.24829023	-122.2745626	Napa County
341517	Ordering, Referring, Prescribing	N/A	1659474229	0	0	ANDERSON, RACHEL DMD	9/9/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS104784	N/A	N/A	N/A	N/A	N/A	1325 N ANAHEIM BLVD	None	ANAHEIM	CA	92801	1202	00	06000	33.85331047	-117.9199617	Orange County
341525	Ordering, Referring, Prescribing	N/A	1659495018	0	0	ALI, FARHANA LMFT	10/12/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51184	N/A	N/A	N/A	N/A	N/A	301 E 13TH ST	None	MERCED	CA	95341	6211	00	06000	37.29248035	-120.4730619	Merced County
341536	Ordering, Referring, Prescribing	N/A	1659501880	0	0	ARELLANES, CAROLYN L PA-C	5/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	20429	N/A	N/A	N/A	N/A	N/A	501 N INDIAN RD	None	SMITH RIVER	CA	95567	9509	00	06000	41.95702601	-124.2045614	Del Norte County
341577	Ordering, Referring, Prescribing	N/A	1659602621	0	0	ARCENEAUX, JENNIFER L LMFT	1/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	90325	N/A	N/A	N/A	N/A	N/A	12777 W JEFFERSON BLVD	BUILDING D, SUITE 300	LOS ANGELES	CA	90066	7048	00	06000	33.97772559	-118.4175713	Los Angeles County
341596	Ordering, Referring, Prescribing	N/A	1659637734	0	0	ACOSTA, BELEM CCC-SLP	12/4/2022	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	SP29127	N/A	N/A	N/A	N/A	N/A	511 S ORCHARD AVE	None	UKIAH	CA	95482	5022	00	06000	39.14729048	-123.1987868	Mendocino County
341624	Ordering, Referring, Prescribing	N/A	1659663136	0	0	ARBUCKLE, ROBERT MD	1/18/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A114731	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK RD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
341674	Ordering, Referring, Prescribing	N/A	1659746956	0	0	ARRAZOLA, VIOLETA S LMFT	3/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT113417	N/A	N/A	N/A	N/A	N/A	160 SOUTH 7TH AVE	None	LA PUENTE	CA	91746	8971	00	06000	34.0335863	-117.9760093	Los Angeles County
341687	Ordering, Referring, Prescribing	N/A	1659765576	0	0	AMLADI, ANJANI MD	2/2/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145048	N/A	N/A	N/A	N/A	N/A	6051 N FRESNO STREET	201	FRESNO	CA	93710	5280	00	06000	36.823905	-119.781436	Fresno County
341701	Ordering, Referring, Prescribing	N/A	1659786234	0	0	ARNESON, JESSICA E LPCC	8/10/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC6028	N/A	N/A	N/A	N/A	N/A	928 BROADWAY	None	SAN DIEGO	CA	92101	5514	00	06000	32.71575045	-117.1560915	San Diego County
341709	Ordering, Referring, Prescribing	N/A	1659800522	0	0	ANDERSON, TIFFANY PHD	7/24/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY34394	N/A	N/A	N/A	N/A	N/A	3671 BUSINESS DR	None	SACRAMENTO	CA	95820	2165	00	06000	38.54133	-121.41891	Sacramento County
341721	Ordering, Referring, Prescribing	N/A	1659813640	0	0	ALPER, ATARA G CCC-SLP	3/27/2023	Taxonomy not applicable	NA	n/a	037	SPEECH THERAPISTS	27670	N/A	N/A	N/A	N/A	N/A	511 S ORCHARD AVE	None	UKIAH	CA	95482	5022	00	06000	39.14729048	-123.1987868	Mendocino County
341728	Ordering, Referring, Prescribing	N/A	1659825644	0	0	ALLINGER, BRITTANY N LCSW	12/15/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102887	N/A	N/A	N/A	N/A	N/A	3200 CLAYTON RD	None	CONCORD	CA	94519	2819	00	06000	37.97283909	-122.0196497	Contra Costa County
341752	Ordering, Referring, Prescribing	N/A	1659860195	0	0	AKOBUNDU, RAPHAEL NP	11/2/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95007925	N/A	N/A	N/A	N/A	N/A	347 W MISSION AVE	None	ESCONDIDO	CA	92025	1729	00	06000	33.12861918	-117.0906689	San Diego County
341761	Ordering, Referring, Prescribing	N/A	1659878569	0	0	ARRIAZA, ELINA R OT	4/29/2021	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	22039	N/A	N/A	N/A	N/A	N/A	1901 N RICE AVE	STE 170-180	OXNARD	CA	93030	7912	00	06000	34.21960355	-119.1421345	Ventura County
341768	Ordering, Referring, Prescribing	N/A	1659894988	0	0	AMAYA, JESSICA PAOLA	6/17/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95006999	N/A	N/A	N/A	N/A	N/A	1530 S. OLIVE STREET	None	LOS ANGELES	CA	90015	0000	00	06000	34.03542552	-118.2652073	Los Angeles County
341793	Ordering, Referring, Prescribing	N/A	1659944411	0	0	ANDRADE DOS SANTOS, AMANDA ROSA PA-C	8/18/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61532	N/A	N/A	N/A	N/A	N/A	1344 W CLINTON AVE	None	FRESNO	CA	93705	3805	00	06000	36.77199051	-119.8275525	Fresno County
341797	Ordering, Referring, Prescribing	N/A	1659954402	0	0	AHMED, SYED S DDS	11/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	0401418230	N/A	N/A	N/A	N/A	N/A	36977 PARK AVE	None	BURNEY	CA	96013	4067	00	06000	40.87640189	-121.6730441	Shasta County
341812	Ordering, Referring, Prescribing	N/A	1659997765	0	0	ALHENDY, MOHAMMED MD	2/21/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A184441	N/A	N/A	N/A	N/A	N/A	1344 W CLINTON AVE	None	FRESNO	CA	93705	3805	00	06000	36.77199051	-119.8275525	Fresno County
341825	Ordering, Referring, Prescribing	N/A	1669024295	0	0	ABBAS, HASNAIN G	7/27/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	104880	N/A	N/A	N/A	N/A	N/A	201 E LAKEVIEW AVE	None	WOODLAKE	CA	93286	1301	00	06000	36.4172997	-119.0975768	Tulare County
341845	Ordering, Referring, Prescribing	N/A	1669091948	0	0	ANKUS, EMILY J MD	5/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PTL4669	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
341846	Ordering, Referring, Prescribing	N/A	1669090767	0	0	AGUILAR, SARAH ELIZABETH R NP	2/24/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014635	N/A	N/A	N/A	N/A	N/A	155 15TH ST	SUITE A	WEST SACRAMENTO	CA	95691	3737	00	06000	38.57104661	-121.5260133	Yolo County
341847	Ordering, Referring, Prescribing	N/A	1669092128	0	0	ABDELRAZEK, AHMED MD	12/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A192283	N/A	N/A	N/A	N/A	N/A	2180 HARVARD ST	SUITE 210	SACRAMENTO	CA	95815	3317	00	06000	38.60568	-121.4345385	Sacramento County
341864	Ordering, Referring, Prescribing	N/A	1669150561	0	0	ARCILLA, ALEXANDRIA NP	6/9/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025538	N/A	N/A	N/A	N/A	N/A	321 E CHAPMAN AVE	None	FULLERTON	CA	92832	2011	00	06000	33.87399454	-117.918234	Orange County
341899	Ordering, Referring, Prescribing	N/A	1669411369	0	0	ALBRECHT, GREGORY C DPM	9/13/2017	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E4591	N/A	N/A	N/A	N/A	N/A	10300 COMPTON AVE	None	LOS ANGELES	CA	90002	3628	00	06000	33.94274917	-118.2461916	Los Angeles County
341903	Ordering, Referring, Prescribing	N/A	1669402467	0	0	AHLUWALIA, BIKRAMJIT S MD	12/14/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C52278	N/A	N/A	N/A	N/A	N/A	16143 KOKANEE ROAD STE.	None	APPLE VALLEY	CA	92307	1355	00	06000	34.54439055	-117.2678905	San Bernardino County
341910	Ordering, Referring, Prescribing	N/A	1669490660	0	0	AZIZ, ALI D	5/15/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A45799	N/A	N/A	N/A	N/A	N/A	1625 N SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
341921	Ordering, Referring, Prescribing	N/A	1669513750	0	0	ANDERSON, BENJAMIN J LCSW	2/13/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22969	N/A	N/A	N/A	N/A	N/A	333 LAWS AVE	None	UKIAH	CA	95482	6540	00	06000	39.12772164	-123.2111168	Mendocino County
341929	Ordering, Referring, Prescribing	N/A	1669535621	0	0	AUSTIN, MARIA D LMFT	2/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53666	N/A	N/A	N/A	N/A	N/A	1907 BOYS REPUBLIC DR	None	CHINO HILLS	CA	91709	5447	00	06000	33.993846	-117.725661	San Bernardino County
341961	Ordering, Referring, Prescribing	N/A	1669601498	0	0	ASTORGA, YESENIA C LMFT	6/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	83090	N/A	N/A	N/A	N/A	N/A	120 S STATE COLLEGE BLVD	SUITE 150	BREA	CA	92821	5834	00	06000	33.92111797	-117.8828786	Orange County
341993	Ordering, Referring, Prescribing	N/A	1669706826	0	0	ALVAREZ, MABEL LCSW	5/3/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93139	N/A	N/A	N/A	N/A	N/A	801 E CHAPMAN AVE	203	FULLERTON	CA	92831	3839	00	06000	33.87407517	-117.9110814	Orange County
342041	Ordering, Referring, Prescribing	N/A	1669805248	0	0	AYALA, PATRICIA LCSW	3/10/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	114186	N/A	N/A	N/A	N/A	N/A	2101 COURAGE DR.	None	FAIRFIELD	CA	94533	6717	00	06000	38.23737478	-122.0676832	Solano County
342147	Ordering, Referring, Prescribing	N/A	1669994406	0	0	ARREDONDO, ARETE M	2/6/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95006953	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	4353	00	06000	34.42887662	-119.7237878	Santa Barbara County
342162	Ordering, Referring, Prescribing	N/A	1679006191	0	0	AMIR, RAPHAEL LMFT	12/23/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	152209	N/A	N/A	N/A	N/A	N/A	5168 HONPIE RD	None	PLACERVILLE	CA	95667	8635	00	06000	38.6943603	-120.9018271	El Dorado County
342178	Ordering, Referring, Prescribing	N/A	1679043442	0	0	ANTONIO, MARC C	3/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124951	N/A	N/A	N/A	N/A	N/A	3127 N MILLBROOK AVE	None	FRESNO	CA	93703	1425	00	06000	36.77841	-119.7635455	Fresno County
342202	Ordering, Referring, Prescribing	N/A	1679072334	0	0	ARMSTRONG, CHARLOTTE D LPCC	6/16/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC6386	N/A	N/A	N/A	N/A	N/A	25910 ACERO	160	MISSION VIEJO	CA	92691	2790	00	06000	33.61712389	-117.6780482	Orange County
342229	Ordering, Referring, Prescribing	N/A	1679115356	0	0	ALSHARIF, MAJID LMFT	4/19/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146495	N/A	N/A	N/A	N/A	N/A	1625 SCHRADER BLVD	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
342249	Ordering, Referring, Prescribing	N/A	1679150171	0	0	ADEYEMI, ABAYOMI MD	8/2/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187667	N/A	N/A	N/A	N/A	N/A	25825 VERMONT AVE	None	HARBOR CITY	CA	90710	3518	00	06000	33.78673844	-118.2965289	Los Angeles County
342278	Ordering, Referring, Prescribing	N/A	1679226427	0	0	ARELLANO, CHRISTINA LCSW	2/15/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100002	N/A	N/A	N/A	N/A	N/A	439 W 97TH ST	None	LOS ANGELES	CA	90003	3968	00	06000	33.94831439	-118.282325	Los Angeles County
342316	Ordering, Referring, Prescribing	N/A	1679597033	0	0	ANANTH, LALITHA MD	4/18/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A40291	N/A	N/A	N/A	N/A	N/A	11100 WARNER AVE	200	FOUNTAIN VALLEY	CA	92708	4006	00	06000	33.716291	-117.9355051	Orange County
342341	Ordering, Referring, Prescribing	N/A	1679652333	0	0	ASSEFA, BETHLEHEM PSYD	3/21/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY27755	N/A	N/A	N/A	N/A	N/A	510 S VERMONT AVE	None	LOS ANGELES	CA	90020	1992	00	06000	34.065	-118.291631	Los Angeles County
342363	Ordering, Referring, Prescribing	N/A	1679706089	0	0	AUSTIN-WILLIAMS, KYMIL S LMFT	2/19/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT103636	N/A	N/A	N/A	N/A	N/A	27261 LAS RAMBLAS	SUITE 200	MISSION VIEJO	CA	92691	6468	00	06000	33.56536541	-117.670334	Orange County
342367	Ordering, Referring, Prescribing	N/A	1679707418	0	0	ACOBA, REYNO R LMFT	12/30/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	47592	N/A	N/A	N/A	N/A	N/A	20101 HAMILTON AVE	155	TORRANCE	CA	90502	1351	00	06000	33.84828383	-118.2860386	Los Angeles County
342374	Ordering, Referring, Prescribing	N/A	1679710644	0	0	AGUILAR, HECTOR M PA-C	7/12/2022	Taxonomy not applicable	NA	n/a	000	Unknown	20147	N/A	N/A	N/A	N/A	N/A	271 N L ST	None	DINUBA	CA	93618	2107	00	06000	36.54248431	-119.3921496	Tulare County
342381	Ordering, Referring, Prescribing	N/A	1679734149	0	0	ALFIERIS, KATINA M	7/31/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D41338	N/A	N/A	N/A	N/A	N/A	517 S MADERA AVE	None	KERMAN	CA	93630	1523	00	06000	36.72710606	-120.060325	Fresno County
342386	Ordering, Referring, Prescribing	N/A	1679738827	0	0	ABASS, OLAWUNMI M	10/7/2015	Taxonomy not applicable	NA	n/a	099	DENTIST	D57399	N/A	N/A	N/A	N/A	N/A	106 E MAIN ST	None	FOWLER	CA	93625	2433	00	06000	36.62899034	-119.6785493	Fresno County
342429	Ordering, Referring, Prescribing	N/A	1679823637	0	0	ALDANA, PILLEY LMFT	5/1/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	111520	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD.	MS #53	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
342476	Ordering, Referring, Prescribing	N/A	1679932529	0	0	AGUILAR, ISABEL G LMFT	5/22/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147048	N/A	N/A	N/A	N/A	N/A	5628 EAST SLAUSON AVENUE	None	COMMERCE	CA	90040	2922	00	06000	33.98593459	-118.163681	Los Angeles County
342486	Ordering, Referring, Prescribing	N/A	1679941306	0	0	ANDRADE, LOUISA LMFT	2/16/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT145133	N/A	N/A	N/A	N/A	N/A	306 E MAIN ST	307	STOCKTON	CA	95202	2941	00	06000	37.95318725	-121.2867842	San Joaquin County
342490	Ordering, Referring, Prescribing	N/A	1679945166	0	0	ACOSTA, AIMEE LCSW	2/14/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	121042	N/A	N/A	N/A	N/A	N/A	3303 N BROADWAY	None	LOS ANGELES	CA	90031	2803	00	06000	34.07380397	-118.20586	Los Angeles County
342497	Ordering, Referring, Prescribing	N/A	1679962443	0	0	ALMEIDA, BECKY R LMFT	8/28/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115223	N/A	N/A	N/A	N/A	N/A	8801 FOLSOM BLVD.	SUITE 265	SACRAMENTO	CA	95826	3250	00	06000	38.553381	-121.376421	Sacramento County
342527	Ordering, Referring, Prescribing	N/A	1689006397	0	0	APPEL, OONA PSYD	6/6/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY30180	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
342552	Ordering, Referring, Prescribing	N/A	1689040230	0	0	AVILA, ALMA R LMFT	1/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116668	N/A	N/A	N/A	N/A	N/A	480 EAST 13TH STREET	None	MERCED	CA	95341	6214	00	06000	37.29194565	-120.4717887	Merced County
342565	Ordering, Referring, Prescribing	N/A	1689067746	0	0	AWAD, TRAIZ I	7/26/2021	Taxonomy not applicable	NA	n/a	000	Unknown	70623	N/A	N/A	N/A	N/A	N/A	205 W SHAW AVE	None	CLOVIS	CA	93612	3602	00	06000	36.8086	-119.7143248	Fresno County
342575	Ordering, Referring, Prescribing	N/A	1689082836	0	0	AZNAVOUR, GERMINE PHARMD	4/10/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61789	N/A	N/A	N/A	N/A	N/A	6100 SEPULVEDA BLVD	None	VAN NUYS	CA	91411	2503	00	06000	34.181325	-118.463634	Los Angeles County
342582	Ordering, Referring, Prescribing	N/A	1689093494	0	0	ADACKAPARA, NYSSA MD	2/16/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A134973	N/A	N/A	N/A	N/A	N/A	5100 S EASTERN AVE	None	COMMERCE	CA	90040	2950	00	06000	33.98882955	-118.1615175	Los Angeles County
342599	Ordering, Referring, Prescribing	N/A	1689123176	0	0	AGUIRRE, LILY LCSW	12/2/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW98953	N/A	N/A	N/A	N/A	N/A	4701 E CESAR E CHAVEZ AV	2ND FL	LOS ANGELES	CA	90022	1209	00	06000	34.04062547	-118.1643975	Los Angeles County
342608	Ordering, Referring, Prescribing	N/A	1689137226	0	0	ABLE, BRANDEE LCSW	1/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92929	N/A	N/A	N/A	N/A	N/A	1720 E 120TH ST	#1119	LOS ANGELES	CA	90059	3052	00	06000	33.92455929	-118.2423557	Los Angeles County
342611	Ordering, Referring, Prescribing	N/A	1689145807	0	0	AYVAZYAN, SALINE NP	12/10/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010615	N/A	N/A	N/A	N/A	N/A	1975 VERDUGO BLVD	None	LA CANADA	CA	91011	3022	00	06000	34.20501855	-118.219857	Los Angeles County
342612	Ordering, Referring, Prescribing	N/A	1689145294	0	0	AGBONKPOLO, SAMUEL PHARMD	7/30/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79732	N/A	N/A	N/A	N/A	N/A	22456 BARTON RD	None	GRAND TERRACE	CA	92313	5009	00	06000	34.0339605	-117.3146175	San Bernardino County
342615	Ordering, Referring, Prescribing	N/A	1689150443	0	0	AVILEZ, QUETZALLI A LCSW	8/25/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW117731	N/A	N/A	N/A	N/A	N/A	1529 GRAND AVE	SUITE A	SAN MARCOS	CA	92078	2464	00	06000	33.14484004	-117.1969923	San Diego County
342633	Ordering, Referring, Prescribing	N/A	1689170573	0	0	ARENSON, ALEXANDRA M DO	4/1/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17977	N/A	N/A	N/A	N/A	N/A	2500 MERCED STREET	None	SAN LEANDRO	CA	94577	4201	00	06000	37.706364	-122.165163	Alameda County
342636	Ordering, Referring, Prescribing	N/A	1689169005	0	0	ABADIAN, BAHAREH E	9/9/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	102630	N/A	N/A	N/A	N/A	N/A	801 S CHEVY CHASE DR	STE 250	GLENDALE	CA	91205	4433	00	06000	34.136757	-118.2396195	Los Angeles County
342639	Ordering, Referring, Prescribing	N/A	1689179020	0	0	AQUINO, MONICA G LCSW	3/30/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88899	N/A	N/A	N/A	N/A	N/A	3105 WILSON RD	None	BAKERSFIELD	CA	93304	5319	00	06000	35.33217634	-119.037921	Kern County
342641	Ordering, Referring, Prescribing	N/A	1689182800	0	0	AOYAMA, NORIKO NP	1/18/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008164	N/A	N/A	N/A	N/A	N/A	2490 W SHAW AVE	SUITE 101	FRESNO	CA	93711	3305	00	06000	36.80841598	-119.8371594	Fresno County
342653	Ordering, Referring, Prescribing	N/A	1689198616	0	0	ARGAW, MIHRET PHARMD	3/1/2021	Taxonomy not applicable	NA	n/a	000	Unknown	74985	N/A	N/A	N/A	N/A	N/A	6600 BRUCEVILLE RD	None	SACRAMENTO	CA	95823	4671	00	06000	38.470392	-121.4223975	Sacramento County
342669	Ordering, Referring, Prescribing	N/A	1689233546	0	0	ALCORN, MARIA LCSW	7/21/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	109289	N/A	N/A	N/A	N/A	N/A	734 10TH AVE	None	SAN DIEGO	CA	92101	6502	00	06000	32.71306718	-117.1556209	San Diego County
342674	Ordering, Referring, Prescribing	N/A	1689235558	0	0	AU, SARA LPCC	7/12/2023	Taxonomy not applicable	NA	n/a	000	Unknown	14234	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
342675	Ordering, Referring, Prescribing	N/A	1689238560	0	0	AHADIAN, DONIA MD	6/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178849	N/A	N/A	N/A	N/A	N/A	2325 COMMERCIAL ST	None	SAN DIEGO	CA	92113	1189	00	06000	32.70514724	-117.1429916	San Diego County
342703	Ordering, Referring, Prescribing	N/A	1689296576	0	0	ANDRADE, EZEQUIEL A MD	10/10/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181210	N/A	N/A	N/A	N/A	N/A	1670 E. 120TH STREET	None	LOS ANGELES	CA	90059	0000	00	06000	33.92456051	-118.2417525	Los Angeles County
342705	Ordering, Referring, Prescribing	N/A	1689316481	0	0	AMIRFATHI, FELIX MD	12/11/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188967	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
342756	Ordering, Referring, Prescribing	N/A	1689681512	0	0	AMOS, CYNTHIA D LMFT	11/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFC43792	N/A	N/A	N/A	N/A	N/A	7001-A EAST PARKWAY, SUI	300	SACRAMENTO	CA	95823	2501	00	06000	38.497689	-121.4498385	Sacramento County
342832	Ordering, Referring, Prescribing	N/A	1689868242	0	0	AGUILAR, JACQUELINE D	11/2/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	106962	N/A	N/A	N/A	N/A	N/A	15301 S SAN JOSE AVE	None	COMPTON	CA	90221	3131	00	06000	33.8941921	-118.1817657	Los Angeles County
342833	Ordering, Referring, Prescribing	N/A	1689866634	0	0	AGUIRRE, NATALIE A LMFT	3/29/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125231	N/A	N/A	N/A	N/A	N/A	11731 E TELEGRAPH RD	STE K	SANTA FE SPRINGS	CA	90670	6824	00	06000	33.94630253	-118.0832082	Los Angeles County
342852	Ordering, Referring, Prescribing	N/A	1689920001	0	0	ARREOLA MARTINEZ, SAHILI LCSW	12/10/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	77567	N/A	N/A	N/A	N/A	N/A	1359 N GRAND AVE	None	COVINA	CA	91724	1016	00	06000	34.104681	-117.872706	Los Angeles County
342877	Ordering, Referring, Prescribing	N/A	1689955676	0	0	ALLEN, TAMARA A LMFT	7/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126866	N/A	N/A	N/A	N/A	N/A	13585 SAN PABLO AVE	2ND FL	SAN PABLO	CA	94806	3804	00	06000	37.95651393	-122.3371491	Contra Costa County
342884	Ordering, Referring, Prescribing	N/A	1689958258	0	0	ANTONIO, CRISTINA D	7/10/2021	Taxonomy not applicable	NA	n/a	000	Unknown	53061	N/A	N/A	N/A	N/A	N/A	111 W WASHINGTON AVE	None	ESCONDIDO	CA	92025	2629	00	06000	33.1266858	-117.0846994	San Diego County
342903	Ordering, Referring, Prescribing	N/A	1699015602	0	0	ANTONIO, IANINA NIKA B LMFT	5/28/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT104522	N/A	N/A	N/A	N/A	N/A	1309 EVANS AVENUE	None	SAN FRANCISCO	CA	94124	1705	00	06000	37.74005234	-122.3834106	San Francisco County
342911	Ordering, Referring, Prescribing	N/A	1699025338	0	0	AMJADI, JINOUS PHARMD	1/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	49562	N/A	N/A	N/A	N/A	N/A	4071 18TH STREET	None	SAN FRANCISCO	CA	94114	2535	00	06000	37.76089183	-122.4343778	San Francisco County
342931	Ordering, Referring, Prescribing	N/A	1699059311	0	0	ARMAS, STEPHEN W	8/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	47173	N/A	N/A	N/A	N/A	N/A	41169 GOODWIN WAY	110	MADERA	CA	93636	8766	00	06000	36.88577349	-119.800021	Madera County
342934	Ordering, Referring, Prescribing	N/A	1699052605	0	0	AKKINENI, KEERTHI MD	3/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A149978	N/A	N/A	N/A	N/A	N/A	6051 N FRESNO ST	None	FRESNO	CA	93710	5280	00	06000	36.823905	-119.781436	Fresno County
342982	Ordering, Referring, Prescribing	N/A	1699137661	0	0	ABDELMEGEED, MANAR MD	2/4/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158204	N/A	N/A	N/A	N/A	N/A	301 THE CITY DR S	None	ORANGE	CA	92868	3205	00	06000	33.78547994	-117.8888036	Orange County
343013	Ordering, Referring, Prescribing	N/A	1699192377	0	0	ARTAZ, JENNA LMFT	6/12/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101564	N/A	N/A	N/A	N/A	N/A	900 E MAIN ST.	STE. 201	GRASS VALLEY	CA	95945	4117	00	06000	39.22827201	-121.0517684	Nevada County
343015	Ordering, Referring, Prescribing	N/A	1699200857	0	0	AL SUDANY, LAITH H	7/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	75185	N/A	N/A	N/A	N/A	N/A	1111 THIRD AVE	None	CHULA VISTA	CA	91911	3105	00	06000	32.61310923	-117.0688372	San Diego County
343033	Ordering, Referring, Prescribing	N/A	1699228205	0	0	ANCENO, MARLENE J LCSW	6/18/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW102051	N/A	N/A	N/A	N/A	N/A	850 E. FOOTHILL BLVD	None	RIALTO	CA	92376	5230	00	06000	34.10679449	-117.3542535	San Bernardino County
343035	Ordering, Referring, Prescribing	N/A	1699233445	0	0	AZIZ-HANIFZAI, LAMBA LMFT	11/3/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129029	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	401	ORANGE	CA	92868	1001	00	06000	33.78016046	-117.8956101	Orange County
343041	Ordering, Referring, Prescribing	N/A	1699243568	0	0	AMIGABLE, PATRICK PT	10/31/2018	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT295731	N/A	N/A	N/A	N/A	N/A	4456 BLACK AVENUE	SUITE 150	PLEASANTON	CA	94566	6112	00	06000	37.67216054	-121.876569	Alameda County
343049	Ordering, Referring, Prescribing	N/A	1699258442	0	0	AGUIRRE, DANIELLE R LMFT	3/16/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124957	N/A	N/A	N/A	N/A	N/A	652 FOREST AVENUE	None	PALO ALTO	CA	94301	2622	00	06000	37.44868402	-122.1547101	Santa Clara County
343093	Ordering, Referring, Prescribing	N/A	1699348425	0	0	AGUITE, ALFRED Y LMFT	4/19/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125601	N/A	N/A	N/A	N/A	N/A	3132 JEFFERSON STREET	None	SAN DIEGO	CA	92110	4421	00	06000	32.75567499	-117.203517	San Diego County
343104	Ordering, Referring, Prescribing	N/A	1699371773	0	0	ALVAREZ, ASTRID M PA-C	2/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA59188	N/A	N/A	N/A	N/A	N/A	13193 CENTRAL AVE	SUITE 100	CHINO	CA	91710	4179	00	06000	34.01406506	-117.6891684	San Bernardino County
343116	Ordering, Referring, Prescribing	N/A	1699374686	0	0	ANOWIA, NARIMAN PHARMD	4/3/2022	Taxonomy not applicable	NA	n/a	000	Unknown	83533	N/A	N/A	N/A	N/A	N/A	2955 N TEGNER RD	None	TURLOCK	CA	95380	9401	00	06000	37.518768	-120.888963	Stanislaus County
343151	Ordering, Referring, Prescribing	N/A	1699461566	0	0	ASHLA, MARK MD	1/17/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL12612	N/A	N/A	N/A	N/A	N/A	1000 W CARSON ST	N26A	TORRANCE	CA	90502	2004	00	06000	33.83155851	-118.2920625	Los Angeles County
343152	Ordering, Referring, Prescribing	N/A	1699489435	0	0	ARIAS PEREZ, CARMEN L NP	11/22/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023414	N/A	N/A	N/A	N/A	N/A	3861 SEPULVEDA BLVD	None	CULVER CITY	CA	90230	4605	00	06000	34.01133074	-118.4159833	Los Angeles County
343176	Ordering, Referring, Prescribing	N/A	1699720706	0	0	AMINOVA, ALLA MD	9/5/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A63469	N/A	N/A	N/A	N/A	N/A	2039 FOREST AVE	STE 105	SAN JOSE	CA	95128	4817	00	06000	37.32711929	-121.934266	Santa Clara County
343214	Ordering, Referring, Prescribing	N/A	1699826545	0	0	ARMSTRONG, KERRY E LCSW	3/17/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW24750	N/A	N/A	N/A	N/A	N/A	300 E LELAND RD	None	PITTSBURG	CA	94565	4960	00	06000	38.01129897	-121.8878132	Contra Costa County
343221	Ordering, Referring, Prescribing	N/A	1699840587	0	0	ABDULLAH, KERI A PHD	6/19/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY29990	N/A	N/A	N/A	N/A	N/A	2391 ISLAND AVE	None	SAN DIEGO	CA	92102	2941	00	06000	32.71044228	-117.1425241	San Diego County
343232	Ordering, Referring, Prescribing	N/A	1699862417	0	0	AVERY, JEFFERY C LMFT	5/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT30660	N/A	N/A	N/A	N/A	N/A	3127 N MILLBROOK AVE	None	FRESNO	CA	93703	1425	00	06000	36.77841	-119.7635455	Fresno County
343241	Ordering, Referring, Prescribing	N/A	1699885475	0	0	ABRAHAMSON, HEATHER L DO	12/21/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A8501	N/A	N/A	N/A	N/A	N/A	67 EVANS ROAD	None	WOFFORD HEIGHTS	CA	93285	9640	00	06000	35.70661847	-118.4580008	Kern County
343249	Ordering, Referring, Prescribing	N/A	1699911412	0	0	ANNE, PRATAP K	9/16/2020	Taxonomy not applicable	NA	n/a	000	Unknown	59595	N/A	N/A	N/A	N/A	N/A	828 DELBON AVE	None	TURLOCK	CA	95382	2005	00	06000	37.51046855	-120.838905	Stanislaus County
343277	Ordering, Referring, Prescribing	N/A	1699977041	0	0	ADAMS PAYNE, ROTYNIA LCSW	6/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW81658	N/A	N/A	N/A	N/A	N/A	22320 FOOTHILL BLVD.	400	HAYWARD	CA	94541	2719	00	06000	37.67836576	-122.0838763	Alameda County
343308	Ordering, Referring, Prescribing	N/A	1700074853	0	0	ABBI, GAURAV MD	1/7/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A102193	N/A	N/A	N/A	N/A	N/A	2171 JUNIPERO SERRA BLVD	388	DALY CITY	CA	94104	1985	00	06000	37.69836798	-122.4706688	San Mateo County
343315	Ordering, Referring, Prescribing	N/A	1700088465	0	0	ADHIKARI, LAURA A	7/5/2022	Taxonomy not applicable	NA	n/a	018	NURSE ANESTHETISTS	AP03871	N/A	N/A	N/A	N/A	N/A	1415 TULANE AVE	None	NEW ORLEANS	LA	70112	0000	00	06000	29.95527949	-90.07612766	Orleans Parish
343326	Ordering, Referring, Prescribing	N/A	1700110657	0	0	ADU-POKU, QUEEN L LCSW	8/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25265	N/A	N/A	N/A	N/A	N/A	2810 LONE TREE WAY	SUITE 9	ANTIOCH	CA	94509	4956	00	06000	37.99499587	-121.8077774	Contra Costa County
343351	Ordering, Referring, Prescribing	N/A	1700144557	0	0	ALLEN, STEVEN A MD	1/26/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A129366	N/A	N/A	N/A	N/A	N/A	14659 OLIVE VIEW DR	None	SYLMAR	CA	91342	1652	00	06000	34.32412624	-118.4525494	Los Angeles County
343357	Ordering, Referring, Prescribing	N/A	1700155496	0	0	ALLA, NIRUPAMA R	9/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	80093	N/A	N/A	N/A	N/A	N/A	1620 1ST STREET	None	LIVERMORE	CA	94550	4363	00	06000	37.67959685	-121.7758608	Alameda County
343381	Ordering, Referring, Prescribing	N/A	1700180825	0	0	ABARTE, STEPHANIE A	9/6/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D59886	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
343417	Ordering, Referring, Prescribing	N/A	1700235454	0	0	ACCARDO, SHANNON A LMFT	12/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	106079	N/A	N/A	N/A	N/A	N/A	6051 N FRESNO ST	103	FRESNO	CA	93710	5280	00	06000	36.823905	-119.781436	Fresno County
343420	Ordering, Referring, Prescribing	N/A	1700235306	0	0	ALLEN, ROBERT W PHARMD	4/1/2018	Taxonomy not applicable	NA	n/a	000	Unknown	67862	N/A	N/A	N/A	N/A	N/A	250 E PARKCENTER BLVD	None	BOISE	ID	83706	3940	00	06000	43.59860438	-116.1806635	Ada County
343473	Ordering, Referring, Prescribing	N/A	1700316783	0	0	AN, ANA I LCSW	2/2/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW106721	N/A	N/A	N/A	N/A	N/A	5121 STOCKDALE HWY	None	BAKERSFIELD	CA	93309	2656	00	06000	35.35413152	-119.058471	Kern County
343501	Ordering, Referring, Prescribing	N/A	1700365475	0	0	ABSEY, KELLIE N BSN PHN	11/7/2018	Taxonomy not applicable	NA	n/a	000	Unknown	720668	N/A	N/A	N/A	N/A	N/A	1102 5TH ST.	None	WASCO	CA	93280	0001	00	06000	35.59698742	-119.3384925	Kern County
343523	Ordering, Referring, Prescribing	N/A	1700388451	0	0	AVRATIN, SARA LMFT	2/15/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124342	N/A	N/A	N/A	N/A	N/A	831 E. ARROW HWY	None	POMONA	CA	91767	0000	00	06000	34.09030767	-117.7353578	Los Angeles County
343556	Ordering, Referring, Prescribing	N/A	1700445186	0	0	ALANIZ, ADILENE LCSW	5/16/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW122559	N/A	N/A	N/A	N/A	N/A	1126 N GRAND AVE	None	COVINA	CA	91724	1551	00	06000	34.100082	-117.8724825	Los Angeles County
343558	Ordering, Referring, Prescribing	N/A	1700446291	0	0	ALVIZURES, ESDRAS R PSYD	6/5/2024	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	35085	N/A	N/A	N/A	N/A	N/A	800 N ECKHOFF ST.	#4124	ORANGE	CA	92868	1008	00	06000	33.79960624	-117.8741126	Orange County
343592	Ordering, Referring, Prescribing	N/A	1700518750	0	0	AKAR, SYLVIA N DMD	8/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	107520	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	None	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
343594	Ordering, Referring, Prescribing	N/A	1700539640	0	0	AUDIJE, REGINE C PHARMD	8/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84773	N/A	N/A	N/A	N/A	N/A	160 1ST ST	None	LOS ALTOS	CA	94022	2705	00	06000	37.37917164	-122.118817	Santa Clara County
343628	Ordering, Referring, Prescribing	N/A	1700839818	0	0	AMJADI, FIROOZ B MD	4/20/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A79509	N/A	N/A	N/A	N/A	N/A	2701 CHESTER AVE	STE 202	BAKERSFIELD	CA	93301	2016	00	06000	35.384166	-119.0188765	Kern County
343630	Ordering, Referring, Prescribing	N/A	1700849049	0	0	ALI, MUMTAZ A MD	3/21/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A43472	N/A	N/A	N/A	N/A	N/A	12665 GARDEN GROVE BLVD	514	GARDEN GROVE	CA	92843	1901	00	06000	33.77450141	-117.9123364	Orange County
343632	Ordering, Referring, Prescribing	N/A	1700858214	0	0	AMPUDIA, PETER A MD	9/15/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G72021	N/A	N/A	N/A	N/A	N/A	23700 CAMINO DEL SOL	None	TORRANCE	CA	90505	5017	00	06000	33.8102385	-118.3441185	Los Angeles County
343642	Ordering, Referring, Prescribing	N/A	1700903895	0	0	AGUILA, MARIA G LMFT	6/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	40865	N/A	N/A	N/A	N/A	N/A	5740 RALSTON STREET	SUITE 201	VENTURA	CA	93003	5864	00	06000	34.26070802	-119.213699	Ventura County
343645	Ordering, Referring, Prescribing	N/A	1700911450	0	0	ALDACO, ERIC LMFT	3/6/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT1166882	N/A	N/A	N/A	N/A	N/A	2523 W. 7TH ST	None	LOS ANGELES	CA	90057	3801	00	06000	34.05889258	-118.2821556	Los Angeles County
343663	Ordering, Referring, Prescribing	N/A	1700938941	0	0	ALLEN, DIANE L NP	9/17/2019	Taxonomy not applicable	NA	n/a	000	Unknown	7585	N/A	N/A	N/A	N/A	N/A	501 S BROOKHURST RD	None	FULLERTON	CA	92833	3207	00	06000	33.865002	-117.959396	Orange County
343698	Ordering, Referring, Prescribing	N/A	1710017900	0	0	ADAME, ANTHONY LMFT	2/4/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT22716	N/A	N/A	N/A	N/A	N/A	149 PASADENA AVENUE	None	SOUTH PASADENA	CA	91030	2947	00	06000	34.11188281	-118.1734374	Los Angeles County
343724	Ordering, Referring, Prescribing	N/A	1710078472	0	0	AKOPYAN, DIANA M	7/26/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	D51038	N/A	N/A	N/A	N/A	N/A	1127 WILSHIRE BLVD	STE 1504	LOS ANGELES	CA	90017	4006	00	06000	34.05270508	-118.2641005	Los Angeles County
343739	Ordering, Referring, Prescribing	N/A	1710120084	0	0	ARMENTA, LORRAINE M LCSW	3/25/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100762	N/A	N/A	N/A	N/A	N/A	237 W. MILL ST	None	SAN BERNARDINO	CA	92408	1403	00	06000	34.09212454	-117.288036	San Bernardino County
343752	Ordering, Referring, Prescribing	N/A	1710170048	0	0	ANAYA, YANIRA E LMFT	12/30/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT52253	N/A	N/A	N/A	N/A	N/A	480 EAST 13TH STREET	None	MERCED	CA	95341	6214	00	06000	37.29194565	-120.4717887	Merced County
343793	Ordering, Referring, Prescribing	N/A	1710243019	0	0	ALEJO, ALEX LMFT	8/14/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	140187	N/A	N/A	N/A	N/A	N/A	499 LOMA ALTA AVE	None	LOS GATOS	CA	95030	6227	00	06000	37.21747493	-121.9662128	Santa Clara County
343799	Ordering, Referring, Prescribing	N/A	1710255591	0	0	AKHTAR, EHSAAN MD MPH	6/18/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133960	N/A	N/A	N/A	N/A	N/A	451 E ALMOND AVE STE 103	STE 103	MADERA	CA	93637	5562	00	06000	36.948069	-120.051972	Madera County
343817	Ordering, Referring, Prescribing	N/A	1710275375	0	0	AGHAZADEHSANAI, NONA J	3/1/2021	Taxonomy not applicable	NA	n/a	099	DENTIST	D61255	N/A	N/A	N/A	N/A	N/A	10300 COMPTON AVENUE	None	LOS ANGELES	CA	90002	3628	00	06000	33.94274917	-118.2461916	Los Angeles County
343831	Ordering, Referring, Prescribing	N/A	1710288964	0	0	ACOSTA, VERONICA LCSW	3/28/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW114576	N/A	N/A	N/A	N/A	N/A	905 E 8TH ST	None	LOS ANGELES	CA	90021	1848	00	06000	34.03639545	-118.2465917	Los Angeles County
343832	Ordering, Referring, Prescribing	N/A	1710294343	0	0	ANDREWS, CAITLIN L PSYD	5/3/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY26930	N/A	N/A	N/A	N/A	N/A	1930 MARKET ST.	None	SAN FRANCISCO	CA	94102	6228	00	06000	37.77037155	-122.4255051	San Francisco County
343882	Ordering, Referring, Prescribing	N/A	1710367586	0	0	ALVARADO, EDNA LCSW	9/15/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	96930	N/A	N/A	N/A	N/A	N/A	21545 CENTRE POINTE PARK	None	SANTA CLARITA	CA	91350	2947	00	06000	34.413021	-118.514534	Los Angeles County
343889	Ordering, Referring, Prescribing	N/A	1710376819	0	0	ARMAO, CATHERINE LCSW	11/30/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	84395	N/A	N/A	N/A	N/A	N/A	975 FLYNN RD	None	CAMARILLO	CA	93012	8704	00	06000	34.22667906	-119.0196947	Ventura County
343904	Ordering, Referring, Prescribing	N/A	1710405733	0	0	ANDERSEN, LAURI N LMFT	3/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46930	N/A	N/A	N/A	N/A	N/A	4545 N. WEST AVE.	None	FRESNO	CA	93705	0946	00	06000	36.799623	-119.8264355	Fresno County
343928	Ordering, Referring, Prescribing	N/A	1710446133	0	0	ABBADE, SAMANTHA NP	1/18/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95010923	N/A	N/A	N/A	N/A	N/A	20601 WEST PAOLI LANE	None	WEIMAR	CA	95736	0486	00	06000	39.03521526	-120.9755343	Placer County
343940	Ordering, Referring, Prescribing	N/A	1710462080	0	0	ALCARAZ-GUTIERREZ, MICHELLE LMFT	7/14/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT148040	N/A	N/A	N/A	N/A	N/A	301 E 13TH ST	None	MERCED	CA	95341	6211	00	06000	37.29248035	-120.4730619	Merced County
343951	Ordering, Referring, Prescribing	N/A	1710480389	0	0	ALETA, ANNA LYN DDS	5/1/2023	Taxonomy not applicable	NA	n/a	000	Unknown	102319	N/A	N/A	N/A	N/A	N/A	6339 MACK RD	None	SACRAMENTO	CA	95823	4655	00	06000	38.475585	-121.4285265	Sacramento County
343966	Ordering, Referring, Prescribing	N/A	1710513064	0	0	AYERS, KELSEY C	4/30/2020	Taxonomy not applicable	NA	n/a	000	Unknown	58059	N/A	N/A	N/A	N/A	N/A	2500 CALIFORNIA ST	None	MOUNTAIN VIEW	CA	94040	1359	00	06000	37.40337202	-122.1063817	Santa Clara County
343978	Ordering, Referring, Prescribing	N/A	1710523444	0	0	ARROYO, MICHELYN LCSW	9/26/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	118272	N/A	N/A	N/A	N/A	N/A	1350 THIRD ST	None	LA VERNE	CA	91750	5201	00	06000	34.10427088	-117.7847615	Los Angeles County
343979	Ordering, Referring, Prescribing	N/A	1710530522	0	0	ARRIBENO, VALERIE	7/27/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102753	N/A	N/A	N/A	N/A	N/A	9864 BALDWIN PL	None	EL MONTE	CA	91731	2202	00	06000	34.07063297	-118.054303	Los Angeles County
343994	Ordering, Referring, Prescribing	N/A	1710531579	0	0	AROSTEGUI, FRANCESCA	10/27/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	135551	N/A	N/A	N/A	N/A	N/A	2750 SUTTERVILLE ROAD, S	None	SACRAMENTO	CA	95820	1024	00	06000	38.540124	-121.4786745	Sacramento County
343999	Ordering, Referring, Prescribing	N/A	1710603196	0	0	ASADORIAN MASIHI, MINELIE PHARMD	11/15/2023	Taxonomy not applicable	NA	n/a	000	Unknown	86577	N/A	N/A	N/A	N/A	N/A	8510 BALBOA BLVD	150	NORTHRIDGE	CA	91325	3583	00	06000	34.224507	-118.5026015	Los Angeles County
344026	Ordering, Referring, Prescribing	N/A	1710691340	0	0	ASAMSAMA, KRISTINA I CNP	8/19/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95031768	N/A	N/A	N/A	N/A	N/A	4094 4TH AVE	None	SAN DIEGO	CA	92103	2143	00	06000	32.75153771	-117.161688	San Diego County
344030	Ordering, Referring, Prescribing	N/A	1710719547	0	0	AGY, SEAN W RDH	8/26/2023	Taxonomy not applicable	NA	n/a	000	Unknown	26392	N/A	N/A	N/A	N/A	N/A	2540 SISTER MARY COLUMBA	None	RED BLUFF	CA	96080	4327	00	06000	40.14893664	-122.2178101	Tehama County
344075	Ordering, Referring, Prescribing	N/A	1720104649	0	0	ANTELL, JILL NP	7/14/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026011	N/A	N/A	N/A	N/A	N/A	6283 CLARK RD	5	PARADISE	CA	95969	4100	00	06000	39.7674117	-121.6005321	Butte County
344093	Ordering, Referring, Prescribing	N/A	1720123623	0	0	ANICETE, LUISITA V MD	12/22/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A45134	N/A	N/A	N/A	N/A	N/A	11721 E. TELEGRAPH ROAD	None	SANTA FE SPRINGS	CA	90670	3674	00	06000	33.94629336	-118.0832752	Los Angeles County
344117	Ordering, Referring, Prescribing	N/A	1720178890	0	0	ASSEFA, MESSERET PA	3/11/2018	Taxonomy not applicable	NA	n/a	000	Unknown	13102	N/A	N/A	N/A	N/A	N/A	8540 ALONDRA BLVD	SUITE B-2	PARAMOUNT	CA	90723	5200	00	06000	33.88915049	-118.1500515	Los Angeles County
344126	Ordering, Referring, Prescribing	N/A	1720189939	0	0	ALVARELLOS, MIGUEL A D MD	1/8/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A94524	N/A	N/A	N/A	N/A	N/A	4900 HOPYARD RD	100	PLEASANTON	CA	94588	7101	00	06000	37.693368	-121.9037975	Alameda County
344166	Ordering, Referring, Prescribing	N/A	1720303340	0	0	ALVARADO, EDMUND R PA-C	10/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	20888	N/A	N/A	N/A	N/A	N/A	2325 COMMERCIAL ST	SUITE 1400	SAN DIEGO	CA	92113	1189	00	06000	32.70514724	-117.1429916	San Diego County
344209	Ordering, Referring, Prescribing	N/A	1720360712	0	0	ADVANI, SHIELA PHARMD	3/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	66074	N/A	N/A	N/A	N/A	N/A	3825 HOPYARD RD	SUITE 140	PLEASANTON	CA	94588	8528	00	06000	37.683009	-121.9036935	Alameda County
344216	Ordering, Referring, Prescribing	N/A	1720367808	0	0	ARANDA RAMIREZ, FELIPE D MSW LCSW	3/22/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107379	N/A	N/A	N/A	N/A	N/A	3030 ALUM ROCK AVE	None	SAN JOSE	CA	95127	2807	00	06000	37.36514449	-121.8292446	Santa Clara County
344263	Ordering, Referring, Prescribing	N/A	1720426752	0	0	ALVAREZ, BONNIE LMFT	1/30/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	126766	N/A	N/A	N/A	N/A	N/A	1600 PACIFIC HWY	None	SAN DIEGO	CA	92101	2429	00	06000	32.7217581	-117.1711788	San Diego County
344317	Ordering, Referring, Prescribing	N/A	1720487895	0	0	AZIZI, AZITA M MSW LCSW	10/26/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	111500	N/A	N/A	N/A	N/A	N/A	3301 E12TH ST	None	OAKLAND	CA	94601	2940	00	06000	37.77617499	-122.2247899	Alameda County
344318	Ordering, Referring, Prescribing	N/A	1720495690	0	0	AGUILAR, ALFONSO L LCSW	6/4/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80822	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DR.	150	OXNARD	CA	93036	5341	00	06000	34.219566	-119.1539365	Ventura County
344325	Ordering, Referring, Prescribing	N/A	1720500838	0	0	ABAUNZA, LIZBETH M LCSW	6/2/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101804	N/A	N/A	N/A	N/A	N/A	11429 VALLEY BOULEVARD,	None	EL MONTE	CA	91731	3227	00	06000	34.06953065	-118.0288485	Los Angeles County
344336	Ordering, Referring, Prescribing	N/A	1720518129	0	0	AITALI, ADEL DPM	9/16/2018	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5495	N/A	N/A	N/A	N/A	N/A	635 ANDERSON RD	SUITE 19	DAVIS	CA	95616	3505	00	06000	38.5487623	-121.7587554	Yolo County
344361	Ordering, Referring, Prescribing	N/A	1720552722	0	0	ALCALA, MARIELA J	6/5/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014687	N/A	N/A	N/A	N/A	N/A	5385 FRANKLIN BLVD	SUITE A-D	SACRAMENTO	CA	95820	0000	00	06000	38.526282	-121.471398	Sacramento County
344372	Ordering, Referring, Prescribing	N/A	1720570682	0	0	AMAYA, STEPHANIE	7/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A180601	N/A	N/A	N/A	N/A	N/A	1691 THE ALAMEDA	None	SAN JOSE	CA	95126	2203	00	06000	37.3373761	-121.9192532	Santa Clara County
344377	Ordering, Referring, Prescribing	N/A	1720577422	0	0	AJAYI, VERONICA F LMFT	11/14/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	151354	N/A	N/A	N/A	N/A	N/A	1212 N. CALIFORNIA STREE	None	STOCKTON	CA	95202	1522	00	06000	37.96681769	-121.2881382	San Joaquin County
344430	Ordering, Referring, Prescribing	N/A	1720681943	0	0	ANDERSON, JOHN H PHARMD	3/15/2021	Taxonomy not applicable	NA	n/a	000	Unknown	37133	N/A	N/A	N/A	N/A	N/A	2374 FLORIN RD	None	SACRAMENTO	CA	95822	4403	00	06000	38.4956427	-121.4833568	Sacramento County
344443	Ordering, Referring, Prescribing	N/A	1720697683	0	0	ANEBERE, IMMACULATE O NP	8/31/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014842	N/A	N/A	N/A	N/A	N/A	501 E HARDY STR.	220	INGLEWWOD	CA	90301	7456	00	06000	33.9491005	-118.348857	Los Angeles County
344465	Ordering, Referring, Prescribing	N/A	1720777550	0	0	AHMED, YONIS PA-C	12/9/2024	Taxonomy not applicable	NA	n/a	000	Unknown	65552	N/A	N/A	N/A	N/A	N/A	6501 GARFIELD AVE	None	BELL GARDENS	CA	90201	1805	00	06000	33.97292523	-118.1475473	Los Angeles County
344481	Ordering, Referring, Prescribing	N/A	1720868235	0	0	ALBERTSON, RACHEL D NP	7/5/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95025788	N/A	N/A	N/A	N/A	N/A	9300 VALLEY CHILDRENS PL	None	MADERA	CA	93636	8761	00	06000	36.88437894	-119.8003484	Madera County
344547	Ordering, Referring, Prescribing	N/A	1730258740	0	0	AZULAY, JOANNE PHD	5/20/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	29543	N/A	N/A	N/A	N/A	N/A	815 HYDE STREET	None	SAN FRANCISCO	CA	94109	5996	00	06000	37.78855	-122.416917	San Francisco County
344563	Ordering, Referring, Prescribing	N/A	1730308651	0	0	AGRIOS, ANGELA C	9/1/2016	Taxonomy not applicable	NA	n/a	000	Unknown	232	N/A	N/A	N/A	N/A	N/A	17250 SUNSET BLVD	STE 302	PACIFIC PALISADES	CA	90272	3827	00	06000	34.04302848	-118.5536094	Los Angeles County
344568	Ordering, Referring, Prescribing	N/A	1730270828	0	0	AFSHARI, PARVANEH NP	7/18/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	6795	N/A	N/A	N/A	N/A	N/A	7301 STATE ST	None	HUNTINGTON PARK	CA	90255	5823	00	06000	33.97149395	-118.2097278	Los Angeles County
344579	Ordering, Referring, Prescribing	N/A	1730348459	0	0	ASHER, HOWARD LMFT	11/9/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	17204	N/A	N/A	N/A	N/A	N/A	23201 MILL CREEK DR	220	LAGUNA HILLS	CA	92653	7905	00	06000	33.62516256	-117.7353393	Orange County
344581	Ordering, Referring, Prescribing	N/A	1730351610	0	0	AERNAN, JACINTA R NP	3/10/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95009048	N/A	N/A	N/A	N/A	N/A	1360 W 6TH ST	STE 200	SAN PEDRO	CA	90732	3561	00	06000	33.73886546	-118.3075065	Los Angeles County
344652	Ordering, Referring, Prescribing	N/A	1730495060	0	0	AGUILAR, JOSE A LCSW	11/13/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	72128	N/A	N/A	N/A	N/A	N/A	1570 7TH ST	None	SANGER	CA	93657	2402	00	06000	36.70608966	-119.5596086	Fresno County
344676	Ordering, Referring, Prescribing	N/A	1730528191	0	0	ABASCAL, PILAR C	5/26/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A136309	N/A	N/A	N/A	N/A	N/A	2712 MISSION STREET	None	SAN FRANCISCO	CA	94110	3104	00	06000	37.75336705	-122.4185922	San Francisco County
344697	Ordering, Referring, Prescribing	N/A	1730561499	0	0	AYALA, ANDREW R LMFT	2/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113438	N/A	N/A	N/A	N/A	N/A	210 E ENOS DR	None	SANTA MARIA	CA	93454	7215	00	06000	34.9340215	-120.4343968	Santa Barbara County
344714	Ordering, Referring, Prescribing	N/A	1730558867	0	0	ALNES, LESLIE LCSW	4/6/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	100955	N/A	N/A	N/A	N/A	N/A	2116 ARLINGTON AVE	STE. 100	LOS ANGELES	CA	90401	1301	00	06000	34.037415	-118.3176815	Los Angeles County
344728	Ordering, Referring, Prescribing	N/A	1730619172	0	0	ARBALLO, JAMES F LMFT	10/31/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	142526	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	00	06000	37.34293689	-121.9270392	Santa Clara County
344744	Ordering, Referring, Prescribing	N/A	1730649229	0	0	ANIS, BUSHRA	6/28/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179317	N/A	N/A	N/A	N/A	N/A	1421 E 17TH ST	None	SANTA ANA	CA	92705	8505	00	06000	33.75994564	-117.847815	Orange County
344745	Ordering, Referring, Prescribing	N/A	1730655143	0	0	AVILA, ERICA M NP	3/3/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020188	N/A	N/A	N/A	N/A	N/A	1540 FLORIDA AVENUE	None	MODESTO	CA	95350	4408	00	06000	37.667115	-120.9962205	Stanislaus County
344755	Ordering, Referring, Prescribing	N/A	1730676412	0	0	ARDON, MERLIN CNP	9/1/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021148	N/A	N/A	N/A	N/A	N/A	9653 ALDER AVE	None	FONTANA	CA	92335	6129	00	06000	34.078509	-117.4182305	San Bernardino County
344761	Ordering, Referring, Prescribing	N/A	1730685983	0	0	AKERS, BEATRICE S DO	3/17/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A17896	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	0000	00	06000	38.555181	-121.4566785	Sacramento County
344768	Ordering, Referring, Prescribing	N/A	1730690389	0	0	ARSOUZY, ALLISON E LCSW	3/20/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW87671	N/A	N/A	N/A	N/A	N/A	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	00	06000	37.9469952	-122.5373892	Marin County
344820	Ordering, Referring, Prescribing	N/A	1730797069	0	0	ALVAREZ, MAYRA C CNP	2/10/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95024247	N/A	N/A	N/A	N/A	N/A	3081 TEAGARDEN ST	None	SAN LEANDRO	CA	94577	5720	00	06000	37.70519163	-122.1536391	Alameda County
344847	Ordering, Referring, Prescribing	N/A	1730858952	0	0	ASHONG, SHARON	8/18/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84815	N/A	N/A	N/A	N/A	N/A	4601 DALE RD	None	MODESTO	CA	95356	9718	00	06000	37.706508	-121.052457	Stanislaus County
344864	Ordering, Referring, Prescribing	N/A	1740009372	0	0	AMIS, GABRIELLE NP	10/2/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032439	N/A	N/A	N/A	N/A	N/A	600 B ST	None	LIVINGSTON	CA	95334	9593	00	06000	37.38589253	-120.734559	Merced County
344869	Ordering, Referring, Prescribing	N/A	1740050673	0	0	ALI, SHAZIANA	12/12/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028368	N/A	N/A	N/A	N/A	N/A	965 EL CAMINO AVE	None	SACRAMENTO	CA	95815	2530	00	06000	38.611638	-121.4444745	Sacramento County
344889	Ordering, Referring, Prescribing	N/A	1740291848	0	0	ANDERSON, JENNIFER L MD FAAP	3/15/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A80810	N/A	N/A	N/A	N/A	N/A	930 DEWING AVENUE	None	LAFAYETTE	CA	94549	4223	00	06000	37.88865608	-122.1230076	Contra Costa County
344894	Ordering, Referring, Prescribing	N/A	1740299015	0	0	ABBOTT, BRIAN S LMFT	1/15/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT38633	N/A	N/A	N/A	N/A	N/A	1612 MARKET STREET	None	REDDING	CA	96001	1021	00	06000	40.58309514	-122.390293	Shasta County
344897	Ordering, Referring, Prescribing	N/A	1740295419	0	0	AW, THAN A MD	10/19/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A53206	N/A	N/A	N/A	N/A	N/A	4844 N FIRST ST	STE 104	FRESNO	CA	93726	0529	00	06000	36.80569286	-119.7720261	Fresno County
344900	Ordering, Referring, Prescribing	N/A	1740306018	0	0	AFUSO-SUGANO, SUZANNE OT	1/29/2020	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	OT582	N/A	N/A	N/A	N/A	N/A	19401 S VERMONT AVENUE	L102	TORRANCE	CA	90502	1029	00	06000	33.85486409	-118.2905603	Los Angeles County
344909	Ordering, Referring, Prescribing	N/A	1740310994	0	0	ACCINELLI, THERESE LMFT	12/8/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT38609	N/A	N/A	N/A	N/A	N/A	5150 E PACIFIC COAST HWY	SUITE 100	LONG BEACH	CA	90804	3312	00	06000	33.7831762	-118.1333125	Los Angeles County
344975	Ordering, Referring, Prescribing	N/A	1740487362	0	0	ANGELAKIS, IOANNA LMFT	3/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT47682	N/A	N/A	N/A	N/A	N/A	2370 MARKET ST.	SUITE 130-395	SAN FRANCISCO	CA	94114	1696	00	06000	37.7631734	-122.4345607	San Francisco County
344978	Ordering, Referring, Prescribing	N/A	1740507052	0	0	AKINWOLE, YEMI K NP	1/16/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000369	N/A	N/A	N/A	N/A	N/A	1110 W ANAHEIM ST	#6	WILMINGTON	CA	90744	4131	00	06000	33.77921216	-118.2759309	Los Angeles County
345027	Ordering, Referring, Prescribing	N/A	1740586619	0	0	ANCHETA, JOSRITO A LMFT	12/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT127866	N/A	N/A	N/A	N/A	N/A	1830 S CENTRAL STREET	None	VISALIA	CA	93277	4418	00	06000	36.314271	-119.311362	Tulare County
345042	Ordering, Referring, Prescribing	N/A	1740618420	0	0	ANTONIO, ANTONETTE M NP	5/16/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	753737	N/A	N/A	N/A	N/A	N/A	3851 ROSECRANS	MS P576	SAN DIEGO	CA	92110	3115	00	06000	32.75343795	-117.2028528	San Diego County
345043	Ordering, Referring, Prescribing	N/A	1740618479	0	0	ASHE, KATHRYN N LMFT	11/6/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	MFT109294	N/A	N/A	N/A	N/A	N/A	1400 S GRAND AVE	SUITE 600	LOS ANGELES	CA	90015	3068	00	06000	34.03692236	-118.2655238	Los Angeles County
345065	Ordering, Referring, Prescribing	N/A	1740645977	0	0	ALABBAS, NAHLA PHARMD	3/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH57076	N/A	N/A	N/A	N/A	N/A	3101 BOWLING GREEN DR	None	WALNUT CREEK	CA	94598	4556	00	06000	37.90890419	-122.0038515	Contra Costa County
345069	Ordering, Referring, Prescribing	N/A	1740669688	0	0	AKPATI, NKOLIKA C MD	10/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A151244	N/A	N/A	N/A	N/A	N/A	284 SPRUCE STREET	None	GRIDLEY	CA	95948	2216	00	06000	39.36699345	-121.6910745	Butte County
345089	Ordering, Referring, Prescribing	N/A	1740695519	0	0	ALCID, JULIE A NP	8/8/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN805621	N/A	N/A	N/A	N/A	N/A	1550 N GAREY AVE	None	POMONA	CA	91767	3826	00	06000	34.07356342	-117.7522392	Los Angeles County
345194	Ordering, Referring, Prescribing	N/A	1740844596	0	0	ANDERSON, KIRSTEN PA-C	7/5/2019	Taxonomy not applicable	NA	n/a	000	Unknown	PA56975	N/A	N/A	N/A	N/A	N/A	1276 HALYARD DRIVE	None	WEST SACRAMENTO	CA	95691	3412	00	06000	38.573118	-121.5501275	Yolo County
345201	Ordering, Referring, Prescribing	N/A	1740856459	0	0	ANDERSON, ANDRES A LCSW	7/15/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	124093	N/A	N/A	N/A	N/A	N/A	995 POTRERO AVE	None	SAN FRANCISCO	CA	94110	2859	00	06000	37.75729541	-122.4066641	San Francisco County
345216	Ordering, Referring, Prescribing	N/A	1740907534	0	0	ALATORRE, MARIA F NP	10/18/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023032	N/A	N/A	N/A	N/A	N/A	2023 VALE RD	None	SAN PABLO	CA	94806	3834	00	06000	37.95369824	-122.3378493	Contra Costa County
345226	Ordering, Referring, Prescribing	N/A	1740946862	0	0	AYON, MARCO F NP	9/22/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95018541	N/A	N/A	N/A	N/A	N/A	3255 WILSHIRE BLVD	120	LOS ANGELES	CA	90010	1404	00	06000	34.0618166	-118.2932612	Los Angeles County
345245	Ordering, Referring, Prescribing	N/A	1750010005	0	0	ARANDIA, EARTHA MAY L OT	5/10/2022	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	23679	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95127	1439	00	06000	37.34293689	-121.9270392	Santa Clara County
345254	Ordering, Referring, Prescribing	N/A	1740953249	0	0	ALBARRAN-SLOVIN, MELODY NP	9/24/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95018023	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
345262	Ordering, Referring, Prescribing	N/A	1750058905	0	0	ALVARADO, DESIREE S LCSW	4/30/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101338	N/A	N/A	N/A	N/A	N/A	401 W CIVIC CENTER DR	600	SANTA ANA	CA	92701	4515	00	06000	33.75157353	-117.870921	Orange County
345271	Ordering, Referring, Prescribing	N/A	1750140562	0	0	ASSAYAG, LAUREN NP	7/5/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95025820	N/A	N/A	N/A	N/A	N/A	3772 TIBBETTS ST	None	RIVERSIDE	CA	92506	2605	00	06000	33.94720849	-117.399204	Riverside County
345356	Ordering, Referring, Prescribing	N/A	1750508362	0	0	ASSUNTO, VICKIE LMFT	11/18/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT36577	N/A	N/A	N/A	N/A	N/A	720 CAPITOLA AVE	SUITE A	CAPITOLA	CA	95010	2784	00	06000	36.9803434	-121.9527431	Santa Cruz County
345397	Ordering, Referring, Prescribing	N/A	1750631933	0	0	ALBERT, ERIKA B LMFT	2/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	96677	N/A	N/A	N/A	N/A	N/A	105 N LINCOLN ST	None	SANTA MARIA	CA	93458	4319	00	06000	34.9535882	-120.4374049	Santa Barbara County
345402	Ordering, Referring, Prescribing	N/A	1750645008	0	0	ALLEN, DEBBIE	6/21/2022	Taxonomy not applicable	NA	n/a	082	LICENSED MIDWIVES	LM391	N/A	N/A	N/A	N/A	N/A	4474 W ADAMS BLVD	SUITE 204	LOS ANGELES	CA	90016	3171	00	06000	34.03254704	-118.3375744	Los Angeles County
345403	Ordering, Referring, Prescribing	N/A	1750647681	0	0	ALZAMORA, LESLIE J LMFT	3/22/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97626	N/A	N/A	N/A	N/A	N/A	1350 E GRAND AVE	None	ARROYO GRANDE	CA	93420	2422	00	06000	35.12076617	-120.6044977	San Luis Obispo County
345418	Ordering, Referring, Prescribing	N/A	1750665220	0	0	ADCOCK, ALLISON J LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	115215	N/A	N/A	N/A	N/A	N/A	250 BON AIR RD	None	GREENBRAE	CA	94904	1702	00	06000	37.9469952	-122.5373892	Marin County
345427	Ordering, Referring, Prescribing	N/A	1750681524	0	0	AREJIAN, SILVA A DDS	4/12/2023	Taxonomy not applicable	NA	n/a	000	Unknown	55269	N/A	N/A	N/A	N/A	N/A	445 W BROADWAY	None	GLENDALE	CA	91204	1208	00	06000	34.14684551	-118.2633525	Los Angeles County
345445	Ordering, Referring, Prescribing	N/A	1750713764	0	0	AMIN, AISHA G	3/8/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	D62691	N/A	N/A	N/A	N/A	N/A	290 N WAYTE LN	STE 2500	FRESNO	CA	93701	2124	00	06000	36.74643429	-119.7837416	Fresno County
345556	Ordering, Referring, Prescribing	N/A	1750876017	0	0	AMIN, NIKKEE MD	2/3/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A165862	N/A	N/A	N/A	N/A	N/A	4650 SUNSET BLVD	None	LOS ANGELES	CA	90027	0029	00	06000	34.09813032	-118.2901794	Los Angeles County
345569	Ordering, Referring, Prescribing	N/A	1750904751	0	0	AGLUBAT, EMMANUEL O	5/20/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014593	N/A	N/A	N/A	N/A	N/A	1691 THE ALAMEDA	None	SAN JOSE	CA	95126	2203	00	06000	37.3373761	-121.9192532	Santa Clara County
345583	Ordering, Referring, Prescribing	N/A	1750926143	0	0	AN, ANGELA LMFT	11/4/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112769	N/A	N/A	N/A	N/A	N/A	5870 MELROSE AVE	3-225	LOS ANGELES	CA	90038	3756	00	06000	34.08344951	-118.3284225	Los Angeles County
345607	Ordering, Referring, Prescribing	N/A	1750994323	0	0	AMERI, GINA NP	2/17/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014769	N/A	N/A	N/A	N/A	N/A	2292 FARADAY AVE	100	CARLSBAD	CA	92008	7238	00	06000	33.13490794	-117.2765569	San Diego County
345624	Ordering, Referring, Prescribing	N/A	1760018196	0	0	ACEVES, ADRIANA V LMFT	2/6/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	137637	N/A	N/A	N/A	N/A	N/A	2550 E FOOTHILL BLVD	None	PASADENA	CA	91107	3406	00	06000	34.14979153	-118.0979955	Los Angeles County
345628	Ordering, Referring, Prescribing	N/A	1760026470	0	0	ALBERT, TYLER J OD	8/11/2020	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	34628	N/A	N/A	N/A	N/A	N/A	4600 PANAMA LN	102B	BAKERSFIELD	CA	93313	3509	00	06000	35.29596129	-119.0543102	Kern County
345650	Ordering, Referring, Prescribing	N/A	1760070932	0	0	ADANGAI, JUSTINA NP	1/7/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019680	N/A	N/A	N/A	N/A	N/A	655 S CENTRAL VALLEY HWY	None	SHAFTER	CA	93263	2790	00	06000	35.49504475	-119.264496	Kern County
345656	Ordering, Referring, Prescribing	N/A	1760091201	0	0	ALTMAN, AMARA M NP	9/8/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95018342	N/A	N/A	N/A	N/A	N/A	1620 SANTA CLARA DR	100	ROSEVILLE	CA	95661	3558	00	06000	38.74243973	-121.2620867	Placer County
345694	Ordering, Referring, Prescribing	N/A	1760248207	0	0	APARICIO, JACQUELINE NP	1/26/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95028859	N/A	N/A	N/A	N/A	N/A	9380 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3749	00	06000	33.9215355	-117.4442978	Riverside County
345699	Ordering, Referring, Prescribing	N/A	1760409197	0	0	ARRETZ, DESIREE MD	3/11/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A53241	N/A	N/A	N/A	N/A	N/A	1580 VALENCIA ST	SUITE 506	SAN FRANCISCO	CA	94110	4418	00	06000	37.74746923	-122.4202583	San Francisco County
345716	Ordering, Referring, Prescribing	N/A	1760508758	0	0	ADLER, DANNIELLE E LCSW	4/15/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	27137	N/A	N/A	N/A	N/A	N/A	406 SUNRISE AVE	None	ROSEVILLE	CA	95661	4106	00	06000	38.73944898	-121.2720559	Placer County
345762	Ordering, Referring, Prescribing	N/A	1760588925	0	0	AQUINO, MARY FELICIT T	5/4/1999	Taxonomy not applicable	NA	n/a	099	DENTIST	D45085	N/A	N/A	N/A	N/A	N/A	1855 N FAIR OAKS AVE	None	PASADENA	CA	91103	1620	00	06000	34.177806	-118.1507985	Los Angeles County
345773	Ordering, Referring, Prescribing	N/A	1760634513	0	0	AUSTIN, GERALD D DPM	2/23/2021	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E4373	N/A	N/A	N/A	N/A	N/A	3150 ALMADEN EXPY	205	SAN JOSE	CA	95118	1253	00	06000	37.276537	-121.8777357	Santa Clara County
345775	Ordering, Referring, Prescribing	N/A	1760630396	0	0	ALVARADO, DAVID E PSYD	11/20/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY27541	N/A	N/A	N/A	N/A	N/A	1339 20TH STREET	None	SANTA MONICA	CA	90404	2033	00	06000	34.02917949	-118.4805651	Los Angeles County
345779	Ordering, Referring, Prescribing	N/A	1760657217	0	0	ACKER, ROBIN E	4/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT	N/A	N/A	N/A	N/A	N/A	1801 VICENTE	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
345781	Ordering, Referring, Prescribing	N/A	1760661516	0	0	AJMAL, LUBNA MD	9/22/2014	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A97610	N/A	N/A	N/A	N/A	N/A	2650 S BRISTOL ST	SUITE 101	SANTA ANA	CA	92704	5751	00	06000	33.71118647	-117.885452	Orange County
345833	Ordering, Referring, Prescribing	N/A	1760753255	0	0	ALMODOVAR, LYNN N PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	61440	N/A	N/A	N/A	N/A	N/A	7300 N FRESNO ST	None	FRESNO	CA	93720	2941	00	06000	36.84133078	-119.7824983	Fresno County
345860	Ordering, Referring, Prescribing	N/A	1760783062	0	0	AUSTIN-PAULEY, STACEY PHARMD	11/16/2021	Taxonomy not applicable	NA	n/a	000	Unknown	CA51732	N/A	N/A	N/A	N/A	N/A	3900 BROAD ST	None	SAN LUIS OBISPO	CA	93401	7015	00	06000	35.24966646	-120.643747	San Luis Obispo County
345915	Ordering, Referring, Prescribing	N/A	1760869937	0	0	ABIDI, NEIL S DO	11/4/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A15472	N/A	N/A	N/A	N/A	N/A	3751 STOCKER ST	None	VIEW PARK	CA	90008	5101	00	06000	34.00616017	-118.3385751	Los Angeles County
345916	Ordering, Referring, Prescribing	N/A	1760868111	0	0	AVEZOVA, RAISA I	6/28/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D64939	N/A	N/A	N/A	N/A	N/A	767 N HILL ST	STE 200	LOS ANGELES	CA	90012	2365	00	06000	34.06255157	-118.2397077	Los Angeles County
345919	Ordering, Referring, Prescribing	N/A	1760871123	0	0	ADAME, AMADA LCSW	5/19/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81513	N/A	N/A	N/A	N/A	N/A	2801 SANTA MARIA WAY	None	SANTA MARIA	CA	93455	2118	00	06000	34.90914521	-120.4339538	Santa Barbara County
345925	Ordering, Referring, Prescribing	N/A	1760871719	0	0	ARMENTA, JESSIE LMFT	11/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107975	N/A	N/A	N/A	N/A	N/A	3301 37TH ST.	None	SACRAMENTO	CA	95824	2418	00	06000	38.5445894	-121.4671827	Sacramento County
345926	Ordering, Referring, Prescribing	N/A	1760890289	0	0	ALVARADO, DANIELLE N LCSW	11/16/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88561	N/A	N/A	N/A	N/A	N/A	301 FARRAGUT AVE	None	VALLEJO	CA	94590	4309	00	06000	38.11217604	-122.2611705	Solano County
345938	Ordering, Referring, Prescribing	N/A	1760895460	0	0	ACEVES, CYNTHIA B LMFT	9/16/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128154	N/A	N/A	N/A	N/A	N/A	2615 S MILLER ST.	106	SANTA MARIA	CA	93455	1775	00	06000	34.91141828	-120.4320168	Santa Barbara County
345941	Ordering, Referring, Prescribing	N/A	1760904239	0	0	AKRAM, FAISAL MD	4/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A172488	N/A	N/A	N/A	N/A	N/A	1212 BROADWAY	STE 1200	OAKLAND	CA	94612	1814	00	06000	37.80315112	-122.2718722	Alameda County
345987	Ordering, Referring, Prescribing	N/A	1760970313	0	0	ALEMAN, NANCY LCSW	10/27/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW105026	N/A	N/A	N/A	N/A	N/A	401 E. IMPERIAL HWY	None	FULLERTON	CA	92835	1145	00	06000	33.9175203	-117.926132	Orange County
345999	Ordering, Referring, Prescribing	N/A	1760986889	0	0	ARIAS, ATHENA C MD MPH	2/9/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A164165	N/A	N/A	N/A	N/A	N/A	2219 1ST STREET	None	LOS ANGELES	CA	90033	0041	00	06000	34.04452444	-118.2114844	Los Angeles County
346003	Ordering, Referring, Prescribing	N/A	1760999114	0	0	ACHUAMANG, IRINE N RN PNP	11/17/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95007827	N/A	N/A	N/A	N/A	N/A	3210 LONG BEACH BLVD	None	LONG BEACH	CA	90807	0000	00	06000	33.815637	-118.1892215	Los Angeles County
346025	Ordering, Referring, Prescribing	N/A	1770045361	0	0	ABOUD SYRIANI, LAYA DDS	9/21/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109513	N/A	N/A	N/A	N/A	N/A	7526 MONTEREY ST	None	GILROY	CA	95020	0000	00	06000	37.00852861	-121.5694352	Santa Clara County
346028	Ordering, Referring, Prescribing	N/A	1770045478	0	0	ASTLEY, SHANON MD	6/24/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179852	N/A	N/A	N/A	N/A	N/A	7001-A EAST PARKWAY	300	SACRAMENTO	CA	95823	2501	00	06000	38.497689	-121.4498385	Sacramento County
346093	Ordering, Referring, Prescribing	N/A	1770191397	0	0	ALVAREZ, DIANA LCSW	7/15/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	94685	N/A	N/A	N/A	N/A	N/A	2000 EMBARCADERO	None	OAKLAND	CA	94606	5334	00	06000	37.78179304	-122.2428136	Alameda County
346099	Ordering, Referring, Prescribing	N/A	1770205478	0	0	AYOUB, RITA NP	10/17/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95022892	N/A	N/A	N/A	N/A	N/A	117 N SAN MATEO DR	None	SAN MATEO	CA	94401	2793	00	06000	37.56866767	-122.3286434	San Mateo County
346104	Ordering, Referring, Prescribing	N/A	1770230021	0	0	ANUDOKEM, NKIRUKA D PA-C	9/5/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA65002	N/A	N/A	N/A	N/A	N/A	2201 COURAGE DR	None	FAIRFIELD	CA	94533	6733	00	06000	38.23727106	-122.0692856	Solano County
346127	Ordering, Referring, Prescribing	N/A	1770357394	0	0	ABAD, MARK RYAN DDS	9/7/2023	Taxonomy not applicable	NA	n/a	000	Unknown	109295	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
346173	Ordering, Referring, Prescribing	N/A	1770643546	0	0	ARKELIAN, BRIAN S LCSW	4/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW16363	N/A	N/A	N/A	N/A	N/A	4441 E KINGS CANYON RD	None	FRESNO	CA	93702	3604	00	06000	36.738144	-119.753361	Fresno County
346192	Ordering, Referring, Prescribing	N/A	1770707044	0	0	APARICIO, TERESA LCSW	5/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	79270	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4569	00	06000	34.67013731	-118.1222748	Los Angeles County
346196	Ordering, Referring, Prescribing	N/A	1770712689	0	0	ABBASSI, SHERVIN LMFT	3/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105217	N/A	N/A	N/A	N/A	N/A	3055 W ORANGE AVE	105	ANAHEIM	CA	92804	3159	00	06000	33.8247435	-117.99621	Orange County
346200	Ordering, Referring, Prescribing	N/A	1770710782	0	0	AMINI, MONA MD	11/22/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C183367	N/A	N/A	N/A	N/A	N/A	1722 S LEWIS RD	None	CAMARILLO	CA	93012	8520	00	06000	34.18921316	-119.0340743	Ventura County
346260	Ordering, Referring, Prescribing	N/A	1770852337	0	0	ALLMAN, SEAN P PHARMD	3/19/2018	Taxonomy not applicable	NA	n/a	000	Unknown	56938	N/A	N/A	N/A	N/A	N/A	2050 NUT TREE RD	None	VACAVILLE	CA	95687	7108	00	06000	38.350575	-121.9530605	Solano County
346302	Ordering, Referring, Prescribing	N/A	1770916785	0	0	AHMED, RAED O PHARMD	11/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	68928	N/A	N/A	N/A	N/A	N/A	8405 BEVERLY BLVD.	None	LOS ANGELES	CA	90048	0000	00	06000	34.07607952	-118.373418	Los Angeles County
346311	Ordering, Referring, Prescribing	N/A	1770935405	0	0	ASLANI, ASSAL F	12/6/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	101796	N/A	N/A	N/A	N/A	N/A	550 E WASHINGTON BLVD	None	CRESCENT CITY	CA	95531	8160	00	06000	41.77274546	-124.19892	Del Norte County
346320	Ordering, Referring, Prescribing	N/A	1770917767	0	0	ALVAREZ, KYLIE	12/4/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	80321	N/A	N/A	N/A	N/A	N/A	333 S. BEAUDRY ST.	None	LOS ANGELES	CA	90017	1466	00	06000	34.05611213	-118.2570905	Los Angeles County
346368	Ordering, Referring, Prescribing	N/A	1780020578	0	0	AL ATASSI, KAOSAR MD	8/12/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A122651	N/A	N/A	N/A	N/A	N/A	1828 E CESAR E CHAVEZ AV	5000	LOS ANGELES	CA	90033	2400	00	06000	34.05023174	-118.2154927	Los Angeles County
346375	Ordering, Referring, Prescribing	N/A	1780026625	0	0	ARVISO-RICHMOND, RUTH D PSYD	7/13/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	31917	N/A	N/A	N/A	N/A	N/A	725 E MAIN ST	SECOND FLOOR	SANTA PAULA	CA	93060	2748	00	06000	34.35240876	-119.0649129	Ventura County
346401	Ordering, Referring, Prescribing	N/A	1780077941	0	0	ANTE, CYNTHIA A LCSW	4/27/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101280	N/A	N/A	N/A	N/A	N/A	5400 E OLYMPIC BLVD	SUITE A	COMMERCE	CA	90022	5147	00	06000	34.01564534	-118.1555473	Los Angeles County
346406	Ordering, Referring, Prescribing	N/A	1780082677	0	0	ALEJANDRE, BEATRIZ LMFT	9/16/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT134762	N/A	N/A	N/A	N/A	N/A	2280 N VALENTINE AVE	None	FRESNO	CA	93722	5553	00	06000	36.76966023	-119.8532997	Fresno County
346454	Ordering, Referring, Prescribing	N/A	1780139576	0	0	AGUILAR, GABRIELA LCSW	4/1/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW107510	N/A	N/A	N/A	N/A	N/A	3569 LEXINGTON AVE	None	EL MONTE	CA	91731	2607	00	06000	34.0744277	-118.039296	Los Angeles County
346462	Ordering, Referring, Prescribing	N/A	1780160499	0	0	AIELLO, LEAH A RN BS	2/1/2019	Taxonomy not applicable	NA	n/a	000	Unknown	180273002	N/A	N/A	N/A	N/A	N/A	800 NIBLICK RD	None	PASO ROBLES	CA	93446	4858	00	06000	35.61575355	-120.672279	San Luis Obispo County
346464	Ordering, Referring, Prescribing	N/A	1780161398	0	0	ARAD, GOLSA DDS	9/6/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS107287	N/A	N/A	N/A	N/A	N/A	3100 PONTE MORINO DR	None	CAMERON PARK	CA	95682	8282	00	06000	38.66252014	-120.9672091	El Dorado County
346470	Ordering, Referring, Prescribing	N/A	1780169920	0	0	ARAKELIAN, SAREEN R PHARMD	9/24/2018	Taxonomy not applicable	NA	n/a	000	Unknown	79177	N/A	N/A	N/A	N/A	N/A	1046 COAST VILLAGE RD	B	MONTECITO	CA	93108	2732	00	06000	34.42170279	-119.6507446	Santa Barbara County
346474	Ordering, Referring, Prescribing	N/A	1780189209	0	0	ANDAYA, MIKHAEL D MD	4/9/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A176878	N/A	N/A	N/A	N/A	N/A	1000 EUCLID AVE	None	NATIONAL CITY	CA	91950	3856	00	06000	32.68067201	-117.0804893	San Diego County
346506	Ordering, Referring, Prescribing	N/A	1780281154	0	0	AGUIRRE, JACLYN LMFT	11/27/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT151648	N/A	N/A	N/A	N/A	N/A	850 N AVENUE 66	None	LOS ANGELES	CA	90042	1508	00	06000	34.1211075	-118.1725535	Los Angeles County
346516	Ordering, Referring, Prescribing	N/A	1780296335	0	0	ADKINS, CHRISTOPHER PHARMD	1/17/2021	Taxonomy not applicable	NA	n/a	000	Unknown	82376	N/A	N/A	N/A	N/A	N/A	2433 HARBOR BLVD	None	VENTURA	CA	93001	3904	00	06000	34.26410076	-119.2695962	Ventura County
346521	Ordering, Referring, Prescribing	N/A	1780316794	0	0	ARIAS, PATRICK DOMINIC NP	5/11/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020928	N/A	N/A	N/A	N/A	N/A	502 W HOLT AVE	None	POMONA	CA	91768	3604	00	06000	34.06219961	-117.7571033	Los Angeles County
346603	Ordering, Referring, Prescribing	N/A	1780742361	0	0	AMADOR, GERARDO DDS	1/20/2024	Taxonomy not applicable	NA	n/a	000	Unknown	43751	N/A	N/A	N/A	N/A	N/A	1381 UNIVERSITY ST	None	HEALDSBURG	CA	95448	3314	00	06000	38.62729851	-122.8637785	Sonoma County
346612	Ordering, Referring, Prescribing	N/A	1780753798	0	0	AZIMZADEH, MAHNAZ DC	6/14/2018	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	24277	N/A	N/A	N/A	N/A	N/A	15206 PARTHENIA ST	None	NORTH HILLS	CA	91343	5305	00	06000	34.22817313	-118.4636497	Los Angeles County
346641	Ordering, Referring, Prescribing	N/A	1780826628	0	0	ARGELAGOS, LOURDES LMFT	4/18/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	146479	N/A	N/A	N/A	N/A	N/A	5628 E. SLAUSON AVE	None	COMMERCE	CA	90040	7511	00	06000	33.98593459	-118.163681	Los Angeles County
346643	Ordering, Referring, Prescribing	N/A	1780828384	0	0	APPENZELLER, ERICA LAC	8/7/2023	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC12711	N/A	N/A	N/A	N/A	N/A	2630 FIRST AVENUE	None	SAN DIEGO	CA	92103	6599	00	06000	32.73288727	-117.1639712	San Diego County
346699	Ordering, Referring, Prescribing	N/A	1780939470	0	0	ALLEN, SUSAN E LMFT	6/26/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105896	N/A	N/A	N/A	N/A	N/A	4065 3RD AVE	None	SAN DIEGO	CA	92103	2184	00	06000	32.75123948	-117.1627318	San Diego County
346700	Ordering, Referring, Prescribing	N/A	1780945766	0	0	ALBERTO, JOSE G MD	12/22/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133124	N/A	N/A	N/A	N/A	N/A	12619 BENTLEY ST	None	WATERFORD	CA	95386	9011	00	06000	37.64073442	-120.7613165	Stanislaus County
346727	Ordering, Referring, Prescribing	N/A	1780985804	0	0	ASHAR, PANKAJ ARUNKUMAR PHARMD	3/22/2018	Taxonomy not applicable	NA	n/a	000	Unknown	45872	N/A	N/A	N/A	N/A	N/A	5431 CLAYTON ROAD	None	CLAYTON	CA	94517	0001	00	06000	37.953792	-121.953483	Contra Costa County
346737	Ordering, Referring, Prescribing	N/A	1790011971	0	0	ABELL, BRIAN M LCSW	2/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW66261	N/A	N/A	N/A	N/A	N/A	670 PLACERVILLE DR	None	PLACERVILLE	CA	95667	4200	00	06000	38.73161765	-120.8213885	El Dorado County
346743	Ordering, Referring, Prescribing	N/A	1790027035	0	0	ARIAS, JESSIE W PHARMD	7/20/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH67995	N/A	N/A	N/A	N/A	N/A	8917 TRAUTWEIN RD	None	RIVERSIDE	CA	92508	9473	00	06000	33.88900767	-117.3244103	Riverside County
346747	Ordering, Referring, Prescribing	N/A	1790033488	0	0	ARREDONDO, GABRIEL LPCC	1/22/2020	Taxonomy not applicable	NA	n/a	000	Unknown	2922	N/A	N/A	N/A	N/A	N/A	1812 W PARK AVE	None	REDLANDS	CA	92373	9999	00	06000	34.05931058	-117.216243	San Bernardino County
346772	Ordering, Referring, Prescribing	N/A	1790059145	0	0	AWAD, RANDA PHARMD	8/27/2022	Taxonomy not applicable	NA	n/a	000	Unknown	57936	N/A	N/A	N/A	N/A	N/A	591 TRES PINOS RD	None	HOLLISTER	CA	95023	5569	00	06000	36.83929019	-121.3918712	San Benito County
346801	Ordering, Referring, Prescribing	N/A	1790098341	0	0	ARELLANO BANONI, GISELA MD	9/18/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A127294	N/A	N/A	N/A	N/A	N/A	2630 1ST AVE	None	SAN DIEGO	CA	92103	6599	00	06000	32.73288727	-117.1639712	San Diego County
346842	Ordering, Referring, Prescribing	N/A	1790161107	0	0	ANAYA, ROCIO LMFT	11/30/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT119245	N/A	N/A	N/A	N/A	N/A	27403 YNEZ RD	104	TEMECULA	CA	92591	5603	00	06000	33.5066395	-117.15022	Riverside County
346846	Ordering, Referring, Prescribing	N/A	1790165322	0	0	ACEVEDO, KARLA J	3/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88263	N/A	N/A	N/A	N/A	N/A	2311 W EL SEGUNDO BLVD	None	HAWTHORNE	CA	90250	3315	00	06000	33.91647947	-118.3189815	Los Angeles County
346853	Ordering, Referring, Prescribing	N/A	1790167146	0	0	ALTAVAS, NATHANIEL M R NP	5/29/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	826627	N/A	N/A	N/A	N/A	N/A	501 SIXTH ST	None	TAFT	CA	93268	2704	00	06000	35.14427303	-119.4591272	Kern County
346932	Ordering, Referring, Prescribing	N/A	1790282960	0	0	AYOMANOR, VIVIENNE NP	6/20/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95008956	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
346939	Ordering, Referring, Prescribing	N/A	1790303733	0	0	ATACHIAN, PAULINA M	1/16/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95014843	N/A	N/A	N/A	N/A	N/A	303 W. LINCOLN AVE	# 105	ANAHEIM	CA	92805	2928	00	06000	33.83508976	-117.9177981	Orange County
346967	Ordering, Referring, Prescribing	N/A	1790353274	0	0	ASMUS, ALEXANDRA	3/12/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	153838	N/A	N/A	N/A	N/A	N/A	499 LOMA ALTA AVE	BUILDING 10	LOS GATOS	CA	95030	6227	00	06000	37.21747493	-121.9662128	Santa Clara County
346969	Ordering, Referring, Prescribing	N/A	1790358257	0	0	AGUIGAM-LEACH, LINSEY S NP	3/6/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95017786	N/A	N/A	N/A	N/A	N/A	470 CHADBOURNE RD	SUITE A	FAIRFIELD	CA	94534	9600	00	06000	38.23474317	-122.0838031	Solano County
346980	Ordering, Referring, Prescribing	N/A	1790390193	0	0	ALEXANDER, GEORGE LPCC	1/22/2024	Taxonomy not applicable	NA	n/a	000	Unknown	15644	N/A	N/A	N/A	N/A	N/A	11601 S WESTERN AVE	None	LOS ANGELES	CA	90047	5006	00	06000	33.92826552	-118.3092091	Los Angeles County
346984	Ordering, Referring, Prescribing	N/A	1790396794	0	0	AGUILAR, HEIDI NP	8/11/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95015102	N/A	N/A	N/A	N/A	N/A	3031 S VERMONT AVE	None	LOS ANGELES	CA	90007	3033	00	06000	34.02666679	-118.2915608	Los Angeles County
347016	Ordering, Referring, Prescribing	N/A	1790493245	0	0	ALMA, JOANA NP	6/13/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95021261	N/A	N/A	N/A	N/A	N/A	2501 W EL SEGUNDO BLVD	B	HAWTHORNE	CA	90250	3317	00	06000	33.91648148	-118.3206645	Los Angeles County
347046	Ordering, Referring, Prescribing	N/A	1790800795	0	0	ACEVEDO GREEN, AIDA B LMFT	7/26/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT127148	N/A	N/A	N/A	N/A	N/A	5121 STOCKDALE HWY	275	BAKERSFIELD	CA	93309	2656	00	06000	35.35413152	-119.058471	Kern County
347082	Ordering, Referring, Prescribing	N/A	1790862340	0	0	ARIAS, JANET M	10/19/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D39591	N/A	N/A	N/A	N/A	N/A	3945 WHITTIER BLVD	None	LOS ANGELES	CA	90023	2440	00	06000	34.02394552	-118.187748	Los Angeles County
347104	Ordering, Referring, Prescribing	N/A	1790904738	0	0	ARELLANO, MARIA G NP	2/10/2014	Taxonomy not applicable	NA	n/a	000	Unknown	RN430719	N/A	N/A	N/A	N/A	N/A	225 SAN ANTONIO RD	None	MOUNTAIN VIEW	CA	94040	1209	00	06000	37.40620433	-122.110589	Santa Clara County
347116	Ordering, Referring, Prescribing	N/A	1790953560	0	0	AROUS, LENA R MD	11/21/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A124309	N/A	N/A	N/A	N/A	N/A	2151 E. PALMDALE BLVD	None	PALMDALE	CA	93550	4037	00	06000	34.58013142	-118.0898273	Los Angeles County
347173	Ordering, Referring, Prescribing	N/A	1801051511	0	0	ARANGO YANEZ, ALICIA E LMFT	3/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	105132	N/A	N/A	N/A	N/A	N/A	849 E 6TH ST	None	LOS ANGELES	CA	90021	1026	00	06000	34.03994957	-118.2414778	Los Angeles County
347175	Ordering, Referring, Prescribing	N/A	1801059860	0	0	ATHANASIOU, NICHOLAS A MD	11/17/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A110558	N/A	N/A	N/A	N/A	N/A	10605 BALBOA AVE	SUITE #100	GRANADA HILLS	CA	91344	6342	00	06000	34.263378	-118.5022965	Los Angeles County
347186	Ordering, Referring, Prescribing	N/A	1801087606	0	0	ACUNA, JEANNELLI LCSW	3/22/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW29625	N/A	N/A	N/A	N/A	N/A	3303 N BROADWAY	None	LOS ANGELES	CA	90031	0000	00	06000	34.07380397	-118.20586	Los Angeles County
347205	Ordering, Referring, Prescribing	N/A	1801095351	0	0	AHAD, TERRY I LMFT	5/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	53255	N/A	N/A	N/A	N/A	N/A	1420 WILLOW PASS RD	200	CONCORD	CA	94520	5823	00	06000	37.96956948	-122.0507563	Contra Costa County
347259	Ordering, Referring, Prescribing	N/A	1801196753	0	0	AUSTIN, SHAWNA N PHARMD	3/25/2018	Taxonomy not applicable	NA	n/a	000	Unknown	RPH60922	N/A	N/A	N/A	N/A	N/A	1000 WEST EL NORTE PKWY	None	ESCONDIDO	CA	92026	3341	00	06000	33.14714527	-117.106754	San Diego County
347289	Ordering, Referring, Prescribing	N/A	1801250188	0	0	ALLEN, PERRIANN PHARMD	2/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	72926	N/A	N/A	N/A	N/A	N/A	7071 ORCHARD CIR	None	PENRYN	CA	95663	9314	00	06000	38.83392553	-121.170816	Placer County
347328	Ordering, Referring, Prescribing	N/A	1801293311	0	0	ANGH, VENYEI	12/15/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105897	N/A	N/A	N/A	N/A	N/A	275 BECK AVE	None	FAIRFIELD	CA	94533	6804	00	06000	38.23532718	-122.0663968	Solano County
347338	Ordering, Referring, Prescribing	N/A	1801311741	0	0	ARMENTA, ARIADNA A LCSW	7/13/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	102477	N/A	N/A	N/A	N/A	N/A	66 HURLBUT ST	None	PASADENA	CA	91105	4025	00	06000	34.12993251	-118.1516625	Los Angeles County
347348	Ordering, Referring, Prescribing	N/A	1801324132	0	0	ARANGO, NATALIE LCSW	11/18/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	87454	N/A	N/A	N/A	N/A	N/A	1540 E COLORADO ST	None	GLENDALE	CA	91205	1514	00	06000	34.1427285	-118.230039	Los Angeles County
347356	Ordering, Referring, Prescribing	N/A	1801332051	0	0	ANI, EBERECHI J NP	6/26/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95005799	N/A	N/A	N/A	N/A	N/A	1307 W. 6TH STREET	SUITE 113	CORONA	CA	92882	1642	00	06000	33.87790309	-117.589666	Riverside County
347444	Ordering, Referring, Prescribing	N/A	1801518840	0	0	ALTAMURA, HEATHER M NP	6/20/2022	Taxonomy not applicable	NA	n/a	000	Unknown	95021380	N/A	N/A	N/A	N/A	N/A	1735 JEFFERSON ST	None	NAPA	CA	94559	1702	00	06000	38.30356022	-122.2943872	Napa County
347450	Ordering, Referring, Prescribing	N/A	1801528690	0	0	ARABIAN, FARNOOSH NP	3/7/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029379	N/A	N/A	N/A	N/A	N/A	1450 E HOLT AVE	None	POMONA	CA	91767	5822	00	06000	34.06299829	-117.7215562	Los Angeles County
347484	Ordering, Referring, Prescribing	N/A	1801881552	0	0	ARTS, SERENA C NP	5/25/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	10769	N/A	N/A	N/A	N/A	N/A	1501 IMPERIAL AVE	None	SAN DIEGO	CA	92101	7638	00	06000	32.70625742	-117.1498948	San Diego County
347487	Ordering, Referring, Prescribing	N/A	1801864269	0	0	AREVIAN, SARKIS MD	1/29/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A26549	N/A	N/A	N/A	N/A	N/A	121 S LONG BEACH BLVD	None	COMPTON	CA	90221	3423	00	06000	33.89475493	-118.2080292	Los Angeles County
347500	Ordering, Referring, Prescribing	N/A	1801923719	0	0	AOKI, ELLEN M MD	5/31/2013	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A00063333	N/A	N/A	N/A	N/A	N/A	11670 ATWOOD ROAD	None	AUBURN	CA	95603	9522	00	06000	38.93485327	-121.0988193	Placer County
347561	Ordering, Referring, Prescribing	N/A	1811047830	0	0	ANTHONY, AWAD MD	10/9/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A43036	N/A	N/A	N/A	N/A	N/A	6368 HOLLYWOOD BLVD	None	LOS ANGELES	CA	90028	6320	00	06000	34.1015865	-118.328976	Los Angeles County
347562	Ordering, Referring, Prescribing	N/A	1811056575	0	0	AJIT-UPPAL, JASVIR K MD	3/29/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A49427	N/A	N/A	N/A	N/A	N/A	9380 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3749	00	06000	33.9215355	-117.4442978	Riverside County
347605	Ordering, Referring, Prescribing	N/A	1811166234	0	0	AYRES, ELLEN S LCSW	7/8/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW22273	N/A	N/A	N/A	N/A	N/A	1505 SOLANO AVENUE	None	ALBANY	CA	94707	2106	00	06000	37.89096733	-122.2870766	Alameda County
347611	Ordering, Referring, Prescribing	N/A	1811183585	0	0	ANUNTIYO, JEREMY MD	12/12/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A94526	N/A	N/A	N/A	N/A	N/A	1360 W 6TH STREET	#310N	SAN PEDRO	CA	90732	3599	00	06000	33.73886546	-118.3075065	Los Angeles County
347612	Ordering, Referring, Prescribing	N/A	1811180839	0	0	AZIMI, SHIDEH E	10/17/1996	Taxonomy not applicable	NA	n/a	099	DENTIST	D44455	N/A	N/A	N/A	N/A	N/A	31161 NIGUEL RD	SUITE K	LAGUNA NIGUEL	CA	92677	4102	00	06000	33.50952412	-117.708405	Orange County
347634	Ordering, Referring, Prescribing	N/A	1811217532	0	0	ACOSTA, ARTURO MD	5/15/2015	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A123657	N/A	N/A	N/A	N/A	N/A	1400 N MAIN ST	None	SANTA ANA	CA	92701	2304	00	06000	33.75688822	-117.8676134	Orange County
347740	Ordering, Referring, Prescribing	N/A	1811391980	0	0	AYLER, KENDRA D NP	12/25/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95014008	N/A	N/A	N/A	N/A	N/A	1414 NORTH CALIFORNIA ST	SUITE# C	STOCKTON	CA	95202	1515	00	06000	37.96761084	-121.2883234	San Joaquin County
347770	Ordering, Referring, Prescribing	N/A	1811428071	0	0	ANDO, TIMOTHY MD	1/18/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157022	N/A	N/A	N/A	N/A	N/A	582 MARKET ST	STE 812	SAN FRANCISCO	CA	94104	5309	00	06000	37.78931415	-122.4013437	San Francisco County
347775	Ordering, Referring, Prescribing	N/A	1811433238	0	0	ANGUIANO, ANNA M LCSW	2/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW89759	N/A	N/A	N/A	N/A	N/A	1211 5TH ST	None	EUREKA	CA	95501	0636	00	06000	40.80305422	-124.1581436	Humboldt County
347801	Ordering, Referring, Prescribing	N/A	1811472673	0	0	AGUIRRE, PRISCILLA E LMFT	2/21/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124466	N/A	N/A	N/A	N/A	N/A	1266 14TH ST	None	OAKLAND	CA	94607	2247	00	06000	37.81022696	-122.2887619	Alameda County
347806	Ordering, Referring, Prescribing	N/A	1811483712	0	0	AYOUB, SABRINA LMFT	2/25/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT124581	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	400	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
347807	Ordering, Referring, Prescribing	N/A	1811483258	0	0	ALBERGO, LAURA PA	1/29/2022	Taxonomy not applicable	NA	n/a	000	Unknown	PA55723	N/A	N/A	N/A	N/A	N/A	593 E ELDER ST	SUITE B	FALLBROOK	CA	92028	5000	00	06000	33.3801147	-117.2453962	San Diego County
347831	Ordering, Referring, Prescribing	N/A	1811513187	0	0	ANGULO, RAFAEL C LCSW	8/19/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	70015	N/A	N/A	N/A	N/A	N/A	1510 S CENTRAL AVE	600	GLENDALE	CA	91204	2500	00	06000	34.12709764	-118.2577911	Los Angeles County
347839	Ordering, Referring, Prescribing	N/A	1811546765	0	0	ALTMILLER-RUBIO, RAYLENE T PHARMD	8/19/2019	Taxonomy not applicable	NA	n/a	000	Unknown	33024	N/A	N/A	N/A	N/A	N/A	1017 ELLINGTON ST	None	DELANO	CA	93215	2621	00	06000	35.76891908	-119.2515219	Kern County
347861	Ordering, Referring, Prescribing	N/A	1811601685	0	0	AGNIR, TANNEY D CNP	1/3/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95023794	N/A	N/A	N/A	N/A	N/A	3340 W BALL ROAD	UNIT G	ANAHEIM	CA	92880	3917	00	06000	33.81726795	-118.0068541	Orange County
347920	Ordering, Referring, Prescribing	N/A	1811995293	0	0	AITKEN, COLLEEN A MD	11/18/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A68298	N/A	N/A	N/A	N/A	N/A	1317 OAKDALE ROAD	440	MODESTO	CA	95355	3364	00	06000	37.662489	-120.957588	Stanislaus County
347928	Ordering, Referring, Prescribing	N/A	1821040023	0	0	ARENDT, SCOTT M LMFT	3/31/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	51695	N/A	N/A	N/A	N/A	N/A	1555 PARKMOOR AVENUE	None	SAN JOSE	CA	95128	2407	00	06000	37.31712017	-121.9185451	Santa Clara County
347935	Ordering, Referring, Prescribing	N/A	1821071549	0	0	AGUILAR, CHRISTOPHER MD	1/22/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G83131	N/A	N/A	N/A	N/A	N/A	1920 TIENDA DR	STE 102	LODI	CA	95242	3930	00	06000	38.11678155	-121.2957005	San Joaquin County
347939	Ordering, Referring, Prescribing	N/A	1821066333	0	0	ALLWEIN, ALEX T MD	11/12/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C146148	N/A	N/A	N/A	N/A	N/A	1081 N CHINA LAKE BLVD	None	RIDGECREST	CA	93555	3130	00	06000	35.640783	-117.6698475	Kern County
347944	Ordering, Referring, Prescribing	N/A	1821113499	0	0	AGUIRRE, JUAN LCSW	7/8/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29292	N/A	N/A	N/A	N/A	N/A	130 N BRAND BLVD	None	GLENDALE	CA	91203	2644	00	06000	34.147521	-118.2549325	Los Angeles County
347978	Ordering, Referring, Prescribing	N/A	1821160383	0	0	ACOSTA-ERICKSON, LISA E LCSW	2/22/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW19020	N/A	N/A	N/A	N/A	N/A	200 SOUTH WELLS ROAD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
347988	Ordering, Referring, Prescribing	N/A	1821183732	0	0	ARROYO, JAVIER DC	10/14/2021	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	25642	N/A	N/A	N/A	N/A	N/A	925 BEVINS CT	None	LAKEPORT	CA	95453	9754	00	06000	39.03772106	-122.9223338	Lake County
348001	Ordering, Referring, Prescribing	N/A	1821209412	0	0	ARNESON, TASHA D PHD	3/25/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY16945	N/A	N/A	N/A	N/A	N/A	24799 LINCOLN AVE	None	MURRIETA	CA	92562	5867	00	06000	33.56839703	-117.1949305	Riverside County
348010	Ordering, Referring, Prescribing	N/A	1821235110	0	0	ALVARADO, JULIE LMFT	2/21/2025	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	153385	N/A	N/A	N/A	N/A	N/A	405 W 5TH STREET	STE 590	SANTA ANA	CA	92701	4599	00	06000	33.74893088	-117.8713859	Orange County
348011	Ordering, Referring, Prescribing	N/A	1821232422	0	0	AGUILAR, LUCIA S LMFT	6/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	97803	N/A	N/A	N/A	N/A	N/A	4468 E KINGS CANYON RD	BUILDING #333 STOP#97	FRESNO	CA	93702	3605	00	06000	36.732339	-119.750688	Fresno County
348034	Ordering, Referring, Prescribing	N/A	1821294455	0	0	ANSARI, SHAUKAT A	4/5/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A105923	N/A	N/A	N/A	N/A	N/A	3120 FREEBOARD DR	SUITE 102	WEST SACRAMENTO	CA	95691	5039	00	06000	38.5746747	-121.552383	Yolo County
348068	Ordering, Referring, Prescribing	N/A	1821357054	0	0	AVALOS, BRENDA NP	6/18/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	19876	N/A	N/A	N/A	N/A	N/A	2051 MARENGO ST	None	LOS ANGELES	CA	90033	1352	00	06000	34.05627579	-118.2064774	Los Angeles County
348102	Ordering, Referring, Prescribing	N/A	1821412974	0	0	ANDERSON, CAROL	11/5/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	20604	N/A	N/A	N/A	N/A	N/A	2940 SUMMIT ST	2D	OAKLAND	CA	94609	3416	00	06000	37.81849213	-122.2647718	Alameda County
348112	Ordering, Referring, Prescribing	N/A	1821423898	0	0	ABHADHAN, TASFIA LMFT	5/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	112584	N/A	N/A	N/A	N/A	N/A	4 LOWER RAGSDALE DR	130	MONTEREY	CA	93940	7803	00	06000	36.575991	-121.821588	Monterey County
348167	Ordering, Referring, Prescribing	N/A	1821511387	0	0	ARAMIAN, ARMELA NP	7/28/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95003630	N/A	N/A	N/A	N/A	N/A	3505 LONE TREE WAY	STE 1	ANTIOCH	CA	94509	6067	00	06000	37.98725411	-121.8065036	Contra Costa County
348190	Ordering, Referring, Prescribing	N/A	1821540063	0	0	ALEMI, AREZU LMFT	7/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	119888	N/A	N/A	N/A	N/A	N/A	8912 VOLUNTEER LANE	None	SACRAMENTO	CA	95826	3221	00	06000	38.55438	-121.3756965	Sacramento County
348215	Ordering, Referring, Prescribing	N/A	1821583485	0	0	AYALA-CADENA, JUDITH N LCSW	1/21/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW102622	N/A	N/A	N/A	N/A	N/A	4200 ASHE RD	None	BAKERSFIELD	CA	93313	2029	00	06000	35.316864	-119.0744405	Kern County
348261	Ordering, Referring, Prescribing	N/A	1821664996	0	0	AU, LONG HUEN PA	9/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	60133	N/A	N/A	N/A	N/A	N/A	3580 5TH AVE	None	SAN DIEGO	CA	92103	3193	00	06000	32.74286786	-117.160418	San Diego County
348269	Ordering, Referring, Prescribing	N/A	1821699133	0	0	AHAMD, AYESHA I DMD	12/21/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	105684	N/A	N/A	N/A	N/A	N/A	2020 J STREET	None	SACRAMENTO	CA	95811	3120	00	06000	38.576331	-121.4791155	Sacramento County
348300	Ordering, Referring, Prescribing	N/A	1821834151	0	0	ARAMBULA SALAZAR, YADIRA NP	6/10/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030455	N/A	N/A	N/A	N/A	N/A	344 E 6TH ST	None	MADERA	CA	93638	3631	00	06000	36.96288964	-120.0556279	Madera County
348313	Ordering, Referring, Prescribing	N/A	1831127869	0	0	AGUILAR, NORMA R MD	1/28/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A37060	N/A	N/A	N/A	N/A	N/A	11721 TELEGRAPH RD	None	SANTA FE SPRINGS	CA	90670	3674	00	06000	33.94629336	-118.0832752	Los Angeles County
348325	Ordering, Referring, Prescribing	N/A	1831200153	0	0	AULAKH, RAHAT MD	11/15/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A76754	N/A	N/A	N/A	N/A	N/A	550 PATTERSON BLVD	None	PLEASANT HILL	CA	94523	4155	00	06000	37.93513944	-122.0730983	Contra Costa County
348354	Ordering, Referring, Prescribing	N/A	1831245414	0	0	ALDOUS, JOHN MD	6/10/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A85081	N/A	N/A	N/A	N/A	N/A	4309 3RD AVE	None	SAN DIEGO	CA	92103	1407	00	06000	32.75638577	-117.162084	San Diego County
348363	Ordering, Referring, Prescribing	N/A	1831275908	0	0	ACHUCK, CORDELIA S	8/8/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D40522	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
348374	Ordering, Referring, Prescribing	N/A	1831312727	0	0	AMARILIO, DIANA L LCSW	1/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW62692	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
348379	Ordering, Referring, Prescribing	N/A	1831318542	0	0	AVILA-MENDOZA, MARCELA G LMFT	4/14/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	50322	N/A	N/A	N/A	N/A	N/A	391 TAYLOR BLVD	100	PLEASANT HILL	CA	94523	2294	00	06000	37.96119614	-122.070409	Contra Costa County
348384	Ordering, Referring, Prescribing	N/A	1831322320	0	0	ANDRESEN, KIMBERLY LCSW	6/15/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	101960	N/A	N/A	N/A	N/A	N/A	4200 ASHE RD	None	BAKERSFIELD	CA	93313	2029	00	06000	35.316864	-119.0744405	Kern County
348401	Ordering, Referring, Prescribing	N/A	1831377688	0	0	AGYEMAN, AKUA A MD	3/27/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A84608	N/A	N/A	N/A	N/A	N/A	649 MISSION STREET	5TH FLOOR	SAN FRANCISCO	CA	94105	4126	00	06000	37.78704236	-122.4009518	San Francisco County
348433	Ordering, Referring, Prescribing	N/A	1831448646	0	0	ARROYO-MCCARTHY, TIFFANY L LCSW	2/22/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW85529	N/A	N/A	N/A	N/A	N/A	6001 CLARA STREET	None	BELL GARDENS	CA	90201	4723	00	06000	33.96259296	-118.1593487	Los Angeles County
348449	Ordering, Referring, Prescribing	N/A	1831472141	0	0	AMINIAN, FARSHID PHARMD	5/2/2023	Taxonomy not applicable	NA	n/a	000	Unknown	RPH59345	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
348460	Ordering, Referring, Prescribing	N/A	1831494087	0	0	ALTON, KATIE G MD	6/16/2016	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A135822	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY 4TH FLOOR	SUITE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
348489	Ordering, Referring, Prescribing	N/A	1831545185	0	0	ASARE, SIMONE MD	10/10/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152543	N/A	N/A	N/A	N/A	N/A	1500 21ST ST	None	SACRAMENTO	CA	95811	5216	00	06000	38.570553	-121.481325	Sacramento County
348500	Ordering, Referring, Prescribing	N/A	1831557024	0	0	ALLEN, KATHERINE L NP	1/16/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95009933	N/A	N/A	N/A	N/A	N/A	352 L ST	None	CHULA VISTA	CA	91911	1208	00	06000	32.61997526	-117.0739163	San Diego County
348510	Ordering, Referring, Prescribing	N/A	1831568633	0	0	AGUIRRE, BELEN MSW LCSW	2/27/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW112559	N/A	N/A	N/A	N/A	N/A	331 N SANBORN RD	None	SALINAS	CA	93905	2220	00	06000	36.67873598	-121.6255027	Monterey County
348533	Ordering, Referring, Prescribing	N/A	1831608876	0	0	ALCALA BARBOSA, KARINA H	11/27/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	102015	N/A	N/A	N/A	N/A	N/A	22331 MISSION BLVD	None	HAYWARD	CA	94541	3911	00	06000	37.67442187	-122.0867356	Alameda County
348552	Ordering, Referring, Prescribing	N/A	1831638766	0	0	ABT, LILLIAN LCSW	12/1/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	88329	N/A	N/A	N/A	N/A	N/A	1540 E COLORADO ST	None	GLENDALE	CA	91205	1514	00	06000	34.1427285	-118.230039	Los Angeles County
348676	Ordering, Referring, Prescribing	N/A	1831853258	0	0	ANDRAWES, DIANA J PHARMD	7/9/2021	Taxonomy not applicable	NA	n/a	000	Unknown	84528	N/A	N/A	N/A	N/A	N/A	1820 FULLERTON AVE	STE 105	CORONA	CA	92881	4520	00	06000	33.858756	-117.5503465	Riverside County
348700	Ordering, Referring, Prescribing	N/A	1831950880	0	0	ALEXANDER, DEVIN OT	7/22/2023	Taxonomy not applicable	NA	n/a	019	OCCUPATIONAL THERAPISTS	25273	N/A	N/A	N/A	N/A	N/A	10431 COMMERCE ST	None	REDLANDS	CA	92374	0110	00	06000	34.06427678	-117.2416506	San Bernardino County
348702	Ordering, Referring, Prescribing	N/A	1831976901	0	0	ACEVEDO-TREJO, JOSE DDS	9/12/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS109376	N/A	N/A	N/A	N/A	N/A	1325 N ANAHEIM BLVD	SUITE 200	ANAHEIM	CA	92801	1202	00	06000	33.85331047	-117.9199617	Orange County
348705	Ordering, Referring, Prescribing	N/A	1831964105	0	0	ANTON, CECILIA LAC	10/26/2023	Taxonomy not applicable	NA	n/a	032	CERTIFIED ACUPUNCTURIST	AC19907	N/A	N/A	N/A	N/A	N/A	1149 N 2ND ST	None	EL CAJON	CA	92021	5024	00	06000	32.810319	-116.935643	San Diego County
348735	Ordering, Referring, Prescribing	N/A	1841275823	0	0	ARAGON, JOHN R	9/22/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	105208	N/A	N/A	N/A	N/A	N/A	1209 WHITLEY AVE	None	CORCORAN	CA	93212	2327	00	06000	36.09801547	-119.5628355	Kings County
348750	Ordering, Referring, Prescribing	N/A	1841321932	0	0	AGCAYAB, VIRGINIA V LMFT	4/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	32750	N/A	N/A	N/A	N/A	N/A	3605 VISTA WAY	258	OCEANSIDE	CA	92056	4565	00	06000	33.1818929	-117.3104591	San Diego County
348835	Ordering, Referring, Prescribing	N/A	1841488665	0	0	AIKINS-ADJAYE, ABA A LCSW	4/7/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW107607	N/A	N/A	N/A	N/A	N/A	3300 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3137	00	06000	35.37353416	-119.0392409	Kern County
348848	Ordering, Referring, Prescribing	N/A	1841513488	0	0	ALSAADI, ANN LMFT	7/13/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	45036	N/A	N/A	N/A	N/A	N/A	22445 ALESSANDRO BLVD	113 - 114	MORENO VALLEY	CA	92553	8358	00	06000	33.91687854	-117.270999	Riverside County
348891	Ordering, Referring, Prescribing	N/A	1841570579	0	0	AIKENS, JESSICA N LCSW	3/1/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92483	N/A	N/A	N/A	N/A	N/A	88 TABLE MOUNTAIN BLVD	None	OROVILLE	CA	95965	3578	00	06000	39.52148732	-121.5548586	Butte County
348961	Ordering, Referring, Prescribing	N/A	1841683729	0	0	AREIAS, CASSONDRA C LMFT	12/29/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT106721	N/A	N/A	N/A	N/A	N/A	1393 BAILEY DR.	None	HANFORD	CA	93230	5921	00	06000	36.32726257	-119.6663418	Kings County
348984	Ordering, Referring, Prescribing	N/A	1841674785	0	0	AMBLE, CATHERINE D MD	8/29/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A145074	N/A	N/A	N/A	N/A	N/A	8520 S BROADWAY AVENUE	None	LOS ANGELES	CA	90047	0000	00	06000	33.96110579	-118.2782667	Los Angeles County
348997	Ordering, Referring, Prescribing	N/A	1841731098	0	0	ADAMS, BRETT J MD	8/17/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A158052	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
348999	Ordering, Referring, Prescribing	N/A	1841735263	0	0	ALLEN, KATHERINE B LMFT	3/28/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	87374	N/A	N/A	N/A	N/A	N/A	101 WEST COAST RD	BOX 769	REDWAY	CA	95560	0769	00	06000	40.11704433	-123.8133408	Humboldt County
349013	Ordering, Referring, Prescribing	N/A	1841755626	0	0	ALCANTAR, BRIANNA M PSYD	8/29/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	33027	N/A	N/A	N/A	N/A	N/A	855 E LAUREL DR	BUILDING H	SALINAS	CA	93905	1300	00	06000	36.695799	-121.6292715	Monterey County
349030	Ordering, Referring, Prescribing	N/A	1841780186	0	0	ARMSTRONG, EMILY K MD	3/14/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166495	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
349047	Ordering, Referring, Prescribing	N/A	1841802535	0	0	AH SUE, ROBERT PA-C	3/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	58660	N/A	N/A	N/A	N/A	N/A	2740 S. ELM AVENUE	None	FRESNO	CA	93706	5296	00	06000	36.70101129	-119.7908643	Fresno County
349056	Ordering, Referring, Prescribing	N/A	1841829611	0	0	AZOSE, AARON S MD	10/6/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A181691	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
349057	Ordering, Referring, Prescribing	N/A	1841832979	0	0	ARBALLO, ELIZABETH	11/4/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	127108	N/A	N/A	N/A	N/A	N/A	1550 HOTEL CIR N	SUITE 450	SAN DIEGO	CA	92108	2901	00	06000	32.75959113	-117.1772351	San Diego County
349090	Ordering, Referring, Prescribing	N/A	1841908597	0	0	ANUKAM, CHINWENDU C	10/3/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032456	N/A	N/A	N/A	N/A	N/A	29101 HOSPITAL RD	None	LAKE ARROWHEAD	CA	92352	9706	00	06000	34.26577765	-117.1695461	San Bernardino County
349099	Ordering, Referring, Prescribing	N/A	1841949054	0	0	AVILA HERNANDEZ, CAROL ANDREINA MD	7/9/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A197596	N/A	N/A	N/A	N/A	N/A	100 E NORTH ST	None	TAFT	CA	93268	3606	00	06000	35.13962803	-119.4517471	Kern County
349103	Ordering, Referring, Prescribing	N/A	1841960655	0	0	ANDERSON, KIMBERLY NP	7/20/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021883	N/A	N/A	N/A	N/A	N/A	39500 LIBERTY ST	None	FREMONT	CA	94538	2211	00	06000	37.54845774	-121.9773463	Alameda County
349106	Ordering, Referring, Prescribing	N/A	1841962727	0	0	ACUNA, DANIELLA PA	9/23/2021	Taxonomy not applicable	NA	n/a	000	Unknown	PA60105	N/A	N/A	N/A	N/A	N/A	3580 5TH AVE	None	SAN DIEGO	CA	92103	3193	00	06000	32.74286786	-117.160418	San Diego County
349118	Ordering, Referring, Prescribing	N/A	1851015044	0	0	ARNOLD, WESLEY R DDS	9/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	100735	N/A	N/A	N/A	N/A	N/A	1970 UNIVERSITY AVE	None	RIVERSIDE	CA	92507	5202	00	06000	33.97555819	-117.3545428	Riverside County
349142	Ordering, Referring, Prescribing	N/A	1851087738	0	0	AUNG, HNIN PYIE PHYOE MD	8/17/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	PTL11543	N/A	N/A	N/A	N/A	N/A	1520 STOCKTON ST	None	SAN FRANCISCO	CA	94133	3354	00	06000	37.79989786	-122.4090369	San Francisco County
349146	Ordering, Referring, Prescribing	N/A	1851157937	0	0	ABU-DOULEH, NADIA E NP	2/27/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029244	N/A	N/A	N/A	N/A	N/A	10737 CAMINO RUIZ	None	SAN DIEGO	CA	92126	2359	00	06000	32.91416051	-117.1437943	San Diego County
349156	Ordering, Referring, Prescribing	N/A	1851305908	0	0	APPLEFIELD, PAUL S	4/17/2012	Taxonomy not applicable	NA	n/a	099	DENTIST	D26026	N/A	N/A	N/A	N/A	N/A	7843 LANKERSHIM BLVD	None	NORTH HOLLYWOOD	CA	91605	2523	00	06000	34.213581	-118.3878055	Los Angeles County
349185	Ordering, Referring, Prescribing	N/A	1851428981	0	0	ABDUL CADER, NISHA MD FAAP	3/5/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A62847	N/A	N/A	N/A	N/A	N/A	2925 MCMILLAN AVE	108	SAN LUIS OBISPO	CA	93401	6765	00	06000	35.263386	-120.648157	San Luis Obispo County
349206	Ordering, Referring, Prescribing	N/A	1851456214	0	0	ARELLANO, TERESA NP	5/25/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	3474	N/A	N/A	N/A	N/A	N/A	400 W 30TH ST	None	LOS ANGELES	CA	90007	3320	00	06000	34.0239409	-118.2755606	Los Angeles County
349229	Ordering, Referring, Prescribing	N/A	1851488696	0	0	AVED, KIERRA A PHD	3/18/2020	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	17345	N/A	N/A	N/A	N/A	N/A	401 THE CITY DR S	None	ORANGE	CA	92868	3303	00	06000	33.78395385	-117.8887742	Orange County
349233	Ordering, Referring, Prescribing	N/A	1851503973	0	0	ADACHI, SHARON PA	5/6/2021	Taxonomy not applicable	NA	n/a	000	Unknown	12508	N/A	N/A	N/A	N/A	N/A	1031 W 34TH ST	None	LOS ANGELES	CA	90089	3602	00	06000	34.024005	-118.2895875	Los Angeles County
349273	Ordering, Referring, Prescribing	N/A	1851608012	0	0	ATWAL, BHAVANDEEP LMFT	6/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49831	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST	100	SAN JOSE	CA	95112	5865	00	06000	37.32582868	-121.8777868	Santa Clara County
349283	Ordering, Referring, Prescribing	N/A	1851632061	0	0	AVITIA, MARIA LCSW	1/20/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	120538	N/A	N/A	N/A	N/A	N/A	2040 CAMFIELD AVE	None	COMMERCE	CA	90040	1502	00	06000	34.00861575	-118.1559052	Los Angeles County
349284	Ordering, Referring, Prescribing	N/A	1851624241	0	0	AGUINIGA, JULIE R LCSW	11/5/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75122	N/A	N/A	N/A	N/A	N/A	1223 MAIN ST.	None	NEWMAN	CA	95360	1324	00	06000	37.31659228	-121.0231945	Stanislaus County
349301	Ordering, Referring, Prescribing	N/A	1851657746	0	0	ARUNRUT, TEDA MD	8/31/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A129850	N/A	N/A	N/A	N/A	N/A	1600 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
349314	Ordering, Referring, Prescribing	N/A	1851675789	0	0	AGUIRRE, JESSICA S LMFT	11/28/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	124023	N/A	N/A	N/A	N/A	N/A	4930 NAPLES ST	None	SAN DIEGO	CA	92110	3820	00	06000	32.77013831	-117.2030986	San Diego County
349331	Ordering, Referring, Prescribing	N/A	1851691927	0	0	ANDONIAN, ALEEN PHARMD	8/4/2022	Taxonomy not applicable	NA	n/a	000	Unknown	55856	N/A	N/A	N/A	N/A	N/A	1655 S EL CAMINO REAL	None	SAN MATEO	CA	94402	3023	00	06000	37.55266175	-122.3145643	San Mateo County
349366	Ordering, Referring, Prescribing	N/A	1851731756	0	0	ARIAS-SHAH, ANNAMARIE MD FAAP	3/11/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A168184	N/A	N/A	N/A	N/A	N/A	1201 E LA VETA AVE	None	ORANGE	CA	92856	0000	00	06000	33.78059984	-117.8487738	Orange County
349380	Ordering, Referring, Prescribing	N/A	1851764088	0	0	ALLAHWERDY, YOUSIF PHARMD	9/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	72549	N/A	N/A	N/A	N/A	N/A	480 4TH AVE	SUITE 100	CHULA VISTA	CA	91910	4411	00	06000	32.63411298	-117.0816772	San Diego County
349425	Ordering, Referring, Prescribing	N/A	1851831242	0	0	AGANS, ADRIANNA K LMFT	2/22/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	131299	N/A	N/A	N/A	N/A	N/A	1414 N CALIFORNIA ST	None	STOCKTON	CA	95202	1515	00	06000	37.96761084	-121.2883234	San Joaquin County
349472	Ordering, Referring, Prescribing	N/A	1851898209	0	0	ANTWI, ELVI A NP	9/3/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008807	N/A	N/A	N/A	N/A	N/A	701 SOUTH MOUNT VERNON A	None	SAN BERNARDINO	CA	92410	2748	00	06000	34.08892704	-117.3137698	San Bernardino County
349485	Ordering, Referring, Prescribing	N/A	1851925689	0	0	ARTEAGA, ZAIDA N	1/4/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT136966	N/A	N/A	N/A	N/A	N/A	160 S 7TH AVE	None	LA PUENTE	CA	91746	3211	00	06000	34.0335863	-117.9760093	Los Angeles County
349506	Ordering, Referring, Prescribing	N/A	1851973648	0	0	ACEVEDO, MAYRA LCSW	4/24/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW100254	N/A	N/A	N/A	N/A	N/A	867 N FAIR OAKS AVE	None	PASADENA	CA	91103	3050	00	06000	34.160877	-118.1506375	Los Angeles County
349511	Ordering, Referring, Prescribing	N/A	1851999122	0	0	ALVARADO, BARBARA NP	9/23/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95015534	N/A	N/A	N/A	N/A	N/A	12683 AVENUE 416	None	OROSI	CA	93647	2017	00	06000	36.54475363	-119.28962	Tulare County
349543	Ordering, Referring, Prescribing	N/A	1861057937	0	0	ARELLANO, CONNIE A LMFT	8/27/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT30290	N/A	N/A	N/A	N/A	N/A	123 S MONTEBELLO BLVD	None	MONTEBELLO	CA	90640	4729	00	06000	34.00959043	-118.1084192	Los Angeles County
349550	Ordering, Referring, Prescribing	N/A	1861077034	0	0	AZEKE, FIDELIS E NP	12/17/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95016272	N/A	N/A	N/A	N/A	N/A	401 STREET	None	SACRAMENTO	CA	95811	6919	00	06000	0	0	None
349560	Ordering, Referring, Prescribing	N/A	1861113508	0	0	ANG, JONATHAN PHARMD	8/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86580	N/A	N/A	N/A	N/A	N/A	5030 HAMNER AVE	None	EASTVALE	CA	91752	1009	00	06000	33.996744	-117.555534	Riverside County
349586	Ordering, Referring, Prescribing	N/A	1861239014	0	0	ALEJOS RIVERA, ADELINA	6/5/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030387	N/A	N/A	N/A	N/A	N/A	5050 SAN BERNARDINO STRE	None	MONTCLAIR	CA	91763	2326	00	06000	34.0776775	-117.694521	San Bernardino County
349589	Ordering, Referring, Prescribing	N/A	1861422529	0	0	AMIGON, REMEDIOS A	10/13/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D54731	N/A	N/A	N/A	N/A	N/A	1300 S SUNSET AVE	None	WEST COVINA	CA	91790	3342	00	06000	34.0601054	-117.9474205	Los Angeles County
349674	Ordering, Referring, Prescribing	N/A	1861662124	0	0	AGUILERA, ERIKA C LPCC	6/17/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LPCC2887	N/A	N/A	N/A	N/A	N/A	121 DOWNEY AVE	None	MODESTO	CA	95354	1208	00	06000	37.64552748	-120.992607	Stanislaus County
349698	Ordering, Referring, Prescribing	N/A	1861711327	0	0	ANDERSON, HEATHER L LMFT	4/8/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	49921	N/A	N/A	N/A	N/A	N/A	405 E BRANCH ST	103C	ARROYO GRANDE	CA	93420	2802	00	06000	35.12497034	-120.5755297	San Luis Obispo County
349704	Ordering, Referring, Prescribing	N/A	1861728768	0	0	AU, LILIAN	1/5/2015	Taxonomy not applicable	NA	n/a	000	Unknown	382	N/A	N/A	N/A	N/A	N/A	740 N LAKE AVE	None	PASADENA	CA	91104	4557	00	06000	34.158762	-118.132432	Los Angeles County
349714	Ordering, Referring, Prescribing	N/A	1861735409	0	0	ALZUBI, CHRISTIAN F LMFT	7/12/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	107617	N/A	N/A	N/A	N/A	N/A	1117 S B ST	APT 4	SAN MATEO	CA	94401	4350	00	06000	37.55886295	-122.3148717	San Mateo County
349736	Ordering, Referring, Prescribing	N/A	1861774150	0	0	ADMAL, DIVYA PHARMD	7/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	56652	N/A	N/A	N/A	N/A	N/A	121 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2701	00	06000	37.37959628	-122.071458	Santa Clara County
349775	Ordering, Referring, Prescribing	N/A	1861834178	0	0	AGUILERA, IVAN BRANDO T DPM	5/12/2021	Taxonomy not applicable	NA	n/a	027	PODIATRISTS	E5245	N/A	N/A	N/A	N/A	N/A	1485 UNIVERSITY AVENUE	B	RIVERSIDE	CA	92507	9500	00	06000	33.97575646	-117.3439215	Riverside County
349781	Ordering, Referring, Prescribing	N/A	1861839771	0	0	AMUNDSON, MCKENZIE R LMFT	10/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122605	N/A	N/A	N/A	N/A	N/A	315 CAMINO DEL REMEDIO	SUITE B	SANTA BARBARA	CA	93110	1332	00	06000	34.444881	-119.7793725	Santa Barbara County
349789	Ordering, Referring, Prescribing	N/A	1861848582	0	0	ALI, SARAH A MD	4/9/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A150624	N/A	N/A	N/A	N/A	N/A	2425 GEARY BLVD	M160	SAN FRANCISCO	CA	94115	3358	00	06000	37.78272203	-122.4433297	San Francisco County
349790	Ordering, Referring, Prescribing	N/A	1861849390	0	0	ALTMILLER, ELIZABETH PHARMD	3/12/2019	Taxonomy not applicable	NA	n/a	000	Unknown	RPH70820	N/A	N/A	N/A	N/A	N/A	2303 NILES POINT	None	BAKERSFIELD	CA	93306	4025	00	06000	35.3757297	-118.9662182	Kern County
349864	Ordering, Referring, Prescribing	N/A	1861954687	0	0	AZAR, GEZELLE C MD	5/16/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178676	N/A	N/A	N/A	N/A	N/A	101 THE CITY DR S	None	ORANGE	CA	92868	3201	00	06000	33.78674051	-117.8888713	Orange County
349874	Ordering, Referring, Prescribing	N/A	1861969370	0	0	ALRUTZ, ELAINE PT	8/23/2022	Taxonomy not applicable	NA	n/a	025	PHYSICAL THERAPISTS	PT12748	N/A	N/A	N/A	N/A	N/A	162 S MAIN ST	None	BISHOP	CA	93514	3415	00	06000	37.3608019	-118.3951979	Inyo County
349890	Ordering, Referring, Prescribing	N/A	1871003400	0	0	AGUADO, JESUS Z NP	12/10/2019	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95012726	N/A	N/A	N/A	N/A	N/A	101 CIRBY HILLS DR	None	ROSEVILLE	CA	95678	4360	00	06000	38.7303989	-121.2872592	Placer County
349902	Ordering, Referring, Prescribing	N/A	1871027623	0	0	ALEGRIA, ANGIE DO	1/31/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18477	N/A	N/A	N/A	N/A	N/A	4650 W SUNSET BLVD	None	LOS ANGELES	CA	90027	6062	00	06000	34.09813032	-118.2901794	Los Angeles County
349904	Ordering, Referring, Prescribing	N/A	1871027722	0	0	ANGKADJAJA, WILLIAM MD	12/1/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156962	N/A	N/A	N/A	N/A	N/A	1910 ORANGE TREE LANE	SUITE 320	REDLANDS	CA	92374	0105	00	06000	34.06785848	-117.2189386	San Bernardino County
349926	Ordering, Referring, Prescribing	N/A	1871054114	0	0	ALDRICH BARRERA, CHRISTINA MD	6/14/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A187014	N/A	N/A	N/A	N/A	N/A	1801 VICENTE ST	None	SAN FRANCISCO	CA	94116	2923	00	06000	37.7388459	-122.4861544	San Francisco County
349943	Ordering, Referring, Prescribing	N/A	1871081794	0	0	ALTHUKAIR, ABDULRAHMAN MD	1/29/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A193458	N/A	N/A	N/A	N/A	N/A	13585 SAN PABLO AVE	1ST FLOOR	SAN PABLO	CA	94806	3863	00	06000	37.95651393	-122.3371491	Contra Costa County
349950	Ordering, Referring, Prescribing	N/A	1871087874	0	0	AL-TAHAN, SEJAD	7/26/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	19006	N/A	N/A	N/A	N/A	N/A	3750 ARLINGTON AVE	None	RIVERSIDE	CA	92506	2607	00	06000	33.94621715	-117.399167	Riverside County
349953	Ordering, Referring, Prescribing	N/A	1871088575	0	0	ARMENDARIZ, VANESSA P LCSW	6/28/2017	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	29546	N/A	N/A	N/A	N/A	N/A	3100 ACTIS RD	None	BAKERSFIELD	CA	93309	5911	00	06000	35.326998	-119.052223	Kern County
349978	Ordering, Referring, Prescribing	N/A	1871144550	0	0	ALCAZAR, MIREYA LMFT	10/29/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT150964	N/A	N/A	N/A	N/A	N/A	3880 OAK TREE LN	None	LOOMIS	CA	95650	9316	00	06000	38.81510737	-121.1817244	Placer County
350010	Ordering, Referring, Prescribing	N/A	1871214122	0	0	AGRAZ, ARACELIE PHARMD	9/1/2022	Taxonomy not applicable	NA	n/a	000	Unknown	86728	N/A	N/A	N/A	N/A	N/A	12110 INDUSTRY BLVD	None	JACKSON	CA	95642	9373	00	06000	38.36981229	-120.8002806	Amador County
350040	Ordering, Referring, Prescribing	N/A	1871342014	0	0	ALMOG, IDO DMD	11/21/2024	Taxonomy not applicable	NA	n/a	000	Unknown	111053	N/A	N/A	N/A	N/A	N/A	2500 MAIN ST	None	RED BLUFF	CA	96080	2336	00	06000	40.19240296	-122.2399354	Tehama County
350049	Ordering, Referring, Prescribing	N/A	1871372474	0	0	ALVARADO, KAREN	7/9/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95030979	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL ST	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
350062	Ordering, Referring, Prescribing	N/A	1871569400	0	0	ASHER, ALAIN S MD	2/27/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	49496	N/A	N/A	N/A	N/A	N/A	1739 BEVERLY AVE	STE 218	KINGMAN	AZ	86409	3593	00	06000	35.2186683	-114.0385121	Mohave County
350065	Ordering, Referring, Prescribing	N/A	1871571141	0	0	AWASTHI, SARVAMITRA MD	2/11/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A33855	N/A	N/A	N/A	N/A	N/A	324 N VERMONT AVE	None	DINUBA	CA	93618	1631	00	06000	36.54780049	-119.3894155	Tulare County
350067	Ordering, Referring, Prescribing	N/A	1871585968	0	0	ATKINSON, KAREN L	5/29/2017	Taxonomy not applicable	NA	n/a	000	Unknown	18404	N/A	N/A	N/A	N/A	N/A	11899 SHAW PL	None	HANFORD	CA	93230	6644	00	06000	36.30003132	-119.6312291	Kings County
350068	Ordering, Referring, Prescribing	N/A	1871580670	0	0	AWENDER, RITA DC	10/22/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC22787	N/A	N/A	N/A	N/A	N/A	1695 S SAN JACINTO AVE	SUITE A	SAN JACINTO	CA	92583	5103	00	06000	33.770961	-116.954649	Riverside County
350072	Ordering, Referring, Prescribing	N/A	1871605170	0	0	AUGUSTSON, LAURA K LMFT	6/18/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	116619	N/A	N/A	N/A	N/A	N/A	2142 N BLYTHE AVE	None	FRESNO	CA	93722	5402	00	06000	36.76693886	-119.871282	Fresno County
350099	Ordering, Referring, Prescribing	N/A	1871640060	0	0	AYERS, DANIEL DC	1/23/2023	Taxonomy not applicable	NA	n/a	006	CHIROPRACTORS	DC25042	N/A	N/A	N/A	N/A	N/A	77 CASA ST	None	SAN LUIS OBISPO	CA	93405	5803	00	06000	35.29306786	-120.6650709	San Luis Obispo County
350124	Ordering, Referring, Prescribing	N/A	1871681569	0	0	ALTHEN, LISA E PHD	11/25/2019	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	18976	N/A	N/A	N/A	N/A	N/A	21081 S. WESTERN AVE.	None	TORRANCE	CA	90501	1707	00	06000	33.83886841	-118.3093605	Los Angeles County
350157	Ordering, Referring, Prescribing	N/A	1871769273	0	0	ANTHONY, KAY M	9/30/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	9783	N/A	N/A	N/A	N/A	N/A	1043 ELM AVE	302	LOS ANGELES	CA	90813	3295	00	06000	33.779655	-118.1880065	Los Angeles
350166	Ordering, Referring, Prescribing	N/A	1871796920	0	0	AGOHA, RUBY MD	2/19/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A125851	N/A	N/A	N/A	N/A	N/A	401 EAST OCEAN AVE	None	LOMPOC	CA	93436	6828	00	06000	34.6389765	-120.4537095	Santa Barbara County
350173	Ordering, Referring, Prescribing	N/A	1871800136	0	0	ALVARENGA, NANCY LCSW	1/7/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	75744	N/A	N/A	N/A	N/A	N/A	815 N EL CENTRO AVE	None	LOS ANGELES	CA	90038	3805	00	06000	34.08577365	-118.3244665	Los Angeles County
350181	Ordering, Referring, Prescribing	N/A	1871816207	0	0	ABDOLMOHAMMADI, ALIREZA MD	2/13/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A114907	N/A	N/A	N/A	N/A	N/A	193 FAIRVIEW LN	None	SONORA	CA	95370	4828	00	06000	37.97880957	-120.3912459	Tuolumne County
350233	Ordering, Referring, Prescribing	N/A	1871888123	0	0	AL-RAWI, WISAM S	10/27/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	102025	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
350245	Ordering, Referring, Prescribing	N/A	1871900217	0	0	ALVARADO, MAYRA LCSW	12/15/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW88703	N/A	N/A	N/A	N/A	N/A	21081 S. WESTERN AVE	295	TORRANCE	CA	90501	1701	00	06000	33.83886841	-118.3093605	Los Angeles County
350246	Ordering, Referring, Prescribing	N/A	1871906172	0	0	ARIA, AMIR	3/31/2018	Taxonomy not applicable	NA	n/a	000	Unknown	68835	N/A	N/A	N/A	N/A	N/A	6040 TELEGRAPH RD	None	VENTURA	CA	93003	4372	00	06000	34.278241	-119.2127847	Ventura County
350257	Ordering, Referring, Prescribing	N/A	1871921536	0	0	ALKHOURY, KENAN PHD	8/19/2021	Taxonomy not applicable	NA	n/a	000	Unknown	69874	N/A	N/A	N/A	N/A	N/A	2900 FULTON AVENUE	None	SACRAMENTO	CA	95821	4994	00	06000	38.619288	-121.399884	Sacramento County
350262	Ordering, Referring, Prescribing	N/A	1871925339	0	0	AYALA, LIZETTE B LCSW	2/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	91571	N/A	N/A	N/A	N/A	N/A	1555 SOUTH GAREY AVENUE	None	POMONA	CA	91766	5222	00	06000	34.04317024	-117.7497127	Los Angeles County
350282	Ordering, Referring, Prescribing	N/A	1871958710	0	0	AMAYA-MIJARES, MELISSA R LMFT	8/4/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	127305	N/A	N/A	N/A	N/A	N/A	100 W WALNUT ST #375	None	PASADENA	CA	91124	0000	00	06000	34.14963648	-118.1522925	Los Angeles County
350285	Ordering, Referring, Prescribing	N/A	1871963512	0	0	ARISTIGI, JANNET LCSW	4/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	92728	N/A	N/A	N/A	N/A	N/A	801 E CHAPMAN AVE	#203	FULLERTON	CA	92831	3839	00	06000	33.87407517	-117.9110814	Orange County
350287	Ordering, Referring, Prescribing	N/A	1871961839	0	0	AMPARO, ALEJANDRA MSW LCSW	12/31/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93629	N/A	N/A	N/A	N/A	N/A	593 W 6TH ST	None	SAN PEDRO	CA	90731	2521	00	06000	33.73875253	-118.2899475	Los Angeles County
350306	Ordering, Referring, Prescribing	N/A	1871987610	0	0	ALEMAN, MARIA L LMFT	3/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT112181	N/A	N/A	N/A	N/A	N/A	3300 TRUXTUN AVE	None	BAKERSFIELD	CA	93301	3137	00	06000	35.37353416	-119.0392409	Kern County
350347	Ordering, Referring, Prescribing	N/A	1881056026	0	0	AVILA, VANESA MD	8/22/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157887	N/A	N/A	N/A	N/A	N/A	1101 N CHERRY ST	None	TULARE	CA	93274	2231	00	06000	36.22333808	-119.337575	Tulare County
350369	Ordering, Referring, Prescribing	N/A	1881075646	0	0	ALI, NIDA MD	3/15/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A156233	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
350374	Ordering, Referring, Prescribing	N/A	1881078731	0	0	ALVAREZ MARTINEZ, ELIZABETH LCSW	5/17/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW115303	N/A	N/A	N/A	N/A	N/A	3120 FREEBOARD DRIVE	SUITE 102	WEST SACRAMENTO	CA	95691	5039	00	06000	38.5746747	-121.552383	Yolo County
350400	Ordering, Referring, Prescribing	N/A	1881118974	0	0	AMBRIZ, ABRAHAM LPCC	4/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	9540	N/A	N/A	N/A	N/A	N/A	1911 WILLIAMS DRIVE	STE. 210	OXNARD	CA	93036	0673	00	06000	34.219566	-119.1539365	Ventura County
350413	Ordering, Referring, Prescribing	N/A	1881141521	0	0	ARNBRECHT, LEAH M PHARMD	2/25/2021	Taxonomy not applicable	NA	n/a	000	Unknown	79901	N/A	N/A	N/A	N/A	N/A	275 HOSPITAL PKWY	SUITE 625	SAN JOSE	CA	95119	1106	00	06000	37.23951066	-121.8013511	Santa Clara County
350471	Ordering, Referring, Prescribing	N/A	1881238657	0	0	AMOS, LINDSEY LCSW	3/6/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW114071	N/A	N/A	N/A	N/A	N/A	1555 PARKMOOR AVE	None	SAN JOSE	CA	95128	2407	00	06000	37.31712017	-121.9185451	Santa Clara County
350487	Ordering, Referring, Prescribing	N/A	1881272300	0	0	ASIABAN, SARAH MD	2/27/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A194226	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
350496	Ordering, Referring, Prescribing	N/A	1881280113	0	0	AHADY, MARWA N PA-C	11/24/2020	Taxonomy not applicable	NA	n/a	000	Unknown	58888	N/A	N/A	N/A	N/A	N/A	12100 VALLEY BLVD	109A	EL MONTE	CA	91732	3161	00	06000	34.06130355	-118.0164048	Los Angeles County
350512	Ordering, Referring, Prescribing	N/A	1881331775	0	0	ACUNA, MARCELA NP	5/13/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019349	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
350552	Ordering, Referring, Prescribing	N/A	1881695401	0	0	ALAS, JUAN L	8/10/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A55051	N/A	N/A	N/A	N/A	N/A	545 N SAN GABRIEL AVE	None	AZUSA	CA	91702	2939	00	06000	34.131537	-117.908859	Los Angeles County
350561	Ordering, Referring, Prescribing	N/A	1881719458	0	0	AHN, GRACE LCSW	11/6/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW25426	N/A	N/A	N/A	N/A	N/A	1 CIVIC PLAZA DR	None	CARSON	CA	90745	2243	00	06000	33.8328256	-118.2592958	Los Angeles County
350578	Ordering, Referring, Prescribing	N/A	1881735512	0	0	ASHTON, DIANE C LMFT	4/23/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	78342	N/A	N/A	N/A	N/A	N/A	1600 PACIFIC HWY	None	SAN DIEGO	CA	92101	2429	00	06000	32.7217581	-117.1711788	San Diego County
350603	Ordering, Referring, Prescribing	N/A	1881776326	0	0	ABDISHOO, LISA B MD	5/2/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A64712	N/A	N/A	N/A	N/A	N/A	325 E 7TH ST	None	LOS ANGELES	CA	90014	2209	00	06000	34.04209386	-118.2486813	Los Angeles County
350604	Ordering, Referring, Prescribing	N/A	1881788248	0	0	ACKERMAN, BERNADETTE E CNP	3/30/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	950139671	N/A	N/A	N/A	N/A	N/A	9015 MURRAY AVE	STE 100	GILROY	CA	95020	3675	00	06000	37.03080985	-121.5741639	Santa Clara County
350617	Ordering, Referring, Prescribing	N/A	1881831857	0	0	AHLERS, PATRIZIA LMFT	9/30/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	88809	N/A	N/A	N/A	N/A	N/A	3185 GLORY RD	None	PLACERVILLE	CA	95667	5833	00	06000	38.72207141	-120.7865543	El Dorado County
350637	Ordering, Referring, Prescribing	N/A	1881874907	0	0	AUSTIN, MICHELLE M LMFT	5/29/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT126218	N/A	N/A	N/A	N/A	N/A	232 E GISH RD	None	SAN JOSE	CA	95112	4706	00	06000	37.36411044	-121.9052075	Santa Clara County
350643	Ordering, Referring, Prescribing	N/A	1881894244	0	0	ALMANZA, NUVIA LMFT	11/27/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	151621	N/A	N/A	N/A	N/A	N/A	602 ANACAPA STREET	None	SANTA BARBARA	CA	93101	1615	00	06000	34.41898237	-119.6956812	Santa Barbara County
350686	Ordering, Referring, Prescribing	N/A	1881974624	0	0	AU, FRANCESCA PHARMD	7/5/2023	Taxonomy not applicable	NA	n/a	000	Unknown	65776	N/A	N/A	N/A	N/A	N/A	1411 E 31ST ST	None	OAKLAND	CA	94602	1018	00	06000	37.79926205	-122.2314248	Alameda County
350692	Ordering, Referring, Prescribing	N/A	1881978674	0	0	AMIRI, FATEMEH P	7/13/2021	Taxonomy not applicable	NA	n/a	000	Unknown	48393	N/A	N/A	N/A	N/A	N/A	121 E EL CAMINO REAL	None	MOUNTAIN VIEW	CA	94040	2701	00	06000	37.37959628	-122.071458	Santa Clara County
350711	Ordering, Referring, Prescribing	N/A	1891027314	0	0	ALCANTAR, SANDY MSW LCSW	11/17/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	83466	N/A	N/A	N/A	N/A	N/A	25 S RAYMOND AVE	None	ALHAMBRA	CA	91801	3128	00	06000	34.09042452	-118.1450725	Los Angeles County
350739	Ordering, Referring, Prescribing	N/A	1891074738	0	0	AHN, SIMON	3/24/2021	Taxonomy not applicable	NA	n/a	000	Unknown	64331	N/A	N/A	N/A	N/A	N/A	12254 BELLFLOWER BLVD	None	DOWNEY	CA	90242	2804	00	06000	33.921405	-118.125323	Los Angeles County
350746	Ordering, Referring, Prescribing	N/A	1891079265	0	0	ACOSTA, NICOLE M LMFT	10/12/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122515	N/A	N/A	N/A	N/A	N/A	370 W CRENSHAW BLVD.	E100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
350775	Ordering, Referring, Prescribing	N/A	1891127403	0	0	AMADOR, KEITH O LMFT	4/13/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	102725	N/A	N/A	N/A	N/A	N/A	1212 N CALIFORNIA ST	None	STOCKTON	CA	95202	1552	00	06000	37.96681769	-121.2881382	San Joaquin County
350811	Ordering, Referring, Prescribing	N/A	1891146908	0	0	ALEMOH, KEMI A LCSW	9/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97278	N/A	N/A	N/A	N/A	N/A	1908 S BUSINESS CENTER D	SUITE 202	SAN BERNARDINO	CA	92408	3468	00	06000	34.06732096	-117.2801085	San Bernardino County
350849	Ordering, Referring, Prescribing	N/A	1891239075	0	0	AIHARA, EMILY M LMFT	4/18/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT125600	N/A	N/A	N/A	N/A	N/A	4000 W METROPOLITAN DR	401	ORANGE	CA	92868	3504	00	06000	33.78016046	-117.8956101	Orange County
350875	Ordering, Referring, Prescribing	N/A	1891278628	0	0	ALMEIDA, EMILY J LCSW	11/21/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW101254	N/A	N/A	N/A	N/A	N/A	3002 ARMSTRONG ST	None	SAN DIEGO	CA	92111	5702	00	06000	32.80043242	-117.165431	San Diego County
350925	Ordering, Referring, Prescribing	N/A	1891405338	0	0	ANYAECHE, EUPHEMIA C PHARMD	11/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	87373	N/A	N/A	N/A	N/A	N/A	20261 HIGHWAY 18	None	APPLE VALLEY	CA	92307	0640	00	06000	34.52556433	-117.2198711	San Bernardino County
350928	Ordering, Referring, Prescribing	N/A	1891420709	0	0	ALBAKRI, JASMINE R PHARMD	11/8/2021	Taxonomy not applicable	NA	n/a	000	Unknown	85601	N/A	N/A	N/A	N/A	N/A	6100 PACIFIC BLVD	None	HUNTINGTON PARK	CA	90255	2923	00	06000	33.984981	-118.2251735	Los Angeles County
350931	Ordering, Referring, Prescribing	N/A	1891413274	0	0	ANSARI, POUYA DMD	8/21/2022	Taxonomy not applicable	NA	n/a	000	Unknown	107837	N/A	N/A	N/A	N/A	N/A	1919 S SAN PEDRO ST	None	LOS ANGELES	CA	90011	1121	00	06000	34.02704017	-118.2578387	Los Angeles County
350940	Ordering, Referring, Prescribing	N/A	1891438966	0	0	ALUGBUE, ANTOINETTE MD	8/17/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A188935	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
350956	Ordering, Referring, Prescribing	N/A	1891473708	0	0	ALATRISTE, KRISTEEN L NP	8/8/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026553	N/A	N/A	N/A	N/A	N/A	2760 S. ELM AVENUE	None	FRESNO	CA	93706	5435	00	06000	36.700542	-119.790868	Fresno County
350974	Ordering, Referring, Prescribing	N/A	1891710661	0	0	ATMAR, FARIHA PA-C	1/13/2022	Taxonomy not applicable	NA	n/a	000	Unknown	18458	N/A	N/A	N/A	N/A	N/A	527 E ST	None	MARYSVILLE	CA	95901	5529	00	06000	39.14098899	-121.5905578	Yuba County
351000	Ordering, Referring, Prescribing	N/A	1891821856	0	0	AGRICOLA, CHRISTIAN D MD	8/3/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C169619	N/A	N/A	N/A	N/A	N/A	720 WOOD ST	None	EUREKA	CA	95501	4413	00	06000	40.78118068	-124.1607622	Humboldt County
351004	Ordering, Referring, Prescribing	N/A	1891829362	0	0	ARCOS, LUIS LMFT	6/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	48317	N/A	N/A	N/A	N/A	N/A	1849 SAWTELLE BLVD	610	LOS ANGELES	CA	90025	7006	00	06000	34.04266851	-118.4451527	Los Angeles County
351019	Ordering, Referring, Prescribing	N/A	1891853461	0	0	ATKINS, STACI LCSW	6/21/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26308	N/A	N/A	N/A	N/A	N/A	3740 SANTA ROSALIA DR.	220	LOS ANGELES	CA	90008	9998	00	06000	34.00799127	-118.3385451	Los Angeles County
351022	Ordering, Referring, Prescribing	N/A	1891858825	0	0	AUSTIN-TAYLOR, JANICE L LMFT	2/24/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT36808	N/A	N/A	N/A	N/A	N/A	16350 FILBERT ST	None	SYLMAR	CA	91342	1002	00	06000	34.31595736	-118.4853828	Los Angeles County
351060	Ordering, Referring, Prescribing	N/A	1891957783	0	0	ARTEAGA, LIESL A CNP	2/7/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95000978	N/A	N/A	N/A	N/A	N/A	400 W PUEBLO ST	None	SANTA BARBARA	CA	93105	1698	00	06000	34.42887662	-119.7237878	Santa Barbara County
351062	Ordering, Referring, Prescribing	N/A	1891963997	0	0	ASHORI, BAHAR PHARMD	1/20/2024	Taxonomy not applicable	NA	n/a	000	Unknown	59164	N/A	N/A	N/A	N/A	N/A	9552 BAYPOINT WAY	None	ELK GROVE	CA	95624	0000	00	06000	38.410794	-121.3473285	Sacramento County
351068	Ordering, Referring, Prescribing	N/A	1891969572	0	0	AYOOLA-ARCHIE, OLATOKUNBO M MD	3/3/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A79131	N/A	N/A	N/A	N/A	N/A	535 AIRPORT RD	None	HOOPA	CA	95546	1288	00	06000	41.04169689	-123.6656063	Humboldt County
351079	Ordering, Referring, Prescribing	N/A	1891993838	0	0	ALBIE, NICOLE A LMFT	12/18/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT78382	N/A	N/A	N/A	N/A	N/A	1401 N. TUSITN AVE	STE 225	SANTA ANA	CA	92705	8688	00	06000	33.757254	-117.8341425	Orange County
351085	Ordering, Referring, Prescribing	N/A	1902003734	0	0	AGGARWAL, SHRUTI MD	9/29/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C134645	N/A	N/A	N/A	N/A	N/A	263 S WEST ST	None	TULARE	CA	93274	3411	00	06000	36.20460711	-119.3668926	Tulare County
351090	Ordering, Referring, Prescribing	N/A	1902023666	0	0	ARMANIOUS, NADER F MD	9/13/2020	Taxonomy not applicable	NA	n/a	000	Unknown	A72796	N/A	N/A	N/A	N/A	N/A	8780 VAN NUYS BLVD SUITE	B	PANORAM CITY	CA	91402	1000	00	06000	34.22956721	-118.4502171	Los Angeles County
351092	Ordering, Referring, Prescribing	N/A	1902027907	0	0	AUZENNE, TANA DDS	3/26/2023	Taxonomy not applicable	NA	n/a	000	Unknown	37592	N/A	N/A	N/A	N/A	N/A	19969 GREENLEY RD	C AND D	SONORA	CA	95370	5908	00	06000	37.98497262	-120.3669198	Tuolumne County
351147	Ordering, Referring, Prescribing	N/A	1902150147	0	0	ALVARADO, JOSE D LMFT	10/28/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT84610	N/A	N/A	N/A	N/A	N/A	1359 N GRAND AVE	None	COVINA	CA	91724	1016	00	06000	34.104681	-117.872706	Los Angeles County
351239	Ordering, Referring, Prescribing	N/A	1902257868	0	0	ALMAHMOUD, MOHANAD MD	4/16/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A185587	N/A	N/A	N/A	N/A	N/A	757 WESTWOOD BOULEVARD	None	LOS ANGELES	CA	90095	8358	00	06000	34.06633051	-118.4452686	Los Angeles County
351246	Ordering, Referring, Prescribing	N/A	1902292196	0	0	ALEXANDER, VERONICA MD	11/30/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A170900	N/A	N/A	N/A	N/A	N/A	215 W BEAMER STREET	None	WOODLAND	CA	95695	2510	00	06000	38.68483629	-121.7937301	Yolo County
351252	Ordering, Referring, Prescribing	N/A	1902302599	0	0	AKHAMZADEH, ESTHER NP	9/20/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	F02181111	N/A	N/A	N/A	N/A	N/A	320 ARDEN AVE	100	GLENDALE	CA	91203	1128	00	06000	34.15846336	-118.2589473	Los Angeles County
351273	Ordering, Referring, Prescribing	N/A	1902338122	0	0	ARIBINDI, KATYAYINI MD	3/29/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A172090	N/A	N/A	N/A	N/A	N/A	2315 STOCKTON BLVD	None	SACRAMENTO	CA	95817	2201	00	06000	38.555181	-121.4566785	Sacramento County
351292	Ordering, Referring, Prescribing	N/A	1902361678	0	0	ABBASI, DAVOUD M OD	5/6/2019	Taxonomy not applicable	NA	n/a	020	OPTOMETRISTS	OPT34216	N/A	N/A	N/A	N/A	N/A	106 E. MAIN ST.	None	FOWLER	CA	93625	2433	00	06000	36.62899034	-119.6785493	Fresno County
351334	Ordering, Referring, Prescribing	N/A	1902463755	0	0	AHN, ALISON Y PSYD	5/13/2022	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY33352	N/A	N/A	N/A	N/A	N/A	301 THE CITY DR S	MOB 44 - 2ND FL	ORANGE	CA	92868	3205	00	06000	33.78547994	-117.8888036	Orange County
351382	Ordering, Referring, Prescribing	N/A	1902877269	0	0	ANTARAMIAN, JAMES C PHARMD	8/23/2022	Taxonomy not applicable	NA	n/a	000	Unknown	27849	N/A	N/A	N/A	N/A	N/A	8949 N CEDAR AVE	None	FRESNO	CA	93720	1890	00	06000	36.86491283	-119.7569254	Fresno County
351394	Ordering, Referring, Prescribing	N/A	1902922198	0	0	ANDERSON, DANIEL L LMFT	8/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	41549	N/A	N/A	N/A	N/A	N/A	350 E GOBBI ST	B	UKIAH	CA	95482	5511	00	06000	39.14427808	-123.2021038	Mendocino County
351398	Ordering, Referring, Prescribing	N/A	1902924509	0	0	ARENDS, JULIE C MD	1/12/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A73891	N/A	N/A	N/A	N/A	N/A	5044 N BARTON AVE	M/S HC81	FRESNO	CA	93740	8012	00	06000	36.80942142	-119.7496436	Fresno County
351404	Ordering, Referring, Prescribing	N/A	1902930100	0	0	AMIGHETTI, LUISA LMFT	2/24/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50632	N/A	N/A	N/A	N/A	N/A	1339 20TH STREET	None	SANTA MONICA	CA	90404	2033	00	06000	34.02917949	-118.4805651	Los Angeles County
351415	Ordering, Referring, Prescribing	N/A	1902936313	0	0	AKIATEN, EILEEN F LMFT	12/15/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT50587	N/A	N/A	N/A	N/A	N/A	5054 S VERMONT AVE	None	LOS ANGELES	CA	90037	2946	00	06000	33.996681	-118.291502	Los Angeles County
351418	Ordering, Referring, Prescribing	N/A	1902940844	0	0	ARMSTRONG, TIFFANY LCSW	8/26/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	66443	N/A	N/A	N/A	N/A	N/A	555 HOSPITAL LN	None	SUSANVILLE	CA	96130	4808	00	06000	40.40857373	-120.666989	Lassen County
351429	Ordering, Referring, Prescribing	N/A	1902959240	0	0	ARMENTA, AMALIA MD	9/26/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A80646	N/A	N/A	N/A	N/A	N/A	3600 N VERDUGO BLVD	301	GLENDALE	CA	91208	1219	00	06000	34.20395492	-118.2258507	Los Angeles County
351449	Ordering, Referring, Prescribing	N/A	1902999220	0	0	AGRAWAL, MANJU MD	7/29/2013	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A00051434	N/A	N/A	N/A	N/A	N/A	10300 COMPTON AVE	None	LOS ANGELES	CA	90002	3628	00	06000	33.94274917	-118.2461916	Los Angeles County
351498	Ordering, Referring, Prescribing	N/A	1912106824	0	0	ANAYA, CESAR G LMFT	6/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT49500	N/A	N/A	N/A	N/A	N/A	1441 CONSTITUTION BLVD	BLDG 400, STE 202	SALINAS	CA	93906	3100	00	06000	36.696987	-121.633164	Monterey County
351513	Ordering, Referring, Prescribing	N/A	1912137498	0	0	ABDELMALAK, NANCY MD	11/26/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A133007	N/A	N/A	N/A	N/A	N/A	9280 WEST STOCKTON BLVD	230	ELK GROVE	CA	95758	8078	00	06000	38.420235	-121.394961	Sacramento County
351558	Ordering, Referring, Prescribing	N/A	1912240318	0	0	ANELLO, MARGARET LMFT	1/26/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT100350	N/A	N/A	N/A	N/A	N/A	625 CITRACADO PKWY	STE 102	ESCONDIDO	CA	92025	6428	00	06000	33.09177699	-117.078913	San Diego County
351570	Ordering, Referring, Prescribing	N/A	1912264938	0	0	AZIZI, HAFIZULLAH A MD	5/4/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139334	N/A	N/A	N/A	N/A	N/A	14677 MERRILL AVE	None	FONTANA	CA	92335	4219	00	06000	34.09195549	-117.484956	San Bernardino County
351577	Ordering, Referring, Prescribing	N/A	1912274713	0	0	ALVARADO, SANDRA PHD	11/7/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY24545	N/A	N/A	N/A	N/A	N/A	200 SOUTH WELLS RD	250	VENTURA	CA	93004	1383	00	06000	34.29321532	-119.1597424	Ventura County
351587	Ordering, Referring, Prescribing	N/A	1912284647	0	0	ALADE, ERICA LMFT	9/9/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	128006	N/A	N/A	N/A	N/A	N/A	9660 HAVEN AVE	STE 203	RANCHO CUCAMONGA	CA	91730	5896	00	06000	34.08001728	-117.5758578	San Bernardino County
351597	Ordering, Referring, Prescribing	N/A	1912289703	0	0	ADLER, EDNA C LCSW	8/23/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW75602	N/A	N/A	N/A	N/A	N/A	6280 W LAS POSITAS BLVD	SUITE 203	PLEASANTON	CA	94588	4942	00	06000	37.6814997	-121.9050479	Alameda County
351638	Ordering, Referring, Prescribing	N/A	1912346305	0	0	AKRIDGE, EVANGELINE	1/21/2024	Taxonomy not applicable	NA	n/a	000	Unknown	3265	N/A	N/A	N/A	N/A	N/A	1111 SIXTH AVE	600	SAN DIEGO	CA	92101	5213	00	06000	32.71699334	-117.1592106	San Diego County
351644	Ordering, Referring, Prescribing	N/A	1912354689	0	0	AGRAWAL, PRIYADARSHIN K	3/22/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	100150	N/A	N/A	N/A	N/A	N/A	2180 N MAIN ST	None	SALINAS	CA	93906	1735	00	06000	36.72675972	-121.6563161	Monterey County
351647	Ordering, Referring, Prescribing	N/A	1912361106	0	0	ALVAREZ, JOHN N MD	2/17/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A155288	N/A	N/A	N/A	N/A	N/A	401 IMPERIAL HWY	None	FULLERTON	CA	92835	1145	00	06000	33.91748848	-117.925704	Orange County
351659	Ordering, Referring, Prescribing	N/A	1912370131	0	0	AZIZ, SALLY	3/31/2018	Taxonomy not applicable	NA	n/a	000	Unknown	65121	N/A	N/A	N/A	N/A	N/A	4700 PANAMA LANE, SUITE	None	BAKERSFIELD	CA	93313	3481	00	06000	35.29593849	-119.055258	Kern County
351670	Ordering, Referring, Prescribing	N/A	1912388802	0	0	AUBREY, JENNIFER M LMFT	5/31/2018	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT85356	N/A	N/A	N/A	N/A	N/A	9100 FAIR OAKS BLVD, SUI	None	FAIR OAKS	CA	95628	6814	00	06000	38.636163	-121.291425	Sacramento County
351690	Ordering, Referring, Prescribing	N/A	1912421637	0	0	ARTEAGA, SHYANNE D MSW LCSW	12/21/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	99237	N/A	N/A	N/A	N/A	N/A	370 W. CRENSHAW BLVD	E-100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
351699	Ordering, Referring, Prescribing	N/A	1912430919	0	0	AGUIAR, BONNIE LCSW	3/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	72970	N/A	N/A	N/A	N/A	N/A	686 E MILL STREET	None	SAN BERNARDINO	CA	92415	0640	00	06000	34.09216669	-117.2710544	San Bernardino County
351700	Ordering, Referring, Prescribing	N/A	1912432295	0	0	ANTONINO, NICHOLAS F DO	3/25/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	20A18741	N/A	N/A	N/A	N/A	N/A	101 BODIN CIRCLE	None	FRESNO	CA	94535	1800	00	06000	38.2676007	-121.9650445	Solano County
351701	Ordering, Referring, Prescribing	N/A	1912442724	0	0	ALVARADO, DANIELA Y LCSW	12/6/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW92053	N/A	N/A	N/A	N/A	N/A	11080 W OLYMPIC BLVD	None	LOS ANGELES	CA	90064	1937	00	06000	34.04036814	-118.4376056	Los Angeles County
351707	Ordering, Referring, Prescribing	N/A	1912447939	0	0	ANDRESEN, YAZMIN NP	1/14/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95005890	N/A	N/A	N/A	N/A	N/A	1125 10TH ST	None	SACRAMENTO	CA	95814	3503	00	06000	38.57890563	-121.4939739	Sacramento County
351713	Ordering, Referring, Prescribing	N/A	1912460536	0	0	ANTONENKO, ANDREY	2/5/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	122926	N/A	N/A	N/A	N/A	N/A	300 BRADFORD STREET	None	REDWOOD CITY	CA	94063	1530	00	06000	37.48767403	-122.2323005	San Mateo County
351724	Ordering, Referring, Prescribing	N/A	1912472614	0	0	AQUINO, BENBENEDIC M	8/14/2019	Taxonomy not applicable	NA	n/a	000	Unknown	180206474	N/A	N/A	N/A	N/A	N/A	431 W ALISAL ST	None	SALINAS	CA	93901	1624	00	06000	36.67235917	-121.6654346	Monterey County
351758	Ordering, Referring, Prescribing	N/A	1912533597	0	0	AL SAMMARRAIE, MOHLAB N	7/20/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	104831	N/A	N/A	N/A	N/A	N/A	10418 VALLEY BLVD	STE B	EL MONTE	CA	91731	3600	00	06000	34.07647884	-118.0458956	Los Angeles County
351788	Ordering, Referring, Prescribing	N/A	1912590662	0	0	ARBANI, PARVANEH	6/22/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019547	N/A	N/A	N/A	N/A	N/A	22030 SHERMAN WAY	211	CANOGA PARK	CA	91303	1855	00	06000	34.20099551	-118.6071615	Los Angeles County
351854	Ordering, Referring, Prescribing	N/A	1922045558	0	0	ASHLEY, JANICE L NP	2/5/2014	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	RN256373	N/A	N/A	N/A	N/A	N/A	2633 16TH STREET	None	SACRAMENTO	CA	93301	3348	00	06000	38.559168	-121.492845	Sacramento County
351862	Ordering, Referring, Prescribing	N/A	1922122167	0	0	AZRAEL, RUTH S LCSW	11/18/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW17628	N/A	N/A	N/A	N/A	N/A	9650 ZELZAH AVE	None	NORTHRIDGE	CA	91325	2003	00	06000	34.24628267	-118.5232668	Los Angeles County
351892	Ordering, Referring, Prescribing	N/A	1922175041	0	0	AMBROSE, PETER D MD	9/18/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G21832	N/A	N/A	N/A	N/A	N/A	8112 MILLIKEN AVE	SUITE# 201	RANCHO CUCAMONGA	CA	91730	7473	00	06000	34.10480366	-117.5570863	San Bernardino County
351894	Ordering, Referring, Prescribing	N/A	1922180835	0	0	ASKREN, KAREN A	4/19/2017	Taxonomy not applicable	NA	n/a	000	Unknown	12065	N/A	N/A	N/A	N/A	N/A	444 W EL MONTE WY	None	DINUBA	CA	93618	1500	00	06000	36.54592542	-119.39921	Tulare County
351926	Ordering, Referring, Prescribing	N/A	1922275254	0	0	ALLEN II, GREGORY P	5/28/2008	Taxonomy not applicable	NA	n/a	099	DENTIST	D56992	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
351931	Ordering, Referring, Prescribing	N/A	1922292218	0	0	ANTOR, MAXWELL J LMFT	6/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	52546	N/A	N/A	N/A	N/A	N/A	3800 COOLIDGE AVE	None	OAKLAND	CA	94602	3311	00	06000	37.8007257	-122.2064578	Alameda County
351974	Ordering, Referring, Prescribing	N/A	1922371962	0	0	ARAUJO, GERSON P MD	4/2/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A153886	N/A	N/A	N/A	N/A	N/A	246 HOSPITAL DRIVE	None	UKIAH	CA	95482	4533	00	06000	39.15280729	-123.2037741	Mendocino County
352093	Ordering, Referring, Prescribing	N/A	1922533777	0	0	ALFARO, ERNAN LCSW	8/12/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	103126	N/A	N/A	N/A	N/A	N/A	2712 MISSION ST	None	SAN FRANCISCO	CA	94110	3104	00	06000	37.75336705	-122.4185922	San Francisco County
352102	Ordering, Referring, Prescribing	N/A	1922542612	0	0	AVILA, ALEJANDRO A LMFT	12/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT123466	N/A	N/A	N/A	N/A	N/A	83-912 AVENUE 45	SUITE 9	INDIO	CA	92201	3338	00	06000	33.722208	-116.2097446	Riverside County
352117	Ordering, Referring, Prescribing	N/A	1922555499	0	0	ALDRICH COFFEY, ERYN T LMFT	1/26/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT105055	N/A	N/A	N/A	N/A	N/A	85 SIERRA PARK ROAD	None	MAMMOTH LAKES	CA	93546	2073	00	06000	37.64575895	-118.9638914	Mono County
352189	Ordering, Referring, Prescribing	N/A	1922746775	0	0	ANDERSON, KARLEE LCSW	10/14/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	126735	N/A	N/A	N/A	N/A	N/A	1780 VERNON ST	1	ROSEVILLE	CA	95678	6311	00	06000	38.732967	-121.2997685	Placer County
352202	Ordering, Referring, Prescribing	N/A	1922837624	0	0	AVALOS, ERICA NP	11/3/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95026106	N/A	N/A	N/A	N/A	N/A	2898 LINDEN AVE	None	LONG BEACH	CA	90806	1627	00	06000	33.809688	-118.1868115	Los Angeles County
352205	Ordering, Referring, Prescribing	N/A	1922868009	0	0	ASTORGA, KACIE L	3/19/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029520	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
352207	Ordering, Referring, Prescribing	N/A	1922849116	0	0	AYUDANTE, ALYSSA MARIE PA-C	10/25/2024	Taxonomy not applicable	NA	n/a	000	Unknown	PA65301	N/A	N/A	N/A	N/A	N/A	200 S WELLS RD	100	VENTURA	CA	93004	1302	00	06000	34.29321532	-119.1597424	Ventura County
352240	Ordering, Referring, Prescribing	N/A	1932227295	0	0	ALBAN, BENJAMIN D LCSW	3/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26094	N/A	N/A	N/A	N/A	N/A	1414 N CALIFORNIA ST	None	STOCKTON	CA	95202	1515	00	06000	37.96761084	-121.2883234	San Joaquin County
352336	Ordering, Referring, Prescribing	N/A	1932442845	0	0	AVILA-MARTINEZ, LUCIA LMFT	5/11/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT115028	N/A	N/A	N/A	N/A	N/A	142 E CALIFORNIA AVE	None	FRESNO	CA	93706	3642	00	06000	36.72133047	-119.810421	Fresno County
352343	Ordering, Referring, Prescribing	N/A	1932441359	0	0	ALLEN, REBECCA M MD	6/12/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A143449	N/A	N/A	N/A	N/A	N/A	24422 AVENIDA DE LA CARL	SUITE 130	LAGUNA HILLS	CA	92653	3636	00	06000	33.56726005	-117.705397	Orange County
352348	Ordering, Referring, Prescribing	N/A	1932474459	0	0	AGUILAR, JENNIFER A LMFT	10/21/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101788	N/A	N/A	N/A	N/A	N/A	2130 NATIONAL AVE	None	SAN DIEGO	CA	92113	2209	00	06000	32.69800063	-117.1411927	San Diego County
352367	Ordering, Referring, Prescribing	N/A	1932500568	0	0	ALVAREZ, ALICE LCSW	3/24/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW93935	N/A	N/A	N/A	N/A	N/A	850 E FOOTHILL BLVD	None	RIALTO	CA	92376	5230	00	06000	34.10679449	-117.3542535	San Bernardino County
352378	Ordering, Referring, Prescribing	N/A	1932515145	0	0	AUSTIN-TOWNSEND, ALICIA LMFT	2/1/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	114307	N/A	N/A	N/A	N/A	N/A	1002 N DOUTY ST	None	HANFORD	CA	93230	3723	00	06000	36.335133	-119.646077	Kings County
352388	Ordering, Referring, Prescribing	N/A	1932531738	0	0	ACEVEZ, ALMA LMFT	11/16/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	113606	N/A	N/A	N/A	N/A	N/A	10965 MT. GLEASON AVE	None	SUNLAND	CA	91040	2229	00	06000	34.26870694	-118.3027643	Los Angeles County
352393	Ordering, Referring, Prescribing	N/A	1932527462	0	0	AGUILAR, ASHLEY M LMFT	3/9/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT114910	N/A	N/A	N/A	N/A	N/A	780 E GILBERT ST.	None	SAN BERNARDINO	CA	92415	1003	00	06000	34.1268333	-117.2705634	San Bernardino County
352400	Ordering, Referring, Prescribing	N/A	1932544657	0	0	ATAIE, YALDA MD	9/19/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139509	N/A	N/A	N/A	N/A	N/A	2 UPPER RAGSDALE DR	BLDG A	MONTEREY	CA	93940	5736	00	06000	36.57940327	-121.8142876	Monterey County
352404	Ordering, Referring, Prescribing	N/A	1932557253	0	0	AGUILERA, ANDREINA LCSW	9/6/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW110338	N/A	N/A	N/A	N/A	N/A	290 IOOF AVE	None	GILROY	CA	95020	5204	00	06000	37.01377513	-121.5685719	Santa Clara County
352419	Ordering, Referring, Prescribing	N/A	1932568839	0	0	AVILA, MARIA LCSW	8/9/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW116240	N/A	N/A	N/A	N/A	N/A	790 E SANTA CLARA ST	SUITE 104	VENTURA	CA	93001	2964	00	06000	34.27950947	-119.2888755	Ventura County
352490	Ordering, Referring, Prescribing	N/A	1932683448	0	0	ASPEL, BRETT M LMFT	12/11/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	129829	N/A	N/A	N/A	N/A	N/A	370 W CRENSHAW BLVD	E-100	TORRANCE	CA	90503	1727	00	06000	33.84549	-118.3287415	Los Angeles County
352497	Ordering, Referring, Prescribing	N/A	1932689080	0	0	AGUIAR, MICHAELA LCSW	10/31/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW111377	N/A	N/A	N/A	N/A	N/A	137 N COTTONWOOD ST	None	WOODLAND	CA	95695	6646	00	06000	38.68538399	-121.7933582	Yolo County
352499	Ordering, Referring, Prescribing	N/A	1932696192	0	0	AVALOS, JORGE LCSW	4/15/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW97356	N/A	N/A	N/A	N/A	N/A	855 3RD AVE	None	CHULA VISTA	CA	91911	1110	00	06000	32.62197574	-117.0723222	San Diego County
352502	Ordering, Referring, Prescribing	N/A	1932685641	0	0	AGUIRRE, JUANA LCSW	8/5/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	124838	N/A	N/A	N/A	N/A	N/A	4500 E PACIFIC COAST HIG	None	LONG BEACH	CA	90804	3275	00	06000	33.78808863	-118.1399827	Los Angeles County
352538	Ordering, Referring, Prescribing	N/A	1932750155	0	0	AMEZCUA, LAURA LCSW	5/9/2024	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	122433	N/A	N/A	N/A	N/A	N/A	658 E BRIER DR	200	SAN BERNARDINO	CA	92408	2880	00	06000	34.07137738	-117.2702805	San Bernardino County
352562	Ordering, Referring, Prescribing	N/A	1932821881	0	0	ABELEDA, NICOLE LCSW	9/25/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	118232	N/A	N/A	N/A	N/A	N/A	2400 GLENDALE LN	None	SACRAMENTO	CA	95825	2431	00	06000	38.597355	-121.405212	Sacramento County
352571	Ordering, Referring, Prescribing	N/A	1932845385	0	0	AFIF, HAMMAD DDS	10/17/2022	Taxonomy not applicable	NA	n/a	000	Unknown	DDS107413	N/A	N/A	N/A	N/A	N/A	8788 JAMACHA RD	None	SPRING VALLEY	CA	91977	4035	00	06000	32.71482507	-117.0098243	San Diego County
352576	Ordering, Referring, Prescribing	N/A	1932876323	0	0	ANGELES, LORI LMFT	8/19/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	140982	N/A	N/A	N/A	N/A	N/A	12966 EUCLID ST	SUITE 280	GARDEN GROVE	CA	92840	5200	00	06000	33.77455935	-117.9378298	Orange County
352593	Ordering, Referring, Prescribing	N/A	1932957826	0	0	ALES, DREW M	4/23/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95029903	N/A	N/A	N/A	N/A	N/A	808 W 58TH ST	None	LOS ANGELES	CA	90037	3632	00	06000	33.98965917	-118.287673	Los Angeles County
352598	Ordering, Referring, Prescribing	N/A	1942031752	0	0	ALEXANDER, STEPHANIE NP	8/12/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP95031621	N/A	N/A	N/A	N/A	N/A	4004 BEYER BLVD	None	SAN YSIDRO	CA	92173	2007	00	06000	32.55831005	-117.0475102	San Diego County
352604	Ordering, Referring, Prescribing	N/A	1942220447	0	0	AVILA, LIANNE C LMFT	3/21/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	41507	N/A	N/A	N/A	N/A	N/A	427 PAJARO STREET	SUITE 1	SALINAS	CA	93901	3424	00	06000	36.67129432	-121.6519553	Monterey County
352634	Ordering, Referring, Prescribing	N/A	1942335831	0	0	ALVAREZCAMPOS, MICHELLE LCSW	4/23/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	25228	N/A	N/A	N/A	N/A	N/A	2919 MISSION STREET	None	SAN FRANCISCO	CA	94110	3917	00	06000	37.75028364	-122.418239	San Francisco County
352665	Ordering, Referring, Prescribing	N/A	1942380738	0	0	AXELROD, JESSICA P	1/16/2018	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NP16715	N/A	N/A	N/A	N/A	N/A	1001 POTRERO AVE	None	SAN FRANCISCO	CA	94110	3518	00	06000	37.75548534	-122.4065362	San Francisco County
352699	Ordering, Referring, Prescribing	N/A	1942470299	0	0	ALCARAZ TAPIA, MARIA MARLEN LMFT	4/16/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT93646	N/A	N/A	N/A	N/A	N/A	1414 N CALIFORNIA ST	2ND FLOOR	STOCKTON	CA	95202	1515	00	06000	37.96761084	-121.2883234	San Joaquin County
352719	Ordering, Referring, Prescribing	N/A	1942512256	0	0	ASHOK, MALA MD	3/10/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A85579	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
352720	Ordering, Referring, Prescribing	N/A	1942511845	0	0	ACOSTA EKINS, KATHLEEN LCSW	9/22/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	26258	N/A	N/A	N/A	N/A	N/A	7120 FRANKLIN AVE	None	LOS ANGELES	CA	90046	3002	00	06000	34.10383456	-118.3455459	Los Angeles County
352736	Ordering, Referring, Prescribing	N/A	1942559695	0	0	ANDERSON-TESHIMA, AUDREY C LMFT	7/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT107465	N/A	N/A	N/A	N/A	N/A	1045 9TH AVE	None	SAN DIEGO	CA	92101	5504	00	06000	32.71607643	-117.1564968	San Diego County
352739	Ordering, Referring, Prescribing	N/A	1942568894	0	0	ALZAGA, VERONICA LMFT	6/10/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT102142	N/A	N/A	N/A	N/A	N/A	474 W VERMONT AVE	STE 104	ESCONDIDO	CA	92025	6584	00	06000	33.10046604	-117.0729623	San Diego County
352741	Ordering, Referring, Prescribing	N/A	1942569553	0	0	ARREDONDO, MARIA E PA-C	5/6/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	15147	N/A	N/A	N/A	N/A	N/A	2928 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	3110	00	06000	34.04364362	-118.2006515	Los Angeles County
352778	Ordering, Referring, Prescribing	N/A	1942617634	0	0	ADAMSON, MEGHANN R NP	11/16/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	831048	N/A	N/A	N/A	N/A	N/A	520 COTTONWOOD	STE 10	WOODLAND	CA	95695	3603	00	06000	38.675016	-121.7933365	Yolo County
352824	Ordering, Referring, Prescribing	N/A	1942686100	0	0	ABBOTT, CHERI A LMFT	7/8/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT120006	N/A	N/A	N/A	N/A	N/A	327 S K ST	None	TULARE	CA	93274	5416	00	06000	36.20476387	-119.3454489	Tulare County
352862	Ordering, Referring, Prescribing	N/A	1942728308	0	0	ALVARADO, CRISTAL LMFT	7/25/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT122532	N/A	N/A	N/A	N/A	N/A	2828 FORD ST	None	OAKLAND	CA	94601	2114	00	06000	37.77357837	-122.2352589	Alameda County
352873	Ordering, Referring, Prescribing	N/A	1942757083	0	0	ABITIA, KARLA LCSW	6/29/2021	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW83204	N/A	N/A	N/A	N/A	N/A	1414 S. GRAND AVE	200	LOS ANGELES	CA	90015	3067	00	06000	34.03661142	-118.2657227	Los Angeles County
352876	Ordering, Referring, Prescribing	N/A	1942765151	0	0	ADAMS, TAIWO O NP	9/17/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95008108	N/A	N/A	N/A	N/A	N/A	18651 VALLEY BLVD	None	BLOOMINGTON	CA	92316	1831	00	06000	34.07044952	-117.3974715	San Bernardino County
352887	Ordering, Referring, Prescribing	N/A	1942784087	0	0	ARAUJO, WENDY C LCSW	6/13/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	115836	N/A	N/A	N/A	N/A	N/A	3787 S VERMONT AVE	None	LOS ANGELES	CA	90007	4203	00	06000	34.01739	-118.291567	Los Angeles County
352908	Ordering, Referring, Prescribing	N/A	1942828769	0	0	ANAMOSA, ALICE LMFT	6/20/2024	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	147565	N/A	N/A	N/A	N/A	N/A	2310 FIRST STREET	None	NAPA	CA	94559	2239	00	06000	38.29806271	-122.2989388	Napa County
352921	Ordering, Referring, Prescribing	N/A	1942858980	0	0	ASUNCION, MICHAEL LMFT	1/31/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130883	N/A	N/A	N/A	N/A	N/A	1486 HUNTINGTON AVE	SUITE 100	SOUTH SAN FRANCIS	CA	94080	5970	00	06000	37.64441633	-122.4219331	San Mateo County
352924	Ordering, Referring, Prescribing	N/A	1942867718	0	0	AKIKI, TEDDY MD	11/21/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183341	N/A	N/A	N/A	N/A	N/A	2001 THE ALAMEDA	None	SAN JOSE	CA	95126	1136	00	06000	37.34293689	-121.9270392	Santa Clara County
352931	Ordering, Referring, Prescribing	N/A	1942879283	0	0	ALSOBROOK, KATHERINE NP	5/28/2021	Taxonomy not applicable	NA	n/a	000	Unknown	95017447	N/A	N/A	N/A	N/A	N/A	250 W 5TH ST	None	HANFORD	CA	93230	5029	00	06000	36.32439821	-119.6472235	Kings County
352952	Ordering, Referring, Prescribing	N/A	1942939707	0	0	ALBERTO-DELGADO, JULIAN LMFT	10/6/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT141914	N/A	N/A	N/A	N/A	N/A	2525 N CHESTER AVE	None	BAKERSFIELD	CA	93308	1770	00	06000	35.429463	-119.0213795	Kern County
352961	Ordering, Referring, Prescribing	N/A	1942971304	0	0	ADAMS, ARLINE N PA-C	11/9/2022	Taxonomy not applicable	NA	n/a	000	Unknown	61955	N/A	N/A	N/A	N/A	N/A	9375 SAN FERNANDO ROAD	None	SUN VALLEY	CA	91352	1428	00	06000	34.2395322	-118.3939944	Los Angeles County
353031	Ordering, Referring, Prescribing	N/A	1952426587	0	0	ANGEL, CLAUDIA I LMFT	10/23/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT102274	N/A	N/A	N/A	N/A	N/A	5350 MACHADO RD	None	CULVER CITY	CA	90230	8800	00	06000	33.99781622	-118.3966503	Los Angeles County
353047	Ordering, Referring, Prescribing	N/A	1952435364	0	0	ARMSTRONG, JESSICA M LMFT	4/2/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT46738	N/A	N/A	N/A	N/A	N/A	2525 N CHESTER AVE	None	BAKERSFIELD	CA	93308	1770	00	06000	35.429463	-119.0213795	Kern County
353049	Ordering, Referring, Prescribing	N/A	1952442865	0	0	ALOSIOUS, NISHA PA-C	1/12/2020	Taxonomy not applicable	NA	n/a	000	Unknown	55884	N/A	N/A	N/A	N/A	N/A	441 N MAIN ST	None	ALTURAS	CA	96101	3457	00	06000	41.48803571	-120.542554	Modoc County
353072	Ordering, Referring, Prescribing	N/A	1952508145	0	0	ALBERICO, PAUL J	5/5/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	C172554	N/A	N/A	N/A	N/A	N/A	330 N BRAND BLVD	700	GLENDALE	CA	91203	2308	00	06000	34.15116156	-118.2549512	Los Angeles County
353073	Ordering, Referring, Prescribing	N/A	1952509689	0	0	APODACA, LOURDES LCSW	11/13/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW28254	N/A	N/A	N/A	N/A	N/A	1140 MAIN STREET	None	LIVINGSTON	CA	95334	1257	00	06000	37.37992056	-120.7234222	Merced County
353143	Ordering, Referring, Prescribing	N/A	1952663122	0	0	AQUINO, EUGENE R JR MD	4/19/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A139757	N/A	N/A	N/A	N/A	N/A	1142 ROSE AVE	STE C	SELMA	CA	93662	3251	00	06000	36.56886527	-119.5983853	Fresno County
353222	Ordering, Referring, Prescribing	N/A	1952794455	0	0	AZGHADI, SOHEILA MD	3/16/2021	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157410	N/A	N/A	N/A	N/A	N/A	4501 X STREET	G140	SACRAMENTO	CA	95817	3245	00	06000	38.553822	-121.452822	Sacramento County
353225	Ordering, Referring, Prescribing	N/A	1952792467	0	0	AHINASI, SONNIA A NP	12/22/2017	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	764498	N/A	N/A	N/A	N/A	N/A	805 W ARROW HWY	None	GLENDORA	CA	91740	5413	00	06000	34.10553987	-117.8765895	Los Angeles County
353246	Ordering, Referring, Prescribing	N/A	1952827784	0	0	ACEVEDO, DOMINIQUE A LMFT	4/28/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT132543	N/A	N/A	N/A	N/A	N/A	327 S. K STREET	None	TULARE	CA	93274	5416	00	06000	36.20476387	-119.3454489	Tulare County
353262	Ordering, Referring, Prescribing	N/A	1952852741	0	0	ALRABADI, DANA J NP	12/20/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95003773	N/A	N/A	N/A	N/A	N/A	10050 GARVEY AVE	111	EL MONTE	CA	91733	2088	00	06000	34.06270952	-118.049481	Los Angeles County
353272	Ordering, Referring, Prescribing	N/A	1952859399	0	0	ALVAREZ, MARIA L LCSW	9/29/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	97284	N/A	N/A	N/A	N/A	N/A	6800 OWENSMOUTH AVE STE	STE. 150	CANOGA PARK	CA	91303	4255	00	06000	34.194276	-118.6014945	Los Angeles County
353275	Ordering, Referring, Prescribing	N/A	1952864654	0	0	AGUILAR-FERNANDEZ, LAURA DDS	8/29/2023	Taxonomy not applicable	NA	n/a	000	Unknown	DDS105364	N/A	N/A	N/A	N/A	N/A	172 E GRANT AVE.	None	WINTERS	CA	95694	1780	00	06000	38.5264496	-121.9668052	Yolo County
353276	Ordering, Referring, Prescribing	N/A	1952857237	0	0	ABADESCO, AUTUMN DDS	2/2/2022	Taxonomy not applicable	NA	n/a	000	Unknown	100414	N/A	N/A	N/A	N/A	N/A	3834 S WESTERN AVE	None	LOS ANGELES	CA	90062	1104	00	06000	34.016157	-118.3088825	Los Angeles County
353309	Ordering, Referring, Prescribing	N/A	1952930513	0	0	ALLISON, ZEV A MD	9/27/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A178682	N/A	N/A	N/A	N/A	N/A	8700 BEVERLY BLVD	5512	WEST HOLLYWOOD	CA	90048	1804	00	06000	34.07671715	-118.3799413	Los Angeles County
353318	Ordering, Referring, Prescribing	N/A	1952950479	0	0	ALVARADO, CARLOS D PA	9/6/2019	Taxonomy not applicable	NA	n/a	000	Unknown	PA57194	N/A	N/A	N/A	N/A	N/A	1005 E WASHINGTON BLVD	A	LOS ANGELES	CA	90021	3020	00	06000	34.02578238	-118.2530622	Los Angeles County
353338	Ordering, Referring, Prescribing	N/A	1952980336	0	0	AHWAZI, HODA MD	1/21/2025	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A200826	N/A	N/A	N/A	N/A	N/A	43322 GINGHAM AVE	None	LANCASTER	CA	93535	4576	00	06000	34.67013731	-118.1222748	Los Angeles County
353365	Ordering, Referring, Prescribing	N/A	1962044347	0	0	ABAUNZA, ELIZABETH NP	1/22/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95011186	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL STREET	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
353386	Ordering, Referring, Prescribing	N/A	1962088799	0	0	AHMADI, ALAST MD	10/21/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183260	N/A	N/A	N/A	N/A	N/A	11541 ROSECRANS AVE	None	NORWALK	CA	90650	3898	00	06000	33.90224638	-118.0874048	Los Angeles County
353399	Ordering, Referring, Prescribing	N/A	1962138545	0	0	AMJADI, ROYA NP	6/27/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021464	N/A	N/A	N/A	N/A	N/A	9380 MAGNOLIA AVE	None	RIVERSIDE	CA	92503	3749	00	06000	33.9215355	-117.4442978	Riverside County
353424	Ordering, Referring, Prescribing	N/A	1962279778	0	0	ALBERTY, WENDY C NP	10/19/2023	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95027761	N/A	N/A	N/A	N/A	N/A	82934 CIVIC CENTER DR	None	INDIO	CA	92201	4308	00	06000	33.71864703	-116.2178997	Riverside County
353438	Ordering, Referring, Prescribing	N/A	1962470922	0	0	AWAD, MIRA A	2/26/2018	Taxonomy not applicable	NA	n/a	000	Unknown	19525	N/A	N/A	N/A	N/A	N/A	311 W NOBLE AVE	None	VISALIA	CA	93249	1425	00	06000	36.326304	-119.295477	Tulare County
353458	Ordering, Referring, Prescribing	N/A	1962529552	0	0	ALQARWANI, LATIKA LMFT	11/29/2017	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	42640	N/A	N/A	N/A	N/A	N/A	8217 PLUMERIA AVE	None	FAIR OAKS	CA	95628	6024	00	06000	38.651013	-121.258647	Sacramento County
353500	Ordering, Referring, Prescribing	N/A	1962623538	0	0	AVENTURA, CAROLINE M MD	10/14/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A102553	N/A	N/A	N/A	N/A	N/A	18601 VALLEY BLVD	None	BLOOMINGTON	CA	92316	1831	00	06000	34.07045653	-117.3982455	San Bernardino County
353511	Ordering, Referring, Prescribing	N/A	1962639278	0	0	AGUILAR, RAMONA M LCSW	8/20/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW87631	N/A	N/A	N/A	N/A	N/A	17707 STUDEBAKER RD	None	CERRITOS	CA	90703	8888	00	06000	33.87008991	-118.0991298	Los Angeles County
353516	Ordering, Referring, Prescribing	N/A	1962650580	0	0	AUERBACH, LIZA PHD	6/5/2023	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY29706	N/A	N/A	N/A	N/A	N/A	326 I ST	119	EUREKA	CA	95501	0522	00	06000	40.80356133	-124.1630216	Humboldt County
353526	Ordering, Referring, Prescribing	N/A	1962659615	0	0	ALAMDARI, MAHIN S	3/29/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	117883	N/A	N/A	N/A	N/A	N/A	3580 WILSHIRE BLVD	8TH	LOS ANGELES	CA	90010	2501	00	06000	34.06170677	-118.302787	Los Angeles County
353569	Ordering, Referring, Prescribing	N/A	1962752501	0	0	ALI, ASIF PHARMD	4/27/2021	Taxonomy not applicable	NA	n/a	000	Unknown	67530	N/A	N/A	N/A	N/A	N/A	9961 SIERRA	None	FONTANA	CA	92335	0001	00	06000	34.072245	-117.4319685	San Bernardino County
353615	Ordering, Referring, Prescribing	N/A	1962801738	0	0	ABDELRAHIM, ADHAM F	2/26/2020	Taxonomy not applicable	NA	n/a	099	DENTIST	104219	N/A	N/A	N/A	N/A	N/A	19270 SONOMA HIGHWAY	None	SONOMA	CA	95476	0000	00	06000	38.29871411	-122.4751509	Sonoma County
353675	Ordering, Referring, Prescribing	N/A	1962877365	0	0	AZIMTASH, SAHAR PA-C	9/23/2018	Taxonomy not applicable	NA	n/a	000	Unknown	52225	N/A	N/A	N/A	N/A	N/A	1919 W 7TH ST	2	LOS ANGELES	CA	90057	4103	00	06000	34.05575686	-118.2751751	Los Angeles County
353678	Ordering, Referring, Prescribing	N/A	1962884973	0	0	ALEGRIA, CHERYL LCSW	12/4/2019	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	93245	N/A	N/A	N/A	N/A	N/A	1555 S GAREY AVE	None	POMONA	CA	91766	5222	00	06000	34.04317024	-117.7497127	Los Angeles County
353694	Ordering, Referring, Prescribing	N/A	1962906941	0	0	ADAMO, MEREDITH MD	2/5/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A166494	N/A	N/A	N/A	N/A	N/A	230 GOLDEN GATE AVE	None	SAN FRANCISCO	CA	94102	3706	00	06000	37.78184696	-122.4142203	San Francisco County
353699	Ordering, Referring, Prescribing	N/A	1962920413	0	0	AGUILERA, ELEANOR M LMFT	12/8/2019	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT101594	N/A	N/A	N/A	N/A	N/A	1200 WILSHIRE BLVD	200	LOS ANGELES	CA	90017	1908	00	06000	34.05307427	-118.2651099	Los Angeles County
353705	Ordering, Referring, Prescribing	N/A	1962932376	0	0	ABURAS, RAWIYA S PHARMD	6/9/2019	Taxonomy not applicable	NA	n/a	000	Unknown	RPH74306	N/A	N/A	N/A	N/A	N/A	1270 UNIVERSITY AVE	None	SAN DIEGO	CA	92103	3312	00	06000	32.74861393	-117.1517063	San Diego County
353712	Ordering, Referring, Prescribing	N/A	1962936450	0	0	AVILA, MICHAEL A MD	3/1/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A159727	N/A	N/A	N/A	N/A	N/A	460 N ELM ST	None	ESCONDIDO	CA	92025	3002	00	06000	33.12850258	-117.0729169	San Diego County
353722	Ordering, Referring, Prescribing	N/A	1962956227	0	0	ASSAD, MARTINA M	10/26/2017	Taxonomy not applicable	NA	n/a	099	DENTIST	100600	N/A	N/A	N/A	N/A	N/A	14689 VALLEY CENTER DR	STE E101	VICTORVILLE	CA	92395	4200	00	06000	34.51818658	-117.3165748	San Bernardino County
353783	Ordering, Referring, Prescribing	N/A	1972058220	0	0	ARIAS, KARINA LMFT	3/29/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	125215	N/A	N/A	N/A	N/A	N/A	2051 JOHN JONES RD	None	DAVIS	CA	95816	9701	00	06000	38.56371578	-121.7691963	Yolo County
353823	Ordering, Referring, Prescribing	N/A	1972134294	0	0	AYSON, MARL PHARMD	8/4/2020	Taxonomy not applicable	NA	n/a	000	Unknown	80993	N/A	N/A	N/A	N/A	N/A	510 S VERMONT AVE	None	LOS ANGELES	CA	90020	1992	00	06000	34.065	-118.291631	Los Angeles County
353852	Ordering, Referring, Prescribing	N/A	1972226140	0	0	ALMANZA, MICHELLE LCSW	5/17/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	115310	N/A	N/A	N/A	N/A	N/A	409 CAMINO DEL RIO SOUTH	None	SAN DIEGO	CA	92108	3505	00	06000	32.76094819	-117.1611994	San Diego County
353855	Ordering, Referring, Prescribing	N/A	1972230522	0	0	ANDERSEN, GAYLE LMFT	12/14/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT42766	N/A	N/A	N/A	N/A	N/A	2935 4TH ST	None	CERES	CA	95307	3222	00	06000	37.59084176	-120.9534033	Stanislaus County
353867	Ordering, Referring, Prescribing	N/A	1972263945	0	0	ABARCA, JESSIKA NP	8/29/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95019499	N/A	N/A	N/A	N/A	N/A	1600 SAN FERNANDO RD	None	SAN FERNANDO	CA	91340	3115	00	06000	34.28899399	-118.4481394	Los Angeles County
353882	Ordering, Referring, Prescribing	N/A	1972338382	0	0	ALIBUDBUD, PHILIP NP	10/30/2024	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95032777	N/A	N/A	N/A	N/A	N/A	6608 MERCY COURT	None	FAIR OAKS	CA	95628	3170	00	06000	38.665917	-121.3106895	Sacramento County
353920	Ordering, Referring, Prescribing	N/A	1972630804	0	0	AGNOST, VICTORIA MD	3/4/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	G71056	N/A	N/A	N/A	N/A	N/A	240 SHOTWELL ST	None	SAN FRANCISCO	CA	94110	1323	00	06000	37.76460716	-122.416335	San Francisco County
353945	Ordering, Referring, Prescribing	N/A	1972680692	0	0	ACTON, ALISON M	9/27/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT27001	N/A	N/A	N/A	N/A	N/A	520 E TULARE AVE	None	VISALIA	CA	93292	3629	00	06000	36.320679	-119.2870845	Tulare County
353956	Ordering, Referring, Prescribing	N/A	1972697134	0	0	ANDERSON, ALAN M	5/11/2016	Taxonomy not applicable	NA	n/a	099	DENTIST	D35066	N/A	N/A	N/A	N/A	N/A	250 N SEE VEE LN	None	BISHOP	CA	93514	8130	00	06000	37.365066	-118.410912	Inyo County
353960	Ordering, Referring, Prescribing	N/A	1972701324	0	0	ABBASI, SALEHA MD	12/14/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A106565	N/A	N/A	N/A	N/A	N/A	2180 HARVARD ST.	210	SACRAMENTO	CA	95815	3318	00	06000	38.60568	-121.4345385	Sacramento County
353982	Ordering, Referring, Prescribing	N/A	1972755304	0	0	ALBERT, ROBERT D	8/31/2010	Taxonomy not applicable	NA	n/a	099	DENTIST	D47837	N/A	N/A	N/A	N/A	N/A	15301 S SAN JOSE AVE	None	COMPTON	CA	90221	3131	00	06000	33.8941921	-118.1817657	Los Angeles County
354024	Ordering, Referring, Prescribing	N/A	1972833556	0	0	ALVAREZ, ALVA G LCSW	3/28/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81838	N/A	N/A	N/A	N/A	N/A	1801 S POPLAR ST	None	SANTA ANA	CA	92704	4321	00	06000	33.72358134	-117.8872543	Orange County
354038	Ordering, Referring, Prescribing	N/A	1972855500	0	0	ARIAS, MICOL C LCSW	5/20/2022	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	108171	N/A	N/A	N/A	N/A	N/A	611 S KINGSLEY DR.	None	LOS ANGELES	CA	90005	2319	00	06000	34.06305793	-118.3028813	Los Angeles County
354044	Ordering, Referring, Prescribing	N/A	1972865988	0	0	ALVARADO, CHRISTOPHER N LMFT	9/28/2021	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT89614	N/A	N/A	N/A	N/A	N/A	160 E VIRGINIA ST	280	SAN JOSE	CA	95112	5857	00	06000	37.32582868	-121.8777868	Santa Clara County
354081	Ordering, Referring, Prescribing	N/A	1972920171	0	0	ARMIJO, DONNY J PHARMD	10/12/2021	Taxonomy not applicable	NA	n/a	000	Unknown	RPH67745	N/A	N/A	N/A	N/A	N/A	35875 WARM SPRINGS PKWY	None	MURRIETA	CA	92563	4538	00	06000	33.59836696	-117.1690502	Riverside County
354125	Ordering, Referring, Prescribing	N/A	1972965291	0	0	ARONOW-WERNER, SARAH P MD	3/23/2018	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A152392	N/A	N/A	N/A	N/A	N/A	3600 BROADWAY	4TH FL STE 43	OAKLAND	CA	94611	5730	00	06000	37.8237837	-122.2590026	Alameda County
354140	Ordering, Referring, Prescribing	N/A	1972985158	0	0	ABU-LIBDEH, REEM A MD	10/11/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A147321	N/A	N/A	N/A	N/A	N/A	1328 SOUTH MISSION RD	None	FALLBROOK	CA	92028	4006	00	06000	33.36868654	-117.2507699	San Diego County
354174	Ordering, Referring, Prescribing	N/A	1982044483	0	0	ALASSIL, SALLY MD	12/14/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A122238	N/A	N/A	N/A	N/A	N/A	1809 NATIONAL AVE	None	SAN DIEGO	CA	92113	2113	00	06000	32.70162897	-117.1465065	San Diego County
354191	Ordering, Referring, Prescribing	N/A	1982070249	0	0	ANCKER, ELIZABETH LMFT	3/3/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	118043	N/A	N/A	N/A	N/A	N/A	1521 UNIVERSITY AVE	None	BERKELEY	CA	94703	1422	00	06000	37.87060038	-122.2812128	Alameda County
354199	Ordering, Referring, Prescribing	N/A	1982074571	0	0	ARREOLA, GUADALUPE MD	10/27/2022	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A179258	N/A	N/A	N/A	N/A	N/A	850 5TH ST	None	GONZALES	CA	93926	0000	00	06000	36.51464322	-121.4354965	Monterey County
354214	Ordering, Referring, Prescribing	N/A	1982090841	0	0	AVILES, TANYA D LMFT	1/13/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	130617	N/A	N/A	N/A	N/A	N/A	3924 RIVERVIEW DR	None	JURUPA VALLEY	CA	92509	6611	00	06000	33.99857971	-117.4142203	Riverside County
354224	Ordering, Referring, Prescribing	N/A	1982128203	0	0	ANICAMA, CATHERINE PHD	3/5/2021	Taxonomy not applicable	NA	n/a	031	PSYCHOLOGISTS	PSY32441	N/A	N/A	N/A	N/A	N/A	3301 E. 12TH STREET	SUITE. 259	OAKLAND	CA	94601	2940	00	06000	37.77617499	-122.2247899	Alameda County
354245	Ordering, Referring, Prescribing	N/A	1982159075	0	0	ANGEL GARCIA, ANAHI E LMFT	2/25/2020	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	LMFT117108	N/A	N/A	N/A	N/A	N/A	855 N EUCLID AVE	None	ONTARIO	CA	91762	2729	00	06000	34.074063	-117.6514785	San Bernardino County
354246	Ordering, Referring, Prescribing	N/A	1982154324	0	0	ALLEN, EVERETT PA	2/7/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	63179	N/A	N/A	N/A	N/A	N/A	1515 S OREGON ST	None	YREKA	CA	96097	3475	00	06000	41.7176996	-122.642006	Siskiyou County
354258	Ordering, Referring, Prescribing	N/A	1982172904	0	0	ACEVES, JOSLYNE MSW LCSW	10/19/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	118721	N/A	N/A	N/A	N/A	N/A	12141 BROOKHURST ST STE	STE 101	GARDEN GROVE	CA	92840	2865	00	06000	33.78614503	-117.9587915	Orange County
354308	Ordering, Referring, Prescribing	N/A	1982263497	0	0	AZER, JESSICA M LMFT	8/3/2022	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	134027	N/A	N/A	N/A	N/A	N/A	1910 OLYMPIC BLVD	SUITE 365	WALNUT CREEK	CA	94596	5096	00	06000	37.89453628	-122.0662326	Contra Costa County
354314	Ordering, Referring, Prescribing	N/A	1982282364	0	0	AI, ANGELA C MD	8/8/2023	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A183746	N/A	N/A	N/A	N/A	N/A	14445 OLIVE VIEW DR	None	SYLMAR	CA	91342	1437	00	06000	34.32450186	-118.4456317	Los Angeles County
354332	Ordering, Referring, Prescribing	N/A	1982349957	0	0	AYALA BRAVO, MARIA LCSW	4/9/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	107408	N/A	N/A	N/A	N/A	N/A	661 W 1ST STREET	SUITE G	TUSTIN	CA	92780	2939	00	06000	33.74578153	-117.831231	Orange County
354337	Ordering, Referring, Prescribing	N/A	1982362026	0	0	ALLOTEY, JONATHAN S NP	7/19/2022	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95021858	N/A	N/A	N/A	N/A	N/A	333 H ST	SUITE 2010	CHULA VISTA	CA	91910	5555	00	06000	32.63411233	-117.0783636	San Diego County
354426	Ordering, Referring, Prescribing	N/A	1982806287	0	0	ABRAMOWITZ, BEVERLY MD	11/17/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A63502	N/A	N/A	N/A	N/A	N/A	6171 BRADSHAW ROAD	115	SACRAMENTO	CA	95829	9334	00	06000	38.514942	-121.3325235	Sacramento County
354491	Ordering, Referring, Prescribing	N/A	1982947198	0	0	ALBERS, MARK C MD	6/26/2017	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A134567	N/A	N/A	N/A	N/A	N/A	710 LAWRENCE EXPY	DEPT 384	SANTA CLARA	CA	95051	5173	00	06000	37.33636857	-121.9958111	Santa Clara County
354521	Ordering, Referring, Prescribing	N/A	1982981411	0	0	ABDILLA, JILL M LCSW	6/27/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCSW22619	N/A	N/A	N/A	N/A	N/A	124 RIVER ROAD	None	SALINAS	CA	93908	9601	00	06000	36.61705976	-121.6608103	Monterey County
354526	Ordering, Referring, Prescribing	N/A	1982983508	0	0	AGU, JANET N NP	1/14/2020	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	23546	N/A	N/A	N/A	N/A	N/A	1720 E 120TH ST	None	LOS ANGELES	CA	90059	3052	00	06000	33.92455929	-118.2423557	Los Angeles County
354539	Ordering, Referring, Prescribing	N/A	1992005961	0	0	AHMADI, LINDA PHARMD	3/23/2018	Taxonomy not applicable	NA	n/a	000	Unknown	58086	N/A	N/A	N/A	N/A	N/A	11800 DE PALMA RD	None	CORONA	CA	92883	8498	00	06000	33.74635292	-117.4536847	Riverside County
354540	Ordering, Referring, Prescribing	N/A	1992006837	0	0	AHUJA, AMIR K MD	5/15/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A130751	N/A	N/A	N/A	N/A	N/A	1625 N. SCHRADER BLVD.	None	LOS ANGELES	CA	90028	6213	00	06000	34.100523	-118.3324855	Los Angeles County
354542	Ordering, Referring, Prescribing	N/A	1992009294	0	0	ADAMS, LESLEY C LMFT	3/27/2023	Taxonomy not applicable	NA	n/a	077	MARRIAGE AND FAMILY THERAPIST INDIVIDUAL	138857	N/A	N/A	N/A	N/A	N/A	500 S SAN PEDRO ST	None	LOS ANGELES	CA	90013	2102	00	06000	34.04392795	-118.2440415	Los Angeles County
354581	Ordering, Referring, Prescribing	N/A	1992080196	0	0	ANDRADE, ANGELICA LCSW	1/30/2018	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	71142	N/A	N/A	N/A	N/A	N/A	1413 GRIFFITH DR	None	WOODLAND	CA	95776	5571	00	06000	38.66094126	-121.7487906	Yolo County
354598	Ordering, Referring, Prescribing	N/A	1992098750	0	0	ATEMAN, JESSICA A LMFT	12/10/2020	Taxonomy not applicable	NA	n/a	000	Unknown	LMFT109607	N/A	N/A	N/A	N/A	N/A	1305 BEAR MOUNTAIN BLVD	None	ARVIN	CA	93203	1231	00	06000	35.20895551	-118.839294	Kern County
354605	Ordering, Referring, Prescribing	N/A	1992106918	0	0	ANDERSON, AMY C LCSW	6/9/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	81636	N/A	N/A	N/A	N/A	N/A	1000 S MAIN ST	210B	SALINAS	CA	93901	2352	00	06000	36.66226091	-121.6578913	Monterey County
354681	Ordering, Referring, Prescribing	N/A	1992233571	0	0	AVELAR, PATRICIA A MD	10/9/2019	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A157795	N/A	N/A	N/A	N/A	N/A	1301 PINOLE VALLEY RD	None	PINOLE	CA	94564	0121	00	06000	37.9991883	-122.2867117	Contra Costa County
354715	Ordering, Referring, Prescribing	N/A	1992311823	0	0	AHMED, JIBRAN NP	1/29/2025	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	95020754	N/A	N/A	N/A	N/A	N/A	1200 QUAIL ST STE 205	STE 205	NEWPORT BEACH	CA	92660	2707	00	06000	33.65991601	-117.8670813	Orange County
354717	Ordering, Referring, Prescribing	N/A	1992314660	0	0	ARIQAT, NADIA PA-C	3/13/2020	Taxonomy not applicable	NA	n/a	000	Unknown	57945	N/A	N/A	N/A	N/A	N/A	2928 E CESAR E CHAVEZ AV	None	LOS ANGELES	CA	90033	3110	00	06000	34.04364362	-118.2006515	Los Angeles County
354763	Ordering, Referring, Prescribing	N/A	1992389134	0	0	AGUILAR, HUGO A PHARMD	3/22/2021	Taxonomy not applicable	NA	n/a	000	Unknown	83081	N/A	N/A	N/A	N/A	N/A	401 BICENTENNIAL WAY	None	SANTA ROSA	CA	95403	2149	00	06000	38.471625	-122.7259935	Sonoma County
354783	Ordering, Referring, Prescribing	N/A	1992464572	0	0	ANSELMO, MARIA FRANCESCA L CNP	9/24/2021	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	NPF95018572	N/A	N/A	N/A	N/A	N/A	2020 SANTA MONICA BLVD	SUITE 600	SANTA MONICA	CA	90404	2131	00	06000	34.02901811	-118.4795396	Los Angeles County
354809	Ordering, Referring, Prescribing	N/A	1992741979	0	0	AKRA, IKHLAS Y	6/11/2020	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A88535	N/A	N/A	N/A	N/A	N/A	125 W THOUSAND OAKS BLVD	None	THOUSAND OAKS	CA	91360	4402	00	06000	34.17854676	-118.8805015	Ventura County
354820	Ordering, Referring, Prescribing	N/A	1992778666	0	0	ASOMBRADO, DORIS L NP	7/1/2016	Taxonomy not applicable	NA	n/a	007	CERTIFIED NURSE PRACTIONER	439207	N/A	N/A	N/A	N/A	N/A	1140 WEST MISSION RD	None	SAN MARCOS	CA	92069	1415	00	06000	33.151851	-117.178731	San Diego County
354833	Ordering, Referring, Prescribing	N/A	1992829386	0	0	ANGLIN, RHONDA C MSW LCSW	3/5/2020	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	LCS20161	N/A	N/A	N/A	N/A	N/A	14545 SHERMAN CIR	None	VAN NUYS	CA	91405	3087	00	06000	34.20064259	-118.450312	Los Angeles County
354850	Ordering, Referring, Prescribing	N/A	1992847263	0	0	ADJAN, ROULA MD	1/9/2024	Taxonomy not applicable	NA	n/a	026	PHYSICIANS	A81682	N/A	N/A	N/A	N/A	N/A	4060 FAIRMOUNT AVE	None	SAN DIEGO	CA	92105	1608	00	06000	32.750523	-117.100927	San Diego County
354916	Ordering, Referring, Prescribing	N/A	1992969778	0	0	AMICO, LISA LCSW	10/15/2023	Taxonomy not applicable	NA	n/a	070	LICENSED CLINICAL SOCIAL WORKER INDIVIDUAL	22410	N/A	N/A	N/A	N/A	N/A	3840 JOY ROAD	TELEMEDICINE ONLY	OCCIDENTAL	CA	95465	9249	00	06000	38.39988286	-122.974312	Sonoma County